Science.gov

Sample records for launches telehealth demonstration

  1. Magnetic Launch Assist System Demonstration

    NASA Technical Reports Server (NTRS)

    1999-01-01

    This Quick Time movie demonstrates the Magnetic Launch Assist system, previously referred to as the Magnetic Levitation (Maglev) system, for space launch using a 5 foot model of a reusable Bantam Class launch vehicle on a 50 foot track that provided 6-g acceleration and 6-g de-acceleration. Overcoming the grip of Earth's gravity is a supreme challenge for engineers who design rockets that leave the planet. Engineers at the Marshall Space Flight Center have developed and tested Magnetic Launch Assist technologies that could levitate and accelerate a launch vehicle along a track at high speeds before it leaves the ground. Using electricity and magnetic fields, a Magnetic Launch Assist system would drive a spacecraft along a horizontal track until it reaches desired speeds. A full-scale, operational track would be about 1.5-miles long and capable of accelerating a vehicle to 600 mph in 9.5 seconds. The major advantages of launch assist for NASA launch vehicles is that it reduces the weight of the takeoff, the landing gear, the wing size, and less propellant resulting in significant cost savings. The US Navy and the British MOD (Ministry of Defense) are planning to use magnetic launch assist for their next generation aircraft carriers as the aircraft launch system. The US Army is considering using this technology for launching target drones for anti-aircraft training.

  2. Magnetic Launch Assist System Demonstration

    NASA Technical Reports Server (NTRS)

    1999-01-01

    This Quick Time movie demonstrates the Magnetic Launch Assist system, previously referred to as the Magnetic Levitation (Maglev) system, for space launch using a 5 foot model of a reusable Bantam Class launch vehicle on a 50 foot track that provided 6-g acceleration and 6-g de-acceleration. Overcoming the grip of Earth's gravity is a supreme challenge for engineers who design rockets that leave the planet. Engineers at the Marshall Space Flight Center have developed and tested Magnetic Launch Assist technologies that could levitate and accelerate a launch vehicle along a track at high speeds before it leaves the ground. Using electricity and magnetic fields, a Magnetic Launch Assist system would drive a spacecraft along a horizontal track until it reaches desired speeds. A full-scale, operational track would be about 1.5-miles long and capable of accelerating a vehicle to 600 mph in 9.5 seconds. The major advantages of launch assist for NASA launch vehicles is that it reduces the weight of the takeoff, the landing gear, the wing size, and less propellant resulting in significant cost savings. The US Navy and the British MOD (Ministry of Defense) are planning to use magnetic launch assist for their next generation aircraft carriers as the aircraft launch system. The US Army is considering using this technology for launching target drones for anti-aircraft training.

  3. Launch Vehicle Dynamics Demonstrator Model

    NASA Technical Reports Server (NTRS)

    1963-01-01

    Launch Vehicle Dynamics Demonstrator Model. The effect of vibration on launch vehicle dynamics was studied. Conditions included three modes of instability. The film includes close up views of the simulator fuel tank with and without stability control. [Entire movie available on DVD from CASI as Doc ID 20070030984. Contact help@sti.nasa.gov

  4. Magnetic Launch Assist Demonstration Test

    NASA Technical Reports Server (NTRS)

    2001-01-01

    This image shows a 1/9 subscale model vehicle clearing the Magnetic Launch Assist System, formerly referred to as the Magnetic Levitation (MagLev), test track during a demonstration test conducted at the Marshall Space Flight Center (MSFC). Engineers at MSFC have developed and tested Magnetic Launch Assist technologies. To launch spacecraft into orbit, a Magnetic Launch Assist System would use magnetic fields to levitate and accelerate a vehicle along a track at very high speeds. Similar to high-speed trains and roller coasters that use high-strength magnets to lift and propel a vehicle a couple of inches above a guideway, a launch-assist system would electromagnetically drive a space vehicle along the track. A full-scale, operational track would be about 1.5-miles long and capable of accelerating a vehicle to 600 mph in 9.5 seconds. This track is an advanced linear induction motor. Induction motors are common in fans, power drills, and sewing machines. Instead of spinning in a circular motion to turn a shaft or gears, a linear induction motor produces thrust in a straight line. Mounted on concrete pedestals, the track is 100-feet long, about 2-feet wide and about 1.5-feet high. The major advantages of launch assist for NASA launch vehicles is that it reduces the weight of the take-off, the landing gear, the wing size, and less propellant resulting in significant cost savings. The US Navy and the British MOD (Ministry of Defense) are planning to use magnetic launch assist for their next generation aircraft carriers as the aircraft launch system. The US Army is considering using this technology for launching target drones for anti-aircraft training.

  5. Magnetic Launch Assist Demonstration Test

    NASA Technical Reports Server (NTRS)

    2001-01-01

    This image shows a 1/9 subscale model vehicle clearing the Magnetic Launch Assist System, formerly referred to as the Magnetic Levitation (MagLev), test track during a demonstration test conducted at the Marshall Space Flight Center (MSFC). Engineers at MSFC have developed and tested Magnetic Launch Assist technologies. To launch spacecraft into orbit, a Magnetic Launch Assist System would use magnetic fields to levitate and accelerate a vehicle along a track at very high speeds. Similar to high-speed trains and roller coasters that use high-strength magnets to lift and propel a vehicle a couple of inches above a guideway, a launch-assist system would electromagnetically drive a space vehicle along the track. A full-scale, operational track would be about 1.5-miles long and capable of accelerating a vehicle to 600 mph in 9.5 seconds. This track is an advanced linear induction motor. Induction motors are common in fans, power drills, and sewing machines. Instead of spinning in a circular motion to turn a shaft or gears, a linear induction motor produces thrust in a straight line. Mounted on concrete pedestals, the track is 100-feet long, about 2-feet wide and about 1.5-feet high. The major advantages of launch assist for NASA launch vehicles is that it reduces the weight of the take-off, the landing gear, the wing size, and less propellant resulting in significant cost savings. The US Navy and the British MOD (Ministry of Defense) are planning to use magnetic launch assist for their next generation aircraft carriers as the aircraft launch system. The US Army is considering using this technology for launching target drones for anti-aircraft training.

  6. Outcomes of an integrated telehealth network demonstration project.

    PubMed

    Dimmick, Susan L; Burgiss, Samuel G; Robbins, Sherry; Black, David; Jarnagin, Bertha; Anders, Mary

    2003-01-01

    An integrated telehealth network that linked three hospitals, a federally qualified health care clinic with six sites, a county dental clinic, and patient homes was developed and implemented using both private and federal funding. The goal of the network was to deliver 10 different medical, dental, and behavioral health services to a rural community. The network served patients from nine different counties and two states. Outcomes from the disease management programs for congestive heart failure and diabetes, as well as crisis telehealth and teledental health, were reported. Results for the diabetes disease management program increased the number of diabetics who brought their blood sugar under control. Additionally, based on hospital days per patient per year with and without intervention, and the cost of intervention by telehealth, it was projected that the national cost of care for CHF hospitalizations could be reduced from 8 billion dollars to 4.2 billion dollars. This telehealth network can serve as a model for integrating health services in each county of the state. Once each county had an integrated telehealth network, the county networks could be linked to provide regional services and coordination on a statewide basis.

  7. An organisational analysis of the implementation of telecare and telehealth: the whole systems demonstrator

    PubMed Central

    2012-01-01

    Background To investigate organisational factors influencing the implementation challenges of redesigning services for people with long term conditions in three locations in England, using remote care (telehealth and telecare). Methods Case-studies of three sites forming the UK Department of Health’s Whole Systems Demonstrator (WSD) Programme. Qualitative research techniques were used to obtain data from various sources, including semi-structured interviews, observation of meetings over the course programme and prior to its launch, and document review. Participants were managers and practitioners involved in the implementation of remote care services. Results The implementation of remote care was nested within a large pragmatic cluster randomised controlled trial (RCT), which formed a core element of the WSD programme. To produce robust benefits evidence, many aspect of the trial design could not be easily adapted to local circumstances. While remote care was successfully rolled-out, wider implementation lessons and levels of organisational learning across the sites were hindered by the requirements of the RCT. Conclusions The implementation of a complex innovation such as remote care requires it to organically evolve, be responsive and adaptable to the local health and social care system, driven by support from front-line staff and management. This need for evolution was not always aligned with the imperative to gather robust benefits evidence. This tension needs to be resolved if government ambitions for the evidence-based scaling-up of remote care are to be realised. PMID:23153014

  8. Launch Vehicle Demonstrator Using Shuttle Assets

    NASA Technical Reports Server (NTRS)

    Threet, Grady E., Jr.; Creech, Dennis M.; Philips, Alan D.; Water, Eric D.

    2011-01-01

    The Marshall Space Flight Center Advanced Concepts Office (ACO) has the leading role for NASA s preliminary conceptual launch vehicle design and performance analysis. Over the past several years the ACO Earth-to-Orbit Team has evaluated thousands of launch vehicle concept variations for a multitude of studies including agency-wide efforts such as the Exploration Systems Architecture Study (ESAS), Constellation, Heavy Lift Launch Vehicle (HLLV), Heavy Lift Propulsion Technology (HLPT), Human Exploration Framework Team (HEFT), and Space Launch System (SLS). NASA plans to continue human space exploration and space station utilization. Launch vehicles used for heavy lift cargo and crew will be needed. One of the current leading concepts for future heavy lift capability is an inline one and a half stage concept using solid rocket boosters (SRB) and based on current Shuttle technology and elements. Potentially, the quickest and most cost-effective path towards an operational vehicle of this configuration is to make use of a demonstrator vehicle fabricated from existing shuttle assets and relying upon the existing STS launch infrastructure. Such a demonstrator would yield valuable proof-of-concept data and would provide a working test platform allowing for validated systems integration. Using shuttle hardware such as existing RS-25D engines and partial MPS, propellant tanks derived from the External Tank (ET) design and tooling, and four-segment SRB s could reduce the associated upfront development costs and schedule when compared to a concept that would rely on new propulsion technology and engine designs. There are potentially several other additional benefits to this demonstrator concept. Since a concept of this type would be based on man-rated flight proven hardware components, this demonstrator has the potential to evolve into the first iteration of heavy lift crew or cargo and serve as a baseline for block upgrades. This vehicle could also serve as a demonstration

  9. Magnetic Launch Assist System Demonstration Test

    NASA Technical Reports Server (NTRS)

    2001-01-01

    Engineers at the Marshall Space Flight Center (MSFC) have been testing Magnetic Launch Assist Systems, formerly known as Magnetic Levitation (MagLev) technologies. To launch spacecraft into orbit, a Magnetic Launch Assist system would use magnetic fields to levitate and accelerate a vehicle along a track at a very high speed. Similar to high-speed trains and roller coasters that use high-strength magnets to lift and propel a vehicle a couple of inches above a guideway, the launch-assist system would electromagnetically drive a space vehicle along the track. A full-scale, operational track would be about 1.5-miles long and capable of accelerating a vehicle to 600 mph in 9.5 seconds. This photograph shows a subscale model of an airplane running on the experimental track at MSFC during the demonstration test. This track is an advanced linear induction motor. Induction motors are common in fans, power drills, and sewing machines. Instead of spinning in a circular motion to turn a shaft or gears, a linear induction motor produces thrust in a straight line. Mounted on concrete pedestals, the track is 100-feet long, about 2-feet wide, and about 1.5- feet high. The major advantages of launch assist for NASA launch vehicles is that it reduces the weight of the take-off, the landing gear, the wing size, and less propellant resulting in significant cost savings. The US Navy and the British MOD (Ministry of Defense) are planning to use magnetic launch assist for their next generation aircraft carriers as the aircraft launch system. The US Army is considering using this technology for launching target drones for anti-aircraft training.

  10. Magnetic Launch Assist System Demonstration Test

    NASA Technical Reports Server (NTRS)

    2001-01-01

    Engineers at the Marshall Space Flight Center (MSFC) have been testing Magnetic Launch Assist Systems, formerly known as Magnetic Levitation (MagLev) technologies. To launch spacecraft into orbit, a Magnetic Launch Assist system would use magnetic fields to levitate and accelerate a vehicle along a track at a very high speed. Similar to high-speed trains and roller coasters that use high-strength magnets to lift and propel a vehicle a couple of inches above a guideway, the launch-assist system would electromagnetically drive a space vehicle along the track. A full-scale, operational track would be about 1.5-miles long and capable of accelerating a vehicle to 600 mph in 9.5 seconds. This photograph shows a subscale model of an airplane running on the experimental track at MSFC during the demonstration test. This track is an advanced linear induction motor. Induction motors are common in fans, power drills, and sewing machines. Instead of spinning in a circular motion to turn a shaft or gears, a linear induction motor produces thrust in a straight line. Mounted on concrete pedestals, the track is 100-feet long, about 2-feet wide, and about 1.5- feet high. The major advantages of launch assist for NASA launch vehicles is that it reduces the weight of the take-off, the landing gear, the wing size, and less propellant resulting in significant cost savings. The US Navy and the British MOD (Ministry of Defense) are planning to use magnetic launch assist for their next generation aircraft carriers as the aircraft launch system. The US Army is considering using this technology for launching target drones for anti-aircraft training.

  11. Launch Vehicle Demonstrator Using Shuttle Assets

    NASA Technical Reports Server (NTRS)

    Creech, Dennis M.; Threet, Grady E., Jr.; Waters, Eric D.

    2011-01-01

    Study Objective is to characterize the performance capabilities of an inline, shuttle-derived launch vehicle using two design strategies: the first as an early program demonstrator utilizing high structural margins, maximum shuttle assets, and minimal pad impact, the later having undergone structural optimization, flying operational mission GR&A and serving as a baseline for evolutionary upgrades.

  12. Launch Vehicle Demonstrator Using Shuttle Assets

    NASA Technical Reports Server (NTRS)

    Creech, Dennis M.; Threet, Grady E., Jr.; Philips, Alan D.; Waters, Eric D.

    2011-01-01

    The Advanced Concepts Office at NASA's George C. Marshall Space Flight Center undertook a study to define candidate early heavy lift demonstration launch vehicle concepts derived from existing space shuttle assets. The objective was to determine the performance capabilities of these vehicles and characterize potential early demonstration test flights. Given the anticipated budgetary constraints that may affect America's civil space program, and a lapse in U.S. heavy launch capability with the retirement of the space shuttle, an early heavy lift launch vehicle demonstration flight would not only demonstrate capabilities that could be utilized for future space exploration missions, but also serve as a building block for the development of our nation s next heavy lift launch system. An early heavy lift demonstration could be utilized as a test platform, demonstrating capabilities of future space exploration systems such as the Multi Purpose Crew Vehicle. By using existing shuttle assets, including the RS-25D engine inventory, the shuttle equipment manufacturing and tooling base, and the segmented solid rocket booster industry, a demonstrator concept could expedite the design-to-flight schedule while retaining critical human skills and capital. In this study two types of vehicle designs are examined. The first utilizes a high margin/safety factor battleship structural design in order to minimize development time as well as monetary investment. Structural design optimization is performed on the second, as if an operational vehicle. Results indicate low earth orbit payload capability is more than sufficient to support various vehicle and vehicle systems test programs including Multi-Purpose Crew Vehicle articles. Furthermore, a shuttle-derived, hydrogen core vehicle configuration offers performance benefits when trading evolutionary paths to maximum capability.

  13. Impact of telehealth on general practice contacts: findings from the whole systems demonstrator cluster randomised trial.

    PubMed

    Bardsley, Martin; Steventon, Adam; Doll, Helen

    2013-10-08

    Telehealth is increasingly used in the care of people with long term conditions. Whilst many studies look at the impacts of the technology on hospital use, few look at how it changes contacts with primary care professionals. The aim of this paper was to assess the impacts of home-based telehealth interventions on general practice contacts. Secondary analysis of data from a Department of Health funded cluster-randomised trial with 179 general practices in three areas of England randomly assigned to offer telehealth or usual care to eligible patients. Telehealth included remote exchange of vitals signs and symptoms data between patients and healthcare professionals as part of the continuing management of patients. Usual care reflected the range of services otherwise available in the sites, excluding telehealth. Anonymised data from GP systems were used to construct person level histories for control and intervention patients. We tested for differences in numbers of general practitioner and practice nurse contacts over twelve months and in the number of clinical readings recorded on general practice systems over twelve months. 3,230 people with diabetes, chronic obstructive pulmonary disease or heart failure were recruited in 2008 and 2009. 1219 intervention and 1098 control cases were available for analysis. No statistically significant differences were detected in the numbers of general practitioner or practice nurse contacts between intervention and control groups during the trial, or in the numbers of clinical readings recorded on the general practice systems. Telehealth did not appear associated with different levels of contact with general practitioners and practice nurses. We note that the way that telehealth impacts on primary care roles may be influenced by a number of other features in the health system. The challenge is to ensure that these systems lead to better integration of care than fragmentation. International Standard Randomised Controlled Trial

  14. Space-X Launches Falcon 9 on Demonstration Flight

    NASA Image and Video Library

    SpaceX's Falcon 9 rocket and Dragon spacecraft launched from Launch Complex 40 at Cape Canaveral Air Force Station at 10:43 a.m. EST on Wednesday, Dec. 8. This is first demonstration flight for NAS...

  15. A RCT of telehealth for COPD patient's quality of life: the whole system demonstrator evaluation.

    PubMed

    Rixon, Lorna; Hirani, Shashivadan P; Cartwright, Martin; Beynon, Michelle; Doll, Helen; Steventon, Adam; Henderson, Catherine; Newman, Stanton P

    2017-07-01

    Despite some concerns that the introduction of telehealth (TH) may lead to reductions in quality of life (QoL), lower mood and increased anxiety in response to using assistive technologies to reduce health care utilisation and manage long term conditions, this research focuses on the extent to which providing people with tools to monitor their condition can improve QoL. The Chronic Obstructive Pulmonary Disease (COPD) cohort of the Whole Systems Demonstrator Trial is a pragmatic General Practitioner (GP) clustered randomised controlled trial (RCT) evaluating TH in the UK from three regions in England. All patients at a participating GP practice were deemed eligible for inclusion in the study if they were diagnosed with COPD. 447 participants completed baseline and either a short (4 months) or long term (12 months) follow-up. There was a trend of improved QoL and mood in the TH group at longer-term follow-up, but not short term follow-up. Emotional functioning (g = 0.280 95%CI, 0.051-0.510) and mastery reached (g = 2.979 95%CI, 0-0.46) significance at P < 0.05 (all Hedges g <0.3). TH showed minimal benefit to QoL in COPD patients who were not preselected to be at increased risk of acute exacerbations. Benefits were more likely in disease specific measures at longer term follow-up. TH is a complex intervention and should be embedded in a service that is evidenced based. Outcome measures must be sensitive enough to detect changes in the target population for the specific intervention. © 2015 John Wiley & Sons Ltd.

  16. Hypersonic Force Application and Launch Technology Demonstration

    DTIC Science & Technology

    2004-09-14

    region Regardless of anti-access threats In a single or multi-theater environment Distribution: Gov & Gov Contractors, ITAR Restricted 4 SMALL SATELLITE...demand Distribution: Gov & Gov Contractors, ITAR Restricted Objective: CAV Technology Demonstration Flight Test Description of CAV: Lifting aeroshell...Common Aero Vehicle (CAV) Distribution: Gov & Gov Contractors, ITAR Restricted 7 HYPERSONIC TECHNOLOGY EVOLUTION Building Block Tech Development and

  17. How X-37 Technology Demonstration Supports Reusable Launch Vehicles

    NASA Technical Reports Server (NTRS)

    Manley, David J.; Cervisi, Richard T.; Staszak, Paul R.

    2000-01-01

    This presentation discusses, in viewgraph form, how X-37 Technology Demonstration Supports Reusable Launch Vehicles. The topics include: 1) X-37 Program Objectives; 2) X-37 Description; 3) X-37 Vehicle Characteristics; 4) X-37 Expands the Testbed Envelope to Orbital Capability; 5) Overview of X-37 Flight Test Program; 6) Thirty-Nine Technologies and Experiments are Being Demonstrated on the X-37; 7) X-37 Airframe/Structures Technologies; 8) X-37 Mechanical, Propulsion, and Thermal System Technologies and Experiments; 9) X-37 GN&C Technologies; 10) X-37 Avionics, Power, and Software Technologies and Experiments; and 11) X-37 Technologies and Experiments Support Reusable Launch Vehicle Needs.

  18. Integrating Telehealth Instruction into the Graduate Nursing Curriculum

    ERIC Educational Resources Information Center

    Erickson, Christie

    2015-01-01

    Telehealth can be effective for those who use it; however, very few educational programs prepare their students to utilize telehealth. The goal of this project was to integrate telehealth into the graduate nursing curriculum. This was done by providing a 1-hour classroom educational demonstration and lecture on telehealth along with 4-hour…

  19. Integrating Telehealth Instruction into the Graduate Nursing Curriculum

    ERIC Educational Resources Information Center

    Erickson, Christie

    2015-01-01

    Telehealth can be effective for those who use it; however, very few educational programs prepare their students to utilize telehealth. The goal of this project was to integrate telehealth into the graduate nursing curriculum. This was done by providing a 1-hour classroom educational demonstration and lecture on telehealth along with 4-hour…

  20. Gemini 10 prime crew participate in Simultaneous Launch Demonstration

    NASA Image and Video Library

    1966-07-12

    S66-42702 (12 July 1966) --- Gemini-10 prime crew, astronauts John W. Young (left), command pilot, and Michael Collins (right), pilot, check equipment in the White Room atop Pad 19 where they participated in a Simultaneous Launch Demonstration. Photo credit: NASA

  1. RADEM: An Air Launched, Rocket Demonstrator for Future Advanced Launch Systems

    NASA Astrophysics Data System (ADS)

    Parkinson, R. C.; Skorodelov, V. A.; Serdijk, I. I.; Neiland, V. Ya.

    1995-10-01

    Critical features associated with future reusable launch vehicles include reduction of turn around effort, use of integral liquid hydrogen tanks, advanced structures and thermal protection, and re-usable LOx-hydrogen propulsion with low maintenance overheads. Many doubts associated with such designs could be removed by a sub-orbital demonstrator. An air launched vehicle would fulfil many of the objectives for such demonstration. British Aerospace, NPO Molnija, TsAGI and DB Antonov have made an initial study for ESA for such a demonstrator (RADEM), using earlier studies of operational launch systems with the An-225 /Hotol and MAKS proposals. The paper describes the results of this study, including the selection of two potential vehicle designs, and an approach to sub-system design and vehicle development to minimize the costs. It appears that such a vheicle, capable of flying to Mach 12 or beyond using currently available technology, could have a cost an order of magnitude less than that required for development of an operational vehicle.

  2. Effect of telehealth on glycaemic control: analysis of patients with type 2 diabetes in the Whole Systems Demonstrator cluster randomised trial.

    PubMed

    Steventon, Adam; Bardsley, Martin; Doll, Helen; Tuckey, Elizabeth; Newman, Stanton P

    2014-08-06

    The Whole Systems Demonstrator was a large, pragmatic, cluster randomised trial that compared telehealth with usual care among 3,230 patients with long-term conditions in three areas of England. Telehealth involved the regular transmission of physiological information such as blood glucose to health professionals working remotely. We examined whether telehealth led to changes in glycosylated haemoglobin (HbA1c) among the subset of patients with type 2 diabetes. The general practice electronic medical record was used as the source of information on HbA1c. Effects on HbA1c were assessed using a repeated measures model that included all HbA1c readings recorded during the 12-month trial period, and adjusted for differences in HbA1c readings recorded before recruitment. Secondary analysis averaged multiple HbA1c readings recorded for each individual during the trial period. 513 of the 3,230 participants were identified as having type 2 diabetes and thus were included in the study. Telehealth was associated with lower HbA1c than usual care during the trial period (difference 0.21% or 2.3 mmol/mol, 95% CI, 0.04% to 0.38%, p = 0.013). Among the 457 patients in the secondary analysis, mean HbA1c showed little change for controls following recruitment, but fell for intervention patients from 8.38% to 8.15% (68 to 66 mmol/mol). A higher proportion of intervention patients than controls had HbA1c below the 7.5% (58 mmol/mol) threshold that was targeted by general practices (30.4% vs. 38.0%). This difference, however, did not quite reach statistical significance (adjusted odds ratio 1.63, 95% CI, 0.99 to 2.68, p = 0.053). Telehealth modestly improved glycaemic control in patients with type 2 diabetes over 12 months. The scale of the improvements is consistent with previous meta-analyses, but was relatively modest and seems unlikely to produce significant patient benefit. International Standard Randomized Controlled Trial Number Register ISRCTN43002091.

  3. Exploring barriers to participation and adoption of telehealth and telecare within the Whole System Demonstrator trial: a qualitative study

    PubMed Central

    2012-01-01

    Background Telehealth (TH) and telecare (TC) interventions are increasingly valued for supporting self-care in ageing populations; however, evaluation studies often report high rates of non-participation that are not well understood. This paper reports from a qualitative study nested within a large randomised controlled trial in the UK: the Whole System Demonstrator (WSD) project. It explores barriers to participation and adoption of TH and TC from the perspective of people who declined to participate or withdrew from the trial. Methods Qualitative semi-structured interviews were conducted with 22 people who declined to participate in the trial following explanations of the intervention (n = 19), or who withdrew from the intervention arm (n = 3). Participants were recruited from the four trial groups (with diabetes, chronic obstructive pulmonary disease, heart failure, or social care needs); and all came from the three trial areas (Cornwall, Kent, east London). Observations of home visits where the trial and interventions were first explained were also conducted by shadowing 8 members of health and social care staff visiting 23 people at home. Field notes were made of observational visits and explored alongside interview transcripts to elicit key themes. Results Barriers to adoption of TH and TC associated with non-participation and withdrawal from the trial were identified within the following themes: requirements for technical competence and operation of equipment; threats to identity, independence and self-care; expectations and experiences of disruption to services. Respondents held concerns that special skills were needed to operate equipment but these were often based on misunderstandings. Respondents’ views were often explained in terms of potential threats to identity associated with positive ageing and self-reliance, and views that interventions could undermine self-care and coping. Finally, participants were reluctant to risk potentially

  4. X-33 Reusable Launch Vehicle Demonstrator, Spaceport and Range

    NASA Technical Reports Server (NTRS)

    Letchworth, Gary F.

    2011-01-01

    The X-33 was a suborbital reusable spaceplane demonstrator, in development from 1996 to early 2001. The intent of the demonstrator was to lower the risk of building and operating a full-scale reusable vehicle fleet. Reusable spaceplanes offered the potential to lower the cost of access to space by an order of magnitude, compared with conventional expendable launch vehicles. Although a cryogenic tank failure during testing ultimately led to the end of the effort, the X-33 team celebrated many successes during the development. This paper summarizes some of the accomplishments and milestones of this X-vehicle program, from the perspective of an engineer who was a member of the team throughout the development. X-33 Program accomplishments include rapid, flight hardware design, subsystem testing and fabrication, aerospike engine development and testing, Flight Operations Center and Operations Control Center ground systems design and construction, rapid Environmental Impact Statement NEPA process approval, Range development and flight plan approval for test flights, and full-scale system concept design and refinement. Lessons from the X-33 Program may have potential application to new RLV and other aerospace systems being developed a decade later.

  5. Demonstration and Analysis of Reusable Launch Vehicle Operations

    DTIC Science & Technology

    2006-08-01

    15 Figure 9: P-7B Parachute Recovery...to the Launch Site......................................................... 18 Figure 12: P-7A Flight Profile - From Liftoff to Parachute Deployment...9 Table 6. Updated Model of P-7A Trajectory Events ...................................................... 19 Table

  6. Progress on the National Launch System demonstrates national commitment

    NASA Technical Reports Server (NTRS)

    Gabris, Edward A.; Harris, Ronald J.; Rast, Stephen A.

    1992-01-01

    The paper discusses the process and measures involved in the design and development efforts now underway to achieve the construction of a new NASA/DOD heavy-lift launch system, the National Launch System. Special attention is given to the extensive technology development program initiated with the purpose of achieving robustness, operability, and low cost per flight for the NLS. The design features of the NLS and the constraints utilized are discussed.

  7. Factors relating to home telehealth acceptance and usage compliance

    PubMed Central

    Wade, Rachael; Cartwright, Colleen; Shaw, Kelly

    2012-01-01

    Aim This paper investigates the acceptance of in-home telehealth by frail older adults and carers of the Transition Care Program (TCP), and evaluates telehealth acceptance as a predictor for usage compliance. Method A stratified random sample of participants was allocated to one of five groups: either a control group or to receive telehealth monitoring of their vital signs for a period of 12 or 24 weeks; with or without a medical alarm pendant. Results Before being trained in and using telehealth, the majority of participants and carers demonstrated acceptance of the technology by reporting that they perceived it would be “useful” and “easy to use.” This acceptance was also reported post-TCP (up to 12 weeks of usage). The “perceived ease of use” of the telehealth equipment increased significantly from pre-telehealth training and usage to post-TCP (up to 12 weeks of usage) (P = 0.001). There was no change, (pre-training and usage to post-TCP) in the “perceived usefulness” of the telehealth equipment. The telehealth acceptance constructs of “ease of use” and “usefulness,” at pre-telehealth training and usage, approached statistical significance as a predictor of future compliance (P = 0.06). “Perceived ease of use,” at pre-training and usage, had a positive relationship with future compliance (P = 0.02). Conclusion There is currently limited knowledge about the influences and determinants of home telehealth compliance in frail older people and their carers, potentially a significant user group for the technology into the future. This study’s finding that frail older people and their carers perceive that home telehealth is useful and easy to use demonstrates their acceptance of home telehealth as a therapeutic tool. Further, perceived ease of use of home telehealth is a significant predictor of compliance with frail older people and their carers’ use of home telehealth. Additional research is required in order to identify other

  8. STS-26 launch and entry crew equipment demonstration at Naval Weapons Center

    NASA Technical Reports Server (NTRS)

    1988-01-01

    STS-26 launch and entry crew equipment demonstration is conducted by JSC Crew and Thermal Systems Division's (CTSD's) employee James O. Schlosser at the Naval Weapons Center, China Lake, California. Schlosser (left) gives a briefing on the new crew equipment baselined for STS-26 as Astronaut James P. Bagian models the new gear. Included in the package are navy blue launch and entry suit (LES), launch and entry helmet (LEH), parachute, life raft, and survival gear. A mission specialist seat is visible in background between the two men.

  9. STS-26 launch and entry crew equipment demonstration at Naval Weapons Center

    NASA Technical Reports Server (NTRS)

    1988-01-01

    STS-26 launch and entry crew equipment demonstration is conducted by JSC Crew and Thermal Systems Division's (CTSD's) employee James O. Schlosser at the Naval Weapons Center, China Lake, California. Schlosser (left) gives a briefing on the new crew equipment baselined for STS-26 as Astronaut James P. Bagian models the new gear. Included in the package are navy blue launch and entry suit (LES), launch and entry helmet (LEH), parachute, life raft, and survival gear. A mission specialist seat is visible in background between the two men.

  10. Telehealth Implementation in a Skilled Nursing Facility: Case Report for Physical Therapist Practice in Washington.

    PubMed

    Lee, Alan Chong W; Billings, Michael

    2016-02-01

    Telehealth is defined as the delivery of health-related services and information via telecommunication technologies. The purposes of this case report are: (1) to describe the development, implementation, and evaluation of a telehealth approach for meeting physical therapist supervision requirements in a skilled nursing facility (SNF) in Washington and (2) to explore clinical and human factors of physical therapist practice in an SNF delivered via telehealth. In 2009, Infinity Rehab conducted a pilot program to determine whether telehealth could be used to meet physical therapist supervision requirements in an SNF. In 2011, language allowing telehealth physical therapy was approved by the Washington Board of Physical Therapy (Board). In 2014-2015, telehealth outcomes were evaluated in a 51-person sample at an Infinity Rehab SNF. Cost savings of telehealth implementation from 2011 to 2015 were estimated. The Board deemed the telehealth pilot program a success and subsequently established telehealth practice language for physical therapy. Both human factors and clinical outcomes were required to implement a successful telehealth practice. Clinical outcomes and user satisfaction in telehealth and nontelehealth groups were equivalent. Cost savings were identified. Human factors, such as the need for provider education in appropriate bedside manner with a telehealth session, were identified. Since 2011, more than 1,000 telehealth physical therapy sessions were conducted at Infinity Rehab SNFs in Washington State. In the future, alternative payment models focused on valued-based clinical outcomes may facilitate wider telehealth adoption in physical therapy. Future research on efficacy and cost-effectiveness is needed to promote broader adoption of telehealth physical therapy in SNFs. This experience demonstrates that telehealth implementation in an SNF for the purpose of physical therapy re-evaluation is a feasible alternative to in-person encounters. © 2016 American

  11. Telehealth and telecare news.

    PubMed

    Birmingham, Karen

    2008-10-01

    Swindon Primary Care Trust (PCT) last month became the latest trust to make a substantial expansion to its telehealth service. It joins three other PCTs which have greatly increased their use of remote monitoring in the last six months.

  12. Theory of use behind telehealth applications.

    PubMed

    Lehoux, P; Sicotte, C; Lacroix, A

    1999-01-01

    A variety of telehealth applications have been implemented throughout the industrialized world. Given that telehealth has yet to become routine in the practices of physicians, the impact of such applications on health care management remains difficult to identify. Only by becoming integrated into the 'normal practice' of clinicians can telehealth facilitate smooth communications in health care delivery processes. In this paper we demonstrate the importance of developing a 'theory of use', describing how clinicians are expected to use teleconsultation in their daily activities. By employing Giddens' Structuration Theory, we can develop a clear vision of the utilization of telehealth, and a better framework with which to assess its added value for health care delivery. We illustrate this claim by referring to our research on the Quebec Inter-Regional Telemedicine Network. In this study we compare the 'theory of use' behind the telemedicine network with the perceptions of physicians regarding their needs in terms of communications and access to expert advice. The breach between the theory and the perceptions of physicians may help to explain how the utilization of telehealth could be enhanced, and how new and sustainable routines for its integration into the health care system might be created.

  13. Telehealth stroke education for rural elderly Virginians.

    PubMed

    Schweickert, Patricia A; Rutledge, Carolyn M; Cattell-Gordon, David C; Solenski, Nina J; Jensen, Mary E; Branson, Sheila; Gaughen, John R

    2011-12-01

    Stroke is a prevalent condition found in elderly, rural populations. However, stroke education, which can be effective in addressing the risks, is often difficult to provide in these remote regions. The objective of this study is to evaluate the effectiveness of delivering stroke education to elderly individuals through telehealth versus in-person stroke prevention education methods. A quasi-experimental nonequivalent control group design was used in this study. A convenience sample of 11 elderly adults (36% men, 64% women) with a mean age of 70 was selected from an Appalachian Program for All Inclusive Care for the Elderly (day care) facility. Subjects completed preintervention surveys, received a 20-min group in-person or telehealth delivered education session, and then completed the postintervention surveys. Satisfaction with delivery method and post-education knowledge was equivalent between the two groups. Knowledge increased in both groups after the educational programs. Likelihood of reducing risk factors showed no differences pre-posttest. However, there were significant improvements in the pre-post likelihood scores of the telehealth group in contrast to the in-person group. This project provided a rural, high-risk population access to telehealth stroke education, thus enabling these individuals to receive education at a distance from experts in the field. The telehealth program was found to be equivalent to in-person stroke education in regards to satisfaction, knowledge, and likelihood of making changes to decrease vascular risk factors. The study demonstrated feasibility in providing effective stroke education through telehealth, thus suggesting an often overlooked route for providing patient education at a distance.

  14. Participatory and persuasive telehealth.

    PubMed

    Lee, Duckki; Helal, Sumi; Anton, Steve; De Deugd, Scott; Smith, Andy

    2012-01-01

    Technological advances in telehealth systems are primarily focused on sensing and monitoring. However, these systems are limited in that they only rely on sensors and medical devices to obtain vital signs. New research and development are urgently needed to offer more effective and meaningful interactions between patients, medical professionals and other individuals around the patients. Social networking with Web 2.0 technologies and methods can meet these demands, and help to develop a more complete view of the patient. Also many people, including the elderly, may be resistant to change, which can reduce the efficacy of telehealth systems. Persuasive technology and mechanisms are urgently needed to counter this resistance and promote healthy lifestyles. In this paper, we propose the participatory and persuasive telehealth system as a solution for these two limitations. By integrating connected health solutions with social networking and adding persuasive influence, we increase the chances for effective interventions and behavior alterations.

  15. Demonstration/Validation of Environmentally-Preferable Coatings for Launch Facilities

    NASA Technical Reports Server (NTRS)

    Lewis, Pattie

    2011-01-01

    Kennedy Space Center (KSC) is responsible for a number of facilities/structures with metallic structural and non-structural components in a highly corrosive environment. Metals require periodic maintenance activity to guard against the insidious effects of corrosion and thus ensure that structures meet or exceed design or performance life. The standard practice for protecting metallic substrates in atmospheric environments is the application of an applied coating system. Applied coating systems work via a variety of methods (barrier, galvanic and/or inhibitor) and adhere to the substrate through a combination of chemical and physical bonds. Maintenance at KSC and other NASA Centers is governed by NASA-STD-50088 (Protective Coating of Carbon Steel, Stainless Steel, and Aluminum on Launch Structures, Facilities, and Ground Support Equipment) which establishes practices for the protective coating of ground support equipment and related facilities used by or for NASA programs and projects. The Standard is for the design of non-flight hardware used to support the operations of receiving, transportation, handling, assembly, inspection, test, checkout, service, and launch of space vehicles and payloads at NASA launch, landing, or retrieval sites. These criteria and practices contained within the Standard may be used for items used at the manufacturing, development, and test sites upstream of the launch, landing, or retrieval sites. The objective of this effort is to demonstrate and validate environmentally-preferable alternatives in accordance with NASA-STD-50088 and KSC requirements which can then be added to the Approved Products List. This Test Protocol contains the critical requirements and tests necessary to qualify alternatives for structural steel applications. These tests were derived from engineering, performance, and operational impact (supportability) requirements defined by a consensus of KSC participants. A Test Report will document the results of the testing

  16. Demonstrating the Performance Benefits of the Strutjet RBCC for Space Launch Architectures

    NASA Technical Reports Server (NTRS)

    Siebenhaar, Adam; Bulman, Mel; Johnson, Richard; Fazah, Mike

    1999-01-01

    The Rocket Based Combined Cycle (RBCC) engine synergistically combines the best elements of airbreathing and rocket propulsion to benefit a wide range of future reusable launch vehicles (RLV). Aerojet's Strutjet RBCC offers high Isp during mid-phase acceleration, and high thrust for boost and final ascent phases. The result is a relatively low gross weight vehicle that reduces thrust requirements compared with all-rocket solutions. Relative to combination propulsion systems, the integrated propulsive elements of the Strutjet reduce engine weight and complexity. This paper will summarize the results of tests demonstrating our latest hydrogen-fueled Strutjet RBCC engine performance, including inlet operability and performance over a range of conditions, sea level static and Mach 2.4 rocket thrust augmentation, ramjet and scramjet performance, combined scramjet/rocket performance at Mach 8, and ascent mode rocket performance. These tests have significantly advanced the technology readiness of the Strutjet engine and substantiate the performance benefits of RBCC engines for reusable launch vehicle applications. A companion paper provides a focus on Strutjet as a basis for advanced air and space architecture, covering hydrogen and hydrocarbon fuels and cooled structures.

  17. Max Launch Abort System (MLAS) Landing Parachute Demonstrator (LPD) Drop Test

    NASA Technical Reports Server (NTRS)

    Shreves, Christopher M.

    2011-01-01

    The Landing Parachute Demonstrator (LPD) was conceived as a low-cost, rapidly-developed means of providing soft landing for the Max Launch Abort System (MLAS) crew module (CM). Its experimental main parachute cluster deployment technique and off-the-shelf hardware necessitated a full-scale drop test prior to the MLAS mission in order to reduce overall mission risk. This test was successfully conducted at Wallops Flight Facility on March 6, 2009, with all vehicle and parachute systems functioning as planned. The results of the drop test successfully qualified the LPD system for the MLAS flight test. This document captures the design, concept of operations and results of the drop test.

  18. Evolving telehealth reimbursement in Australia.

    PubMed

    Bursell, S-E; Zang, S; Keech, A C; Jenkins, A J

    2016-08-01

    Video-based consultation is the only telehealth service reimbursed by the Medicare Benefits Schedule in Australia, but the uptake of telehealth is still low and inconsistent. There is a clear need for the development of appropriate medical evidence to support implementation of telehealth services. With the ubiquitous use of mobile phones, mobile health becomes important in facilitating health services and impacting clinical outcomes anywhere.

  19. Earth-to-Orbit Laser Launch Simulation for a Lightcraft Technology Demonstrator

    NASA Astrophysics Data System (ADS)

    Richard, J. C.; Morales, C.; Smith, W. L.; Myrabo, L. N.

    2006-05-01

    Optimized laser launch trajectories have been developed for a 1.4 m diameter, 120 kg (empty mass) Lightcraft Technology Demonstrator (LTD). The lightcraft's combined-cycle airbreathing/rocket engine is designed for single-stage-to-orbit flights with a mass ratio of 2 propelled by a 100 MW class ground-based laser built on a 3 km mountain peak. Once in orbit, the vehicle becomes an autonomous micro-satellite. Two types of trajectories were simulated with the SORT (Simulation and Optimization of Rocket Trajectories) software package: a) direct GBL boost to orbit, and b) GBL boost aided by laser relay satellite. Several new subroutines were constructed for SORT to input engine performance (as a function of Mach number and altitude), vehicle aerodynamics, guidance algorithms, and mass history. A new guidance/steering option required the lightcraft to always point at the GBL or laser relay satellite. SORT iterates on trajectory parameters to optimize vehicle performance, achieve a desired criteria, or constrain the solution to avoid some specific limit. The predicted laser-boost performance for the LTD is undoubtedly revolutionary, and SORT simulations have helped to define this new frontier.

  20. Demonstration of Launch Vehicle Slosh Instability on Pole-Cart Platform

    NASA Technical Reports Server (NTRS)

    Pei, Jing; Rothhaar, Paul

    2015-01-01

    Liquid propellant makes up a significant portion of the total weight for large launch vehicles such as Saturn V, Space Shuttle, and the Space Launch System (SLS). Careful attention must be given to the influence of fuel slosh motion on the stability of the vehicle. A well-documented slosh danger zone occurs when the slosh mass is between the vehicle center of mass and the center of percussion. Passive damping via slosh baffle is generally required when the slosh mass is within this region. The pole-cart hardware system, typically used for academic purposes, has similar dynamic characteristics as an unstable launch vehicle. This setup offers a simple and inexpensive way of analyzing slosh dynamics and its impact on flight control design. In this paper, experimental and numerical results from the pole-cart system will be shown and direct analogies to launch vehicle slosh dynamics will be made.

  1. Telehealth coordinators in hospital based telehealth services: Who are they and what do they do?

    PubMed

    Edirippulige, Sisira; Armfield, Nigel R; Greenup, Phil; Bryett, Andrew

    2016-12-01

    Many studies have identified the importance of 'telehealth coordinators' for successful telehealth implementation and operation. However, little is known about the telehealth coordinators' functions, the skills and competencies required and the reasons for their influence. This study aimed to examine the key functions of telehealth coordinators in the Queensland public health system, their perceptions about their role, and the level of competencies to support this role. All telehealth coordinators within Queensland Health Telehealth Services were invited to complete a questionnaire. We collected: (i) demographic information; (ii) details of their telehealth work; and (iii) information about knowledge and skills relevant to their telehealth coordinator role. Eighteen of 20 (90%) participants completed and submitted the survey. Telehealth coordinators were responsible for a range of tasks relating to telehealth consultations, technical assistance, administration, research, promotion and marketing. Nearly all telehealth coordinators (n = 17, 94%) were confident in carrying out the tasks of their job. The majority of telehealth coordinators (n = 13, 72%) thought education and training relating to telehealth would help improve their job. The top three topics that telehealth coordinators were keen to learn about were: (i) examples of clinical use of telehealth; (ii) types of technologies used; and (iii) telehealth clinical and business models. Our participants were all hospital-based; as the use of telehealth is growing outside of the traditional hospital settings, the role of telehealth coordinators is likely to change. © The Author(s) 2016.

  2. Design and Feasibility Demonstration of a Deployment System for a Rocket Launched Buoy

    DTIC Science & Technology

    1979-09-06

    as described in Section 3.3. 3.2 Deployment Piston After early experiments with the standard Sonobuoy deployment piston it was decided to utilize a...syzt-em- desee 4 s not limited to the electronic buoy for which it was developed but is applicable to any quasi cylindrical payload to be deployed following a rocket launch from the MK 36 launching system. -12-

  3. NASA's Space Launch System Advanced Booster Engineering Demonstration and/or Risk Reduction Efforts

    NASA Technical Reports Server (NTRS)

    Crumbly, Christopher M.; Dumbacher, Daniel L.; May, Todd A.

    2012-01-01

    The National Aeronautics and Space Administration (NASA) formally initiated the Space Launch System (SLS) development in September 2011, with the approval of the program s acquisition plan, which engages the current workforce and infrastructure to deliver an initial 70 metric ton (t) SLS capability in 2017, while using planned block upgrades to evolve to a full 130 t capability after 2021. A key component of the acquisition plan is a three-phased approach for the first stage boosters. The first phase is to complete the development of the Ares and Space Shuttle heritage 5-segment solid rocket boosters (SRBs) for initial exploration missions in 2017 and 2021. The second phase in the booster acquisition plan is the Advanced Booster Risk Reduction and/or Engineering Demonstration NASA Research Announcement (NRA), which was recently awarded after a full and open competition. The NRA was released to industry on February 9, 2012, with a stated intent to reduce risks leading to an affordable advanced booster and to enable competition. The third and final phase will be a full and open competition for Design, Development, Test, and Evaluation (DDT&E) of the advanced boosters. There are no existing boosters that can meet the performance requirements for the 130 t class SLS. The expected thrust class of the advanced boosters is potentially double the current 5-segment solid rocket booster capability. These new boosters will enable the flexible path approach to space exploration beyond Earth orbit (BEO), opening up vast opportunities including near-Earth asteroids, Lagrange Points, and Mars. This evolved capability offers large volume for science missions and payloads, will be modular and flexible, and will be right-sized for mission requirements. NASA developed the Advanced Booster Engineering Demonstration and/or Risk Reduction NRA to seek industry participation in reducing risks leading to an affordable advanced booster that meets the SLS performance requirements

  4. NASA's Space Launch System Advanced Booster Engineering Demonstration and Risk Reduction Efforts

    NASA Technical Reports Server (NTRS)

    Crumbly, Christopher M.; May, Todd; Dumbacher, Daniel

    2012-01-01

    The National Aeronautics and Space Administration (NASA) formally initiated the Space Launch System (SLS) development in September 2011, with the approval of the program s acquisition plan, which engages the current workforce and infrastructure to deliver an initial 70 metric ton (t) SLS capability in 2017, while using planned block upgrades to evolve to a full 130 t capability after 2021. A key component of the acquisition plan is a three-phased approach for the first stage boosters. The first phase is to complete the development of the Ares and Space Shuttle heritage 5-segment solid rocket boosters for initial exploration missions in 2017 and 2021. The second phase in the booster acquisition plan is the Advanced Booster Risk Reduction and/or Engineering Demonstration NASA Research Announcement (NRA), which was recently awarded after a full and open competition. The NRA was released to industry on February 9, 2012, and its stated intent was to reduce risks leading to an affordable Advanced Booster and to enable competition. The third and final phase will be a full and open competition for Design, Development, Test, and Evaluation (DDT&E) of the Advanced Boosters. There are no existing boosters that can meet the performance requirements for the 130 t class SLS. The expected thrust class of the Advanced Boosters is potentially double the current 5-segment solid rocket booster capability. These new boosters will enable the flexible path approach to space exploration beyond Earth orbit, opening up vast opportunities including near-Earth asteroids, Lagrange Points, and Mars. This evolved capability offers large volume for science missions and payloads, will be modular and flexible, and will be right-sized for mission requirements. NASA developed the Advanced Booster Engineering Demonstration and/or Risk Reduction NRA to seek industry participation in reducing risks leading to an affordable Advanced Booster that meets the SLS performance requirements. Demonstrations and

  5. Telehealth and Autism: Treating Challenging Behavior at Lower Cost

    PubMed Central

    Wacker, David; Suess, Alyssa; Schieltz, Kelly; Pelzel, Kelly; Kopelman, Todd; Lee, John; Romani, Patrick; Waldron, Debra

    2016-01-01

    OBJECTIVE: To determine whether challenging behavior in young children with autism and other developmental disabilities can be treated successfully at lower cost by using telehealth to train parents to implement applied behavior analysis (ABA). METHODS: We compared data on the outcomes and costs for implementing evidence-based ABA procedures to reduce problem behavior by using 3 service delivery models: in-home therapy, clinic-based telehealth, and home-based telehealth. Participants were 107 young children diagnosed with autism or other neurodevelopmental disorders, and data analysis focused on the 94 children who completed treatment. RESULTS: All 3 service delivery models demonstrated successful reduction of problem behavior by training parents to conduct functional analysis and functional communication training. The mean percentage reduction in problem behavior was >90% in all 3 groups after treatment, and treatment acceptability based on parent ratings was high for all groups. Total costs for implementing treatment were lowest for home telehealth, but both telehealth models were significantly less costly than in-home therapy. CONCLUSIONS: This research demonstrated that parents can use ABA procedures to successfully treat behavior problems associated with autism spectrum disorders regardless of whether treatment is directed by behavior consultants in person or via remote video coaching. Because ABA telehealth can achieve similar outcomes at lower cost compared with in-home therapy, geographic barriers to providing access to ABA for treating problem behavior can be minimized. These findings support the potential for using telehealth to provide research-based behavioral treatment to any family that has access to the Internet. PMID:26908472

  6. Telehealth and Autism: Treating Challenging Behavior at Lower Cost.

    PubMed

    Lindgren, Scott; Wacker, David; Suess, Alyssa; Schieltz, Kelly; Pelzel, Kelly; Kopelman, Todd; Lee, John; Romani, Patrick; Waldron, Debra

    2016-02-01

    To determine whether challenging behavior in young children with autism and other developmental disabilities can be treated successfully at lower cost by using telehealth to train parents to implement applied behavior analysis (ABA). We compared data on the outcomes and costs for implementing evidence-based ABA procedures to reduce problem behavior by using 3 service delivery models: in-home therapy, clinic-based telehealth, and home-based telehealth. Participants were 107 young children diagnosed with autism or other neurodevelopmental disorders, and data analysis focused on the 94 children who completed treatment. All 3 service delivery models demonstrated successful reduction of problem behavior by training parents to conduct functional analysis and functional communication training. The mean percentage reduction in problem behavior was >90% in all 3 groups after treatment, and treatment acceptability based on parent ratings was high for all groups. Total costs for implementing treatment were lowest for home telehealth, but both telehealth models were significantly less costly than in-home therapy. This research demonstrated that parents can use ABA procedures to successfully treat behavior problems associated with autism spectrum disorders regardless of whether treatment is directed by behavior consultants in person or via remote video coaching. Because ABA telehealth can achieve similar outcomes at lower cost compared with in-home therapy, geographic barriers to providing access to ABA for treating problem behavior can be minimized. These findings support the potential for using telehealth to provide research-based behavioral treatment to any family that has access to the Internet. Copyright © 2016 by the American Academy of Pediatrics.

  7. An evaluation of telehealth websites for design, literacy, information and content.

    PubMed

    Whitten, Pamela; Holtz, Bree; Cornacchione, Jennifer; Wirth, Christina

    2011-01-01

    We examined 62 telehealth websites using four assessment criteria: design, literacy, information and telehealth content. The websites came from the member list of the American Telemedicine Association and the Office for the Advancement of Telehealth and partner sites, and were included if they were currently active and at least three clicks deep. Approximately 130 variables were examined for each website by two independent researchers. The websites reviewed contained most of the design variables (mean 74%, SD 6), but fewer of those relating to literacy (mean 26%, SD 6), website information (mean 35%, SD 16) and telehealth content (mean 37%, SD 18). Only 29% of websites encouraged users to ask about telehealth, and 19% contained information on overcoming telehealth barriers. Nonetheless, 84% promoted awareness of telehealth. All evaluation assessments were significantly correlated with each other except for literacy and information. The present study identified various matters that should be addressed when developing telehealth websites. Although much of this represents simple common sense in website design, our evaluation demonstrates that there is still much room for improvement.

  8. Overview of States' Use of Telehealth for the Delivery of Early Intervention (IDEA Part C) Services.

    PubMed

    Cason, Jana; Behl, Diane; Ringwalt, Sharon

    2012-01-01

    Early intervention (EI) services are designed to promote the development of skills and enhance the quality of life of infants and toddlers who have been identified as having a disability or developmental delay, enhance capacity of families to care for their child with special needs, reduce future educational costs, and promote independent living (NECTAC, 2011). EI services are regulated by Part C of the Individuals with Disabilities Education Improvement Act (IDEA); however, personnel shortages, particularly in rural areas, limit access for children who qualify. Telehealth is an emerging delivery model demonstrating potential to deliver EI services effectively and efficiently, thereby improving access and ameliorating the impact of provider shortages in underserved areas. The use of a telehealth delivery model facilitates inter-disciplinary collaboration, coordinated care, and consultation with specialists not available within a local community. A survey sent by the National Early Childhood Technical Assistance Center (NECTAC) to IDEA Part C coordinators assessed their utilization of telehealth within states' IDEA Part C programs. Reimbursement for provider type and services and barriers to implement a telehealth service delivery model were identified. Representatives from 26 states and one jurisdiction responded to the NECTAC telehealth survey. Of these, 30% (n=9) indicated that they are either currently using telehealth as an adjunct service delivery model (n=6) or plan to incorporate telehealth within the next 1-2 years (n=3). Identified telehealth providers included developmental specialists, teachers of the Deaf/Hard of Hearing (DHH), speech-language pathologists, occupational therapists, physical therapists, behavior specialists, audiologists, and interpreters. Reimbursement was variable and included use of IDEA Part C funding, Medicaid, and private insurance. Expressed barriers and concerns for the implementation of telehealth as a delivery model within Part

  9. Development of the Telehealth Usability Questionnaire (TUQ).

    PubMed

    Parmanto, Bambang; Lewis, Allen Nelson; Graham, Kristin M; Bertolet, Marnie H

    2016-01-01

    Current telehealth usability questionnaires are designed primarily for older technologies, where telehealth interaction is conducted over dedicated videoconferencing applications. However, telehealth services are increasingly conducted over computer-based systems that rely on commercial software and a user supplied computer interface. Therefore, a usability questionnaire that addresses the changes in telehealth service delivery and technology is needed. The Telehealth Usability Questionnaire (TUQ) was developed to evaluate the usability of telehealth implementation and services. This paper addresses: (1) the need for a new measure of telehealth usability, (2) the development of the TUQ, (3) intended uses for the TUQ, and (4) the reliability of the TUQ. Analyses indicate that the TUQ is a solid, robust, and versatile measure that can be used to measure the quality of the computer-based user interface and the quality of the telehealth interaction and services.

  10. Development of the Telehealth Usability Questionnaire (TUQ)

    PubMed Central

    PARMANTO, BAMBANG; LEWIS, ALLEN NELSON; GRAHAM, KRISTIN M.; BERTOLET, MARNIE H.

    2016-01-01

    Current telehealth usability questionnaires are designed primarily for older technologies, where telehealth interaction is conducted over dedicated videoconferencing applications. However, telehealth services are increasingly conducted over computer-based systems that rely on commercial software and a user supplied computer interface. Therefore, a usability questionnaire that addresses the changes in telehealth service delivery and technology is needed. The Telehealth Usability Questionnaire (TUQ) was developed to evaluate the usability of telehealth implementation and services. This paper addresses: (1) the need for a new measure of telehealth usability, (2) the development of the TUQ, (3) intended uses for the TUQ, and (4) the reliability of the TUQ. Analyses indicate that the TUQ is a solid, robust, and versatile measure that can be used to measure the quality of the computer-based user interface and the quality of the telehealth interaction and services. PMID:27563386

  11. Marketing telehealth to align with strategy.

    PubMed

    Dansky, Kathryn H; Ajello, Jeffrey

    2005-01-01

    Telehealth is a twenty-first century solution to an old problem-how to deliver quality health services with shrinking resources. Telehealth enables healthcare providers to interact with and monitor patients remotely, thus adding value to service delivery models. On occasion, telehealth can substitute for live encounters, saving time and resources. Furthermore, as the geriatric population increases, telehealth will support independent living by supplementing the existing network of care. To be used most effectively, however, telehealth services must be carefully planned and executed. This study investigated management practices used to promote telehealth services, focusing on strategic goals for adopting telehealth. Interviews with senior managers from 19 home health agencies identified three strategic goals for adopting telehealth: (1) clinical excellence, (2) technological preeminence, and (3) cost containment. Organizational documents were analyzed to determine the extent to which the telehealth program was featured in marketing materials. Documents included the organization's brochure, newspaper ads and articles, and each home health agency's web site. Results showed that marketing practices vary widely but are correlated with motivations to adopt telehealth. The organizations with the highest marketing scores emphasize clinical excellence as a major reason for using telehealth, whereas those with the lowest marketing scores tend to focus on cost containment. Although this study focused on management practices in home health agencies, results are applicable to hospital and outpatient services as well as to other community-based programs. Using a strategic management framework, the authors offer recommendations to help organizations develop effective marketing approaches for telehealth programs.

  12. Economic Modeling of Heart Failure Telehealth Programs: When Do They Become Cost Saving?

    PubMed Central

    Liu, Sheena Xin; Lagor, Charles; Liu, Nan; Sullivan, Kathleen

    2016-01-01

    Telehealth programs for congestive heart failure have been shown to be clinically effective. This study assesses clinical and economic consequences of providing telehealth programs for CHF patients. A Markov model was developed and presented in the context of a home-based telehealth program on CHF. Incremental life expectancy, hospital admissions, and total healthcare costs were examined at periods ranging up to five years. One-way and two-way sensitivity analyses were also conducted on clinical performance parameters. The base case analysis yielded cost savings ranging from $2832 to $5499 and 0.03 to 0.04 life year gain per patient over a 1-year period. Applying telehealth solution to a low-risk cohort with no prior admission history would result in $2502 cost increase per person over the 1-year time frame with 0.01 life year gain. Sensitivity analyses demonstrated that the cost savings were most sensitive to patient risk, baseline cost of hospital admission, and the length-of-stay reduction ratio affected by the telehealth programs. In sum, telehealth programs can be cost saving for intermediate and high risk patients over a 1- to 5-year window. The results suggested the economic viability of telehealth programs for managing CHF patients and illustrated the importance of risk stratification in such programs. PMID:27528868

  13. Economic Modeling of Heart Failure Telehealth Programs: When Do They Become Cost Saving?

    PubMed

    Liu, Sheena Xin; Xiang, Rui; Lagor, Charles; Liu, Nan; Sullivan, Kathleen

    2016-01-01

    Telehealth programs for congestive heart failure have been shown to be clinically effective. This study assesses clinical and economic consequences of providing telehealth programs for CHF patients. A Markov model was developed and presented in the context of a home-based telehealth program on CHF. Incremental life expectancy, hospital admissions, and total healthcare costs were examined at periods ranging up to five years. One-way and two-way sensitivity analyses were also conducted on clinical performance parameters. The base case analysis yielded cost savings ranging from $2832 to $5499 and 0.03 to 0.04 life year gain per patient over a 1-year period. Applying telehealth solution to a low-risk cohort with no prior admission history would result in $2502 cost increase per person over the 1-year time frame with 0.01 life year gain. Sensitivity analyses demonstrated that the cost savings were most sensitive to patient risk, baseline cost of hospital admission, and the length-of-stay reduction ratio affected by the telehealth programs. In sum, telehealth programs can be cost saving for intermediate and high risk patients over a 1- to 5-year window. The results suggested the economic viability of telehealth programs for managing CHF patients and illustrated the importance of risk stratification in such programs.

  14. Space Launch System NASA Research Announcement Advanced Booster Engineering Demonstration and/or Risk Reduction

    NASA Technical Reports Server (NTRS)

    Crumbly, Christopher M.; Craig, Kellie D.

    2011-01-01

    The intent of the Advanced Booster Engineering Demonstration and/or Risk Reduction (ABEDRR) effort is to: (1) Reduce risks leading to an affordable Advanced Booster that meets the evolved capabilities of SLS (2) Enable competition by mitigating targeted Advanced Booster risks to enhance SLS affordability. Key Concepts (1) Offerors must propose an Advanced Booster concept that meets SLS Program requirements (2) Engineering Demonstration and/or Risk Reduction must relate to the Offeror s Advanced Booster concept (3) NASA Research Announcement (NRA) will not be prescriptive in defining Engineering Demonstration and/or Risk Reduction

  15. Pre-Launch Validation Activities with the Airborne Demonstrator for the ESA ADM- Aeolus Wind-Lidar Mission

    NASA Astrophysics Data System (ADS)

    Reitebuch, Oliver; Lemmerz, Christian; Marksteiner, Uwe; Rahm, Stephan; Schafler, Andreas; Witschas, Benjamin

    2016-08-01

    The first space-borne wind lidar mission ADM-Aeolus from ESA is currently scheduled for launch by mid- 2017. Aeolus carries the direct-detection Doppler lidar ALADIN that operates at an ultraviolet wavelength and makes use of two types of spectrometers to measure frequency shifts from molecular and aerosol backscatter. In order to assess the performance of the Doppler lidar ALADIN and to optimize the retrieval algorithms with atmospheric signals, an airborne prototype - the ALADIN Airborne Demonstrator A2D - was developed. Four airborne campaigns with a coherent-detection wind lidar and the direct-detection wind lidar A2D were performed for pre-launch validation of Aeolus including a coordinated campaign with the NASA DC-8 aircraft in 2015.

  16. A systematic review of economic analyses of telehealth services using real time video communication

    PubMed Central

    2010-01-01

    Background Telehealth is the delivery of health care at a distance, using information and communication technology. The major rationales for its introduction have been to decrease costs, improve efficiency and increase access in health care delivery. This systematic review assesses the economic value of one type of telehealth delivery - synchronous or real time video communication - rather than examining a heterogeneous range of delivery modes as has been the case with previous reviews in this area. Methods A systematic search was undertaken for economic analyses of the clinical use of telehealth, ending in June 2009. Studies with patient outcome data and a non-telehealth comparator were included. Cost analyses, non-comparative studies and those where patient satisfaction was the only health outcome were excluded. Results 36 articles met the inclusion criteria. 22(61%) of the studies found telehealth to be less costly than the non-telehealth alternative, 11(31%) found greater costs and 3 (9%) gave the same or mixed results. 23 of the studies took the perspective of the health services, 12 were societal, and one was from the patient perspective. In three studies of telehealth to rural areas, the health services paid more for telehealth, but due to savings in patient travel, the societal perspective demonstrated cost savings. In regard to health outcomes, 12 (33%) of studies found improved health outcomes, 21 (58%) found outcomes were not significantly different, 2(6%) found that telehealth was less effective, and 1 (3%) found outcomes differed according to patient group. The organisational model of care was more important in determining the value of the service than the clinical discipline, the type of technology, or the date of the study. Conclusion Delivery of health services by real time video communication was cost-effective for home care and access to on-call hospital specialists, showed mixed results for rural service delivery, and was not cost-effective for

  17. A systematic review of economic analyses of telehealth services using real time video communication.

    PubMed

    Wade, Victoria A; Karnon, Jonathan; Elshaug, Adam G; Hiller, Janet E

    2010-08-10

    Telehealth is the delivery of health care at a distance, using information and communication technology. The major rationales for its introduction have been to decrease costs, improve efficiency and increase access in health care delivery. This systematic review assesses the economic value of one type of telehealth delivery--synchronous or real time video communication--rather than examining a heterogeneous range of delivery modes as has been the case with previous reviews in this area. A systematic search was undertaken for economic analyses of the clinical use of telehealth, ending in June 2009. Studies with patient outcome data and a non-telehealth comparator were included. Cost analyses, non-comparative studies and those where patient satisfaction was the only health outcome were excluded. 36 articles met the inclusion criteria. 22(61%) of the studies found telehealth to be less costly than the non-telehealth alternative, 11(31%) found greater costs and 3 (9%) gave the same or mixed results. 23 of the studies took the perspective of the health services, 12 were societal, and one was from the patient perspective. In three studies of telehealth to rural areas, the health services paid more for telehealth, but due to savings in patient travel, the societal perspective demonstrated cost savings. In regard to health outcomes, 12 (33%) of studies found improved health outcomes, 21 (58%) found outcomes were not significantly different, 2(6%) found that telehealth was less effective, and 1 (3%) found outcomes differed according to patient group. The organisational model of care was more important in determining the value of the service than the clinical discipline, the type of technology, or the date of the study. Delivery of health services by real time video communication was cost-effective for home care and access to on-call hospital specialists, showed mixed results for rural service delivery, and was not cost-effective for local delivery of services between

  18. Implementing solutions to improve and expand telehealth adoption: participatory action research in four community healthcare settings.

    PubMed

    Taylor, Johanna; Coates, Elizabeth; Wessels, Bridgette; Mountain, Gail; Hawley, Mark S

    2015-12-01

    , which also hindered implementation efforts and affected motivation of staff to engage with the action research, particularly where local decision-makers were not engaged in the study. Wider technological barriers also limited the potential for change, as did uncertainties about goals for telehealth investment, thereby making it difficult to identify outcomes for demonstrating the added value over existing practice.

  19. Categorizing the telehealth policy response of countries and their implications for complementarity of telehealth policy.

    PubMed

    Varghese, Sunil; Scott, Richard E

    2004-01-01

    Developing countries are exploring the role of telehealth to overcome the challenges of providing adequate health care services. However, this process faces disparities, and no complementarity in telehealth policy development. Telehealth has the potential to transcend geopolitical boundaries, yet telehealth policy developed in one jurisdiction may hamper applications in another. Understanding such policy complexities is essential for telehealth to realize its full global potential. This study investigated 12 East Asian countries that may represent a microcosm of the world, to determine if the telehealth policy response of countries could be categorized, and whether any implications could be identified for the development of complementary telehealth policy. The countries were Cambodia, China, Hong Kong, Indonesia, Japan, Malaysia, Myanmar, Singapore, South Korea, Taiwan, Thailand, and Vietnam. Three categories of country response were identified in regard to national policy support and development. The first category was "None" (Cambodia, Myanmar, and Vietnam) where international partners, driven by humanitarian concerns, lead telehealth activity. The second category was "Proactive" (China, Indonesia, Malaysia, Singapore, South Korea, Taiwan, and Thailand) where national policies were designed with the view that telehealth initiatives are a component of larger development objectives. The third was "Reactive" (Hong Kong and Japan), where policies were only proffered after telehealth activities were sustainable. It is concluded that although complementarity of telehealth policy development is not occurring, increased interjurisdictional telehealth activity, regional clusters, and concerted and coordinated effort amongst researchers, practitioners, and policy makers may alter this trend.

  20. Increasing Access to an ASD Imitation Intervention Via a Telehealth Parent Training Program.

    PubMed

    Wainer, Allison L; Ingersoll, Brooke R

    2015-12-01

    Systematic research focused on developing and improving strategies for the dissemination and implementation of effective ASD services is essential. An innovative and promising area of research is the use of telehealth programs to train parents of children with ASD in intervention techniques. A hybrid telehealth program, combining self-directed internet-based instruction with remote coaching, was created to introduce parents of children with ASD to an imitation intervention. A single-subject multiple-baseline design study evaluated the effect of the program on changes in parent and child behavior. Parents improved in their use of the intervention techniques and their children demonstrated concurrent increases in spontaneous imitation skills. Parents also indicated that the intervention and telehealth service delivery model were acceptable, useable, and effective. Results suggest that this hybrid telehealth program has the potential to increase access to ASD services.

  1. Home Clinical Video Telehealth Promotes Education and Communication with Caregivers of Veterans with TBI.

    PubMed

    Hernandez, Haniel; Scholten, Joel; Moore, Elsie

    2015-09-01

    Ongoing communication and care coordination are essential among patients, their family, and interdisciplinary rehabilitation team members to address the complex and changing rehabilitation needs of traumatic brain injuries. Family members of patients with traumatic brain injury commonly assume a caregiver role following discharge from inpatient rehabilitation. The Department of Veterans Affairs has adopted clinical video telehealth to promote access to care, and use of clinical video telehealth for rehabilitation is expanding. Recent implementation of home clinical video telehealth can assist with the ongoing management and treatment of patients in their home setting. This report demonstrates enhanced education and care coordination by using clinical video telehealth with a Veterans Affairs-eligible beneficiary receiving treatment for traumatic brain injury.

  2. Social acceptance and population confidence in telehealth in Quebec.

    PubMed

    Poder, Thomas G; Bellemare, Christian A; Bédard, Suzanne K; Lemieux, Renald

    2015-02-21

    Access to healthcare in remote areas is difficult and telehealth could be a promising avenue if accepted by the population. The aim of this study is to assess social acceptance and population confidence in telehealth in the Province of Quebec. We conducted a survey using a questionnaire assessing the social acceptance of and confidence level in telehealth. Two strategies were used: 1) paper questionnaires were sent to two hospitals in Quebec; and 2) online questionnaires were randomly sent by a firm specialized in online survey to a representative sample of the population of the Province of Quebec. Respondents were all residents of the Province of Quebec and 18 years and older. Questions were scored with a four-level Likert scale. A total of 1816 questionnaires were analyzed (229 written and 1,587 online questionnaires). The socio-demographic variables in our samples, especially the online questionnaires, were fairly representative of Quebec's population. Overall, social acceptance scored at 77.71% and confidence level at 65.76%. Both scores were higher in the case of treatment (3 scenarios were proposed) vs. diagnosis (p < 0.05). No difference was found when respondents were asked to respond for themselves and for a member of their family, which demonstrates a true interest in telehealth in Quebec. In addition, we found a significant difference (p < 0.05) between written and online questionnaires regarding social acceptance (80.75% vs. 77.33%) and confidence level (74.84% vs. 64.55%). These differences may be due to social desirability or avidity bias in the written questionnaires. Our results suggest that the population in Quebec encourages the development of telehealth for real time diagnosis and long distance treatment for regions deprived of healthcare professionals.

  3. Demonstration of the Dynamic Flowgraph Methodology using the Titan 2 Space Launch Vehicle Digital Flight Control System

    NASA Technical Reports Server (NTRS)

    Yau, M.; Guarro, S.; Apostolakis, G.

    1993-01-01

    Dynamic Flowgraph Methodology (DFM) is a new approach developed to integrate the modeling and analysis of the hardware and software components of an embedded system. The objective is to complement the traditional approaches which generally follow the philosophy of separating out the hardware and software portions of the assurance analysis. In this paper, the DFM approach is demonstrated using the Titan 2 Space Launch Vehicle Digital Flight Control System. The hardware and software portions of this embedded system are modeled in an integrated framework. In addition, the time dependent behavior and the switching logic can be captured by this DFM model. In the modeling process, it is found that constructing decision tables for software subroutines is very time consuming. A possible solution is suggested. This approach makes use of a well-known numerical method, the Newton-Raphson method, to solve the equations implemented in the subroutines in reverse. Convergence can be achieved in a few steps.

  4. Demonstration of the Dynamic Flowgraph Methodology using the Titan 2 Space Launch Vehicle Digital Flight Control System

    NASA Astrophysics Data System (ADS)

    Yau, M.; Guarro, S.; Apostolakis, G.

    1993-06-01

    Dynamic Flowgraph Methodology (DFM) is a new approach developed to integrate the modeling and analysis of the hardware and software components of an embedded system. The objective is to complement the traditional approaches which generally follow the philosophy of separating out the hardware and software portions of the assurance analysis. In this paper, the DFM approach is demonstrated using the Titan 2 Space Launch Vehicle Digital Flight Control System. The hardware and software portions of this embedded system are modeled in an integrated framework. In addition, the time dependent behavior and the switching logic can be captured by this DFM model. In the modeling process, it is found that constructing decision tables for software subroutines is very time consuming. A possible solution is suggested. This approach makes use of a well-known numerical method, the Newton-Raphson method, to solve the equations implemented in the subroutines in reverse. Convergence can be achieved in a few steps.

  5. Participatory design methods for the development of a clinical telehealth service for neonatal homecare

    PubMed Central

    Garne Holm, Kristina; Brødsgaard, Anne; Zachariassen, Gitte; Smith, Anthony C.; Clemensen, Jane

    2017-01-01

    Objectives: Neonatal homecare delivered during home visits by neonatal nurses is a common method for supporting families of preterm infants following discharge. Telehealth has been introduced for the provision of neonatal homecare, resulting in positive feedback from parents of preterm infants. While the benefits are beginning to be realised, widespread uptake of telehealth has been limited due to a range of logistical challenges. Understanding user requirements is important when planning and developing a clinical telehealth service. We therefore used participatory design to develop a clinical telehealth service for neonatal homecare. Methods: The study adopted a participatory design approach to engage users in the development and design of a new telehealth service. Participatory design embraces qualitative research methods. Creative and technical workshops were conducted as part of the study. Tests of the telehealth service were conducted in the neonatal unit. Participants in this study were former and current parents of preterm infants eligible for neonatal homecare, and clinical staff (medical and nursing) from the neonatal unit. Preterm infants accompanied their parents. Results: Based on the results obtained during the workshops and subsequent testing, we developed an application (app), which was integrated into the medical record at the neonatal unit. The app was used to initiate videoconferences and chat messages between the family at home and the neonatal unit, and to share information regarding infant growth and well-being. Conclusion: Results obtained from the workshops and testing demonstrated the importance of involving users when developing new telehealth applications. The workshops helped identify the challenges associated with delivery of the service, and helped instruct the design of a new telehealth service for neonatal homecare based on the needs of parents and clinical staff. PMID:28975028

  6. Visioning technology for the future of telehealth.

    PubMed

    Brennan, David M; Holtz, Bree E; Chumbler, Neale R; Kobb, Rita; Rabinowitz, Terry

    2008-11-01

    By its very nature, telehealth relies on technology. Throughout history, as new technologies emerged and afforded people the ability to send information across distances, it was not long before this capability was applied to the most basic need of all: maintaining health. While much of the early work in telehealth was driven by technology (e.g., making opportunistic use of the systems and devices that were available at the time), recent trends are beginning to push the demand for and the development of new technologies specific to the individual needs of telehealth applications. The future of telehealth will benefit greatly from this technology innovation, in particular, in areas such as home telehealth and remote monitoring, e-health and patient portal applications, personal health records, interactive Internet technologies, and robotics. Telehealth, while not a panacea for all of the challenges facing modern healthcare systems, has a substantial and ever-expanding potential to revolutionize the ways in which people receive medical care while offering the possibility to contain costs, manage chronic diseases, and prevent secondary complications. By demanding innovative solutions and speaking out in support of the field, the telehealth community can and should be leading the charge for greater attention to human factors in technology development, interoperable medical records, staff training and competencies, standards and guidelines, and support for expanded telehealth coverage at the national, state, and local levels.

  7. Assessing home care agencies' readiness for telehealth.

    PubMed

    Demiris, George; Patrick, Timothy; Khatri, Naresh

    2003-01-01

    Home healthcare is facing a set of challenging new realities in the 21st century such as funding limitations and increased life expectancy. Many believe that the use of telehealth enabling patients at home to interact with nurses at the clinical site using videoconferencing technology, will be a cost-effective solution to providing quality care services. Many agencies have adopted or are planning on implementing a telehealth solution. Level of agencies' readiness can lead to a lower level of risk, and a more successful innovation outcome. We developed a framework for assessing home care agencies' readiness for telehealth consisting of 35 items. This instrument can be used as a decision support tool for agencies that are about to implement a telehealth system as well as a formative or summative evaluation tool for agencies already utilizing telehealth.

  8. Telehealth technology in case/disease management.

    PubMed

    Park, Eun-Jun

    2006-01-01

    Case managers can better coordinate and facilitate chronic illness care by adopting telehealth technology. This article overviews four major categories of telehealth technology based on patients' roles in self-management: surveillance, testing peripherals and messaging, decision support aids, and online support groups related to patients' subordinate, structured, collaborative, and autonomous roles, respectively. These various telehealth technologies should be selected on the basis of patients' care needs and preferences. Moreover, when they are integrated with other clinical information systems, case management practice can be better performed. However, the specific role functions and skill sets needed to be competent in telehealth environments have not yet been clearly identified. Considering role ambiguity and stress among telehealth clinicians, clarifying relevant roles is an urgent task.

  9. Reimbursements for telehealth services are likely to be lower than non-telehealth services in the United States.

    PubMed

    Wilson, Fernando A; Rampa, Sankeerth; Trout, Kate E; Stimpson, Jim P

    2016-06-03

    Telehealth technologies promise to increase access to care, particularly in underserved communities. However, little is known about how private payer reimbursements vary between telehealth and non-telehealth services. We use the largest private claims database in the United States provided by the Health Care Cost Institute to identify telehealth claims and compare average reimbursements to non-telehealth claims. We find average reimbursements for telehealth services are significantly lower than those for non-telehealth for seven of the ten most common services. For example, telehealth reimbursements for office visits for evaluation and management of established patients with low complexity were 30% lower than the corresponding non-telehealth service. Reimbursements by clinical diagnosis code also tended to be lower for telehealth than non-telehealth claims. Widespread adoption of telehealth may be hampered by lower reimbursements for telehealth services relative to face-to-face services. This may result in lower incentives for providers to invest in telehealth technologies that do not result in significant cost savings to their practice, even if telehealth improves patient outcomes.

  10. Considerations for the Telehealth Systems of Tomorrow: An Analysis of Student Perceptions of Telehealth Technologies

    PubMed Central

    Bull, Tyler Preston; Malvey, Donna M; Szalma, James Leo

    2016-01-01

    Background While much is known about factors that facilitate telehealth adoption, less is known about why adoption does or does not occur in specific populations, such as students. Objective This study aims to examine the perceptions of telehealth systems within a large student sample. Methods Undergraduate students (N=315) participated in a survey of the perceived advantages and disadvantages of telehealth technologies. The responses to the survey were analyzed using thematic analysis. Results We found that students were likely to adopt telehealth systems for the following reasons: (1) the system worked efficiently, (2) the convenience of telehealth, and (3) to gain access to health services. Students also perceived several disadvantages to telehealth systems, such as issues of trust (ie, security, privacy), the impersonal nature of telehealth systems, and they were concerned about the potential for major system errors. Conclusion By understanding the current barriers to telehealth adoption in a cohort of students, we can not only better anticipate the future needs of this group, but also incorporate such needs into the design of future telehealth systems. PMID:27731865

  11. Telehealth interventions to improve clinical nursing of elders.

    PubMed

    Jones, Josette F; Brennan, Patricia Flatley

    2002-01-01

    This chapter reviews reports of research conducted worldwide from 1966 to January 2001 on telehealth interventions in clinical nursing for elders. Reports were identified through a systematic search of MEDLINE, CINAHL, PsychInfo, ERIC, and ACM using the search terms Telemedicine or Health Information Networks, Nursing, and Research, and were restricted to those published in English. Reports of research using interactive computer technology to assess or intervene with nursing problems commonly observed in persons age 65 and older were sought. Only published reports presenting the findings of an exploratory or experimental study and exploring the association between one intervention variable and technology were included. The search resulted in 18 research reports describing eight research projects. Due to the preponderance of demonstrations and feasibility reports, the dearth of experimental investigations, and the heterogeneous nature of the few studies identified, statistical summarization was not attempted. Telehealth interventions have the potential to improve the clinical nursing care of elders because they provide alternative, equivalent approaches to assess key indicators of the physical and psychological state of elders; are acceptable to nurses, elders, and family caregivers; and may prove less costly than face-to-face interventions. Telehealth approaches provide not only acceptable substitutes for discrete nursing actions but also can serve as a context within which a large range of professional gerontological nursing services can be delivered in a manner that is timely and convenient for elders.

  12. Telehealth: An Assessment of Growth and Distribution.

    ERIC Educational Resources Information Center

    Grigsby, William J.

    2002-01-01

    National surveys of telehealth networks, 1994-99, examined program characteristics; clinical activities (telemedicine); nonclinical activities related to continuing medical education, paraprofessional training, health promotion, administration, and research; technology; and barriers to growth and sustainability. Despite growing utilization,…

  13. Telehealth: An Assessment of Growth and Distribution.

    ERIC Educational Resources Information Center

    Grigsby, William J.

    2002-01-01

    National surveys of telehealth networks, 1994-99, examined program characteristics; clinical activities (telemedicine); nonclinical activities related to continuing medical education, paraprofessional training, health promotion, administration, and research; technology; and barriers to growth and sustainability. Despite growing utilization,…

  14. Optimizing Telehealth Strategies for Subspecialty Care: Recommendations from Rural Pediatricians.

    PubMed

    Ray, Kristin N; Demirci, Jill R; Bogen, Debra L; Mehrotra, Ateev; Miller, Elizabeth

    2015-08-01

    Telehealth offers strategies to improve access to subspecialty care for children in rural communities. Rural pediatrician experiences and preferences regarding the use of these telehealth strategies for children's subspecialty care needs are not known. We elicited rural pediatrician experiences and preferences regarding different pediatric subspecialty telehealth strategies. Seventeen semistructured telephone interviews were conducted with rural pediatricians from 17 states within the United States. Interviewees were recruited by e-mails to a pediatric rural health listserv and to rural pediatricians identified through snowball sampling. Themes were identified through thematic analysis of interview transcripts. Institutional Review Board approval was obtained. Rural pediatricians identified several telehealth strategies to improve access to subspecialty care, including physician access hotlines, remote electronic medical record access, electronic messaging systems, live video telemedicine, and telehealth triage systems. Rural pediatricians provided recommendations for optimizing the utility of each of these strategies based on their experiences with different systems. Rural pediatricians preferred specific telehealth strategies for specific clinical contexts, resulting in a proposed framework describing the complementary role of different telehealth strategies for pediatric subspecialty care. Finally, rural pediatricians identified additional benefits associated with the use of telehealth strategies and described a desire for telehealth systems that enhanced (rather than replaced) personal relationships between rural pediatricians and subspecialists. Rural pediatricians described complementary roles for different subspecialty care telehealth strategies. Additionally, rural pediatricians provided recommendations for optimizing individual telehealth strategies. Input from rural pediatricians will be crucial for optimizing specific telehealth strategies and designing

  15. Optimizing Telehealth Strategies for Subspecialty Care: Recommendations from Rural Pediatricians

    PubMed Central

    Demirci, Jill R.; Bogen, Debra L.; Mehrotra, Ateev; Miller, Elizabeth

    2015-01-01

    Abstract Background: Telehealth offers strategies to improve access to subspecialty care for children in rural communities. Rural pediatrician experiences and preferences regarding the use of these telehealth strategies for children's subspecialty care needs are not known. We elicited rural pediatrician experiences and preferences regarding different pediatric subspecialty telehealth strategies. Materials and Methods: Seventeen semistructured telephone interviews were conducted with rural pediatricians from 17 states within the United States. Interviewees were recruited by e-mails to a pediatric rural health listserv and to rural pediatricians identified through snowball sampling. Themes were identified through thematic analysis of interview transcripts. Institutional Review Board approval was obtained. Results: Rural pediatricians identified several telehealth strategies to improve access to subspecialty care, including physician access hotlines, remote electronic medical record access, electronic messaging systems, live video telemedicine, and telehealth triage systems. Rural pediatricians provided recommendations for optimizing the utility of each of these strategies based on their experiences with different systems. Rural pediatricians preferred specific telehealth strategies for specific clinical contexts, resulting in a proposed framework describing the complementary role of different telehealth strategies for pediatric subspecialty care. Finally, rural pediatricians identified additional benefits associated with the use of telehealth strategies and described a desire for telehealth systems that enhanced (rather than replaced) personal relationships between rural pediatricians and subspecialists. Conclusions: Rural pediatricians described complementary roles for different subspecialty care telehealth strategies. Additionally, rural pediatricians provided recommendations for optimizing individual telehealth strategies. Input from rural pediatricians will be

  16. Is there a business case for telehealth in home health agencies?

    PubMed

    Rumberger, Jill Schumann; Dansky, Kathryn

    2006-04-01

    Telehealth is a tool being considered by home health agencies (HHAs) to help manage costs. Most HHAs in the United States rely on Medicare reimbursement as their primary revenue source. With the implementation of a new payment system in October 2000, HHAs went from a cost-based, fee-for-service payment to a per episode prospective payment reimbursement model. For HHAs, the revenue goal changed from maximizing the number of visits under feefor- service to maximizing the number of patients and managing the episode within the prospective payment reimbursement formula. This paper addresses whether or not there is a financial business case for telehealth in HHAs. For this research effort, building a business case involved identifying and measuring the factors that contribute to the financial effectiveness of the home health organization. Utilizing a return on investment breakeven analysis model, we investigated the financial impact of telehealth, utilizing data from 32 HHAs in the Commonwealth of Pennsylvania. The breakeven analysis demonstrated that telehealth can have a positive impact on the HHA's financial position. Results indicate that HHAs should seriously consider the use of telehealth as part of their agency's care delivery model.

  17. Overcoming the tyranny of distance: An audit of process and outcomes from a pilot telehealth spinal assessment clinic.

    PubMed

    Beard, Matthew; Orlando, Joseph F; Kumar, Saravana

    2017-09-01

    Introduction There is consistent evidence to indicate people living in rural and remote regions have limited access to healthcare and poorer health outcomes. One way to address this inequity is through innovative models of care such as telehealth. The aim of this pilot trial was to determine the feasibility, appropriateness and access to a telehealth clinic. In this pilot trial, the telehealth clinic outcomes are compared with the outreach clinic. Both models of care are commonly utilised means of providing healthcare to meet the needs of people living in rural and remote regions. Methods A prospective audit was conducted on a Spinal Assessment Clinic Telehealth pilot trial for patients with spinal disorders requiring non-urgent surgical consultation. Data were recorded from all consultations managed using videoconferencing technology between the Royal Adelaide Hospital and Port Augusta Community Health Service, South Australia between September 2013 and January 2014. Outcomes included analysis of process, service activity, clinical actions, safety and costs. Data were compared to a previous spinal assessment outreach clinic in the same area between August and December 2012. Results There were 25 consultations with 22 patients over the five-month telehealth pilot trial. Spinal disorders were predominantly of the lumbar region (88%); the majority of initial consultations (64%) were discharged to the general practitioner. There were three requests for further imaging, five for minor interventions and three for other specialist/surgical consultation. Patient follow-up post telehealth pilot trial revealed no adverse outcomes. The total cost of AUD$11,187 demonstrated a 23% reduction in favour of the spinal assessment telehealth pilot trial, with the greatest savings in travel costs. Discussion The telehealth model of care demonstrated the efficient management of patients with spinal disorders in rural regions requiring non-urgent surgical consultation at low costs with

  18. Using Telehealth to Reduce All-Cause 30-Day Hospital Readmissions among Heart Failure Patients Receiving Skilled Home Health Services

    PubMed Central

    O’Connor, Melissa; Dempsey, Mary Louise; Huffenberger, Ann; Jost, Sandra; Flynn, Danielle; Norris, Anne

    2016-01-01

    Summary Background The reduction of all-cause hospital readmission among heart failure (HF) patients is a national priority. Telehealth is one strategy employed to impact this sought-after patient outcome. Prior research indicates varied results on all-cause hospital readmission highlighting the need to understand telehealth processes and optimal strategies in improving patient outcomes. Objectives The purpose of this paper is to describe how one Medicare-certified home health agency launched and maintains a telehealth program intended to reduce all-cause 30-day hospital readmissions among HF patients receiving skilled home health and report its impact on patient outcomes. Methods Using the Transitional Care Model as a guide, the telehealth program employs a 4G wireless tablet-based system that collects patient vital signs (weight, heart rate, blood pressure and blood oxygenation) via wireless peripherals, and is preloaded with subjective questions related to HF and symptoms and instructional videos. Results Year one all-cause 30-day readmission rate was 19.3%. Fiscal year 2015 ended with an all-cause 30-day readmission rate of 5.2%, a reduction by 14 percentage points (a 73% relative reduction) in three years. Telehealth is now an integral part of the University of Pennsylvania Health System’s readmission reduction program. Conclusions Telehealth was associated with a reduction in all-cause 30-day readmission for one mid-sized Medicare-certified home health agency. A description of the program is presented as well as lessons learned that have significantly contributed to this program’s success. Future expansion of the program is planned. Telehealth is a promising approach to caring for a chronically ill population while improving a patient’s ability for self-care. PMID:27437037

  19. DEMONSTRATION OF IN SITU DEHALOGENATION OF DNAPL THROUGH INJECTION OF EMULSIFIED ZERO-VALIENT IRON AT LAUNCH COMPLEX 34 IN CAPE CANAVERAL AIR FORCE STATION, FLORIDA

    EPA Science Inventory

    The purpose of this project was to evaluate the technical and cost performance of emulsified zero-valent iron (EZVI) technology when applied to DNAPL contaminants in the saturated zone. This demonstration was conducted at Launch Complex 34, Cape Canaveral Air Force Station, FL, w...

  20. DEMONSTRATION OF IN SITU DEHALOGENATION OF DNAPL THROUGH INJECTION OF EMULSIFIED ZERO-VALIENT IRON AT LAUNCH COMPLEX 34 IN CAPE CANAVERAL AIR FORCE STATION, FLORIDA

    EPA Science Inventory

    The purpose of this project was to evaluate the technical and cost performance of emulsified zero-valent iron (EZVI) technology when applied to DNAPL contaminants in the saturated zone. This demonstration was conducted at Launch Complex 34, Cape Canaveral Air Force Station, FL, w...

  1. [An overview of telehealth initiatives in Latin America].

    PubMed

    dos Santos, Alaneir de Fátima; D'Agostino, Marcelo; Bouskela, Maurício Simon; Fernandéz, Andrés; Messina, Luiz Ary; Alves, Humberto José

    2014-01-01

    This article aimed to systematize the views on telehealth in Latin America and to present the experience of building an instrument for monitoring the development of telehealth initiatives based on the reality of this region. A group was structured to coordinate telehealth efforts in Latin America, with members appointed by the ministries of health of 16 countries. Five thematic groups were also set up. Based on international experiences and focusing on the reality of telehealth in the continent, an instrument was created to monitor the development of telehealth in Latin America. Several countries have national telehealth projects: Brazil, Colombia, Ecuador, Mexico, Panama. Others are in the process of development and early deployment: Bolivia, Costa Rica, Cuba, El Salvador, Guatemala, Peru, Venezuela. The instrument described in the article, which is still being tested, proposes a characterization of countries according to their telehealth development stage: nonexistent, nascent, intermediate, advanced, and exemplary. Currently, important telehealth initiatives are already underway in Latin America.

  2. WebRTC: delivering telehealth in the browser

    PubMed Central

    2016-01-01

    WebRTC is enabling a new generation of Telehealth applications and will be an important part of the future of Telehealth. WebRTC allows for web applications to control a user's microphone and video camera from the browser. In this viewpoint, the author presents the pros and cons of WebRTC for Telehealth applications. PMID:28293589

  3. QRS Detection Algorithm for Telehealth Electrocardiogram Recordings.

    PubMed

    Khamis, Heba; Weiss, Robert; Xie, Yang; Chang, Chan-Wei; Lovell, Nigel H; Redmond, Stephen J

    2016-07-01

    QRS detection algorithms are needed to analyze electrocardiogram (ECG) recordings generated in telehealth environments. However, the numerous published QRS detectors focus on clean clinical data. Here, a "UNSW" QRS detection algorithm is described that is suitable for clinical ECG and also poorer quality telehealth ECG. The UNSW algorithm generates a feature signal containing information about ECG amplitude and derivative, which is filtered according to its frequency content and an adaptive threshold is applied. The algorithm was tested on clinical and telehealth ECG and the QRS detection performance is compared to the Pan-Tompkins (PT) and Gutiérrez-Rivas (GR) algorithm. For the MIT-BIH Arrhythmia database (virtually artifact free, clinical ECG), the overall sensitivity (Se) and positive predictivity (+P) of the UNSW algorithm was >99%, which was comparable to PT and GR. When applied to the MIT-BIH noise stress test database (clinical ECG with added calibrated noise) after artifact masking, all three algorithms had overall Se >99%, and the UNSW algorithm had higher +P (98%, p < 0.05) than PT and GR. For 250 telehealth ECG records (unsupervised recordings; dry metal electrodes), the UNSW algorithm had 98% Se and 95% +P which was superior to PT (+P: p < 0.001) and GR (Se and +P: p < 0.001). This is the first study to describe a QRS detection algorithm for telehealth data and evaluate it on clinical and telehealth ECG with superior results to published algorithms. The UNSW algorithm could be used to manage increasing telehealth ECG analysis workloads.

  4. Telehealth for paediatric burn patients in rural areas: a retrospective audit of activity and cost savings.

    PubMed

    McWilliams, Tania; Hendricks, Joyce; Twigg, Di; Wood, Fiona; Giles, Margaret

    2016-11-01

    Since 2005, the Western Australian paediatric burn unit has provided a state-wide clinical consultancy and support service for the assessment and management of acute and rehabilitative burn patients via its telehealth service. Since then, the use of this telehealth service has steadily increased as it has become imbedded in the model of care for paediatric burn patients. Primarily, the service involves acute and long term patient reviews conducted by the metropolitan-located burn unit in contact with health practitioners, advising patients and their families who reside outside the metropolitan area thereby avoiding unnecessary transfers and inpatient bed days. A further benefit of the paediatric burn service using telehealth is more efficient use of tertiary level burn unit beds, with only those patients meeting clinical criteria for admission being transferred. To conduct a retrospective audit of avoided transfers and bed days in 2005/06-2012/13 as a result of the use of the paediatric Burns Telehealth Service and estimate their cost savings in 2012/13. A retrospective chart audit identified activity, avoided unnecessary acute and scar review patient transfers, inpatient bed days and their associated avoided costs to the tertiary burn unit and patient travel funding. Over the period 2005/06-2012/13 the audit identified 4,905 avoided inpatient bed days, 364 avoided acute patient transfers and 1,763 avoided follow up review transfers for a total of 1,312 paediatric burn patients as a result of this telehealth service. This paper presents the derivation of these outcomes and an estimation of their cost savings in 2012/13 of AUD 1.89million. This study demonstrates avoided patient transfers, inpatient bed days and associated costs as the result of an integrated burns telehealth service. Copyright © 2016 Elsevier Ltd and ISBI. All rights reserved.

  5. Transitioning a home telehealth project into a sustainable, large-scale service: a qualitative study.

    PubMed

    Wade, Victoria A; Taylor, Alan D; Kidd, Michael R; Carati, Colin

    2016-05-16

    This study was a component of the Flinders Telehealth in the Home project, which tested adding home telehealth to existing rehabilitation, palliative care and geriatric outreach services. Due to the known difficulty of transitioning telehealth projects services, a qualitative study was conducted to produce a preferred implementation approach for sustainable and large-scale operations, and a process model that offers practical advice for achieving this goal. Initially, semi-structured interviews were conducted with senior clinicians, health service managers and policy makers, and a thematic analysis of the interview transcripts was undertaken to identify the range of options for ongoing operations, plus the factors affecting sustainability. Subsequently, the interviewees and other decision makers attended a deliberative forum in which participants were asked to select a preferred model for future implementation. Finally, all data from the study was synthesised by the researchers to produce a process model. 19 interviews with senior clinicians, managers, and service development staff were conducted, finding strong support for home telehealth but a wide diversity of views on governance, models of clinical care, technical infrastructure operations, and data management. The deliberative forum worked through these options and recommended a collaborative consortium approach for large-scale implementation. The process model proposes that the key factor for large-scale implementation is leadership support, which is enabled by 1) showing solutions to the problems of service demand, budgetary pressure and the relationship between hospital and primary care, 2) demonstrating how home telehealth aligns with health service policies, and 3) achieving clinician acceptance through providing evidence of benefit and developing new models of clinical care. Two key actions to enable change were marketing telehealth to patients, clinicians and policy-makers, and building a community of

  6. Telehealth

    MedlinePlus

    ... services. You can get health care using phones, computers, or mobile devices. You find health information or ... your health information remains private. Providers must use computer software that keeps your health records safe. BENEFITS ...

  7. Proposal for a telehealth concept in the translational research model

    PubMed Central

    Silva, Angélica Baptista; Morel, Carlos Médicis; de Moraes, Ilara Hämmerli Sozzi

    2014-01-01

    OBJECTIVE To review the conceptual relationship between telehealth and translational research. METHODS Bibliographical search on telehealth was conducted in the Scopus, Cochrane BVS, LILACS and MEDLINE databases to find experiences of telehealth in conjunction with discussion of translational research in health. The search retrieved eight studies based on analysis of models of the five stages of translational research and the multiple strands of public health policy in the context of telehealth in Brazil. The models were applied to telehealth activities concerning the Network of Human Milk Banks, in the Telemedicine University Network. RESULTS The translational research cycle of human milk collected, stored and distributed presents several integrated telehealth initiatives, such as video conferencing, and software and portals for synthesizing knowledge, composing elements of an information ecosystem, mediated by information and communication technologies in the health system. CONCLUSIONS Telehealth should be composed of a set of activities in a computer mediated network promoting the translation of knowledge between research and health services. PMID:24897057

  8. Telehealth Innovations in Health Education and Training

    PubMed Central

    De, Suvranu; Hall, Richard W.; Johansen, Edward; Meglan, Dwight; Peng, Grace C.Y.

    2010-01-01

    Abstract Telehealth applications are increasingly important in many areas of health education and training. In addition, they will play a vital role in biomedical research and research training by facilitating remote collaborations and providing access to expensive/remote instrumentation. In order to fulfill their true potential to leverage education, training, and research activities, innovations in telehealth applications should be fostered across a range of technology fronts, including online, on-demand computational models for simulation; simplified interfaces for software and hardware; software frameworks for simulations; portable telepresence systems; artificial intelligence applications to be applied when simulated human patients are not options; and the development of more simulator applications. This article presents the results of discussion on potential areas of future development, barries to overcome, and suggestions to translate the promise of telehealth applications into a transformed environment of training, education, and research in the health sciences. PMID:20155874

  9. Occupational Therapy Home Safety Intervention via Telehealth

    PubMed Central

    BREEDEN, LORI E.

    2016-01-01

    Photography can be an effective addition for education-based telehealth services delivered by an occupational therapist. In this study, photography was used as antecedent to telehealth sessions delivered by an occupational therapist focused on narrative learning about home safety. After taking photographs of past home safety challenges, six participants experienced three web-based occupational therapy sessions. Sessions were recorded and transcribed. Data were examined using content analysis. The content analysis identified the following themes: the value of photos to support learning; the value of narrative learning related to home safety education; and abstract versus concrete learners. Procedural findings are included to support future endeavors. Findings indicate that within a wellness context, home safety education for older adults can be delivered effectively via telehealth when using photography as a part of an occupational therapy intervention. PMID:27563389

  10. Telehealth innovations in health education and training.

    PubMed

    Conde, José G; De, Suvranu; Hall, Richard W; Johansen, Edward; Meglan, Dwight; Peng, Grace C Y

    2010-01-01

    Telehealth applications are increasingly important in many areas of health education and training. In addition, they will play a vital role in biomedical research and research training by facilitating remote collaborations and providing access to expensive/remote instrumentation. In order to fulfill their true potential to leverage education, training, and research activities, innovations in telehealth applications should be fostered across a range of technology fronts, including online, on-demand computational models for simulation; simplified interfaces for software and hardware; software frameworks for simulations; portable telepresence systems; artificial intelligence applications to be applied when simulated human patients are not options; and the development of more simulator applications. This article presents the results of discussion on potential areas of future development, barries to overcome, and suggestions to translate the promise of telehealth applications into a transformed environment of training, education, and research in the health sciences.

  11. Home Telehealth Video Conferencing: Perceptions and Performance.

    PubMed

    Taylor, Alan; Morris, Greg; Pech, Joanne; Rechter, Stuart; Carati, Colin; Kidd, Michael R

    2015-09-17

    The Flinders Telehealth in the Home trial (FTH trial), conducted in South Australia, was an action research initiative to test and evaluate the inclusion of telehealth services and broadband access technologies for palliative care patients living in the community and home-based rehabilitation services for the elderly at home. Telehealth services at home were supported by video conferencing between a therapist, nurse or doctor, and a patient using the iPad tablet. The aims of this study are to identify which technical factors influence the quality of video conferencing in the home setting and to assess the impact of these factors on the clinical perceptions and acceptance of video conferencing for health care delivery into the home. Finally, we aim to identify any relationships between technical factors and clinical acceptance of this technology. An action research process developed several quantitative and qualitative procedures during the FTH trial to investigate technology performance and users perceptions of the technology including measurements of signal power, data transmission throughput, objective assessment of user perceptions of videoconference quality, and questionnaires administered to clinical users. The effectiveness of telehealth was judged by clinicians as equivalent to or better than a home visit on 192 (71.6%, 192/268) occasions, and clinicians rated the experience of conducting a telehealth session compared with a home visit as equivalent or better in 90.3% (489/540) of the sessions. It was found that the quality of video conferencing when using a third generation mobile data service (3G) in comparison to broadband fiber-based services was concerning as 23.5% (220/936) of the calls failed during the telehealth sessions. The experimental field tests indicated that video conferencing audio and video quality was worse when using mobile data services compared with fiber to the home services. As well, statistically significant associations were found

  12. Home Telehealth Video Conferencing: Perceptions and Performance

    PubMed Central

    Morris, Greg; Pech, Joanne; Rechter, Stuart; Carati, Colin; Kidd, Michael R

    2015-01-01

    Background The Flinders Telehealth in the Home trial (FTH trial), conducted in South Australia, was an action research initiative to test and evaluate the inclusion of telehealth services and broadband access technologies for palliative care patients living in the community and home-based rehabilitation services for the elderly at home. Telehealth services at home were supported by video conferencing between a therapist, nurse or doctor, and a patient using the iPad tablet. Objective The aims of this study are to identify which technical factors influence the quality of video conferencing in the home setting and to assess the impact of these factors on the clinical perceptions and acceptance of video conferencing for health care delivery into the home. Finally, we aim to identify any relationships between technical factors and clinical acceptance of this technology. Methods An action research process developed several quantitative and qualitative procedures during the FTH trial to investigate technology performance and users perceptions of the technology including measurements of signal power, data transmission throughput, objective assessment of user perceptions of videoconference quality, and questionnaires administered to clinical users. Results The effectiveness of telehealth was judged by clinicians as equivalent to or better than a home visit on 192 (71.6%, 192/268) occasions, and clinicians rated the experience of conducting a telehealth session compared with a home visit as equivalent or better in 90.3% (489/540) of the sessions. It was found that the quality of video conferencing when using a third generation mobile data service (3G) in comparison to broadband fiber-based services was concerning as 23.5% (220/936) of the calls failed during the telehealth sessions. The experimental field tests indicated that video conferencing audio and video quality was worse when using mobile data services compared with fiber to the home services. As well, statistically

  13. Telehealth: is it the silver bullet?

    PubMed

    Conrad, Carol; Fuller, Elizabeth; Kessler, Stephanie

    2007-07-01

    The focus of our CQI Investigation was to determine whether home telehealth is the "Silver Bullet" in reducing re-hospitalizations, managing visits per episode, implementing disease management strategies, and improving patient satisfaction. In this article, we will discuss the challenges of developing and implementing a telehealth program in a free standing non-profit agency, the program design and its components, and obstacles encountered including those presented by home care staff and area physicians. When we started this project, we had no idea what the results would be. There were some surprises along the way.

  14. The untapped potential of Telehealth.

    PubMed

    Suleiman, A B

    2001-05-01

    The people of Malaysia generally enjoy a high standard of health. This is largely attributed to the comprehensive range of health services provided by the Government and the private sector at affordable costs. However, there are changing trends that now seriously challenge this status quo. The changing population structure, lifestyle, disease patterns and globalization are causing healthcare costs to rise. New and innovative ways will have to be devised to further improve the health status and at the same time contain costs. Information and Communication Technology (ICT) presents unprecedented opportunities to help the health sector in Malaysia reinvent itself and transform the way health and healthcare is managed and delivered in the future. Malaysia's Telehealth initiative under the Multimedia Super Corridor (MSC) project is designed to realize Malaysia's health vision and goals and meet future health challenges. Multimedia and Internet technology will be fully harnessed to deploy services that will shift the emphasis from episodic management of illness to proactive promotion of lifelong wellness and disease prevention. Health information content and interactive applications will engage the people to work as partners of health with healthcare professionals in maintaining their own health or managing their illnesses.

  15. Personalized Telehealth in the Future: A Global Research Agenda.

    PubMed

    Dinesen, Birthe; Nonnecke, Brandie; Lindeman, David; Toft, Egon; Kidholm, Kristian; Jethwani, Kamal; Young, Heather M; Spindler, Helle; Oestergaard, Claus Ugilt; Southard, Jeffrey A; Gutierrez, Mario; Anderson, Nick; Albert, Nancy M; Han, Jay J; Nesbitt, Thomas

    2016-03-01

    As telehealth plays an even greater role in global health care delivery, it will be increasingly important to develop a strong evidence base of successful, innovative telehealth solutions that can lead to scalable and sustainable telehealth programs. This paper has two aims: (1) to describe the challenges of promoting telehealth implementation to advance adoption and (2) to present a global research agenda for personalized telehealth within chronic disease management. Using evidence from the United States and the European Union, this paper provides a global overview of the current state of telehealth services and benefits, presents fundamental principles that must be addressed to advance the status quo, and provides a framework for current and future research initiatives within telehealth for personalized care, treatment, and prevention. A broad, multinational research agenda can provide a uniform framework for identifying and rapidly replicating best practices, while concurrently fostering global collaboration in the development and rigorous testing of new and emerging telehealth technologies. In this paper, the members of the Transatlantic Telehealth Research Network offer a 12-point research agenda for future telehealth applications within chronic disease management.

  16. Personalized Telehealth in the Future: A Global Research Agenda

    PubMed Central

    2016-01-01

    As telehealth plays an even greater role in global health care delivery, it will be increasingly important to develop a strong evidence base of successful, innovative telehealth solutions that can lead to scalable and sustainable telehealth programs. This paper has two aims: (1) to describe the challenges of promoting telehealth implementation to advance adoption and (2) to present a global research agenda for personalized telehealth within chronic disease management. Using evidence from the United States and the European Union, this paper provides a global overview of the current state of telehealth services and benefits, presents fundamental principles that must be addressed to advance the status quo, and provides a framework for current and future research initiatives within telehealth for personalized care, treatment, and prevention. A broad, multinational research agenda can provide a uniform framework for identifying and rapidly replicating best practices, while concurrently fostering global collaboration in the development and rigorous testing of new and emerging telehealth technologies. In this paper, the members of the Transatlantic Telehealth Research Network offer a 12-point research agenda for future telehealth applications within chronic disease management. PMID:26932229

  17. Use of Telehealth for Research and Clinical Measures in Cochlear Implant Recipients: A Validation Study

    PubMed Central

    Hughes, Michelle L.; Goehring, Jenny L.; Baudhuin, Jacquelyn L.; Diaz, Gina R.; Sanford, Todd; Harpster, Roger; Valente, Daniel L.

    2012-01-01

    Purpose The goal of this study was to compare clinical and research-based cochlear-implant (CI) measures using telehealth versus traditional methods. Method This prospective study used an ABA design (A: laboratory, B: remote site). All measures were made twice per visit to assess within-session variability. Twenty nine adult and pediatric CI recipients participated. Measures included: electrode impedance, electrically evoked compound action potential (ECAP) thresholds, psychophysical thresholds using an adaptive procedure, map thresholds and upper comfort levels, and speech perception. Subjects completed a questionnaire at the end of the study. Results Results for all electrode-specific measures revealed no statistically significant differences between traditional and remote conditions. Speech perception was significantly poorer in the remote condition, which was likely due to the lack of a sound booth. In general, subjects indicated that they would take advantage of telehealth options at least some of the time, if it were available. Conclusions Results from this study demonstrate that telehealth is a viable option for research and clinical measures. Additional studies are needed to investigate ways to improve speech perception at remote locations that lack sound booths, and to validate the use of telehealth for pediatric services (e.g., play audiometry), sound-field threshold testing, and troubleshooting equipment. PMID:22232388

  18. Telehealth tools for public health, emergency, or disaster preparedness and response: a summary report.

    PubMed

    Alverson, Dale C; Edison, Karen; Flournoy, Larry; Korte, Brenda; Magruder, Charles; Miller, Craig

    2010-01-01

    Rapid advances in telehealth development and adoption are increasing the spectrum of information and communication technologies that can be applied not only to individual patient care but more broadly to population health as well. Participants in this breakout session were asked to address, from their diverse perspectives, a series of questions relating to the current and potential uses of telehealth applications and networks for public health and emergency/disaster preparedness and response systems. Participants identified several gaps in current understanding and research emphasis. There is a clear need for more and larger outcome studies to assess the impact and cost benefit of telehealth applications in terms of improving public health at the population and community levels. In addition, more research is needed to demonstrate the ability of telehealth tools and technologies to facilitate and extend the reach of major national clinical and public health research initiatives. Perhaps most importantly, the National Institutes of Health should develop and/or strengthen strategic partnerships with other funding agencies with overlapping or complementary interests to accelerate interdisciplinary research in this rapidly evolving but relatively understudied and complex field.

  19. Telehealth interventions to reduce management complications in type 1 diabetes: A review.

    PubMed

    Balkhi, Amanda M; Reid, Adam M; Westen, Sarah C; Olsen, Brian; Janicke, David M; Geffken, Gary R

    2015-04-15

    Type 1 diabetes is a chronic illness with a high burden of care. While effective interventions and recommendations for diabetes care exist, the intensive nature of diabetes management makes compliance difficult. This is especially true in children and adolescents as they have unique psychosocial and diabetes needs. Despite the development of effective in-person interventions targeting improving self-management and ameliorating psychosocial difficulties there are still a number of barriers to implementing these interventions, namely time, cost, and access. Telehealth interventions allow for the dissemination of these interventions to a broader audience. Self-management and psychosocial telehealth interventions are reviewed with a special emphasis on mobile phone and internet based technology use. While efficacy has been demonstrated in a number of telehealth interventions with improved cost effectiveness over in-person interventions, many challenges remain including high participant attrition and difficulties with receiving reimbursement for services rendered. These and other challenges are discussed with recommendations for researchers and telehealth providers provided.

  20. Telehealth interventions to reduce management complications in type 1 diabetes: A review

    PubMed Central

    Balkhi, Amanda M; Reid, Adam M; Westen, Sarah C; Olsen, Brian; Janicke, David M; Geffken, Gary R

    2015-01-01

    Type 1 diabetes is a chronic illness with a high burden of care. While effective interventions and recommendations for diabetes care exist, the intensive nature of diabetes management makes compliance difficult. This is especially true in children and adolescents as they have unique psychosocial and diabetes needs. Despite the development of effective in-person interventions targeting improving self-management and ameliorating psychosocial difficulties there are still a number of barriers to implementing these interventions, namely time, cost, and access. Telehealth interventions allow for the dissemination of these interventions to a broader audience. Self-management and psychosocial telehealth interventions are reviewed with a special emphasis on mobile phone and internet based technology use. While efficacy has been demonstrated in a number of telehealth interventions with improved cost effectiveness over in-person interventions, many challenges remain including high participant attrition and difficulties with receiving reimbursement for services rendered. These and other challenges are discussed with recommendations for researchers and telehealth providers provided. PMID:25897348

  1. Telehealth and the Deaf: A Comparison Study

    ERIC Educational Resources Information Center

    Wilson, Jaime A. B.; Wells, M. Gawain

    2009-01-01

    Within the deaf population, an extreme mental health professional shortage exists that may be alleviated with videoconferencing technology--also known as telehealth. Moreover, much needed mental health education within the deaf population remains largely inaccessible. Researchers have warned that the deaf population may remain underserved if…

  2. Managing congestive heart failure using home telehealth.

    PubMed

    Schneider, Nina M

    2004-10-01

    Congestive heart failure (CHF) is the leading cause of rehospitalization and loss of revenue for home care agencies and hospitals. This article outlines how an agency used telehealth to provide CHF patients quality care and improved outcomes while decreasing the number of skilled home nursing visits and reducing rehospitalization rates to 1.2%.

  3. Telehealth and the Deaf: A Comparison Study

    ERIC Educational Resources Information Center

    Wilson, Jaime A. B.; Wells, M. Gawain

    2009-01-01

    Within the deaf population, an extreme mental health professional shortage exists that may be alleviated with videoconferencing technology--also known as telehealth. Moreover, much needed mental health education within the deaf population remains largely inaccessible. Researchers have warned that the deaf population may remain underserved if…

  4. Telehealth to Expand Community Health Nurse Education in Rural Guatemala: A Pilot Feasibility and Acceptability Evaluation

    PubMed Central

    McConnell, Kelly A.; Krisher, Lyndsay K.; Lenssen, Maureen; Bunik, Maya; Bunge Montes, Saskia; Domek, Gretchen J.

    2017-01-01

    Telehealth education has the potential to serve as an important, low-cost method of expanding healthcare worker education and support, especially in rural settings of low- and middle-income countries. We describe an innovative educational strategy to strengthen a long-term health professional capacity building partnership between Guatemalan and US-based partners. In this pilot evaluation, community health nurses in rural Guatemala received customized, interactive education via telehealth from faculty at the supporting US-based institution. Program evaluation of this 10 lecture series demonstrated high levels of satisfaction among learners and instructors as well as knowledge gain by learners. An average of 5.5 learners and 2 instructors attended the 10 lectures and completed surveys using a Likert scale to rate statements regarding lecture content, technology, and personal connection. Positive statements about lecture content and the applicability to daily work had 98% or greater agreement as did statements regarding ease of technology and convenience. The learners agreed with feeling connected to the instructors 100% of the time, while instructors had 86.4% agreement with connection related statements. Instructors, joining at their respective work locations, rated convenience statements at 100% agreement. This evaluation also demonstrated effectiveness with an average 10.7% increase in pre- to posttest knowledge scores by learners. As the global health community considers efficiency in time, money, and our environment, telehealth education is a critical method to consider and develop for health worker education. Our pilot program evaluation shows that telehealth may be an effective method of delivering education to frontline health workers in rural Guatemala. While larger studies are needed to quantify the duration and benefits of specific knowledge gains and to perform a cost-effectiveness analysis of the program, our initial pilot results are encouraging and

  5. Telehealth to Expand Community Health Nurse Education in Rural Guatemala: A Pilot Feasibility and Acceptability Evaluation.

    PubMed

    McConnell, Kelly A; Krisher, Lyndsay K; Lenssen, Maureen; Bunik, Maya; Bunge Montes, Saskia; Domek, Gretchen J

    2017-01-01

    Telehealth education has the potential to serve as an important, low-cost method of expanding healthcare worker education and support, especially in rural settings of low- and middle-income countries. We describe an innovative educational strategy to strengthen a long-term health professional capacity building partnership between Guatemalan and US-based partners. In this pilot evaluation, community health nurses in rural Guatemala received customized, interactive education via telehealth from faculty at the supporting US-based institution. Program evaluation of this 10 lecture series demonstrated high levels of satisfaction among learners and instructors as well as knowledge gain by learners. An average of 5.5 learners and 2 instructors attended the 10 lectures and completed surveys using a Likert scale to rate statements regarding lecture content, technology, and personal connection. Positive statements about lecture content and the applicability to daily work had 98% or greater agreement as did statements regarding ease of technology and convenience. The learners agreed with feeling connected to the instructors 100% of the time, while instructors had 86.4% agreement with connection related statements. Instructors, joining at their respective work locations, rated convenience statements at 100% agreement. This evaluation also demonstrated effectiveness with an average 10.7% increase in pre- to posttest knowledge scores by learners. As the global health community considers efficiency in time, money, and our environment, telehealth education is a critical method to consider and develop for health worker education. Our pilot program evaluation shows that telehealth may be an effective method of delivering education to frontline health workers in rural Guatemala. While larger studies are needed to quantify the duration and benefits of specific knowledge gains and to perform a cost-effectiveness analysis of the program, our initial pilot results are encouraging and

  6. Quality management practices in telehealth programs: a stakeholder accountability framework.

    PubMed Central

    Dansky, Kathryn H.; Gamm, Larry D.

    2002-01-01

    Improved technologies, distances between providers and patients, and an emphasis on cost-containment have encouraged the use of telehealth as a method of service delivery. Despite the increased use of this technology, few studies have been conducted on management of telehealth programs. Research on quality management is essential for disseminating and generalizing information on best practices in telehealth programs. This study focused on quality management practices used in telehealth programs, using a Stakeholder Accountability Framework. We propose that different indicators of quality are employed to satisfy the expectations of different internal and external stakeholders. A national survey of telehealth programs (N=93) was conducted in January, 2001. Wide variations in practices were found, with the most notable differences between not-for-profit and proprietary programs. The dimensions illustrated in the Stakeholder Accountability Framework were supported empirically. Implications of differences are examined as they relate to advancing quality in telehealth. PMID:12463813

  7. Meta-analysis and meta-regression of telehealth programmes for patients with chronic heart failure.

    PubMed

    Xiang, Rui; Li, Lin; Liu, Sheena Xin

    2013-07-01

    To assess the effectiveness of telehealth used for chronic heart failure (CHF) patients, we searched for peer-reviewed, randomized controlled trials published between 2001 and 2012. A total of 33 studies met the inclusion criteria. There were 26 studies (79%) which concerned tele-monitoring and 7 (21%) which concerned case management or nurse administered telephone-based management. There were 7530 patients in all, with an average age of 69 years. A meta-analysis showed that telehealth programmes had significant overall effectiveness in reducing all-cause mortality (Fixed effect model risk ratio 0.76, 95% CI 0.66 to 0.88), CHF-related hospitalization (Random effect model risk ratio 0.72, 95% CI 0.61 to 0.85) and CHF-related length of stay (Random effect model mean difference -1.41 days, 95% CI -2.43 to -0.39). In addition, telehealth programmes showed significantly greater effectiveness in reducing mortality and hospitalizations among patients with higher New York Heart Association (NYHA) categories. With age and NYHA held constant, recording questionnaire (symptoms) data could reduce the mortality risk by 34% and the risk of CHF-related hospitalization by 15%; adding a pulse (heart rate) detector could reduce the mortality risk by 40% and the risk of CHF-related hospitalization by 43%. Finally, telehealth programmes showed a tapering effect on mortality reduction: the longer the follow-up period, the less effective they were on decreasing mortality. In conclusion, telehealth programmes demonstrated clinical effectiveness in patients with CHF compared with usual care.

  8. Telehealth technology applications in speech-language pathology.

    PubMed

    Keck, Casey Stewart; Doarn, Charles R

    2014-07-01

    Speech-language pathologists are anxious to adopt telehealth technologies but have encountered barriers such as limited reimbursement, state licensure laws, and medical information privacy laws. Moreover, speech-language pathologists are confronted with the hurdle of evolving face-to-face clinical practices into effective telehealth practice adapted to the current national infrastructure. Factors such as costs, availability of resources, and diagnostic/intervention and patient needs should be considered when selecting the telehealth infrastructure for service delivery. Understanding the new role of technology in the diagnosis and treatment of communication disorders is vital for the expansion of telehealth as a standard of care. The purpose of this article is to overview the current technologic infrastructure and procedures for telehealth applications in speech-language pathology (SLP) and the innate challenges and opportunities. A literature search was conducted for telehealth publications in the field of SLP. Given the rapid rate at which technology advances, only peer-reviewed articles published over the past 5 years (2008-2013) were included. The majority of articles reviewed used hybrid methodologies to maintain traditional SLP service standards. General technological components for telehealth activities included computers, Web cameras, headsets with an embedded microphone, and Internet connectivity. Advanced technology has limitations in the application of telehealth. Technological adversities were not reported as the cause of discontinuation of telehealth services by the practitioner or the individual. Audio and visual disturbances were primarily associated with videoconferencing. Supplemental asynchronous technology was widely reported as a solution to real-time instabilities.

  9. Implementing a telehealth service: nurses' perceptions and experiences.

    PubMed

    Odeh, Bassel; Kayyali, Reem; Nabhani-Gebara, Shereen; Philip, Nada

    Telehealth is defined as the remote surveillance of a patient's health to aid early diagnosis and timely intervention. Understanding how the stakeholders perceive telehealth can influence its acceptability and diffusion. A primary care trust (PCT) in south London has been providing telehealth services for chronic obstructive pulmonary disease (COPD) and heart-failure patients for the past 22 months. The aim of this study was to elicit practice nurses' perceptions of the telehealth service provided by this PCT. A descriptive qualitative design was chosen to elicit practice nurses' perceptions. A semi-structured email interview was used to investigate their experiences of the service to date and their views about the future of the service. Seven nurses, working on telehealth for an average of 15 months and providing the service to 34 patients, were interviewed. Overall, the nurses described their experience with telehealth to be positive. Lack of resources, organisational support, patient selection criteria and technical support were identified as barriers to effective implementation of telehealth. Additional team members, more input and training, and expanded patient selection criteria were suggested by the nurses to enhance and ensure the success of telehealth. The challenges and barriers to the implementation of telehealth identified by the practice nurses need to be addressed by health services to ensure its continuity and success.

  10. IRIS Launch Animation

    NASA Image and Video Library

    This animation demonstrates the launch and deployment of NASA's Interface Region Imaging Spectrograph (IRIS) mission satellite via a Pegasus rocket. The launch is scheduled for June 26, 2013 from V...

  11. A Review of Telehealth Service Implementation Frameworks

    PubMed Central

    van Dyk, Liezl

    2014-01-01

    Despite the potential of telehealth services to increase the quality and accessibility of healthcare, the success rate of such services has been disappointing. The purpose of this paper is to find and compare existing frameworks for the implementation of telehealth services that can contribute to the success rate of future endeavors. After a thorough discussion of these frameworks, this paper outlines the development methodologies in terms of theoretical background, methodology and validation. Finally, the common themes and formats are identified for consideration in future implementation. It was confirmed that a holistic implementation approach is needed, which includes technology, organizational structures, change management, economic feasibility, societal impacts, perceptions, user-friendliness, evaluation and evidence, legislation, policy and governance. Furthermore, there is some scope for scientifically rigorous framework development and validation approaches. PMID:24464237

  12. Capabilities of proprietary intermediate telehealth devices.

    PubMed

    Adeogun, Oluseun; Tiwari, Ashutosh; Alcock, Jeffrey R

    2011-11-01

    Proprietary intermediate telehealth devices are those which are specifically designed as connectors between the entities of telehealth systems. This article seeks to understand what are the capabilities of such devices and then to investigate how these are clustered on the current generation of devices. Fourteen current-generation devices available from 12 device providers were selected and analyzed. Four categories of questions were composed to evaluate the devices: setup/configuration, available features, inputs, and outputs. Data were collected and synthesized on the following capabilities: availability from suppliers, setup, environments of use, multiple-condition monitoring, multiuser capabilities, prompts, reminders and alerts, interaction with the health professional, access to historical data, device inputs, and their transfer technology. There are three main roles for proprietary intermediate devices in telehealth systems: displaying information to the patient; receiving data manually/automatically; forwarding results and questionnaire responses to another entity. Provider Perspective: Intermediate devices are usually part of closed proprietary systems. Providers produce disease-customisable devices. Connectivity is considerably ahead of the current generation of point-of-care devices. However, little data are available on connection to rest of the proprietary system. Patient Perspective: It shows clear benefit that one intermediate device can be potentially used with several chronic conditions. Simple setup, authentication procedures, and automatic data transfer are key design aspects. Health Professional Perspective: Little direct interaction with the health professional was observed. Payer Perspective: Details of costs of devices are generally unavailable; system providers indicate that cost variability is based on "user requirements."

  13. Telehealth in the School Setting: An Integrative Review

    ERIC Educational Resources Information Center

    Reynolds, Cori A.; Maughan, Erin D.

    2015-01-01

    Telehealth, the provision of health care through long-distance telecommunications technology, is a tool that can be used by school nurses to address and improve the health status of schoolchildren. The purpose of this literature review is to examine research related to implementation of telehealth in the school setting. A review of the literature…

  14. The Use of Telehealth in Schools. Position Statement. Revised

    ERIC Educational Resources Information Center

    Hoffmann, Susan; Dolatowski, Rosemary; McDowell, Bernadette; Mancuso, Patty; Rochkes, Laura L.; Wavra, Theresa Ernst; Selekman, Janice

    2012-01-01

    Telehealth has been defined as "the use of electronic information and telecommunications technologies to support long-distance clinical health care, patient and professional health-related education, public health and health administration" (United States Department of Health and Human Services [USDHHS], n.d.). Telehealth enables collaboration of…

  15. Telehealth in the School Setting: An Integrative Review

    ERIC Educational Resources Information Center

    Reynolds, Cori A.; Maughan, Erin D.

    2015-01-01

    Telehealth, the provision of health care through long-distance telecommunications technology, is a tool that can be used by school nurses to address and improve the health status of schoolchildren. The purpose of this literature review is to examine research related to implementation of telehealth in the school setting. A review of the literature…

  16. Overview of telehealth activities in speech-language pathology.

    PubMed

    Mashima, Pauline A; Doarn, Charles R

    2008-12-01

    It is estimated that 10% of the world's population, approximately 650 million people, have some form of disability. Population growth, aging, and medical advances that preserve and prolong life have increased demands for health and rehabilitation services. Recent predictions indicate a shortage of speech-language pathologists and other rehabilitation specialists to provide care for individuals with disabilities. The application of telemedicine and telehealth technologies offers effective solutions to this challenge. An extensive literature review was conducted that included technical reports, websites, publications from the American Speech-Language-Hearing Association, and peer-reviewed journal articles of telehealth applications in speech-language pathology. Various applications of telehealth in speech-language pathology are described including types of technology, patient and clinician satisfaction, advantages of using telehealth, challenges and barriers to application, and future directions. This review provides a strong foundation for broader applications of telehealth technologies in this area of healthcare.

  17. Telehealth and the national health information technology strategic framework.

    PubMed

    Speedie, Stuart M; Davies, Diane

    2006-01-01

    Telehealth has a role in the federally sponsored plan for health information technology (HIT) that encompasses electronic health records (EHRs) and the National Health Information Network (NHIN). The goals of telehealth and the national plan are complementary. One focuses on improving access to high quality health-care services and the other on the information systems to support those services. Telehealth needs the fully realized EHR to provide the best possible care when patients are geographically and chronologically separated from their providers. Some current telehealth projects are natural examples of how a distributed, accessible EHR such as that envisaged by the plan can be used to provide better care. The experiences of telehealth in organizing large networks of heterogeneous health-care entities can provide useful lessons as the process of implementing HIT moves forward.

  18. Telehealth: important concepts for future nursing practice in space environments.

    PubMed

    Chonin, A

    1998-01-01

    The concept of telehealth has become a vital issue to healthcare providers in this day of instantaneous, varied, and technology-based communications. This article discusses the issues and implications of telehealth to nurses on Earth and in future space environments. Telehealth will be defined as currently implemented and the legal ramifications of practice across state lines, national borders, rural, and in remote and hazardous locations (space environments: orbital, Moon and Mars bases) will be delineated. The age of information is now here, and the age of communication is beginning. Telehealth is and will be an important means of providing communication links and healthcare to clients and providers alike. Healthcare professionals need to be aware of important concepts related to telehealth for their current and future practice.

  19. Competencies required for nursing telehealth activities: A Delphi-study.

    PubMed

    van Houwelingen, Cornelis T M; Moerman, Anna H; Ettema, Roelof G A; Kort, Helianthe S M; Ten Cate, Olle

    2016-04-01

    Telehealth is viewed as a major strategy to address the increasing demand for care and a shrinking care professional population. However, most nurses are not trained or are insufficiently trained to use these technologies effectively. Therefore, the potential of telehealth fails to reach full utilization. A better understanding of nursing telehealth entrustable professional activities (NT-EPAs) and the required competencies can contribute to the development of nursing telehealth education. In a four-round Delphi-study, a panel of experts discussed which NT-EPAs are relevant for nurses and which competencies nurses need to possess to execute these activities effectively. The 51 experts, including nurses, nursing faculty, clients and technicians all familiar with telehealth, were asked to select items from a list of 52 competencies based on the literature and on a previous study. Additionally, the panelists could add competencies based on their experience in practice. The threshold used for consensus was set at 80%. Consensus was achieved on the importance of fourteen NT-EPAs, requiring one or more of the following core competencies; coaching skills, the ability to combine clinical experience with telehealth, communication skills, clinical knowledge, ethical awareness, and a supportive attitude. Each NT-EPA requires a specific set of competencies (at least ten). In total, 52 competencies were identified as essential in telehealth. Many competencies for telehealth, including clinical knowledge and communication skills, are not novel competencies. They are fundamental to nursing care as a whole and therefore are also indispensable for telehealth. Additionally, the fourteen NT-EPAs appeared to require additional subject specific competencies, such as the ability to put patients at ease when they feel insecure about using technology. The NT-EPAs and related competencies presented in this study can be used by nursing schools that are considering including or expanding

  20. Intercontinental telehealth coaching of therapists to improve verbalizations by children with autism.

    PubMed

    Barkaia, Ana; Stokes, Trevor F; Mikiashvili, Tamar

    2017-07-01

    This study examined the effects of intercontinental telehealth coaching on the mastery of therapists' skills and improvements in verbalizations by children with autism, testing whether telehealth can be a solution for underserved communities in developing countries such as Georgia-Sakartvelo in Eastern Europe. Three therapists delivering and three children with autism receiving early-intervention services from the nongovernmental organization Children of Georgia in Tbilisi participated. Experimenters provided coaching from Virginia, USA to therapists in Georgia-Sakartvelo. Observers in Georgia-Sakartvelo and in Virginia conducted the behavioral observations. We used inexpensive communications technology to provide the coaching and a multiple-baseline design across participants to evaluate the effects of the intervention. Therapists demonstrated improvements in two classes of behaviors: correct command sequences and positive consequences. The children demonstrated improvements with echoics and mands. The study demonstrated that telehealth can be a good model for delivering early-intervention services to children with autism in underserved and distant regions of the world. © 2017 Society for the Experimental Analysis of Behavior.

  1. Using the Australian and New Zealand Telehealth Committee framework to evaluate telehealth: identifying conceptual gaps.

    PubMed

    Hughes, Emma; King, Chris; Kitt, Sharon

    2002-01-01

    Telehealth is strongly supported in policy rhetoric as being economically significant to Australia, but evaluation standards have been insufficiently developed to ensure that this is the case. The use of one such evaluation standard, the Australian and New Zealand Telehealth Committee (ANZTC) framework, for telehealth evaluation in Australia makes good sense. However, that framework emphasizes economic and technical considerations at the expense of social contexts. Furthermore, there must be questions about the utility of a framework which, it appears, has been used to evaluate only a single telehealth project in Australia. The combination of the economic rationalism of health-care policy and the technological determinism of a tool model of information and communication technologies (ICTs) can result in evaluations that fail to match the complexities of the intersection of health-care and ICTs. Using the ANZTC framework while at the same time focusing on explaining, rather than just describing, the links between interventions and outcomes seems a reasonable compromise. This involves understanding complex socio-technical networks and relationships, and requires investigators to engage with the gulf between private opinions, public statements and actual behaviour.

  2. Telehealth Regulatory and Legal Considerations: Frequently Asked Questions

    PubMed Central

    Cason, Jana; Brannon, Janice A.

    2011-01-01

    As telehealth gains momentum as a service delivery model in the United States within the rehabilitation professions, regulatory and legal questions arise. This article examines the following questions: Is there a need to secure licenses in two states (i.e., where the practitioner resides, and where the client is located), before engaging in telehealth?Do state laws differ concerning if and how telehealth can occur?Do any states expressly disallow telehealth?Can services delivered through telehealth be billed the same way as services provided in-person?If practitioners fulfill the requirements to maintain licensure (e.g., continuing education obligations) in their state of residence, do they also need to fulfill the requirements to maintain licensure for the state in which the client resides?Will professional malpractice insurance cover services delivered through telehealth?Does a sole practitioner need to abide by HIPAA regulations?Responses to these questions are offered to raise awareness of the regulatory and legal implications associated with the use of a telehealth service delivery model within the professions of occupational therapy, physical therapy, speech-language pathology and audiology. PMID:25945185

  3. An Emergent Research and Policy Framework for Telehealth.

    PubMed

    Edmunds, Margo; Tuckson, Reed; Lewis, Joy; Atchinson, Brian; Rheuban, Karen; Fanberg, Hank; Olinger, Lois; Rosati, Robert; Austein-Casnoff, Cheryl; Capistrant, Gary; Thomas, Latoya

    2017-01-01

    Telehealth is a fast-growing sector in health care, using a variety of technologies to exchange information across locations and to improve access, quality, and outcomes across the continuum of care. Thousands of studies and hundreds of systematic reviews have been done, but their variability leaves many questions about telehealth's effectiveness, implementation priorities, and return on investment. There is an urgent need for a systematic, policy-relevant framework to integrate regulatory, operational, and clinical factors and to guide future investments in telehealth research and practice. An invited multidisciplinary group of 21 experts from AcademyHealth, the American Telemedicine Association (ATA), Kaiser Permanente Institute for Health Policy (KP), and the Physician Insurers Association of America (PIAA) met to review and discuss the components of a draft framework for policy-relevant telehealth research. The framework was revised and presented in a challenge workshop at Concordium 2016, and some additional refinements were made. The current framework encompasses the regulatory and payment policy context for telehealth, delivery system factors, and outcomes of telehealth interventions. Based on the feedback at Concordium 2016, the framework seems to have potential to help educate policymakers, payers, and health systems about the value of telehealth and to frame discussions about implementation barriers, including risk management concerns, technology costs, and organizational culture. However, questions remain about how to disseminate and use the framework to help coordinate policy, research, and implementation efforts in the delivery system.

  4. Post-disaster Gulf Coast Recovery Using Telehealth

    PubMed Central

    Kim, Thomas J.; Eastburn, Sasha L.; Icenogle, Marjorie L.; Slagle, Michelle; Nuriddin, Azizeh H.; Brantley, Katrina M.; Foreman, Rachel D.; Buckner, Ayanna V.

    2013-01-01

    Abstract Objective: The Gulf Coast continues to struggle with service need far outpacing available resources. Since 2005, the Regional Coordinating Center for Hurricane Response (RCC) at Morehouse School of Medicine, Atlanta, GA, has supported telehealth solutions designed to meet high service needs (e.g., psychiatry) within primary care and other healthcare organizations. The overall RCC vision is to support autonomous, useful, and sustainable telehealth programs towards mitigating unmet disaster-related needs. Subjects and Methods: To assess Gulf Coast telehealth experiences, we conducted semistructured interviews with both regional key informants and national organizations with Gulf Coast recovery interests. Using qualitative-descriptive analysis, interview transcripts were analyzed to identify shared development themes. Results: Thirty-eight key informants were interviewed, representing a 77.6% participation rate among organizations engaged by the RCC. Seven elements critical to telehealth success were identified: Funding, Regulatory, Workflow, Attitudes, Personnel, Technology, and Evaluation. These key informant accounts reveal shared insights with telehealth regarding successes, challenges, and recommendations. Conclusions: The seven elements critical to telehealth success both confirm and organize development principles from a diverse collective of healthcare stakeholders. The structured nature of these insights suggests a generalizable framework upon which other organizations might develop telehealth strategies toward addressing high service needs with limited resources. PMID:23427981

  5. Telehealth: current practices and future directions

    NASA Astrophysics Data System (ADS)

    David, Yadin B.

    1996-02-01

    When we review the positive impact that the integration of ostensibly independent patient-care services have on the efficient management of quality care, education, and collaborative research, it is not surprising that telehealth deployment is on the rise. The forces that drive this phenomenon include: the need to manage the entire disease episode; the desire for wider geographically-distributed quality health care; the escalation of customer expectations; globalization of healthcare and its support services; an increase in patient and provider convenience; and the acceptance of the present technological community. At the Telehealth Center at the Texas Children's Hospital, current classifications of clinical applications are listed: (1) initial urgent evaluation of patients, (2) triage decisions and pretransfer arrangements, (3) medical and surgical follow-up and medication review, (4) consultation for primary care encounters, (5) real-time subspecialty care consultation and planning, (6) management of chronic diseases and conditions, (7) extended diagnostic work-ups, (8) review of diagnostic images, and (9) preventive medicine and patient education. The delivery of such services is associated with challenges and opportunities. As we move forward from limited data processing to an integrated communication system, from centralized main frame functions to personalized and location-independent workstations, and from hospitals to clinics and homecare, an increase in the minimum features provided by the equipment and the communication systems must accompany the widening variety of clinical applications. Future expansion of telehealth systems stands to revolutionize the delivery of services to the benefits of providers' networks, our economy, and patients through integration.

  6. A product-service system approach to telehealth application design.

    PubMed

    Flores-Vaquero, Paul; Tiwari, Ashutosh; Alcock, Jeffrey; Hutabarat, Windo; Turner, Chris

    2016-06-01

    A considerable proportion of current point-of-care devices do not offer a wide enough set of capabilities if they are to function in any telehealth system. There is a need for intermediate devices that lie between healthcare devices and service networks. The development of an application is suggested that allows for a smartphone to take the role of an intermediate device. This research seeks to identify the telehealth service requirements for long-term condition management using a product-service system approach. The use of product-service system has proven to be a suitable methodology for the design and development of telehealth smartphone applications.

  7. A nursing home telehealth system: keeping residents connected.

    PubMed

    Daly, Jeanette M; Jogerst, Gerald; Park, Jung-Yong; Kang, Yun-Deok; Bae, Taehee

    2005-08-01

    Live video and detailed images of nursing home residents can be transmitted in real time via the Internet. This telehealth system allows residents and long-term care health professionals to connect with experts not available on-site. Electronic stethoscope, otoscope, dermascope, dentalscope, and electrocardiogram are available for use via the Internet. Impediments to implementing telehealth systems in long-term care include costs and the lack of reimbursement for telehealth services. Reimbursement for telemedicine in nursing homes is limited by originating site, current procedural terminology codes, and facility location.

  8. Telehealth: A Rapidly Developing Service Delivery Model For Occupational Therapy

    PubMed Central

    Cason, Jana

    2014-01-01

    Over the past decade, the practice of occupational therapy has been increasingly influenced by technological advances in the use of information and communication technologies (ICT) and associated changes in health care policy. Emergent from this evolution is the application of telehealth to deliver occupational therapy services to a client who is in a different physical location than the provider. This article furnishes an overview of the evidence for telehealth use in occupational therapy, discusses key policy considerations, and provides resources to guide practitioners in the ethical use of telehealth. PMID:25945220

  9. Automated telehealth for managing psychiatric instability in people with serious mental illness.

    PubMed

    Pratt, Sarah I; Naslund, John A; Wolfe, Rosemarie S; Santos, Meghan; Bartels, Stephen J

    2015-01-01

    Serious mental illness (SMI) with psychiatric instability accounts for disproportionately high use of emergency room visits and hospitalizations. To evaluate the effectiveness of an automated telehealth intervention supported by nurse health care management for improving psychiatric illness management and reducing acute service use among individuals with SMI and psychiatric instability. Thirty-eight individuals with SMI received the automated telehealth intervention for 6 months. Psychiatric symptoms, illness self-management, and self-reported service use (emergency room visits and hospital admissions) were collected at baseline, 3- and 6-months. Measures of quality of life, health indicators, and subjective health status were also collected. Participants demonstrated improvements in self-reported psychiatric symptoms and illness self-management skills, an 82% decrease in hospital admissions (from 76 to 14 hospitalizations, p < 0.001) and a 75% decrease in emergency room visits (from 63 to 16 visits, p < 0.001). Improvements were also observed in quality of life, severity of depressive symptoms, and mental health status. These highly promising findings support the use of an automated telehealth device monitored by a nurse care manager for people with SMI, and highlight the potential for cost savings through reductions in acute health care utilization.

  10. The Telehealth Enhancement of Adherence to Medication in Pediatric IBD (TEAM) Trial: Design and Methodology

    PubMed Central

    Hommel, Kevin A.; Gray, Wendy N.; Hente, Elizabeth; Loreaux, Katherine; Ittenbach, Richard F.; Maddux, Michele; Baldassano, Robert; Sylvester, Francisco; Crandall, Wallace; Doarn, Charles; Heyman, Melvin B.; Keljo, David; Denson, Lee A.

    2015-01-01

    Medication nonadherence is a significant health care issue requiring regular behavioral treatment. Lack of sufficient health care resources and patient/family time commitment for weekly treatment are primary barriers to receiving appropriate self-management support. We describe the methodology of the Telehealth Enhancement of Adherence to Medication (TEAM) trial for medication nonadherence in pediatric inflammatory bowel disease (IBD). For this trial, participants 11–18 years of age will be recruited from seven pediatric hospitals and will complete an initial 4-week run in to assess adherence to a daily medication. Those who take less than 90% of their prescribed medication will be randomized. A total of 194 patients with IBD will be randomized to either a telehealth behavioral treatment (TBT) arm or education only (EO) arm. All treatment will be delivered via telehealth video conferencing. Patients will be assessed at baseline, post-treatment, 3-, 6-, and 12-months. We anticipate that participants in the TBT arm will demonstrate a statistically significant improvement at post-treatment and 3-, 6-, and 12-month follow-up compared to participants in the EO arm for both medication adherence and secondary outcomes (i.e., disease severity, patient quality of life, and health care utilization). If efficacious, the TEAM intervention could be disseminated broadly and reduce health care access barriers so that patients could receive much needed self-management intervention. PMID:26003436

  11. Launch Vehicles

    NASA Image and Video Library

    2006-09-09

    Under the goals of the Vision for Space Exploration, Ares I is a chief component of the cost-effective space transportation infrastructure being developed by NASA's Constellation Program. This transportation system will safely and reliably carry human explorers back to the moon, and then onward to Mars and other destinations in the solar system. The Ares I effort includes multiple project element teams at NASA centers and contract organizations around the nation, and is managed by the Exploration Launch Projects Office at NASA's Marshall Space Flight Center (MFSC). ATK Launch Systems near Brigham City, Utah, is the prime contractor for the first stage booster. ATK's subcontractor, United Space Alliance of Houston, is designing, developing and testing the parachutes at its facilities at NASA's Kennedy Space Center in Florida. NASA's Johnson Space Center in Houston hosts the Constellation Program and Orion Crew Capsule Project Office and provides test instrumentation and support personnel. Together, these teams are developing vehicle hardware, evolving proven technologies, and testing components and systems. Their work builds on powerful, reliable space shuttle propulsion elements and nearly a half-century of NASA space flight experience and technological advances. Ares I is an inline, two-stage rocket configuration topped by the Crew Exploration Vehicle, its service module, and a launch abort system. In this HD video image, the first stage reentry parachute drop test is conducted at the Yuma, Arizona proving ground. The parachute tests demonstrated a three-stage deployment sequence that included the use of an Orbiter drag chute to properly stage the unfurling of the main chute. The parachute recovery system for Orion will be similar to the system used for Apollo command module landings and include two drogue, three pilot, and three main parachutes. (Highest resolution available)

  12. Launch Vehicles

    NASA Image and Video Library

    2007-09-09

    Under the goals of the Vision for Space Exploration, Ares I is a chief component of the cost-effective space transportation infrastructure being developed by NASA's Constellation Program. This transportation system will safely and reliably carry human explorers back to the moon, and then onward to Mars and other destinations in the solar system. The Ares I effort includes multiple project element teams at NASA centers and contract organizations around the nation, and is managed by the Exploration Launch Projects Office at NASA's Marshall Space Flight Center (MFSC). ATK Launch Systems near Brigham City, Utah, is the prime contractor for the first stage booster. ATK's subcontractor, United Space Alliance of Houston, is designing, developing and testing the parachutes at its facilities at NASA's Kennedy Space Center in Florida. NASA's Johnson Space Center in Houston hosts the Constellation Program and Orion Crew Capsule Project Office and provides test instrumentation and support personnel. Together, these teams are developing vehicle hardware, evolving proven technologies, and testing components and systems. Their work builds on powerful, reliable space shuttle propulsion elements and nearly a half-century of NASA space flight experience and technological advances. Ares I is an inline, two-stage rocket configuration topped by the Crew Exploration Vehicle, its service module, and a launch abort system. In this HD video image, the first stage reentry parachute drop test is conducted at the Yuma, Arizona proving ground. The parachute tests demonstrated a three-stage deployment sequence that included the use of an Orbiter drag chute to properly stage the unfurling of the main chute. The parachute recovery system for Orion will be similar to the system used for Apollo command module landings and include two drogue, three pilot, and three main parachutes. (Highest resolution available)

  13. Launch Vehicles

    NASA Image and Video Library

    2007-08-09

    Under the goals of the Vision for Space Exploration, Ares I is a chief component of the cost-effective space transportation infrastructure being developed by NASA's Constellation Program. This transportation system will safely and reliably carry human explorers back to the moon, and then onward to Mars and other destinations in the solar system. The Ares I effort includes multiple project element teams at NASA centers and contract organizations around the nation, and is managed by the Exploration Launch Projects Office at NASA's Marshall Space Flight Center (MFSC). ATK Launch Systems near Brigham City, Utah, is the prime contractor for the first stage booster. ATK's subcontractor, United Space Alliance of Houston, is designing, developing and testing the parachutes at its facilities at NASA's Kennedy Space Center in Florida. NASA's Johnson Space Center in Houston hosts the Constellation Program and Orion Crew Capsule Project Office and provides test instrumentation and support personnel. Together, these teams are developing vehicle hardware, evolving proven technologies, and testing components and systems. Their work builds on powerful, reliable space shuttle propulsion elements and nearly a half-century of NASA space flight experience and technological advances. Ares I is an inline, two-stage rocket configuration topped by the Crew Exploration Vehicle, its service module, and a launch abort system. In this HD video image, processes for upper stage barrel fabrication are talking place. Aluminum panels are manufacturing process demonstration articles that will undergo testing until perfected. The panels are built by AMRO Manufacturing located in El Monte, California. (Largest resolution available)

  14. Launch Vehicles

    NASA Image and Video Library

    2007-08-09

    Under the goals of the Vision for Space Exploration, Ares I is a chief component of the cost-effective space transportation infrastructure being developed by NASA's Constellation Program. This transportation system will safely and reliably carry human explorers back to the moon, and then onward to Mars and other destinations in the solar system. The Ares I effort includes multiple project element teams at NASA centers and contract organizations around the nation, and is managed by the Exploration Launch Projects Office at NASA's Marshall Space Flight Center (MFSC). ATK Launch Systems near Brigham City, Utah, is the prime contractor for the first stage booster. ATK's subcontractor, United Space Alliance of Houston, is designing, developing and testing the parachutes at its facilities at NASA's Kennedy Space Center in Florida. NASA's Johnson Space Center in Houston hosts the Constellation Program and Orion Crew Capsule Project Office and provides test instrumentation and support personnel. Together, these teams are developing vehicle hardware, evolving proven technologies, and testing components and systems. Their work builds on powerful, reliable space shuttle propulsion elements and nearly a half-century of NASA space flight experience and technological advances. Ares I is an inline, two-stage rocket configuration topped by the Crew Exploration Vehicle, its service module, and a launch abort system. This HD video image depicts the manufacturing of aluminum panels that will be used to form the Ares I barrel. The panels are manufacturing process demonstration articles that will undergo testing until perfected. The panels are built by AMRO Manufacturing located in El Monte, California. (Highest resolution available)

  15. Telehealth: voice therapy using telecommunications technology.

    PubMed

    Mashima, Pauline A; Birkmire-Peters, Deborah P; Syms, Mark J; Holtel, Michael R; Burgess, Lawrence P A; Peters, Leslie J

    2003-11-01

    Telehealth offers the potential to meet the needs of underserved populations in remote regions. The purpose of this study was a proof-of-concept to determine whether voice therapy can be delivered effectively remotely. Treatment outcomes were evaluated for a vocal rehabilitation protocol delivered under 2 conditions: with the patient and clinician interacting within the same room (conventional group) and with the patient and clinician in separate rooms, interacting in real time via a hard-wired video camera and monitor (video teleconference group). Seventy-two patients with voice disorders served as participants. Based on evaluation by otolaryngologists, 31 participants were diagnosed with vocal nodules, 29 were diagnosed with edema, 9 were diagnosed with unilateral vocal fold paralysis, and 3 presented with vocal hyperfunction with no laryngeal pathology. Fifty-one participants (71%) completed the vocal rehabilitation protocol. Outcome measures included perceptual judgments of voice quality, acoustic analyses of voice, patient satisfaction ratings, and fiber-optic laryngoscopy. There were no differences in outcome measures between the conventional group and the remote video teleconference group. Participants in both groups showed positive changes on all outcome measures after completing the vocal rehabilitation protocol. Reasons for participants discontinuing therapy prematurely provided support for the telehealth model of service delivery.

  16. Canadian experiences in telehealth: equalizing access to quality care.

    PubMed

    Jennett, P A; Person, V L; Watson, M; Watanabe, M

    2000-01-01

    The Canadian Conference "TExpo'98: Interactive Health" focused on four telehealth themes: community needs, Canadian experiences, industry perspectives, and access/security/interoperability issues. Health and socioeconomic needs have been the driving force behind telehealth initiatives; telelearning is one of the major Canadian initiatives. To encourage Canadian telehealth initiatives, the federal government is building a national health infrastructure. One element in this framework is concerned with empowering the public, strengthening health care services, and ensuring accountability. Technological advancements and innovative partnerships among health communities, government, users, professional bodies, and industry are critical to continued growth. Key issues including access, evaluation, implementation, privacy, confidentiality, security, and interoperability are of universal concern to participants. Research that examines the benefits and costs of telehealth is needed.

  17. Diffusion of innovation: Telehealth for care at home.

    PubMed

    Levy, Sharon

    2015-01-01

    The 'care at home' study focused on a Scottish telehealth service, which was designed to support children with palliative and complex care needs. Using the diffusion of innovation theory, this poster highlights the differences between the way telehealth is used in the public sector and in a third sector or a voluntary organization. Analysis of the data, taken from interviews with key stakeholders, illuminate barriers and solutions as noted by clinicians who see the clear benefits and potential risks of telehealth use at home. In conclusion, it is argued that a strategic steer towards a culture of innovation is needed to support effective use of telehealth in clinical practice. Senior managers in the National Health Service in the United Kingdom need to 'unleash' the goodwill of staff who are eager to exploit innovation in clinical practice.

  18. Effect of Telehealth Interventions on Hospitalization Indicators: A Systematic Review

    PubMed Central

    Kalankesh, Leila R.; Pourasghar, Faramarz; Nicholson, Lorraine; Ahmadi, Shamim; Hosseini, Mohsen

    2016-01-01

    Background Telehealth has been defined as the remote delivery of healthcare services using information and communication technology. Where resource-limited health systems face challenges caused by the increasing burden of chronic diseases and an aging global population, telehealth has been advocated as a solution for changing and improving the paradigm of healthcare delivery to cope with these issues. The aim of this systematic review is to investigate the effect of telehealth interventions on two indicators: hospitalization rate and length of stay. Materials and Methods The reviewers searched the PubMed, ScienceDirect, and Springer electronic databases from January 2005 to November 2013. A search strategy was developed using a combination of the following search keywords: impact, effect, telehealth, telemedicine, telecare, hospitalization, length of stay, and resource utilization. Both randomized controlled trials and observational studies were included in the review. To be included in the review, articles had to be written in English. The results of study were compiled, reviewed, and analyzed on the basis of the review aims. Results This systematic review examined 22 existing studies with a total population of 19,086 patients. The effect of telehealth on all-cause hospitalization was statistically significant in 40 percent of the related studies, whereas it was not statistically significant in 60 percent. Similarly, the effect of telehealth on the all-cause length of stay was statistically significant in 36 percent of the studies and nonsignificant in 64 percent. Conclusion Considering the fact that hospitalization rate and length of stay can be confounded by factors other than telehealth intervention, studies examining the effect of the intervention on these indicators must take into account all other factors influencing them. Otherwise any judgment on the effect of telehealth on these indicators cannot be valid. PMID:27843425

  19. TEAhM-Technologies for Enhancing Access to Health Management: a pilot study of community-based telehealth.

    PubMed

    Resnick, Helaine E; Ilagan, Perla R; Kaylor, Mary Beth; Mehling, Diane; Alwan, Majd

    2012-04-01

    To explore implementation of nurse-mediated telehealth in community-based senior centers. Two senior centers had telehealth kiosks installed, and two other centers served as control sites. Participants with diagnosed hypertension were instructed to use the equipment at least once per week to measure blood pressure (BP). Nurses monitored BP data for 10 months and made referrals based on primary care physicians' protocols. Participants' mean age was 74.1 years, 75% were women, and mean baseline systolic BPs were 131 and 138 mm Hg in the intervention and control groups, respectively. At baseline, 64% and 85% of participants reported ever having owned a home computer and cell phone, respectively, and 84% reported having used an automated BP device outside of a doctor's office. At 10 months, mean systolic BP was 126 and 132 mm Hg in the intervention and control groups, respectively. Intervention participants used the telehealth station once per week during 69% of all follow-up weeks, and 71% of high readings received nurse follow-up within 24 h. Kiosk use increased steadily during the follow-up period, peaking at 80%, but declined over time to 47% at 10 months. Nearly all intervention group participants reported being "very comfortable" with the technology at study end, 81% reported it was "very easy" to use, and 89% would recommend it to friends. Senior center staff reported that the technology was consistent with their organizational mission and that clients and boards of directors were enthusiastic about it. This pilot study demonstrates that telehealth was embraced by clients and staff of community-based senior centers. A larger study is needed to determine the clinical impact and cost-effectiveness of using senior centers as a venue for telehealth-based management of hypertension and other common chronic conditions.

  20. Legal Mapping Analysis of State Telehealth Reimbursement Policies.

    PubMed

    Trout, Kate E; Rampa, Sankeerth; Wilson, Fernando A; Stimpson, Jim P

    2017-04-21

    There exists rapid growth and inconsistency in the telehealth policy environment, which makes it difficult to quantitatively evaluate the impact of telehealth reimbursement and other policies without the availability of a legal mapping database. We describe the creation of a legal mapping database of state-level policies related to telehealth reimbursement of healthcare services. Trends and characteristics of these policies are presented. Information provided by the Center for Connected Health Policy was used to identify statewide laws and regulations regarding telehealth reimbursement. Other information was retrieved by using: (1) LexisNexis database, (2) Westlaw database, and (3) retrieval from legislative Web sites, historical documents, and contacting state officials. We examined policies for live video, store-and-forward, and remote patient monitoring (RPM). In the United States, there are 24 states with policies regarding reimbursement for live video transmission. Fourteen states have store-and-forward policies, and six states have RPM-related policies. Mississippi is the only state that requires reimbursement for all three types of telehealth transmission modes. Most states (47 states) have Medicaid policies regarding live video transmission, followed by 37 states for store-and-forward and 20 states for RPM. Only 13 states require that live video will be reimbursed "consistent with" or at the "same rate" as in-person services in their Medicaid program. There are no widely accepted telehealth reimbursement policies across states. They contain diverse restrictions and requirements that present complexities in policy evaluation and in determining policy effectiveness across states.

  1. Envisioning patient safety in Telehealth: a research perspective.

    PubMed

    Monteagudo, José Luis; Salvador, Carlos H; Kun, Luis

    2014-01-01

    This article explores the need for research into patient safety in large-scale Telehealth systems faced with the perspective of its development extended to healthcare systems. Telehealth systems give rise to significant advantages in improving the quality of healthcare services as well as bringing about the possibility of new types of risk. A theoretical framework is proposed for patient safety for its approach as an emerging property in complex socio-technical systems (CSTS) and their modelling in layers. As regards this framework, the differential characteristic Telehealth elements of the system have been identified, with a greater emphasis on the level of Telehealth system and its typical subsystems. The bases of the analysis are based on references in the literature and the experience accumulated by the researchers in the area. In particular, a case describing an example of Telehealth to control patients undergoing treatment with oral anticoagulants is used. As a result, a series of areas of research into and topics regarding Telehealth patient safety are proposed to cover the detectable gaps. Both the theoretical and practical implications of the study are discussed and future perspectives are reflected on.

  2. Telehealth monitoring: a smart investment for home care patients with heart failure?

    PubMed

    Browning, Sarah Via; Clark, Rebecca Culver; Poff, Renee M; Todd, Darren

    2011-06-01

    This telehealth project was positive overall. It was an agency goal to utilize telehealth to augment, not replace, SN visits while improving quality outcomes for the patient. The findings of this project supported that goal.

  3. 78 FR 53506 - Proposed Information Collection (Care Coordination Home Telehealth (CCHT) Patient Satisfaction...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-08-29

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF VETERANS AFFAIRS Proposed Information Collection (Care Coordination Home Telehealth (CCHT) Patient Satisfaction... forms of information technology. Titles: Care Coordination Home Telehealth (CCHT) Patient Satisfaction...

  4. Using telehealth to support end of life care in the community: a feasibility study.

    PubMed

    Tieman, Jennifer J; Swetenham, Kate; Morgan, Deidre D; To, Timothy H; Currow, David C

    2016-11-17

    Telehealth is being used increasingly in providing care to patients in the community setting. Telehealth enhanced service delivery could offer new ways of managing load and care prioritisation for palliative care patients living in the community. The study assesses the feasibility of a telehealth-based model of service provision for community based palliative care patients, carers and clinicians. This study was a prospective cohort study of a telehealth-based intervention for community based patients of a specialist palliative care service living in Southern Adelaide, South Australia. Participants were 43 community living patients enrolled in the Southern Adelaide Palliative Service. To be eligible patients needed to be over 18 years and have an Australian modified Karnofksy Performance Score > 40. Exclusion criteria included a demonstrated inability to manage the hardware or technology (unless living with a carer who could manage the technology) or non-English speaking without a suitable carer/proxy. Participants received video-based conferences between service staff and the patient/carer; virtual case conferences with the patient/carer, service staff and patient's general practitioner (GP); self-report assessment tools for patient and carer; and remote activity monitoring (ACTRN12613000733774). The average age of patients was 71.6 years (range: 49 to 91 years). All 43 patients managed to enter data using the telehealth system. Self-reported data entered by patients and carers did identify changes in performance status leading to changes in care. Over 4000 alerts were generated. Staff reported that videocalls were similar (22.3%) or better/much better (65.2%) than phone calls and similar (63.1%) or better/much better (27.1%) than face-to-face. Issues with the volume of alerts generated, technical support required and the impact of service change were identified. The trial showed that patients and carers could manage the technology and provide data that

  5. Use of an embedded, micro-randomised trial to investigate non-compliance in telehealth interventions.

    PubMed

    Law, Lisa M; Edirisinghe, Nuwani; Wason, James Ms

    2016-08-01

    Many types of telehealth interventions rely on activity from the patient in order to have a beneficial effect on their outcome. Remote monitoring systems require the patient to record regular measurements at home, for example, blood pressure, so clinicians can see whether the patient's health changes over time and intervene if necessary. A big problem in this type of intervention is non-compliance. Most telehealth trials report compliance rates, but they rarely compare compliance among various options of telehealth delivery, of which there may be many. Optimising telehealth delivery is vital for improving compliance and, therefore, clinical outcomes. We propose a trial design which investigates ways of improving compliance. For efficiency, this trial is embedded in a larger trial for evaluating clinical effectiveness. It employs a technique called micro-randomisation, where individual patients are randomised multiple times throughout the study. The aims of this article are (1) to verify whether the presence of an embedded secondary trial still allows valid analysis of the primary research and (2) to demonstrate the usefulness of the micro-randomisation technique for comparing compliance interventions. Simulation studies were used to simulate a large number of clinical trials, in which no embedded trial was used, a micro-randomised embedded trial was used, and a factorial embedded trial was used. Each simulation recorded the operating characteristics of the primary and secondary trials. We show that the type I error rate of the primary analysis was not affected by the presence of an embedded secondary trial. Furthermore, we show that micro-randomisation is superior to a factorial design as it reduces the variation caused by within-patient correlation. It therefore requires smaller sample sizes - our simulations showed a requirement of 128 patients for a micro-randomised trial versus 760 patients for a factorial design, in the presence of within-patient correlation

  6. Telehealth: the backbone of healthcare financing.

    PubMed

    Suleiman, Abu Bakar

    2004-01-01

    Malaysia, like many other countries faces major challenges in meeting increasing demands with limited resources. Changes in demography, life-style diseases, increasing consumer expectations, new medical technologies and rapid economic growth all fuel demand for more healthcare services. There are problems related to the distribution and delivery of healthcare services, and there is inadequate integration of healthcare delivery and continuity of care is a major concern. Resources tend to be concentrated in the very expensive hospital sector, although services would be cost-effectively and conveniently delivered at primary care level. There is no ideal healthcare system, and how healthcare is supported and organized for service delivery influences the country's social, economic and political well-being. Like many other countries, Malaysia is undergoing health reform in meeting these challenges, and is becoming more reliant on telemedicine and telehealth.

  7. Internet-Based Telehealth Assessment of Language Using the CELF-4

    ERIC Educational Resources Information Center

    Waite, Monique C.; Theodoros, Deborah G.; Russell, Trevor G.; Cahill, Louise M.

    2010-01-01

    Purpose: Telehealth has the potential to improve children's access to speech-language pathology services. Validation of telehealth applications, including the assessment of childhood language disorders, is necessary for telehealth to become an accepted alternative mode of service provision. The aim of this study was to validate an Internet-based…

  8. 77 FR 58952 - Exempting In-Home Video Telehealth From Copayments

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-09-25

    ... AFFAIRS 38 CFR Part 17 RIN 2900-AO26 Exempting In-Home Video Telehealth From Copayments AGENCY: Department... care. Specifically, the regulation exempted in-home video telehealth care from having any required...-home video telehealth. VA published a companion substantially identical proposed rule at 77 FR 13236 on...

  9. Being Spontaneous: The Future of Telehealth Implementation?

    PubMed

    Mars, Maurice; Scott, Richard E

    2017-09-01

    The smartphone simplifies interprofessional communication, and smartphone applications can facilitate telemedicine activity. Much has been written about the steps that need to be followed to implement and establish a successful telemedicine service that is integrated into everyday clinical practice. A traditional and systematic approach has evolved incorporating activities such as strategy development, needs assessment, business cases and plans, readiness assessment, implementation plans, change management interventions, and ongoing monitoring and evaluation. This "best practice" has been promoted in the telehealth literature for many years. In contrast, several recent initiatives have arisen without any such formal undertakings. This article describes the strengths and weaknesses of two "spontaneous" telemedicine services in dermatology and burn management that have evolved in South Africa. Two spontaneous services were identified and reviewed. In one unsolicited service, doctors at rural referring hospitals have been taking photographs of skin lesions and sending them with a brief text message history to dermatologists using the instant messaging smartphone app, WhatsApp. In the other, burns service, admissions to the burns unit or the clinic were triaged by telephonic description of the case and completion of a preadmission questionnaire. More recently, management and referral decisions are made only after completion of the questionnaire and subsequent submission of photographs of the burn sent by WhatsApp, with the decision transmitted by text message. Although efficient and effective, potential legal and ethical shortcomings have been identified. These "spontaneous" telehealth services challenge traditional best practice, yet appear to lead to truly integrated practice and, therefore, are successful and warrant further study.

  10. High patient satisfaction with telehealth in Parkinson disease

    PubMed Central

    Spindler, Meredith; Wood, Stephanie M.; Marcus, Steven C.; Weintraub, Daniel; Morley, James F.; Stineman, Margaret G.; Duda, John E.

    2016-01-01

    Abstract Background: Parkinson disease (PD) is a complex neurodegenerative disorder that benefits from specialty care. Telehealth is an innovative resource that can enhance access to this care within a patient-centered framework. Research suggests that telehealth can lead to increased patient satisfaction, equal or better clinical outcomes, and cost savings, but these outcomes have not been well-studied in PD. Methods: We conducted a dual active-arm 12-month randomized controlled trial to assess patient satisfaction, clinical outcomes, travel burden, and health care utilization in PD using video telehealth for follow-up care with specialty providers. Telehealth visits took place either at a facility nearer to the patient (satellite clinic arm) or in the patient's home (home arm). Each control group received usual in-person care. Patient satisfaction, assessed by quantitative questionnaires, was the primary outcome. Results: Eighty-six men were enrolled (home arm: 18 active, 18 control; satellite clinic arm: 26 active, 24 control) with a mean age of 73 years (range 42–87). There were no differences in baseline characteristics between the active group and the controls in each arm (p > 0.05). A significant difference in overall patient satisfaction was not found; however, high levels of patient satisfaction were found in all groups. Greater satisfaction for the telehealth modality was found in assessments of convenience and accessibility/distance. Clinical outcomes were similar between groups, travel burden was reduced using telehealth, and health care utilization was largely similar in both groups. Conclusions: As the need for PD subspecialty care increases, innovative patient-centered solutions to overcoming barriers to access, such as video telehealth, will be invaluable to patients and may provide high patient satisfaction. PMID:27347441

  11. Clinician behaviors in telehealth care delivery: a systematic review.

    PubMed

    Henry, Beverly W; Block, Derryl E; Ciesla, James R; McGowan, Beth Ann; Vozenilek, John A

    2016-10-01

    Literature on telehealth care delivery often addresses clinical, cost, technological, system, and organizational impacts. Less is known about interpersonal behaviors such as communication patterns and therapeutic relationship-building, which may have workforce development considerations. The purpose of this study was to conduct a systematic literature review to identify interpersonal health care provider (HCP) behaviors and attributes related to provider-patient interaction during care in telehealth delivery. Electronic searches were conducted using five indexes/databases: CINAHL, ERIC, PsychInfo, ProQuest Dissertations, PubMed; with hand-searching of the immediate past 10 years of five journals. Search concepts included: communication, telehealth, education, and health care delivery. Of 5261 unique article abstracts initially identified, 338 full-text articles remained after exclusion criteria were applied and these were reviewed for eligibility. Finally, data were extracted from 45 articles. Through qualitative synthesis of the 45 articles, we noted that papers encompassed many disciplines and targeted care to people in many settings including: home care, primary and specialist care, mental health/counseling, and multi-site teams. Interpersonal behaviors were observed though not manipulated through study designs. Six themes were identified: HCP-based support for telehealth delivery; provider-patient interactions during the telehealth event; environmental attributes; and guidelines for education interventions or evaluation of HCP behaviors. Although unable to identify current best practices, important considerations for practice and education did emerge. These include: perceptions of the utility of telehealth; differences in communication patterns such as pace and type of discourse, reliance on visual cues by both provider and patient especially in communicating empathy and building rapport; and confidentiality and privacy in telehealth care delivery.

  12. Medicare Telehealth Services and Nephrology: Policies for Eligibility and Payment.

    PubMed

    Frilling, Stephanie

    2017-01-01

    The criteria for Medicare payment of telehealth nephrology services, and all other Medicare telehealth services, are set forth in section 1834(m) of the Social Security Act. There are just over 80 professional physician or practitioner services that may be furnished via telehealth and paid under Medicare Part B, when an interactive audio and video telecommunication system that permits real-time communication between a beneficiary at the originating site and the physician or practitioner at the distant site substitutes for an in-person encounter. These services include 16 nephrology billing codes for furnishing ESRD services for monthly monitoring and assessment and two billing codes for chronic kidney disease education. In recent years, many mobile health devices and other web-based tools have been developed in support of monitoring, observation, and collaboration for people living with chronic disease. This article reviews the statutory and program guidance that governs Medicare telehealth services, defines payment policy terms (e.g., originating site and distant site), and explains payment policies when telehealth services are furnished.

  13. Telehealth in New Zealand: current practice and future prospects.

    PubMed

    Kerr, Karolyn; Norris, Tony

    2004-01-01

    We have surveyed the current state of telehealth in New Zealand. The survey found 22 telehealth projects active in 2003, compared with 12 identified in a previous survey in 2000. Many projects were small, localized and led by enthusiasts. Sustainability was a problem and many projects had failed to enter routine operation. Teleradiology and telepsychiatry services focused on acute hospitals were the most frequent clinical applications. The majority of projects (9 of the 22) were on the North Island, concentrated around Auckland. Telehealth appears to have special potential for rural communities and for the remote treatment (telecare) of chronic disease. However, the provision of telehealth in New Zealand is patchy and meets the same barriers to success as have been identified elsewhere, which make it difficult to move telehealth into routine operation. The obstacles constitute not so much a failure of individual projects as a lack of a driving force to take advantage of the opportunities. It is to be hoped that a suggested strategic framework can help to harness the opportunities.

  14. Real-time telehealth for COPD self-management using Skype™.

    PubMed

    Nield, Margaret; Hoo, Guy W Soo

    2012-12-01

    The utility of real-time interactive voice and video telehealth for teaching pursed-lips breathing (PLB) in chronic obstructive pulmonary disease (COPD) is unknown. This was a pilot study to determine its feasibility and efficacy on the key variables of social support and dyspnea. A randomized control study design with repeated measures (baseline, 4 and 12 weeks) was used. All participants in the control and intervention groups received PLB instruction at baseline, but only the intervention group received one weekly PLB reinforcement session for 4 weeks via home computer and Skype™ software. Outcome measures were Medical Outcomes Study Social Support Survey and dyspnea assessment (visual analogue scales for intensity and distress, modified Borg after six-minute walk distance, and Shortness of Breath Questionnaire for activity-associated dyspnea). A total of 22 participants with COPD (mean FEV(1)% predicted = 56) were randomized; 16 (9 telehealth, 7 control) completed the protocol. Intent-to-treat analysis at week 4, but not week 12, demonstrated significantly improved total social support (P = 0.02) and emotional/informational subscale (P = 0.03) scores. Dyspnea intensity decreased (P = 0.08) for the intervention group with a minimal clinical important difference of 10.4 units. Analysis of only participants who completed the protocol demonstrated a significant decrease in dyspnea intensity (P = < 0.01) for the intervention group at both week 4 and 12. Real-time telehealth is a feasible, innovative approach for PLB instruction in the home with outcomes of improved social support and decreased dyspnea.

  15. Positive Clinical Outcomes Are Synergistic With Positive Educational Outcomes When Using Telehealth Consulting in General Practice: A Mixed-Methods Study

    PubMed Central

    Bonney, Andrew; Teuss, Grigorijs; Guppy, Michelle; Lafferre, Danielle; Mullan, Judy; Barnett, Stephen

    2016-01-01

    their views. In the analysis of the qualitative data, five themes emerged from the analyses concerning the educational benefits of Telehealth Consulting for different levels of learners, while three themes were identified concerning clinical benefits. Conclusions The results demonstrated strong synergies between the learning derived from the telehealth consulting and the clinical benefits to the patient and clinicians involved. PMID:26858152

  16. Positive Clinical Outcomes Are Synergistic With Positive Educational Outcomes When Using Telehealth Consulting in General Practice: A Mixed-Methods Study.

    PubMed

    Knight, Patricia; Bonney, Andrew; Teuss, Grigorijs; Guppy, Michelle; Lafferre, Danielle; Mullan, Judy; Barnett, Stephen

    2016-02-08

    qualitative data, five themes emerged from the analyses concerning the educational benefits of Telehealth Consulting for different levels of learners, while three themes were identified concerning clinical benefits. The results demonstrated strong synergies between the learning derived from the telehealth consulting and the clinical benefits to the patient and clinicians involved.

  17. Launch Vehicles

    NASA Image and Video Library

    2007-09-09

    Under the goals of the Vision for Space Exploration, Ares I is a chief component of the cost-effective space transportation infrastructure being developed by NASA's Constellation Program. This transportation system will safely and reliably carry human explorers back to the moon, and then onward to Mars and other destinations in the solar system. Launch Pad 39B of the Kennedy Space Flight Center (KSC), currently used for Space Shuttle launches, will be revised to host the Ares launch vehicles. The fixed and rotating service structures standing at the pad will be dismantled sometime after the Ares I-X test flight. A new launch tower for Ares I will be built onto a new mobile launch platform. The gantry for the shuttle doesn't reach much higher than the top of the four segments of the solid rocket booster. Pad access above the current shuttle launch pad structure will not be required for Ares I-X because the stages above the solid rocket booster are inert. For the test scheduled in 2012 or for the crewed flights, workers and astronauts will need access to the highest levels of the rocket and capsule. When the Ares I rocket rolls out to the launch pad on the back of the same crawler-transporters used now, its launch gantry will be with it. The mobile launchers will nestle under three lightning protection towers to be erected around the pad area. Ares time at the launch pad will be significantly less than the three weeks or more the shuttle requires. This “clean pad” approach minimizes equipment and servicing at the launch pad. It is the same plan NASA used with the Saturn V rockets and industry employs it with more modern launchers. The launch pad will also get a new emergency escape system for astronauts, one that looks very much like a roller coaster. Cars riding on a rail will replace the familiar baskets hanging from steel cables. This artist's concept illustrates the Ares I on launch pad 39B.

  18. Launch vehicle

    NASA Astrophysics Data System (ADS)

    Rutledge, William S.

    1994-06-01

    Concentrated efforts by NASA and the DOD to begin development of a new large launch vehicle have been under way for over a decade. Options include the National Launch System, Advanced Launch System, a heavy lift vehicle, a Shuttle-derived vehicle, a Titan-derived vehicle, Single stage To Orbit, NASP and Spacelifter, to name a few. All initially promised low operations costs achieved at development costs in the $5 billion - $10 billion range. However, none has obtained approval for development, primarily because it became apparent that these cost goals could not realistically be met.

  19. Task 4 supporting technology. Part 2: Detailed test plan for thermal seals. Thermal seals evaluation, improvement and test. CAN8-1, Reusable Launch Vehicle (RLV), advanced technology demonstrator: X-33. Leading edge and seals thermal protection system technology demonstration

    NASA Technical Reports Server (NTRS)

    Hogenson, P. A.; Lu, Tina

    1995-01-01

    The objective is to develop the advanced thermal seals to a technology readiness level (TRL) of 6 to support the rapid turnaround time and low maintenance requirements of the X-33 and the future reusable launch vehicle (RLV). This program is divided into three subtasks: (1) orbiter thermal seals operation history review; (2) material, process, and design improvement; and (3) fabrication and evaluation of the advanced thermal seals.

  20. Continuing education training focused on the development of behavioral telehealth competencies in behavioral healthcare providers.

    PubMed

    Gifford, V; Niles, B; Rivkin, I; Koverola, C; Polaha, J

    2012-01-01

    Telehealth allows behavioral health care and specialty services to be extended to rural residents. Telehealth is an important resource for the Alaskan healthcare system, which is tasked with providing services to culturally diverse populations living in remote areas. Training competent providers to deliver telehealth services is vital for the implementation of successful telehealth programs. Yet, the literature is lacking in the area of provider behavioral telehealth competency training. This study assessed the impact of a Behavioral Telehealth Ethical Competencies Training program on 16 behavioral health providers' development of behavioral telehealth competency. A total of 14 competencies were developed, which required participants to understand the roles and responsibilities of a behavioral telehealth coordinator working at the distal site as well as the roles and responsibilities of the therapist. Video vignettes evaluating the 14 competencies, self-reported competence surveys and follow-up surveys of progress on telehealth goals were utilized to assess effects of the training. Results indicated participants' behavioral telehealth competencies increased following training. Participants reported positive perceptions regarding their competency, and achieved progress on the majority of behavioral telehealth goals set during the training. This study provides a baseline for developing a best practice model for behavioral telehealth service delivery by identifying specific provider competencies for administering effective behavioral telehealth services. A unique continuing education training model, led by content experts including university professors and Alaska Native Elders, incorporating behavioral telehealth, rural ethics, cultural competency and vicarious trauma training is described. Lastly, this study details the use of an innovative video vignette assessment instrument for evaluating the effectiveness of continuing education training.

  1. CONDUCTING FUNCTIONAL ANALYSES OF PROBLEM BEHAVIOR VIA TELEHEALTH

    PubMed Central

    Wacker, David P.; Lee, John F.; Padilla Dalmau, Yaniz C.; Kopelman, Todd G.; Lindgren, Scott D.; Kuhle, Jennifer; Pelzel, Kelly E.; Waldron, Debra B.

    2017-01-01

    Behavior consultants conducted functional analyses (FAs) via telehealth with 20 young children with autism spectrum disorders between the ages of 29 and 80 months who displayed problem behavior and lived an average of 222 miles from the tertiary hospital that housed the behavior consultants. Participants’ parents conducted all procedures during weekly telehealth consultations in regional clinics located an average of 15 miles from the participants’ homes. Behavior consultants briefly trained parent assistants to provide on-site support for families during consultations. FAs completed within a multielement design identified environmental variables that maintained problem behavior for 18 of the 20 cases, and interrater agreement averaged over 90%. Results suggested that behavior analysts can conduct FAs effectively and efficiently via telehealth. PMID:24114083

  2. NPP Launch

    NASA Image and Video Library

    NASA's National Polar-orbiting Operational Environmental Satellite System Preparatory Project (NPP) spacecraft was launched aboard a Delta II rocket at 5:48 a.m. EDT today, on a mission to measure ...

  3. Telehealth at UC Davis--a 20-year experience.

    PubMed

    Nesbitt, Thomas S; Dharmar, Madan; Katz-Bell, Jana; Hartvigsen, Gunnar; Marcin, James P

    2013-05-01

    Telehealth at the University of California Health System began as a telefetal monitoring connection with a rural hospital in 1992 and evolved to become the Center for Health and Technology (CHT) in 2000. The Center supports the vision of the University of California Davis (UC Davis) Health System-a healthier world through bold innovation. The CHT focuses on the four pillars of the academic health center: clinical services, research and scholarly work, education, and public service. Since 1996, the Center has provided more than 33,000 telemedicine consultation (excluding teleradiology, telepathology, and phone consultations) in over 30 clinical specialties and at more than 90 locations across California. Research and continuous evaluation have played an integral role in shaping the telehealth program, as well as strategic collaborations and partnerships. In an effort to expand the field of telehealth the CHT provides telehealth training for health professionals, technical specialists, and administrators. Furthermore, it also plays an integral role in workforce development through the education of the next generation of community primary care physicians through Rural Programs In Medical Education (Rural PRIME) and continuing educational programs for working health professionals through videoconferencing and Web-based modalities. The Center is supported through a variety of funding sources, and its sustainability comes from a mix of fee-for-service payment, contracts, grants, gifts, and institutional funding. Together with key partners, UC Davis has educated and informed initiatives resulting in legislation and policies that advance telehealth. Looking toward the future, UC Davis is focused on technology-enabled healthcare and supporting synergy among electronic health records, health information exchange, mobile health, informatics, and telehealth.

  4. Orion Launch

    NASA Image and Video Library

    2014-12-05

    A Delta IV Heavy rocket lifts off from Space Launch Complex 37 at Cape Canaveral Air Force Station in Florida carrying NASA's Orion spacecraft on an unpiloted flight test to Earth orbit. Liftoff was at 7:05 a.m. EST. During the two-orbit, four-and-a-half hour mission, engineers will evaluate the systems critical to crew safety, the launch abort system, the heat shield and the parachute system.

  5. Usability testing of a prototype multi-user telehealth kiosk.

    PubMed

    Courtney, Karen L; Matthews, Judith T; McMillan, Julie M; Person Mecca, Laurel; Smailagic, Asim; Siewiorek, Daniel

    2015-01-01

    The overall purpose of this study was to learn how community-dwelling older adults would interact with our prototype multi-user telehealth kiosk and their views about its usability. Seven subjects participated in laboratory-based usability sessions to evaluate the physical design, appearance, functionality and perceived ease of use of a multi-user telehealth kiosk prototype. During usability testing participants recommended 18 new features (29% of comments), identified 15 software errors (23% of comments) and 29 user interface errors (47% of comments).

  6. Experiences with Launch Vehicles

    NASA Technical Reports Server (NTRS)

    Dumbacher, Daniel L.

    2006-01-01

    The presentation "NASA Experience with Launch Vehicles" is a compilation of Mr. Dumbacher's career experiences with the Space Shuttle Program, the Delta - Clipper Experimental flight test project, the X-33 demonstrator project, and recent experiences with the Orbital Spaceplane Program agd the current NASA effort on Exploration Launch Systems. Mr. Dumbacher will discuss his personal experiences and provide lessons learned from each program. The accounts provided by Mr. Dumbacher are his own and do not necessarily represent the official NASA position.

  7. Launch Vehicles

    NASA Image and Video Library

    1961-01-01

    This is a comparison illustration of the Redstone, Jupiter-C, and Mercury Redstone launch vehicles. The Redstone ballistic missile was a high-accuracy, liquid-propelled, surface-to-surface missile. Originally developed as a nose cone re-entry test vehicle for the Jupiter intermediate range ballistic missile, the Jupiter-C was a modification of the Redstone missile and successfully launched the first American Satellite, Explorer-1, in orbit on January 31, 1958. The Mercury Redstone lifted off carrying the first American, astronaut Alan Shepard, in his Mercury spacecraft Freedom 7, on May 5, 1961.

  8. Telehealth Business: Boom Times, but Profits May Wait.

    PubMed

    Calandra, Robert

    2017-04-01

    What we have here is irrational telehealth exuberance. Investors are plowing millions into startups. And even though millennials could be eager adopters, these are still early days for the industry. It may take years-and some regulatory changes-for profits to materialize.

  9. Attitudes toward Telehealth Use among Rural Residents: A Danish Survey

    ERIC Educational Resources Information Center

    Sorensen, Jens F. L.

    2008-01-01

    Context: Rural communities tend to be underserved by medical services. Low access to medical services affects quality of life and may also affect settlement decisions. The use of telehealth has often been mentioned as an alternative way to provide health care services in remote, underserved areas. One prerequisite for successful delivery of health…

  10. TeleCITE: Telehealth--A Cochlear Implant Therapy Exchange

    ERIC Educational Resources Information Center

    Stith, Joanna; Stredler-Brown, Arlene; Greenway, Pat; Kahn, Gary

    2012-01-01

    What might bring the efforts of a physician, a speech-language pathologist, a teacher of the deaf and hard of hearing, and a nurse together? The answer is the innovative use of telepractice to deliver high quality, family-centered early intervention to infants and toddlers with hearing loss. TeleCITE: Telehealth--A Cochlear Implant Therapy…

  11. Bridging the Gap: Telehealth in Profoundly Rural America.

    ERIC Educational Resources Information Center

    Holderegger, John; Fortune, Jon; Fortune, Barbara

    This report describes the activities and outcomes of a pioneering Telehealth project in which clinical psychologists use state of the art satellite technology to consult with paraprofessionals who live and provide treatment settings to persons with the dual diagnosis of developmental disabilities and mental illnesses. The goal is to provide early…

  12. Telehealth: Families Finding Ways to Connect in Rural Colorado

    ERIC Educational Resources Information Center

    Kaiser, Kristen

    2011-01-01

    JFK Partners, at the University of Colorado Denver, School of Medicine, is currently implementing a study on the use of telehealth (receiving treatment or services using videoconferencing technology, such as Skype) and youth with autism spectrum disorder (ASD) and anxiety. The study is an exploratory grant from Health Resources and Services…

  13. Attitudes toward Telehealth Use among Rural Residents: A Danish Survey

    ERIC Educational Resources Information Center

    Sorensen, Jens F. L.

    2008-01-01

    Context: Rural communities tend to be underserved by medical services. Low access to medical services affects quality of life and may also affect settlement decisions. The use of telehealth has often been mentioned as an alternative way to provide health care services in remote, underserved areas. One prerequisite for successful delivery of health…

  14. Video telehealth for weight maintenance of African-American women.

    PubMed

    Gerber, Ben S; Schiffer, Linda; Brown, Allison A; Berbaum, Michael L; Rimmer, James H; Braunschweig, Carol L; Fitzgibbon, Marian L

    2013-07-01

    We evaluated the effect of home telehealth on weight maintenance after a group-based weight loss programme. The home telehealth intervention comprised telephone counselling and home Internet-enabled digital video recorders (DVRs) with three channels of video programmes. The video content provided reinforcement and support to promote problem solving, prevent relapse and sustain motivation. Eighty-eight obese or overweight African-American women were randomized to receive monthly telephone counselling (control) or the home telehealth intervention. The weight change during maintenance was not significant in either group (0.6 kg in the intervention group, 0.0 kg in the control group), and there was no significant difference between them. Changes in diet, physical activity, social support and self-efficacy during the maintenance period did not differ significantly between groups. DVR use was low: during the intervention, the number of valid DVR viewings ranged from zero to 42 per person. DVR use was positively associated with previous attendance at the weight loss classes. Home video-based telehealth is a new method of delivering a weight loss maintenance intervention to African-American women. It had no effect on weight maintenance in the present study.

  15. Sustainable Rural Telehealth Innovation: A Public Health Case Study

    PubMed Central

    Singh, Rajendra; Mathiassen, Lars; Stachura, Max E; Astapova, Elena V

    2010-01-01

    Objective To examine adoption of telehealth in a rural public health district and to explain how the innovation became sustainable. Study Setting Longitudinal, qualitative study (1988–2008) of the largest public health district in Georgia. Study Design Case study design provided deep insights into the innovation's social dynamics. Punctuated equilibrium theory helped present and make sense of the process. We identified antecedent conditions and outcomes, and we distinguished between episodes and encounters based on the disruptive effects of events. Data Collection Twenty-five semistructured interviews with 19 decision makers and professionals, direct observations, published papers, grant proposals, technical specifications, and other written materials. Principal Findings Strong collaboration within the district, with local community, and with external partners energized the process. Well-functioning outreach clinics made telehealth desirable. Local champions cultivated participation and generative capability, and overcame barriers through opportunistic exploitation of technological and financial options. Telehealth usage fluctuated between medical and administrative operations in response to internal needs and contextual dynamics. External agencies provided initial funding and supported later expansion. Conclusions Extensive internal and external collaboration, and a combination of technology push and opportunistic exploitation, can enable sustainable rural telehealth innovation. PMID:20459449

  16. Experience of Home Telehealth Technology in Older Patients With Diabetes.

    PubMed

    Chang, Chi-Ping; Lee, Ting-Ting; Mills, Mary Etta

    2017-10-01

    The incidence of diabetes, a common chronic disease among older adults, is increasing annually. The lack of blood glucose regulation can result in severe diabetes-related complications and substantial healthcare costs, making self-care programs specific to this population especially important. Combined with reduced numbers of healthcare professionals, the integration of healthcare and information technology and the older adults' adoption of telehealth services have become increasingly important. This study used a qualitative method to interview 18 older study participants who used a telehealth service. Subject perceptions and suggestions regarding using such a service for diabetes management were investigated. Content analysis was used to examine the interview data and determine the older patients' acceptance and perceived benefits of telehealth service. Four main themes emerged: (1) initial trial encouragement from the doctors, nurses, and financial incentives; (2) enhanced self-management capability through continuous device use for better outcomes; (3) ambivalent feelings regarding dependence on others for problem solving; and (4) consideration for continual technology use for an uncertain future. These results serve as a reference for promoting, assessing, and verifying telehealth models for older patients with diabetes.

  17. Telehealth: Families Finding Ways to Connect in Rural Colorado

    ERIC Educational Resources Information Center

    Kaiser, Kristen

    2011-01-01

    JFK Partners, at the University of Colorado Denver, School of Medicine, is currently implementing a study on the use of telehealth (receiving treatment or services using videoconferencing technology, such as Skype) and youth with autism spectrum disorder (ASD) and anxiety. The study is an exploratory grant from Health Resources and Services…

  18. Video telehealth for weight maintenance of African-American women

    PubMed Central

    Gerber, Ben S; Schiffer, Linda; Brown, Allison A; Berbaum, Michael L; Rimmer, James H; Braunschweig, Carol L; Fitzgibbon, Marian L

    2013-01-01

    Summary We evaluated the effect of home telehealth on weight maintenance after a group-based weight loss programme. The home telehealth intervention comprised telephone counselling and home Internet-enabled digital video recorders (DVRs) with three channels of video programmes. The video content provided reinforcement and support to promote problem solving, prevent relapse, and sustain motivation. Eighty-eight obese or overweight African-American women were randomized to receive monthly telephone counselling (control) or the home telehealth intervention. The weight change during maintenance was not significant in either group (0.6 kg in the intervention group, 0.0 kg in the control group), and there was no significant difference between them. Changes in diet, physical activity, social support and self-efficacy during the maintenance period did not differ significantly between groups. DVR use was low: during the intervention, the number of valid DVR viewings ranged from zero to 42 per person. DVR use was positively associated with previous attendance at the weight loss classes. Home video-based telehealth is a new method of delivering a weight loss maintenance intervention to African-American women. It had no effect on weight maintenance in the present study. PMID:24163236

  19. TeleCITE: Telehealth--A Cochlear Implant Therapy Exchange

    ERIC Educational Resources Information Center

    Stith, Joanna; Stredler-Brown, Arlene; Greenway, Pat; Kahn, Gary

    2012-01-01

    What might bring the efforts of a physician, a speech-language pathologist, a teacher of the deaf and hard of hearing, and a nurse together? The answer is the innovative use of telepractice to deliver high quality, family-centered early intervention to infants and toddlers with hearing loss. TeleCITE: Telehealth--A Cochlear Implant Therapy…

  20. Clinician Behaviors in Telehealth Care Delivery: A Systematic Review

    ERIC Educational Resources Information Center

    Henry, Beverly W.; Block, Derryl E.; Ciesla, James R.; McGowan, Beth Ann; Vozenilek, John A.

    2017-01-01

    Literature on telehealth care delivery often addresses clinical, cost, technological, system, and organizational impacts. Less is known about interpersonal behaviors such as communication patterns and therapeutic relationship-building, which may have workforce development considerations. The purpose of this study was to conduct a systematic…

  1. 42 CFR 414.65 - Payment for telehealth services.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 3 2011-10-01 2011-10-01 false Payment for telehealth services. 414.65 Section 414.65 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM PAYMENT FOR PART B MEDICAL AND OTHER HEALTH SERVICES Physicians and Other...

  2. 42 CFR 414.65 - Payment for telehealth services.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 3 2010-10-01 2010-10-01 false Payment for telehealth services. 414.65 Section 414.65 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM PAYMENT FOR PART B MEDICAL AND OTHER HEALTH SERVICES Physicians and Other...

  3. DEMONSTRATION OF BIODEGRADATION OF DENSE, NONAQUEOUS-PHASE LIQUIDS (DNAPL)THROUGH BIOSTIMULATION AND BIOAUGMENTATION AT LAUNCH COMPLEX 34 IN CAPE CANAVERAL AIR FORCE STATION, FLORIDA

    EPA Science Inventory

    Biostimulation involves stimulating indigenous microbial cultures by adding nutrients whereas bioaugmentation involves introducing microbial cultures that are particularly adept at degrading these contaminants into the target aquifer. This demonstration involved biostimulation fo...

  4. DEMONSTRATION OF BIODEGRADATION OF DENSE, NONAQUEOUS-PHASE LIQUIDS (DNAPL)THROUGH BIOSTIMULATION AND BIOAUGMENTATION AT LAUNCH COMPLEX 34 IN CAPE CANAVERAL AIR FORCE STATION, FLORIDA

    EPA Science Inventory

    Biostimulation involves stimulating indigenous microbial cultures by adding nutrients whereas bioaugmentation involves introducing microbial cultures that are particularly adept at degrading these contaminants into the target aquifer. This demonstration involved biostimulation fo...

  5. Asynchronous telehealth: a scoping review of analytic studies.

    PubMed

    Deshpande, Amol; Khoja, Shariq; Lorca, Julio; McKibbon, Ann; Rizo, Carlos; Husereau, Donald; Jadad, Alejandro R

    2009-06-02

    Asynchronous telehealth captures clinically important digital samples (e.g., still images, video, audio, text files) and relevant data in one location and subsequently transmits these files for interpretation at a remote site by health professionals without requiring the simultaneous presence of the patient involved and his or her health care provider. Its utility in the health care system, however, still remains poorly defined. We conducted this scoping review to determine the impact of asynchronous telehealth on health outcomes, process of care, access to health services, and health resources. A search was performed up to December 2006 of MEDLINE, CINAHL, HealthSTAR, the Database of Abstracts of Reviews of Effectiveness, and The Cochrane Library. Studies were included if they contained original data on the use of asynchronous telehealth and were published in English in a peer-reviewed journal. Two independent reviewers screened all articles and extracted data, reaching consensus on the articles and data identified. Data were extracted on general study characteristics, clinical domain, technology, setting, category of outcome, and results. Study quality (internal validity) was assessed using the Jadad scale for randomized controlled trials and the Downs and Black index for non-randomized studies. Summary data were categorized by medical specialty and presented qualitatively. The scoping review included 52 original studies from 238 citations identified; of these 52, almost half focused on the use of telehealth in dermatology. Included studies were characterized by diverse designs, interventions, and outcomes. Only 16 studies were judged to be of high quality. Most studies showed beneficial effects in terms of diagnostic accuracy, wait times, referral management, and satisfaction with services. Evidence on the impact of asynchronous telehealth on resource use in dermatology suggests a reduction in the number of, or avoidance of, in-person visits. Reports from other

  6. Asynchronous telehealth: a scoping review of analytic studies

    PubMed Central

    Deshpande, Amol; Khoja, Shariq; Lorca, Julio; McKibbon, Ann; Rizo, Carlos; Husereau, Donald; Jadad, Alejandro R

    2009-01-01

    Background Asynchronous telehealth captures clinically important digital samples (e.g., still images, video, audio, text files) and relevant data in one location and subsequently transmits these files for interpretation at a remote site by health professionals without requiring the simultaneous presence of the patient involved and his or her health care provider. Its utility in the health care system, however, still remains poorly defined. We conducted this scoping review to determine the impact of asynchronous telehealth on health outcomes, process of care, access to health services, and health resources. Methods A search was performed up to December 2006 of MEDLINE, CINAHL, HealthSTAR, the Database of Abstracts of Reviews of Effectiveness, and The Cochrane Library. Studies were included if they contained original data on the use of asynchronous telehealth and were published in English in a peer-reviewed journal. Two independent reviewers screened all articles and extracted data, reaching consensus on the articles and data identified. Data were extracted on general study characteristics, clinical domain, technology, setting, category of outcome, and results. Study quality (internal validity) was assessed using the Jadad scale for randomized controlled trials and the Downs and Black index for non-randomized studies. Summary data were categorized by medical specialty and presented qualitatively. Results The scoping review included 52 original studies from 238 citations identified; of these 52, almost half focused on the use of telehealth in dermatology. Included studies were characterized by diverse designs, interventions, and outcomes. Only 16 studies were judged to be of high quality. Most studies showed beneficial effects in terms of diagnostic accuracy, wait times, referral management, and satisfaction with services. Evidence on the impact of asynchronous telehealth on resource use in dermatology suggests a reduction in the number of, or avoidance of, in

  7. Launching "Dunno"

    ERIC Educational Resources Information Center

    Inson, Peter

    2005-01-01

    This article, written in response to an invitation from "CLE," describes the origins and controversial content of "dunno," a first novel, self-published by Peter Inson, a former teacher and headmaster. Inson considers influences upon his writing, the thinking which led him towards self-publication and the process of personally launching and…

  8. Integrating telemedicine and telehealth: putting it all together.

    PubMed

    Weinstein, Ronald S; Lopez, Ana Maria; Krupinski, Elizabeth A; Beinar, Sandra J; Holcomb, Michael; McNeely, Richard A; Latifi, Rifat; Barker, Gail

    2008-01-01

    Telemedicine and telehealth programs are inherently complex compared with their traditional on-site health care delivery counterparts. Relatively few organizations have developed sustainable, multi-specialty telemedicine programs, although single service programs, such as teleradiology and telepsychiatry programs, are common. A number of factors are barriers to the development of sustainable telemedicine and telehealth programs. First, starting programs is often challenging since relatively few organizations have, in house, a critical mass of individuals with the skill sets required to organize and manage a telemedicine program. Therefore, it is necessary to "boot strap" many of the start-up activities using available personnel. Another challenge is to assemble a management team that has time to champion telemedicine and telehealth while dealing with the broad range of issues that often confront telemedicine programs. Telemedicine programs housed within a single health care delivery system have advantages over programs that serve as umbrella telehealth organizations for multiple health care systems. Planning a telemedicine program can involve developing a shared vision among the participants, including the parent organizations, management, customers and the public. Developing shared visions can be a time-consuming, iterative process. Part of planning includes having the partnering organizations and their management teams reach a consensus on the initial program goals, priorities, strategies, and implementation plans. Staffing requirements of telemedicine and telehealth programs may be met by sharing existent resources, hiring additional personnel, or outsourcing activities. Business models, such as the Application Service Provider (ASP) model used by the Arizona Telemedicine Program, are designed to provide staffing flexibility by offering a combination of in-house and out-sourced services, depending on the needs of the individual participating health care

  9. The organising vision for telehealth and telecare: discourse analysis

    PubMed Central

    Procter, Rob; Wherton, Joe; Sugarhood, Paul; Shaw, Sara

    2012-01-01

    Objective To (1) map how different stakeholders understand telehealth and telecare technologies and (2) explore the implications for development and implementation of telehealth and telecare services. Design Discourse analysis. Sample 68 publications representing diverse perspectives (academic, policy, service, commercial and lay) on telehealth and telecare plus field notes from 10 knowledge-sharing events. Method Following a familiarisation phase (browsing and informal interviews), we studied a systematic sample of texts in detail. Through repeated close reading, we identified assumptions, metaphors, storylines, scenarios, practices and rhetorical positions. We added successive findings to an emerging picture of the whole. Main findings Telehealth and telecare technologies featured prominently in texts on chronic illness and ageing. There was no coherent organising vision. Rather, four conflicting discourses were evident and engaged only minimally with one another's arguments. Modernist discourse presented a futuristic utopian vision in which assistive technologies, implemented at scale, would enable society to meet its moral obligations to older people by creating a safe ‘smart’ home environment where help was always at hand, while generating efficiency savings. Humanist discourse emphasised the uniqueness and moral worth of the individual and tailoring to personal and family context; it considered that technologies were only sometimes fit for purpose and could create as well as solve problems. Political economy discourse envisaged a techno-economic complex of powerful vested interests driving commodification of healthcare and diversion of public funds into private business. Change management discourse recognised the complicatedness of large-scale technology programmes and emphasised good project management and organisational processes. Conclusion Introduction of telehealth and telecare is hampered because different stakeholders hold different assumptions

  10. The organising vision for telehealth and telecare: discourse analysis.

    PubMed

    Greenhalgh, Trisha; Procter, Rob; Wherton, Joe; Sugarhood, Paul; Shaw, Sara

    2012-01-01

    To (1) map how different stakeholders understand telehealth and telecare technologies and (2) explore the implications for development and implementation of telehealth and telecare services. Discourse analysis. 68 publications representing diverse perspectives (academic, policy, service, commercial and lay) on telehealth and telecare plus field notes from 10 knowledge-sharing events. Following a familiarisation phase (browsing and informal interviews), we studied a systematic sample of texts in detail. Through repeated close reading, we identified assumptions, metaphors, storylines, scenarios, practices and rhetorical positions. We added successive findings to an emerging picture of the whole. Telehealth and telecare technologies featured prominently in texts on chronic illness and ageing. There was no coherent organising vision. Rather, four conflicting discourses were evident and engaged only minimally with one another's arguments. Modernist discourse presented a futuristic utopian vision in which assistive technologies, implemented at scale, would enable society to meet its moral obligations to older people by creating a safe 'smart' home environment where help was always at hand, while generating efficiency savings. Humanist discourse emphasised the uniqueness and moral worth of the individual and tailoring to personal and family context; it considered that technologies were only sometimes fit for purpose and could create as well as solve problems. Political economy discourse envisaged a techno-economic complex of powerful vested interests driving commodification of healthcare and diversion of public funds into private business. Change management discourse recognised the complicatedness of large-scale technology programmes and emphasised good project management and organisational processes. Introduction of telehealth and telecare is hampered because different stakeholders hold different assumptions, values and world views, 'talk past' each other and compete for

  11. 3D visualization environment for analysis of telehealth indicators in public health.

    PubMed

    Filho, Amadeu S Campos; Novaes, Magdala A; Gomes, Alex S

    2013-01-01

    With the growth of telehealth applications and the need for public health managers to have tools that facilitate visualization of indicators produced by telehealth services arose the need to have simple systems to better planning the interventions. Furthermore, Health systems are considers difficult in order to visualize the right information by many health professionals [1] because of the complexity of its Graphical User Interface (GUI) and the high cognitive load needed to handle it. To overcome this problem, we have proposed a 3D environment for the analysis of telehealth indicators in public health by managers of public health sites. Users who will use the environment are part of public health manager of family health sites that participate of Network of Telehealth Centers of Pernambuco (RedeNUTES) [2] that is part of Brazil telehealth program. This paper aims to present a 3D environment for analysis of telehealth indicators by public health manager.

  12. Narrative as a Means of Understanding the Multi-Dimensional Benefits of Telehealth: An Exploration of Telehealth Stories

    ERIC Educational Resources Information Center

    Carter, Lorraine Mary; Muir, Linda; McLean, Doris

    2011-01-01

    Telehealth is a wide range of health services delivered across distance through technology. In this technology-supported health world, sometimes, the client and his or her family can get lost as clinical consultations are counted for reporting purposes and new technologies are implemented. As a response to this situation and building on the…

  13. Narrative as a Means of Understanding the Multi-Dimensional Benefits of Telehealth: An Exploration of Telehealth Stories

    ERIC Educational Resources Information Center

    Carter, Lorraine Mary; Muir, Linda; McLean, Doris

    2011-01-01

    Telehealth is a wide range of health services delivered across distance through technology. In this technology-supported health world, sometimes, the client and his or her family can get lost as clinical consultations are counted for reporting purposes and new technologies are implemented. As a response to this situation and building on the…

  14. Trials and tribulations: a small pilot telehealth home care program for medicare patients.

    PubMed

    Walsh, Maureen; Coleman, John R

    2005-01-01

    This article describes a home care agency's experience initiating the technology of a telehealth program for a selected view of its home care patients. The goal of the telehealth program was to improve patient outcomes by augmenting patients' regularly scheduled in-home skilled nursing visits with video-conferencing encounters. Patient selection, costs, projected savings, patient satisfaction, and the technical, clinical, and patient problems with the telehealth system are discussed.

  15. Launch vehicles

    NASA Astrophysics Data System (ADS)

    Moss, J. B.

    The basic principles which determine launcher design and hence constrain the spacecraft payload are determined. Some key features of the principal launcher alternatives in Europe and the U.S., namely, the unmanned, expendable Ariane and the manned, substantially reusable, Space Shuttle, are outlined. The equations of motion of the rocket are specialized to the vertical plane, parallel and normal to the flight direction, and to the motion of the center of mass and the pitch rotation. A typical Ariane 2 flight profile for transfer into GTO is illustrated. Some representative mission requirements for spacecraft launches are reviewed. Launch vehicle burnout velocities for spacecraft emplacement are given. Geostationary orbit emplacement, orbital mission performance, and configuration interactions are discussed.

  16. LADEE Launch

    NASA Image and Video Library

    2013-09-07

    NASA's Lunar Atmosphere and Dust Environment Explorer (LADEE) observatory launches aboard the Minotaur V rocket from the Mid-Atlantic Regional Spaceport (MARS) at NASA's Wallops Flight Facility, Friday, Sept. 6, 2013 in Virginia. LADEE is a robotic mission that will orbit the moon where it will provide unprecedented information about the environment around the moon and give scientists a better understanding of other planetary bodies in our solar system and beyond. Photo Credit: (NASA/Carla Cioffi)

  17. Launch Vehicles

    NASA Image and Video Library

    2004-04-15

    The Titan II liftoff. The Titan II launch vehicle was used for carrying astronauts on the Gemini mission. The Gemini Program was an intermediate step between the Project Mercury and the Apollo Program. The major objectives were to subject are two men and supporting equipment to long duration flights, to effect rendezvous and docking with other orbiting vehicle, and to perfect methods of reentry, and landing the spacecraft.

  18. Awareness, experiences and perceptions of telehealth in a rural Queensland community.

    PubMed

    Bradford, Natalie K; Caffery, Liam J; Smith, Anthony C

    2015-09-28

    Telehealth can offer alternative options for receiving healthcare services in rural locations, improving access and reducing costs associated with traveling for services. However, the full potential of telehealth has not been realised with slow and fragmented uptake. This study describes the awareness, experiences and perceptions of telehealth in an Australian rural community. Semi-structured interviews were undertaken with 47 participants from three rural towns in the Darling Downs region of Queensland. Content analysis was used to abstract themes and core concepts from the interviews. Three participants were healthcare providers who had all previously used telehealth in their clinical practice. Twenty-seven (57 %) participants regularly travelled to access specialist healthcare. While 28 (60 %) participants were aware of telehealth, only six (13 %) had actually used telehealth services; three as patients and three as healthcare providers. Major themes evident included: acceptance of the need to travel; paternalism and empowerment; and trust and misconceptions. For telehealth initiatives to be successful, there needs to be greater public awareness and understanding of the potential benefits of telehealth. Empowering patients as partners in the delivery of healthcare may be an important factor in the growth of telehealth services.

  19. The Church as a Bridge to Deliver Health Resources Via Telehealth

    ClinicalTrials.gov

    2016-05-11

    Obesity; Diet, Food, and Nutrition; Church; Healthcare Disparities; Minority Health; Mobile Health; Telehealth; Community-based Participatory Research; Primary Health Care; Weight Loss Programs; Health Behavior

  20. Telehealth and Medicare: Payment Policy, Current Use, and Prospects for Growth

    PubMed Central

    Gilman, Matlin; Stensland, Jeff

    2013-01-01

    Objective Evaluate the growth in various types of Medicare-paid telehealth services. Background There has been a long-standing hope that telehealth could be used to reduce rural patients’ travel times to specialty physicians. Medicare covers telehealth services provided through live, interactive videoconferencing between a beneficiary located at a certified rural site and a distant practitioner. Methods We analyzed 100% of telehealth Medicare claims for 2009 matched to individual patient ZIP codes and individual provider characteristics. Results Despite increases in Medicare payment rates for telehealth services, expansions of covered services, reductions in provider requirements, and provisions of federal grants to encourage telehealth, growth in adoption of telehealth among providers has been modest. Medicare claims indicate that only 369 providers had 10 or more Medicare telehealth consultations in 2009. Roughly half of the 369 were mental health professionals, and about one-in-five of the 369 were non-physician professionals (e.g., physician assistants and nurse practitioners). On balance, the strong areas of telehealth are mental health and, surprisingly, nonphysician professionals. The comparative advantage of mental health could be the verbal (rather than physical contact) nature of mental health care, and the comparative advantage of non-physician professionals could be their lower labor costs. PMID:24834368

  1. Telehealth and Medicare: payment policy, current use, and prospects for growth.

    PubMed

    Gilman, Matlin; Stensland, Jeff

    2013-01-01

    Evaluate the growth in various types of Medicare-paid telehealth services. There has been a long-standing hope that telehealth could be used to reduce rural patients' travel times to specialty physicians. Medicare covers telehealth services provided through live, interactive videoconferencing between a beneficiary located at a certified rural site and a distant practitioner. We analyzed 100% of telehealth Medicare claims for 2009 matched to individual patient ZIP codes and individual provider characteristics. Despite increases in Medicare payment rates for telehealth services, expansions of covered services, reductions in provider requirements, and provisions of federal grants to encourage telehealth, growth in adoption of telehealth among providers has been modest. Medicare claims indicate that only 369 providers had 10 or more Medicare telehealth consultations in 2009. Roughly half of the 369 were mental health professionals, and about one-in-five of the 369 were non-physician professionals (e.g., physician assistants and nurse practitioners). On balance, the strong areas of telehealth are mental health and, surprisingly, nonphysician professionals. The comparative advantage of mental health could be the verbal (rather than physical contact) nature of mental health care, and the comparative advantage of non-physician professionals could be their lower labor costs.

  2. Discovering untapped relationship potential with patients in telehealth: a qualitative interview study

    PubMed Central

    Wolf, Axel; Ali, Lilas; Sonntag, Steffen Mark; Ekman, Inger

    2016-01-01

    Objectives To explore factors that influence relationship building between telehealth professionals and patients with chronic illness over a distance, from a telehealth professional's perspective. Design 4 focus group interviews were conducted in June 2014. Digital recordings were transcribed verbatim and qualitative content analysis was performed using an iterative process of 3 coding rounds. Participants 20 telehealth professionals. Setting A telehealth service centre in the south of Germany that provided care for 12 000 patients with chronic heart failure across Germany. Results Non-video telehealth technology creates an atmosphere that fosters sharing of personal information and a non-judgemental attitude. This facilitates the delivery of fair and equal healthcare. A combination of a protocol-driven service structure along with shared team and organisational values provide a basis for establishing long-term healthcare relationships. However, each contact between a telehealth professional and a patient has an uncertain outcome and requires skilful negotiation of the relationship. Although care provision was personalised, there was scope to include the patients as ‘experts on their own illness’ to a greater extent as advocated by person-centred care. Currently, provision of person-centred care is not sufficiently addressed in telehealth professional training. Conclusions Telehealth offers a viable environment for the delivery of person-centred care for patients with long-standing disease. Current telehealth training programmes may be enhanced by teaching person-centred care skills. PMID:26936904

  3. Use of telehealth for health care of Indigenous peoples with chronic conditions: a systematic review.

    PubMed

    Fraser, Sarah; Mackean, Tamara; Grant, Julian; Hunter, Kate; Towers, Kurt; Ivers, Rebecca

    2017-01-01

    Telehealth may be a cost effective modality in healthcare delivery, but how well used or how appropriate it is for the care of Indigenous peoples is unclear. This review examines the evidence for telehealth in facilitating chronic conditions management with Indigenous peoples. Databases were systematically searched for qualitative or quantitative primary research studies that investigated telehealth use for chronic conditions management with Indigenous peoples worldwide. Evidence of effectiveness was by consumer health outcomes, evidence of acceptability was through consumer and user perception, and health service feasibility was evident by service impact. Data were assessed for quality and data extracted using pre-defined tools. Articles (n=32) examined effectiveness (n=11), critiqued telehealth from the perspectives of the client (n=10) and healthcare professionals (n=8), and examined feasibility (n=12). Studies reported Indigenous people tend to be satisfied with telehealth, but are sceptical about its cultural safety. Evidence for the effectiveness of telehealth from a western biomedical perspective was found. Telehealth is promising; however, a lack of robust studies in this review make tangible conclusions difficult. A better overall understanding of telehealth use with Indigenous peoples, including delivery of culturally competent health care, true consultation and cultural competency of the professionals involved, would be helpful. Telehealth may have the potential to improve health care for Indigenous people, however the modality needs to be culturally competent and the care received must be culturally safe.

  4. Telehealth and eHealth in nurse practitioner training: current perspectives

    PubMed Central

    Rutledge, Carolyn M; Kott, Karen; Schweickert, Patty A; Poston, Rebecca; Fowler, Christianne; Haney, Tina S

    2017-01-01

    Telehealth is becoming a vital process for providing access to cost-effective quality care to patients at a distance. As such, it is important for nurse practitioners, often the primary providers for rural and disadvantaged populations, to develop the knowledge, skills, and attitudes needed to utilize telehealth technologies in practice. In reviewing the literature, very little information was found on programs that addressed nurse practitioner training in telehealth. This article provides an overview of both the topics and the techniques that have been utilized for training nurse practitioners and nurse practitioner students in the delivery of care utilizing telehealth. Specifically, this article focuses on topics including 1) defining telehealth, 2) telehealth etiquette, 3) interprofessional collaboration, 4) regulations, 5) reimbursement, 6) security/Health Insurance Portability and Accountability Act (HIPAA), 7) ethical practice in telehealth, and 8) satisfaction of patients and providers. A multimodal approach based on a review of the literature is presented for providing the training: 1) didactics, 2) simulations including standardized patient encounters, 3) practice immersions, and 4) telehealth projects. Studies found that training using the multimodal approach allowed the students to develop comfort, knowledge, and skills needed to embrace the utilization of telehealth in health care. PMID:28721113

  5. Telehealth and eHealth in nurse practitioner training: current perspectives.

    PubMed

    Rutledge, Carolyn M; Kott, Karen; Schweickert, Patty A; Poston, Rebecca; Fowler, Christianne; Haney, Tina S

    2017-01-01

    Telehealth is becoming a vital process for providing access to cost-effective quality care to patients at a distance. As such, it is important for nurse practitioners, often the primary providers for rural and disadvantaged populations, to develop the knowledge, skills, and attitudes needed to utilize telehealth technologies in practice. In reviewing the literature, very little information was found on programs that addressed nurse practitioner training in telehealth. This article provides an overview of both the topics and the techniques that have been utilized for training nurse practitioners and nurse practitioner students in the delivery of care utilizing telehealth. Specifically, this article focuses on topics including 1) defining telehealth, 2) telehealth etiquette, 3) interprofessional collaboration, 4) regulations, 5) reimbursement, 6) security/Health Insurance Portability and Accountability Act (HIPAA), 7) ethical practice in telehealth, and 8) satisfaction of patients and providers. A multimodal approach based on a review of the literature is presented for providing the training: 1) didactics, 2) simulations including standardized patient encounters, 3) practice immersions, and 4) telehealth projects. Studies found that training using the multimodal approach allowed the students to develop comfort, knowledge, and skills needed to embrace the utilization of telehealth in health care.

  6. Launch Vehicles

    NASA Image and Video Library

    2007-07-09

    Under the goals of the Vision for Space Exploration, Ares I is a chief component of the cost-effective space transportation infrastructure being developed by NASA's Constellation Program. This transportation system will safely and reliably carry human explorers back to the moon, and then onward to Mars and other destinations in the solar system. The Ares I effort includes multiple project element teams at NASA centers and contract organizations around the nation, and is managed by the Exploration Launch Projects Office at NASA's Marshall Space Flight Center (MFSC). ATK Launch Systems near Brigham City, Utah, is the prime contractor for the first stage booster. ATK's subcontractor, United Space Alliance of Houston, is designing, developing and testing the parachutes at its facilities at NASA's Kennedy Space Center in Florida. NASA's Johnson Space Center in Houston hosts the Constellation Program and Orion Crew Capsule Project Office and provides test instrumentation and support personnel. Together, these teams are developing vehicle hardware, evolving proven technologies, and testing components and systems. Their work builds on powerful, reliable space shuttle propulsion elements and nearly a half-century of NASA space flight experience and technological advances. Ares I is an inline, two-stage rocket configuration topped by the Crew Exploration Vehicle, its service module, and a launch abort system. In this HD video image, an Ares I x-test involves the upper stage separating from the first stage. This particular test was conducted at the NASA Langley Research Center in July 2007. (Highest resolution available)

  7. The Malaysian Telehealth Flagship Application: a national approach to health data protection and utilisation and consumer rights.

    PubMed

    Mohan, Jai; Razali Raja Yaacob, Raja

    2004-03-31

    Telehealth refers to the integration of information, telecommunication, human-machine interface technologies and health technologies to deliver health care, to promote the heath status of the people and to create health. The Malaysian Telehealth Application will, on completion, provide every resident of the country an electronic Lifetime Health Record (LHR) and Lifetime Health Plan (LHP). He or she will also hold a smart card that will contain a subset of the data in the Lifetime Health Record. These will be the means by which Malaysians will receive "seamless continuous quality care" across a range of health facilities and health care providers, and by which Malaysia's health goal of a nation of "healthy individuals, families and communities" is achieved. The challenges to security and privacy in providing access to an electronic Lifetime Health Record at private and government health facilities and to the electronic Lifetime Health Plan at homes of consumers require not only technical mechanisms but also national policies and practices addressing threats while facilitating access to health data during health encounters in different care settings. Organisational policies establish the goals that technical mechanisms serve. They should outline appropriate uses and access to information, create mechanisms for preventing and detecting violations, and set sanctions for violations. Some interesting innovations have been used to address these issues against the background of the launching of the multimedia supercorridor (MSC) in Malaysia.

  8. Electromagnetic Launch to Space

    NASA Astrophysics Data System (ADS)

    McNab, I. R.

    Many advances in electromagnetic (EM) propulsion technology have occurred in recent years. Linear motor technology for low-velocity and high-mass applications is being developed for naval catapults. Such technology could serve as the basis for a first-stage booster launch--as suggested by the US National Aeronautics and Space Administration (NASA) in the Maglifter concept. Using railguns, laboratory experiments have demonstrated launch velocities of 2-3 km/s and muzzle energies > 8 MJ. The extension of this technology to the muzzle velocities ( 7500 m/s) and energies ( 10 GJ) needed for the direct launch of payloads into orbit is very challenging but may not be impossible. For launch to orbit, even long launchers (> 1000 m) would need to operate at accelerations > 1000 G to reach the required velocities, so it would only be possible to launch rugged payloads, such as fuel, water, and materiel. Interest is being shown in such concepts by US, European, Russian, and Chinese researchers. An intermediate step proposed in France could be to launch payloads to sounding rocket altitudes for ionospheric research.

  9. Launch Vehicles

    NASA Image and Video Library

    2007-08-09

    Under the goals of the Vision for Space Exploration, Ares I is a chief component of the cost-effective space transportation infrastructure being developed by NASA's Constellation Program. This transportation system will safely and reliably carry human explorers back to the moon, and then onward to Mars and other destinations in the solar system. The Ares I effort includes multiple project element teams at NASA centers and contract organizations around the nation, and is managed by the Exploration Launch Projects Office at NASA's Marshall Space Flight Center (MFSC). ATK Launch Systems near Brigham City, Utah, is the prime contractor for the first stage booster. ATK's subcontractor, United Space Alliance of Houston, is designing, developing and testing the parachutes at its facilities at NASA's Kennedy Space Center in Florida. NASA's Johnson Space Center in Houston hosts the Constellation Program and Orion Crew Capsule Project Office and provides test instrumentation and support personnel. Together, these teams are developing vehicle hardware, evolving proven technologies, and testing components and systems. Their work builds on powerful, reliable space shuttle propulsion elements and nearly a half-century of NASA space flight experience and technological advances. Ares I is an inline, two-stage rocket configuration topped by the Crew Exploration Vehicle, its service module, and a launch abort system. This HD video image depicts the preparation and placement of a confidence ring for friction stir welding used in manufacturing aluminum panels that will fabricate the Ares I upper stage barrel. The aluminum panels are manufactured and subjected to confidence tests during which the bent aluminum is stressed to breaking point and thoroughly examined. The panels are manufactured by AMRO Manufacturing located in El Monte, California. (Highest resolution available)

  10. Launch Vehicles

    NASA Image and Video Library

    2007-08-09

    Under the goals of the Vision for Space Exploration, Ares I is a chief component of the cost-effective space transportation infrastructure being developed by NASA's Constellation Program. This transportation system will safely and reliably carry human explorers back to the moon, and then onward to Mars and other destinations in the solar system. The Ares I effort includes multiple project element teams at NASA centers and contract organizations around the nation, and is managed by the Exploration Launch Projects Office at NASA's Marshall Space Flight Center (MFSC). ATK Launch Systems near Brigham City, Utah, is the prime contractor for the first stage booster. ATK's subcontractor, United Space Alliance of Houston, is designing, developing and testing the parachutes at its facilities at NASA's Kennedy Space Center in Florida. NASA's Johnson Space Center in Houston hosts the Constellation Program and Orion Crew Capsule Project Office and provides test instrumentation and support personnel. Together, these teams are developing vehicle hardware, evolving proven technologies, and testing components and systems. Their work builds on powerful, reliable space shuttle propulsion elements and nearly a half-century of NASA space flight experience and technological advances. Ares I is an inline, two-stage rocket configuration topped by the Crew Exploration Vehicle, its service module, and a launch abort system. This HD video image depicts friction stir welding used in manufacturing aluminum panels that will fabricate the Ares I upper stage barrel. The panels are subjected to confidence tests in which the bent aluminum is stressed to breaking point and thoroughly examined. The panels are manufactured by AMRO Manufacturing located in El Monte, California. (Highest resolution available)

  11. Launch Vehicles

    NASA Image and Video Library

    2007-08-09

    Under the goals of the Vision for Space Exploration, Ares I is a chief component of the cost-effective space transportation infrastructure being developed by NASA's Constellation Program. This transportation system will safely and reliably carry human explorers back to the moon, and then onward to Mars and other destinations in the solar system. The Ares I effort includes multiple project element teams at NASA centers and contract organizations around the nation, and is managed by the Exploration Launch Projects Office at NASA's Marshall Space Flight Center (MFSC). ATK Launch Systems near Brigham City, Utah, is the prime contractor for the first stage booster. ATK's subcontractor, United Space Alliance of Houston, is designing, developing and testing the parachutes at its facilities at NASA's Kennedy Space Center in Florida. NASA's Johnson Space Center in Houston hosts the Constellation Program and Orion Crew Capsule Project Office and provides test instrumentation and support personnel. Together, these teams are developing vehicle hardware, evolving proven technologies, and testing components and systems. Their work builds on powerful, reliable space shuttle propulsion elements and nearly a half-century of NASA space flight experience and technological advances. Ares I is an inline, two-stage rocket configuration topped by the Crew Exploration Vehicle, its service module, and a launch abort system. This HD video image, depicts a manufactured aluminum panel, that will be used to fabricate the Ares I upper stage barrel, undergoing a confidence panel test. In this test, the bent aluminum is stressed to breaking point and thoroughly examined. The panels are manufactured by AMRO Manufacturing located in El Monte, California. (Highest resolution available)

  12. Launch Vehicles

    NASA Image and Video Library

    2006-08-08

    Under the goals of the Vision for Space Exploration, Ares I is a chief component of the cost-effective space transportation infrastructure being developed by NASA's Constellation Program. This transportation system will safely and reliably carry human explorers back to the moon, and then onward to Mars and other destinations in the solar system. The Ares I effort includes multiple project element teams at NASA centers and contract organizations around the nation, and is managed by the Exploration Launch Projects Office at NASA's Marshall Space Flight Center (MFSC). ATK Launch Systems near Brigham City, Utah, is the prime contractor for the first stage booster. ATK's subcontractor, United Space Alliance of Houston, is designing, developing and testing the parachutes at its facilities at NASA's Kennedy Space Center in Florida. NASA's Johnson Space Center in Houston hosts the Constellation Program and Orion Crew Capsule Project Office and provides test instrumentation and support personnel. Together, these teams are developing vehicle hardware, evolving proven technologies, and testing components and systems. Their work builds on powerful, reliable space shuttle propulsion elements and nearly a half-century of NASA space flight experience and technological advances. Ares I is an inline, two-stage rocket configuration topped by the Crew Exploration Vehicle, its service module, and a launch abort system. This HD video image depicts a manufactured aluminum panel that will be used to fabricate the Ares I upper stage barrel, undergoing a confidence panel test. In this test, the bent aluminum is stressed to breaking point and thoroughly examined. The panels are manufactured by AMRO Manufacturing located in El Monte, California. (Highest resolution available)

  13. Launch Vehicles

    NASA Image and Video Library

    2007-08-09

    Under the goals of the Vision for Space Exploration, Ares I is a chief component of the cost-effective space transportation infrastructure being developed by NASA's Constellation Program. This transportation system will safely and reliably carry human explorers back to the moon, and then onward to Mars and other destinations in the solar system. The Ares I effort includes multiple project element teams at NASA centers and contract organizations around the nation, and is managed by the Exploration Launch Projects Office at NASA's Marshall Space Flight Center (MFSC). ATK Launch Systems near Brigham City, Utah, is the prime contractor for the first stage booster. ATK's subcontractor, United Space Alliance of Houston, is designing, developing and testing the parachutes at its facilities at NASA's Kennedy Space Center in Florida. NASA's Johnson Space Center in Houston hosts the Constellation Program and Orion Crew Capsule Project Office and provides test instrumentation and support personnel. Together, these teams are developing vehicle hardware, evolving proven technologies, and testing components and systems. Their work builds on powerful, reliable space shuttle propulsion elements and nearly a half-century of NASA space flight experience and technological advances. Ares I is an inline, two-stage rocket configuration topped by the Crew Exploration Vehicle, its service module, and a launch abort system. This HD video image depicts confidence testing of a manufactured aluminum panel that will fabricate the Ares I upper stage barrel. In this test, bent aluminum is stressed to breaking point and thoroughly examined. The panels are manufactured by AMRO Manufacturing located in El Monte, California. (Highest resolution available)

  14. Launch Vehicles

    NASA Image and Video Library

    2006-08-09

    Under the goals of the Vision for Space Exploration, Ares I is a chief component of the cost-effective space transportation infrastructure being developed by NASA's Constellation Program. This transportation system will safely and reliably carry human explorers back to the moon, and then onward to Mars and other destinations in the solar system. The Ares I effort includes multiple project element teams at NASA centers and contract organizations around the nation, and is managed by the Exploration Launch Projects Office at NASA's Marshall Space Flight Center (MFSC). ATK Launch Systems near Brigham City, Utah, is the prime contractor for the first stage booster. ATK's subcontractor, United Space Alliance of Houston, is designing, developing and testing the parachutes at its facilities at NASA's Kennedy Space Center in Florida. NASA's Johnson Space Center in Houston hosts the Constellation Program and Orion Crew Capsule Project Office and provides test instrumentation and support personnel. Together, these teams are developing vehicle hardware, evolving proven technologies, and testing components and systems. Their work builds on powerful, reliable space shuttle propulsion elements and nearly a half-century of NASA space flight experience and technological advances. Ares I is an inline, two-stage rocket configuration topped by the Crew Exploration Vehicle, its service module, and a launch abort system. This HD video image depicts a manufactured aluminum panel, that will fabricate the Ares I upper stage barrel, undergoing a confidence panel test. In this test, bent aluminum is stressed to breaking point and thoroughly examined. The panels are manufactured by AMRO Manufacturing located in El Monte, California. (Highest resolution available)

  15. Launch Vehicles

    NASA Image and Video Library

    2007-08-09

    Under the goals of the Vision for Space Exploration, Ares I is a chief component of the cost-effective space transportation infrastructure being developed by NASA's Constellation Program. This transportation system will safely and reliably carry human explorers back to the moon, and then onward to Mars and other destinations in the solar system. The Ares I effort includes multiple project element teams at NASA centers and contract organizations around the nation, and is managed by the Exploration Launch Projects Office at NASA's Marshall Space Flight Center (MFSC). ATK Launch Systems near Brigham City, Utah, is the prime contractor for the first stage booster. ATK's subcontractor, United Space Alliance of Houston, is designing, developing and testing the parachutes at its facilities at NASA's Kennedy Space Center in Florida. NASA's Johnson Space Center in Houston hosts the Constellation Program and Orion Crew Capsule Project Office and provides test instrumentation and support personnel. Together, these teams are developing vehicle hardware, evolving proven technologies, and testing components and systems. Their work builds on powerful, reliable space shuttle propulsion elements and nearly a half-century of NASA space flight experience and technological advances. Ares I is an inline, two-stage rocket configuration topped by the Crew Exploration Vehicle, its service module, and a launch abort system. This HD video image depicts a manufactured aluminum panel, that will fabricate the Ares I upper stage barrel, undergoing a confidence panel test. In this test, the bent aluminum is stressed to breaking point and thoroughly examined. The panels are manufactured by AMRO Manufacturing located in El Monte, California. (Highest resolution available)

  16. Measuring Knowledge, Acceptance, and Perceptions of Telehealth in an Interprofessional Curriculum for Student Nurse Practitioners, Occupational Therapists, and Physical Therapists

    ERIC Educational Resources Information Center

    Randall, Ken; Steinheider, Brigitte; Isaacson, Mary; Shortridge, Ann; Bird, Stephanie; Crio, Carrie; Ross, Heather; Loving, Gary

    2016-01-01

    Introduction: The use of telehealth in service delivery is both challenging and beneficial. This paper describes the results of a three semester-long interprofessional education program in team-based care using telehealth technology. The study assessed telehealth knowledge acquisition, practice in a structured environment with a simulated patient,…

  17. Measuring Knowledge, Acceptance, and Perceptions of Telehealth in an Interprofessional Curriculum for Student Nurse Practitioners, Occupational Therapists, and Physical Therapists

    ERIC Educational Resources Information Center

    Randall, Ken; Steinheider, Brigitte; Isaacson, Mary; Shortridge, Ann; Bird, Stephanie; Crio, Carrie; Ross, Heather; Loving, Gary

    2016-01-01

    Introduction: The use of telehealth in service delivery is both challenging and beneficial. This paper describes the results of a three semester-long interprofessional education program in team-based care using telehealth technology. The study assessed telehealth knowledge acquisition, practice in a structured environment with a simulated patient,…

  18. A human centered GeoVisualization framework to facilitate visual exploration of telehealth data: a case study.

    PubMed

    Joshi, Ashish; de Araujo Novaes, Magdala; Machiavelli, Josiane; Iyengar, Sriram; Vogler, Robert; Johnson, Craig; Zhang, Jiajie; Hsu, Chiehwen E

    2012-01-01

    majority of them were females and 100% were professionals with graduate degrees. The users had diverse backgrounds including nursing, computer science, biomedical informatics, statistics, dentistry, administration and engineering. The users had varied roles and responsibilities, used computers frequently but only 5% of them were familiar with GeoVis. Google maps were the most common GeoVis application that the users were familiar with. Despite having minimal spatial skills, there was a strong motivation and relevance among the telehealth users to use GeoVis to facilitate visual exploration of telehealth data for better informed decision making. Results also showed that of the 60% participants with no GeoVis familiarity; 33% had moderate to large data exploratory role, 83% had no spatial skills but 58% preferred analyzing both spatial and temporal dimensions of the data. Majority of the participants agreed to have maps as the first choice to represent the data as it will be able to display the events both in place and time. The results demonstrate a potentially growing need for the use of GeoVis applications to evaluate telehealth data. Understanding of user needs is essential to ensure that the technology is appropriately functional and will be useful to complete the tasks.

  19. Success factors for telehealth--a case study.

    PubMed

    Moehr, J R; Schaafsma, J; Anglin, C; Pantazi, S V; Grimm, N A; Anglin, S

    2006-01-01

    To present the lessons learned from an evaluation of a comprehensive telehealth project regarding success factors and evaluation methodology for such projects. A recent experience with the evaluation of new telehealth services in BC, Canada, is summarized. Two domains of clinical applications, as well as educational and administrative uses, and the project environment were evaluated. In order to contribute to the success of the project, the evaluation included formative and summative approaches employing qualitative and quantitative methods with data collection from telehealth events, participants and existing databases. The evaluation had to be carried out under severe budgetary and time constraints. We therefore deliberately chose a broad ranging exploratory approach within a framework provided, and generated questions to be answered on the basis of initial observations and participant driven interviews with progressively more focused and detailed data gathering, including perusal of a variety of existing data sources. A unique feature was an economic evaluation using static simulation models. The evaluation yielded rich and detailed data, which were able to explain a number of unanticipated findings. One clinical application domain was cancelled after 6 months, the other continues. The factors contributing to success include: Focus on chronic conditions which require visual information for proper management. Involvement of established teams in regular scheduled visits or in sessions scheduled well in advance. Problems arose with: Ad hoc applications, in particular under emergency conditions. Applications that disregard established referral patterns. Applications that support only part of a unit's services. The latter leads to the service mismatch dilemma (SMMD) with the end result that even those e-health services provided are not used. The problems encountered were compounded by issues arising from the manner in which the telehealth services had been introduced

  20. Tablet PC Enabled Body Sensor System for Rural Telehealth Applications

    PubMed Central

    Panicker, Nitha V.; Kumar, A. Sukesh

    2016-01-01

    Telehealth systems benefit from the rapid growth of mobile communication technology for measuring physiological signals. Development and validation of a tablet PC enabled noninvasive body sensor system for rural telehealth application are discussed in this paper. This system includes real time continuous collection of physiological parameters (blood pressure, pulse rate, and temperature) and fall detection of a patient with the help of a body sensor unit and wireless transmission of the acquired information to a tablet PC handled by the medical staff in a Primary Health Center (PHC). Abnormal conditions are automatically identified and alert messages are given to the medical officer in real time. Clinical validation is performed in a real environment and found to be successful. Bland-Altman analysis is carried out to validate the wrist blood pressure sensor used. The system works well for all measurements. PMID:26884757

  1. Exploring challenges to telehealth communication by specialists in poison information.

    PubMed

    Rothwell, Erin; Ellington, Lee; Planalp, Sally; Crouch, Barbara

    2012-01-01

    The use of the telephone for providing health care is growing. A significant amount of social meaning is derived from visual information, and the absence of visual stimuli provides unique barriers to communication and increases the risks for misunderstandings and distractions. Understanding challenges to telephone communication can provide insight into training opportunities for overcoming these difficulties and improving patient care. The purpose of this research was to explore through focus groups the challenges of phone communication perceived by specialists in poison information. General types of challenges to effective phone communication included developing new communication skills to compensate for lack of visual information, difficulty assessing caller understanding, difficulty managing caller misunderstandings, maintaining distinctive assessments for routine calls, and managing the multifaceted aspects of job stress. The desire for training to enhance telehealth and cultural competency skills was also mentioned, and these findings might provide guidance for the development of training opportunities for telehealth professionals.

  2. Satisfaction and Improvements in Peritoneal Dialysis Outcomes Associated with Telehealth.

    PubMed

    Magnus, Manya; Sikka, Neal; Cherian, Teena; Lew, Susie Q

    2017-03-01

    End stage renal disease (ESRD) affects approximately 660,000 persons in the US each year, representing a significant financial burden to the health care system and affected individuals. Telehealth approaches to care offer an important means of reducing costs as well as increasing autonomy for patients. Understanding patient satisfaction with telehealth provides a key towards eventual scalability. Quarterly surveys were conducted to characterize satisfaction with remote biometric monitoring (RBM) for blood pressure, weight, glucose and peritoneal dialysis (PD)-specific educational online videos for ESRD patients using PD. Of 300 participants, 67% participated in the surveys and provided baseline and at least one follow-up assessment. The majority were 45 to 64 years of age (50.5%), Black (64.5%), married or living with significant other (52.0%), and had more than a high school degree (73.0%). RBM was associated with perceived autonomy and confidence in health care activities and decreased negative perceptions of PD care and ESRD. The majority of participants (80.1%) indicated that they were satisfied or completely satisfied with the system. Participants found that the interface increased confidence, reduced frustration, and related perceptions were significantly and positively altered (p<0.05) for each of the separate telehealth components. Educational videos were well utilized with nearly half of the participants (42.5%) reporting that they watched at least one of the videos, and the majority reporting that the videos seen had an overall positive impact on health. Supplementing PD with telehealth has the potential to have a positive impact on patient perceptions of PD care and consequently improve clinical outcomes.

  3. The Same Language Speak We Do - Consensus Terminology for Telehealth.

    PubMed

    Scott, Richard E; Mars, Maurice

    2016-01-01

    e-Health has grown to become interjurisdictional in scope and in practice. Central to successful implementation and scaling of e-heath solutions is clear and concise communication of ideas and principles, and instructions during construction. This paper addresses the need for an agreed taxonomy and terminology and focuses on explaining, proposing, and recommending terms and action for an international consensus-based terminology for telehealth.

  4. Down to the fundamentals of telehealth and home healthcare nursing.

    PubMed

    Vasquez, Monica S

    2008-05-01

    Many changes have taken place in the field of home healthcare. Because of these changes, home health agencies must be creative and implement various tools that help improve quality of care for their patients. Starting with the most basic intervention definitely can lend a hand in improving patient outcomes. Phone monitoring, the most basic form of telehealth, can be an important aspect in a patient's plan of care.

  5. E-learning and telehealth: measuring your success.

    PubMed

    Kobb, Rita F; Lane, Robert J; Stallings, Deidre

    2008-08-01

    Organizations that provide training for their employees are interested in translating training expenditures into benefits. Even though there are several common methodologies that are used to train employees, finding the right methodology to stimulate learning and develop a competent workforce while reducing fiscal burdens can be challenging. One such method that continues to grow in popularity is e-learning. For the purpose of this discussion, e-learning refers to Internet-based or online training. The Veterans Health Administration's (VHA's) Office of Care Coordination (OCC) was established in July 2003 to oversee the national implementation of its telehealth initiatives. As part of this implementation, the OCC created a national center, the Sunshine Training Center, to work directly with the VHA's Employees Education System (EES) to develop a home telehealth Web-based curriculum. After 3 years, the Sunshine Training Center and EES initiated an Impact Evaluation Process. Over five hundred staff completed the online impact survey. This number represented a 74% response rate. Staff responded overwhelmingly in the positive on the benefits of e-learning for building telehealth skills.

  6. Telehealth application on the rehabilitation of children and adolescents

    PubMed Central

    dos Santos, Maria Tereza N.; Moura, Sarah Costa D. O.; Gomes, Ludmila Mourão X.; Lima, Ana Henriques; Moreira, Rafaela Silva; Silva, Caroline Duarte; Guimarães, Eliane Marina P.

    2014-01-01

    Objective: To systematically review the literature on the telehealth initiatives in telerehabilitation practices in children and adolescents from zero to 18 years old. Data sources: Randomized and controlled clinical trials published in the past ten years (January 2002 to February 2012) in Medline/PubMed, Medline/BVS, PEDro and Cochrane Library databases. The descriptors "telemedicine", "rehabilitation" and "telehealth" were used in three different languages (English, Portuguese and Spanish). Data synthesis: From the 20 studies found in the literature, nine were included in this review. Most of the studies showed that telerehabilitation is able to produce better results in the treatment when compared to the traditional methods, providing less frequency of symptoms, better disease control, better quality of life and greater adherence to treatment. Conclusions: Telerehabilitation is a viable and effective strategy in the treatment of common diseases in children and adolescents. However, there are few studies on the subject in this age group. Although telehealth is already consolidated worldwide, there are no studies in Brazil that used the telerehabilitation in children and adolescents, which reinforces the need for more research and investments. PMID:24676201

  7. Building a multicenter telehealth network to advance chronic disease management.

    PubMed

    Khairat, Saif; Wijesinghe, Namal; Wolfson, Julian; Scott, Rob; Simkus, Ray

    2014-01-01

    The use of telehealth solutions has proved to improve clinical management of chronic diseases, expand access to healthcare services and clinicians, and reduce healthcare-related costs. The project aims at improving Heart Failure (HF) management through the utilization of a Telemedicine and Personal Health Records systems that will assist HF specialist in Colombo, Sri Lanka to monitor and consult with remote HF patients. A telehealth network will be built at an international site that connects five remote telehealth clinics to a central clinic at a major University Hospital in Sri Lanka where HF specialists are located. In this study, 200 HF patients will be recruited for nine months, 100 patients will be randomly selected for the treatment group and the other 100 will be selected for the control group. Pre, mid, and post study surveys will be conducted to assess the efficacy and satisfaction levels of patients with both care models. Moreover, clinical outcomes will be collected to evaluate the impact of the intervention on the treatment patients compared to control patients. The research aims at enhancing Heart Failure management through eliminating current health challenges and healthcare-related financial burdens.

  8. Leveraging Telehealth to Bring Volunteer Physicians Into Underserved Communities.

    PubMed

    Uscher-Pines, Lori; Rudin, Robert; Mehrotra, Ateev

    2016-11-28

    Many disadvantaged communities lack sufficient numbers of local primary care and specialty physicians. Yet tens of thousands of physicians, in particular those who are retired or semiretired, desire meaningful volunteer opportunities. Multiple programs have begun to use telehealth to bridge the gap between volunteer physicians and underserved patients. In this brief, we describe programs that are using this model and discuss the promise and pitfalls. Physician volunteers in these programs report that the work can be fulfilling and exciting, a cutting-edge yet convenient way to remain engaged and contribute. Given the projected shortfall of physicians in the United States, recruiting retired and semiretired physicians to provide care through telehealth increases the total supply of active physicians and the capacity of the existing workforce. However, programs typically use volunteers in a limited capacity because of uncertainty about the level and duration of commitment. Acknowledging this reality, most programs only use volunteer physicians for curbside consults rather than fully integrating them into longitudinal patient care. The part-time availability of volunteers may also be difficult to incorporate into the workflow of busy safety net clinics. As more physicians volunteer in a growing number of telehealth programs, the dual benefits of enriching the professional lives of volunteers and improving care for underserved communities will make further development of these programs worthwhile.

  9. For telehealth to succeed, privacy and security risks must be identified and addressed.

    PubMed

    Hall, Joseph L; McGraw, Deven

    2014-02-01

    The success of telehealth could be undermined if serious privacy and security risks are not addressed. For example, sensors that are located in a patient's home or that interface with the patient's body to detect safety issues or medical emergencies may inadvertently transmit sensitive information about household activities. Similarly, routine data transmissions from an app or medical device, such as an insulin pump, may be shared with third-party advertisers. Without adequate security and privacy protections for underlying telehealth data and systems, providers and patients will lack trust in the use of telehealth solutions. Although some federal and state guidelines for telehealth security and privacy have been established, many gaps remain. No federal agency currently has authority to enact privacy and security requirements to cover the telehealth ecosystem. This article examines privacy risks and security threats to telehealth applications and summarizes the extent to which technical controls and federal law adequately address these risks. We argue for a comprehensive federal regulatory framework for telehealth, developed and enforced by a single federal entity, the Federal Trade Commission, to bolster trust and fully realize the benefits of telehealth.

  10. Pediatric Obesity Management in Rural Clinics in California and the Role of Telehealth in Distance Education

    ERIC Educational Resources Information Center

    Shaikh, Ulfat; Nettiksimmons, Jasmine; Romano, Patrick

    2011-01-01

    Objective: To determine health care provider needs related to pediatric obesity management in rural California and to explore strategies to improve care through telehealth. Methods: Cross-sectional survey of health care providers who treated children and adolescents at 41 rural clinics with existing telehealth connectivity. Results: Most of the…

  11. Increasing Access to an ASD Imitation Intervention via a Telehealth Parent Training Program

    ERIC Educational Resources Information Center

    Wainer, Allison L.; Ingersoll, Brooke R.

    2015-01-01

    Systematic research focused on developing and improving strategies for the dissemination and implementation of effective ASD services is essential. An innovative and promising area of research is the use of telehealth programs to train parents of children with ASD in intervention techniques. A hybrid telehealth program, combining self-directed…

  12. A Phase II Trial of Telehealth Delivery of the Lidcombe Program of Early Stuttering Intervention

    ERIC Educational Resources Information Center

    Lewis, Christine; Packman, Ann; Onslow, Mark; Simpson, Judy M.; Jones, Mark

    2008-01-01

    Purpose: The aims of this study were to evaluate the efficacy of telehealth delivery of the Lidcombe Program of Early Stuttering Intervention, compared with a control group, and to determine the number of children who could be regarded as "responders." Method: A speech-language pathologist provided telehealth delivery of the Lidcombe…

  13. The case for home based telehealth in pediatric palliative care: a systematic review

    PubMed Central

    2013-01-01

    Background Over the last decade technology has rapidly changed the ability to provide home telehealth services. At the same time, pediatric palliative care has developed as a small, but distinct speciality. Understanding the experiences of providing home telehealth services in pediatric palliative care is therefore important. Methods A literature review was undertaken to identify and critically appraise published work relevant to the area. Studies were identified by searching the electronic databases Medline, CINAHL and Google Scholar. The reference list of each paper was also inspected to identify any further studies. Results There were 33 studies that met the inclusion criteria of which only six were pediatric focussed. Outcome measures included effects on quality of life and anxiety, substitution of home visits, economic factors, barriers, feasibility, acceptability, satisfaction and readiness for telehealth. While studies generally identified benefits of using home telehealth in palliative care, the utilisation of home telehealth programs was limited by numerous challenges. Conclusion Research in this area is challenging; ethical issues and logistical factors such as recruitment and attrition because of patient death make determining effectiveness of telehealth interventions difficult. Future research in home telehealth for the pediatric palliative care population should focus on the factors that influence acceptance of telehealth applications, including goals of care, access to alternative modes of care, perceived need for care, and comfort with using technology. PMID:23374676

  14. The case for home based telehealth in pediatric palliative care: a systematic review.

    PubMed

    Bradford, Natalie; Armfield, Nigel R; Young, Jeanine; Smith, Anthony C

    2013-02-01

    Over the last decade technology has rapidly changed the ability to provide home telehealth services. At the same time, pediatric palliative care has developed as a small, but distinct speciality. Understanding the experiences of providing home telehealth services in pediatric palliative care is therefore important. A literature review was undertaken to identify and critically appraise published work relevant to the area. Studies were identified by searching the electronic databases Medline, CINAHL and Google Scholar. The reference list of each paper was also inspected to identify any further studies. There were 33 studies that met the inclusion criteria of which only six were pediatric focussed. Outcome measures included effects on quality of life and anxiety, substitution of home visits, economic factors, barriers, feasibility, acceptability, satisfaction and readiness for telehealth. While studies generally identified benefits of using home telehealth in palliative care, the utilisation of home telehealth programs was limited by numerous challenges. Research in this area is challenging; ethical issues and logistical factors such as recruitment and attrition because of patient death make determining effectiveness of telehealth interventions difficult. Future research in home telehealth for the pediatric palliative care population should focus on the factors that influence acceptance of telehealth applications, including goals of care, access to alternative modes of care, perceived need for care, and comfort with using technology.

  15. Pediatric Obesity Management in Rural Clinics in California and the Role of Telehealth in Distance Education

    ERIC Educational Resources Information Center

    Shaikh, Ulfat; Nettiksimmons, Jasmine; Romano, Patrick

    2011-01-01

    Objective: To determine health care provider needs related to pediatric obesity management in rural California and to explore strategies to improve care through telehealth. Methods: Cross-sectional survey of health care providers who treated children and adolescents at 41 rural clinics with existing telehealth connectivity. Results: Most of the…

  16. Using home telehealth to empower patients to monitor and manage long term conditions.

    PubMed

    Paget, Tony; Jones, Craig; Davies, Michelle; Evered, Caroline; Lewis, Clare

    This article describes a pilot telehealth project in Swansea where patients with heart failure and chronic obstructive pulmonary disease were provided with telehealth monitoring equipment. While early evaluation points to some potential economic benefits, supporting patient empowerment was a significant outcome.

  17. Technology support to a telehealth in the home service: Qualitative observations.

    PubMed

    Taylor, Alan; Wade, Victoria; Morris, Greg; Pech, Joanne; Rechter, Stuart; Kidd, Michael; Carati, Colin

    2016-07-01

    The Flinders University Telehealth in the Home (FTH) trial was an action research initiative that introduced and evaluated the impact of telehealth services on palliative care patients living in the community, home-based rehabilitation services for the elderly, and services to the elderly in residential aged care. The aim of this study was to understand the issues encountered during the provision of technology services that supported this trial. A mixed methods approach was undertaken to analyse the roles of information and communication technology (ICT) and clinical staff in design, technology management and training. The data sources were staff observations and documents including job logs, meetings, emails and technology descriptions. Use of consumer technology for telehealth required customisation of applications and services. Clinicians played a key role in definition of applications and the embedding of workflow into applications. Usability of applications was key to their subsequent use. Management of design creep and technology services, coupled with support and training for clinicians were important to maintenance of a telehealth service. In the setting described, an iterative approach to the development of telehealth services to the home using consumer technologies was needed. The efficient management of consumer devices in multiple settings will become critical as telehealth services grow in scale. Effective collaboration between clinical and technical stakeholders and further workforce education in telehealth can be key enablers for the transition of face-to-face care to a telehealth mode of delivery. © The Author(s) 2015.

  18. Telehealth, disease management, home care and the future--part 2.

    PubMed

    Fazzi, Robert; Ashe, Tim; Doak, Lindsay

    2008-01-01

    In October CARING, Part I of the Phillips Study gave information on the background of the study along with insights into the major technologies studied. Part II will focus on what was clearly the area of greatest interest in the web survey--the impact of telehealth on quality and cost, especially the impact of telehealth on disease management.

  19. The Evolution of a Distance Education Initiative into a Major Telehealth Project.

    ERIC Educational Resources Information Center

    Green, Alexia; Esperat, Christina; Seale, Deborah; Chalambaga, Michael; Smith, Sheila; Walker, Glenda; Ellison, Patty; Berg, Bobbye; Robinson, Sally

    2000-01-01

    Three Texas nursing schools collaborated in establishing a telehealth clinic to provide services for chronically ill children. Expanded into public schools, the project provides distance learning and telehealth services to school nurses, teachers, administrators, and families involved in the care of these children. (SK)

  20. Increasing Access to an ASD Imitation Intervention via a Telehealth Parent Training Program

    ERIC Educational Resources Information Center

    Wainer, Allison L.; Ingersoll, Brooke R.

    2015-01-01

    Systematic research focused on developing and improving strategies for the dissemination and implementation of effective ASD services is essential. An innovative and promising area of research is the use of telehealth programs to train parents of children with ASD in intervention techniques. A hybrid telehealth program, combining self-directed…

  1. 77 FR 58977 - Exempting In-Home Video Telehealth From Copayments

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-09-25

    ... AFFAIRS 38 CFR Part 17 RIN 2900-AO27 Exempting In-Home Video Telehealth From Copayments AGENCY: Department... inpatient hospital care or outpatient medical care. Specifically, the regulation exempted in-home video... video telehealth. Additionally, VA published a companion substantially identical direct final rule at 77...

  2. Home telehealth for chronic disease management: selected findings of a narrative synthesis.

    PubMed

    Jones, Alison; Hedges-Chou, Jessica; Bates, Joanna; Loyola, Margarita; Lear, Scott A; Jarvis-Selinger, Sandra

    2014-04-01

    Chronic disease has become an increasingly important issue for individuals and healthcare organizations across Canada. Home telehealth may have the potential to alleviate the economic and social challenges associated with rising rates of chronic disease. An aim of this review was to gather and synthesize the evidence on the effectiveness of home telehealth in chronic disease management. We searched the Medline, EMBASE, Web of Science, CINAHL, and PAIS databases for studies published in English from January 1, 2005, and December 31, 2010. Academic publications, white papers, and gray literature were all considered eligible for inclusion, provided an original research element was present. Articles were screened for relevance. One hundred one articles on quantitative or mixed-methods studies reported the effects of home telehealth on disease state, symptoms, and quality of life in chronic disease patients. Studies were consistent in finding that home telehealth was equivalent or superior to usual care. The literature strongly supports the use of home telehealth as an equally effective alternative to usual care. The circumstances under which home telehealth emerges as significantly better than usual care have not been extensively researched. Further research into factors affecting the effectiveness of home telehealth would support more widespread realization of telehealth's potential benefits.

  3. Family and Practitioner Perspectives on Telehealth for Services to Young Children with Autism.

    PubMed

    Iacono, Teresa; Dissanayake, Cheryl; Trembath, David; Hudry, Kristelle; Erickson, Shane; Spong, Jo

    2016-01-01

    Telehealth offers the potential to address inequalities in autism service access for young children living in regional and rural areas with limited access to autism specialists. Our aim was to explore parent and practitioner uses of technology, and views about telehealth, including perceived barriers, for autism early intervention service delivery in a regional town in Australia. Fifteen mothers and 19 front-line autism practitioners completed surveys distributed by local autism service and support providers in the regional town; eight front-line practitioners from one service participated in interviews. Mothers and practitioners had access to technology that could be used for video-communication, but had little or no experience with telehealth. Mothers appeared more willing to try telehealth for receiving autism services than practitioners appeared to believe, and practitioners preferred to use it for consulting with other professionals and professional development. Barriers to telehealth included limited experience and practitioners not knowing what a telehealth service would look like, poor access to reliable and high speed internet, lack of skill and technical supports, and practitioners believing families preferred face-to-face services. The success of telehealth in this regional town will rely on better infrastructure, and upskilling practitioners in evidence-based autism interventions so they can provide the required support remotely. Use of telehealth to upskill practitioners in evidence-based practice could provide a first step in ensuring equitable access to expert autism services to regional and rural families.

  4. Telehealth: seven strategies to successfully implement disruptive technology and transform health care.

    PubMed

    Schwamm, Lee H

    2014-02-01

    "Telehealth" refers to the use of electronic services to support a broad range of remote services, such as patient care, education, and monitoring. Telehealth must be integrated into traditional ambulatory and hospital-based practices if it is to achieve its full potential, including addressing the six domains of care quality defined by the Institute of Medicine: safe, effective, patient-centered, timely, efficient, and equitable. Telehealth is a disruptive technology that appears to threaten traditional health care delivery but has the potential to reform and transform the industry by reducing costs and increasing quality and patient satisfaction. This article outlines seven strategies critical to successful telehealth implementation: understanding patients' and providers' expectations, untethering telehealth from traditional revenue expectations, deconstructing the traditional health care encounter, being open to discovery, being mindful of the importance of space, redesigning care to improve value in health care, and being bold and visionary.

  5. The Process for the Formulation of the International Telehealth Position Statement for Occupational Therapy

    PubMed Central

    JACOBS, KAREN; CASON, JANA; MCCULLOUGH, ANN

    2015-01-01

    The World Federation of Occupational Therapists (WFOT) consists of 84 member organizations representing over 420,000 occupational therapists internationally (WFOT, 2014). In 2014, WFOT published the WFOT Telehealth Position Statement on the use of telehealth in occupational therapy. The process for the formulation of the official document involved reviewing WFOT member organizations’ telehealth position statements and data collected from a survey sent to member organizations’ delegates in April 2014. Qualitative data from 39 countries yielded factors to consider in five key areas: licensure/registration requirements, the cost of technology, privacy and security, reimbursement/payment models, and other issues (e.g., need for collaboration/transfer of knowledge, client selection, provider competencies, standard of care). The WFOT Telehealth Position Statement addressed each of these areas. The collaborative effort resulting in the development of the WFOT Telehealth Position Statement serves as a model for other international organizations. PMID:27563380

  6. The Process for the Formulation of the International Telehealth Position Statement for Occupational Therapy.

    PubMed

    Jacobs, Karen; Cason, Jana; McCullough, Ann

    2015-01-01

    The World Federation of Occupational Therapists (WFOT) consists of 84 member organizations representing over 420,000 occupational therapists internationally (WFOT, 2014). In 2014, WFOT published the WFOT Telehealth Position Statement on the use of telehealth in occupational therapy. The process for the formulation of the official document involved reviewing WFOT member organizations' telehealth position statements and data collected from a survey sent to member organizations' delegates in April 2014. Qualitative data from 39 countries yielded factors to consider in five key areas: licensure/registration requirements, the cost of technology, privacy and security, reimbursement/payment models, and other issues (e.g., need for collaboration/transfer of knowledge, client selection, provider competencies, standard of care). The WFOT Telehealth Position Statement addressed each of these areas. The collaborative effort resulting in the development of the WFOT Telehealth Position Statement serves as a model for other international organizations.

  7. Understanding heart failure; explaining telehealth - a hermeneutic systematic review.

    PubMed

    Greenhalgh, Trisha; A'Court, Christine; Shaw, Sara

    2017-06-14

    Enthusiasts for telehealth extol its potential for supporting heart failure management. But randomised trials have been slow to recruit and produced conflicting findings; real-world roll-out has been slow. We sought to inform policy by making sense of a complex literature on heart failure and its remote management. Through database searching and citation tracking, we identified 7 systematic reviews of systematic reviews, 32 systematic reviews (including 17 meta-analyses and 8 qualitative reviews); six mega-trials and over 60 additional relevant empirical studies and commentaries. We synthesised these using Boell's hermeneutic methodology for systematic review, which emphasises the quest for understanding. Heart failure is a complex and serious condition with frequent co-morbidity and diverse manifestations including severe tiredness. Patients are often frightened, bewildered, socially isolated and variably able to self-manage. Remote monitoring technologies are many and varied; they create new forms of knowledge and new possibilities for care but require fundamental changes to clinical roles and service models and place substantial burdens on patients, carers and staff. The policy innovation of remote biomarker monitoring enabling timely adjustment of medication, mediated by "activated" patients, is based on a modernist vision of efficient, rational, technology-mediated and guideline-driven ("cold") care. It contrasts with relationship-based ("warm") care valued by some clinicians and by patients who are older, sicker and less technically savvy. Limited uptake of telehealth can be analysed in terms of key tensions: between tidy, "textbook" heart failure and the reality of multiple comorbidities; between basic and intensive telehealth; between activated, well-supported patients and vulnerable, unsupported ones; between "cold" and "warm" telehealth; and between fixed and agile care programmes. The limited adoption of telehealth for heart failure has complex clinical

  8. Audit of primary care electrocardiograms sent as emergency to a telehealth service - the Telehealth Network of Minas Gerais, Brazil.

    PubMed

    Marcolino, Milena S; Carvalho, Bárbara C; Lucena, Aline M; França, Ana Luiza N; Pessoa, Cristiane G; Neves, Daniel S; Alkmim, Maria Beatriz M

    2015-01-01

    The Telehealth Network of Minas Gerais (TNMG) is a public telehealth service in Brazil that has performed electrocardiogram (ECG) analysis since 2005. From February to March 2014, 28% of ECGs were classified as "emergency" by the primary care tele-health sites. This quasi-experimental study aimed to investigate the reasons behind the high number of emergency ECGs being sent in, the implementation of corrective actions, and an assessment of the impact of these actions. In the 1st phase, primary care units that sent >70% of ECGs as emergency from February to March 2014 were selected. The 2nd phase consisted of the intervention. In the 3rd phase, the proportion of ECGs sent as an emergency during the 1st and 2nd months post intervention were assessed. Of the 63 cities selected during the 1st phase, 50% of the practitioners did not know the proper definition of emergency. After the intervention, 67% of the cities had a significant reduction in the proportion of ECGs sent as an emergency during the 1st month, and 17% had a significant reduction during the 2nd month.

  9. Impact of a telehealth and care management program for patients with chronic obstructive pulmonary disease.

    PubMed

    Au, David H; Macaulay, Dendy S; Jarvis, John L; Desai, Urvi S; Birnbaum, Howard G

    2015-03-01

    Improving outcomes and health resource use for patients with chronic obstructive pulmonary disease (COPD) care is a priority for health systems. The Health Buddy Program, a content-driven telehealth system coupled with care management, is designed to enhance patient education, self-management, and timely access to care. To examine the effects of the Health Buddy Program on resource use among Medicare patients with COPD who participated in a Centers for Medicare and Medicaid Services demonstration project from 2006 to 2010. Medicare fee-for-service beneficiaries with COPD who enrolled in the intervention at two participating clinics were propensity-score matched to similar patients with COPD identified from a 5% random sample of Medicare patients. Difference-in-difference analyses descriptively compared the program's effect on quarterly healthcare resource use over the 3-year study period compared with baseline. Negative binomial models estimated the association of the program with healthcare resource outcomes adjusting for significant (P<0.05) baseline differences post matching. The effect of the Health Buddy Program on quarterly all-cause and respiratory-related hospital admissions, hospital admissions for COPD exacerbations, and all-cause emergency department use was assessed after matching. Intervention (n=619) and matched control subjects (n=619) had similar baseline characteristics after matching. The Health Buddy Program was associated with 23% lower quarterly all-cause hospital admissions and 40% lower quarterly respiratory-related hospital admissions compared with baseline for intervention beneficiaries versus control subjects. In subgroup analyses, patients who engaged in the intervention during the study period (n=247) demonstrated significantly lower quarterly hospital admissions for COPD exacerbations. The Health Buddy Program was not associated with reductions in quarterly emergency department use. Results were robust in analyses that adjusted for

  10. The Titan Space Launch System

    NASA Astrophysics Data System (ADS)

    Keeley, J. T.

    1981-04-01

    The Titan III Space Launch Vehicle (SLV) System providing reliable fast response booster capability is discussed. Early Titans, including Titans I and II and the Gemini launch vehicle are described, and the elements of the Titan III, including the upper stages, payload fairings, and launch facilities are presented. The liquid boost module for STS performance augmentation and the Titan 34D SLV System are also discussed. The Titan III SLV System demonstrates excellent versatility while maintaining a high reliability record during thirteen years of operational flights, and provides optional use of solid thrust augmentation and launch sites on both Coasts.

  11. Developing and validating the French-Canadian version of the practitioner and organizational telehealth readiness assessment tools.

    PubMed

    Légaré, Emilie; Vincent, Claude; Lehoux, Pascale; Anderson, Donna; Kairy, Dahlia; Gagnon, Marie-Pierre; Jennett, Penny

    2010-01-01

    Only one telehealth readiness assessment tool, that of Jennett et al., covers all types of telehealth projects, regardless of health-care provision context. However, this instrument is only available in English and has not undergone psychometric evaluation. We developed a French-Canadian version of the Practitioner Telehealth Readiness Assessment Tool and the Organizational Telehealth Readiness Assessment Tool. Transcultural validity was assessed by nine practitioners and 12 clinical project co-ordinators or administrators. For practitioners and managers, there was no significant difference between the scores of the English and the French versions of the questionnaires. The results showed that the telehealth readiness of co-ordinators or administrators was greater than that of practitioners when the range in scores was taken into account. The French-Canadian versions of the two questionnaires make it possible to assess telehealth readiness among French speakers. However, other studies involving patients will be necessary to validate the Patient-Public Telehealth Readiness Assessment Tool.

  12. Integrating Telehealth Care-Generated Data With the Family Practice Electronic Medical Record: Qualitative Exploration of the Views of Primary Care Staff

    PubMed Central

    Davidson, Emma

    2013-01-01

    Background Telehealth care is increasingly being employed in the management of long-term illness. Current systems are largely managed via “stand-alone” websites, which require additional log-ons for clinicians to view their patients’ symptom records and physiological measurements leading to frustrating delays and sometimes failure to engage with the record. However, there are challenges to the full integration of patient-acquired data into family physicians’ electronic medical records (EMR) in terms of reliability, how such data can best be summarized and presented to avoid overload to the clinicians, and how clarity of responsibility is managed when multiple agencies are involved. Objective We aimed to explore the views of primary care clinicians on the acceptability, clinical utility, and, in particular, the benefits and risks of integrating patient-generated telehealth care data into the family practice EMR and to explore how these data should be summarized and presented in order to facilitate use in routine care. Methods In our qualitative study, we carried out semi-structured interviews with clinicians with experience of and naïve to telehealth care following demonstration of pilot software, which illustrated various methods by which data could be incorporated into the EMR. Results We interviewed 20 clinicians and found 2 overarching themes of “workload” and “safety”. Although clinicians were largely positive about integrating telehealth care data into the EMR, they were concerned about the potential increased workload and safety issues, particularly in respect to error due to data overload. They suggested these issues could be mitigated by good system design that summarized and presented data such that they facilitated seamless integration with clinicians’ current routine processes for managing data flows, and ensured clear lines of communication and responsibility between multiple professionals involved in patients’ care. Conclusions

  13. Are people with chronic diseases interested in using telehealth? A cross-sectional postal survey.

    PubMed

    Edwards, Louisa; Thomas, Clare; Gregory, Alison; Yardley, Lucy; O'Cathain, Alicia; Montgomery, Alan A; Salisbury, Chris

    2014-05-08

    There is growing interest in telehealth-the use of technology to support the remote delivery of health care and promote self-management-as a potential alternative to face-to-face care for patients with chronic diseases. However, little is known about what precipitates interest in the use of telehealth among these patients. This survey forms part of a research program to develop and evaluate a telehealth intervention for patients with two exemplar chronic diseases: depression and raised cardiovascular disease (CVD) risk. The survey was designed to explore the key factors that influence interest in using telehealth in these patient groups. Thirty-four general practices were recruited from two different regions within England. Practice records were searched for patients with (1) depression (aged 18+ years) or (2) 10-year risk of CVD ≥20% and at least one modifiable risk factor (aged 40-74 years). Within each general practice, 54 patients in each chronic disease group were randomly selected to receive a postal questionnaire. Questions assessed five key constructs: sociodemographics, health needs, difficulties accessing health care, technology-related factors (availability, confidence using technology, perceived benefits and drawbacks of telehealth), and satisfaction with prior use of telehealth. Respondents also rated their interest in using different technologies for telehealth (phone, email and Internet, or social media). Relationships between the key constructs and interest in using the three mediums of telehealth were examined using multivariable regression models. Of the 3329 patients who were sent a study questionnaire, 44.40% completed it (872/1740, 50.11% CVD risk; 606/1589, 38.14% depression). Overall, there was moderate interest in using phone-based (854/1423, 60.01%) and email/Internet-based (816/1425, 57.26%) telehealth, but very little interest in social media (243/1430, 16.99%). After adjusting for health needs, access difficulties, technology

  14. Integrating telehealth in to 'business as usual': Is it really possible?

    PubMed

    Jury, Susan C; Kornberg, Andrew J

    2016-12-01

    The Royal Children's Hospital, Melbourne, began offering web-based telehealth video consultation in 2011, with the principle being that telehealth should be integrated into 'business as usual'. In telehealth literature, key differences between telehealth and in-person consultations can make this hard to achieve, so an audit was performed that revealed many small gaps in the process.A total of 125 telehealth appointments were booked during the study period. Of these, 13% (n = 16) were rescheduled, cancelled or changed to face-to-face appointments, and up to two main issues were identified for the remaining appointments. Some 69% of the remaining 108 appointments (n = 75) were completed successfully, with 23% (n = 25) completely seamless end to end. Overall, 39 issues were administrative (40%), 34 technical (35%) and 24 scheduling (25%); nine (8%) required some minor troubleshooting.For long-term sustainability, integrating telehealth into business as usual needs to remain the target. Scheduling and technical glitches were the main barriers to seamless telehealth. Several issues have now been addressed with the introduction of an electronic medical record, and the development of standardised processes and staff training.

  15. Education and training to support the use of clinical telehealth: A review of the literature.

    PubMed

    Edirippulige, S; Armfield, N R

    2017-02-01

    Introduction Despite a growing literature base, substantial investment, and policy changes within governments, the integration of telehealth into routine clinical care has been limited. The availability of appropriate systematic education and training for practitioners has been highlighted as necessary for strong adoption. However, the availability and nature of telehealth-related education and training for practitioners is not understood. By reviewing the literature, we aimed to describe the delivery of education and training in telehealth, with particular focus on content, modes of delivery, types of institutions, and target clinician groups. Methods We performed searches using PubMed, Scopus, Embase, Web of Science, PsycINFO, the Cochrane Library, and ERIC. We included studies that were focused on the delivery of telehealth-related academic or vocational education and training. We extracted information pertaining to country, programs and their participants, and tabulated the results. Results Altogether 388 articles were identified, of which nine studies were selected for final review. Programs from five countries were represented and articles were spread across telemedicine and clinically oriented journals. Education and training in telehealth has been provided as both university level and vocational courses using conventional classroom based delivery methods and e-learning. Reported curriculum items included terminology, clinical applications, the evidence-base, and technological aspects. Conclusions Published evidence in peer-reviewed literature on telehealth education and training is limited. According to this review, a number of topics relating to telehealth have been covered by existing education programs both within tertiary and professional development levels.

  16. Telehealth in the trenches: reporting back from the frontlines in rural America.

    PubMed

    Alverson, Dale C; Shannon, Suzanne; Sullivan, Eileen; Prill, Amanda; Effertz, Glen; Helitzer, Deborah; Beffort, Steven; Preston, Alistair

    2004-01-01

    Access to appropriate healthcare services continues to be a major challenge in rural America. Telehealth technologies offer an opportunity to bridge gaps in health services in rural and remote areas and possibly support rural economic development. Lack of access to healthcare services to a growing population may create barriers to recruitment of businesses and economic growth. Several rural-oriented programs have attempted to leverage these emerging distance technologies, but success has varied despite the application of considerable federal, state governmental, and private resources. Barriers to adoption and sustainability of rural telehealth embody several factors that must be considered when planning, developing, implementing, and evaluating a rural telehealth program. New Mexico, the fifth largest state in the United States, represents many of the issues related to the potential benefits and challenges in developing a telehealth system to serve its rural communities. The Center for Telehealth at the University of New Mexico Health Sciences Center has been supported in large part by state and federal funding. Through our experiences, successes, failures, and lessons learned, we have developed approaches to overcoming barriers to adoption and sustainment of telehealth applications, including the establishment of partnerships with economic development projects in the state. This article describes these experiences and identifies and provides strategies for planning, development, implementation, and sustainment of telehealth in a rural program.

  17. A pilot study to engage and counsel HIV-positive African American youth via telehealth technology.

    PubMed

    Saberi, Parya; Yuan, Patrick; John, Malcolm; Sheon, Nicolas; Johnson, Mallory O

    2013-09-01

    Abstract Antiretroviral nonadherence is a strong determinant of virologic failure and is negatively correlated with survival. HIV-positive African American youth have lower antiretroviral adherence and treatment engagement than other populations. We assessed the feasibility and acceptability of a telehealth (remote videoconferencing) medication counseling intervention as an innovative approach to address these disparities. HIV-positive African American youth (18-29 years old) on antiretrovirals were enrolled in a telehealth medication counseling session, followed by a semi-structured qualitative interview to explore likes/dislikes of the format, modality, and content; potential impact on adherence; privacy issues; and interaction quality. Fourteen participants with a mean age of 24 years, who were 86% male, and had a mean self-reported adherence in the past month of 89%, were interviewed. Participants stated that they liked telehealth, would use it if offered in clinic/research settings, and indicated that their privacy was maintained. Participants described telehealth as convenient and efficient, with positive impact on their knowledge. Telehealth provided a modality to interact with providers that participants described as less intimidating than in-person visits. Telehealth is feasible and acceptable for delivering medication counseling to HIV-positive African American youth when conducted in a controlled clinical setting and may improve quality of patient-provider dialogue. Use of telehealth may lead to more disclosure of treatment difficulties, increased patient comfort, and improved health education.

  18. Expendable launch vehicle propulsion

    NASA Technical Reports Server (NTRS)

    Fuller, Paul N.

    1991-01-01

    The current status is reviewed of the U.S. Expendable Launch Vehicle (ELV) fleet, the international competition, and the propulsion technology of both domestic and foreign ELVs. The ELV propulsion technology areas where research, development, and demonstration are most needed are identified. These propulsion technology recommendations are based on the work performed by the Commercial Space Transportation Advisory Committee (COMSTAC), an industry panel established by the Dept. of Transportation.

  19. Discovering untapped relationship potential with patients in telehealth: a qualitative interview study.

    PubMed

    Heckemann, Birgit; Wolf, Axel; Ali, Lilas; Sonntag, Steffen Mark; Ekman, Inger

    2016-03-02

    To explore factors that influence relationship building between telehealth professionals and patients with chronic illness over a distance, from a telehealth professional's perspective. 4 focus group interviews were conducted in June 2014. Digital recordings were transcribed verbatim and qualitative content analysis was performed using an iterative process of 3 coding rounds. 20 telehealth professionals. A telehealth service centre in the south of Germany that provided care for 12,000 patients with chronic heart failure across Germany. Non-video telehealth technology creates an atmosphere that fosters sharing of personal information and a non-judgemental attitude. This facilitates the delivery of fair and equal healthcare. A combination of a protocol-driven service structure along with shared team and organisational values provide a basis for establishing long-term healthcare relationships. However, each contact between a telehealth professional and a patient has an uncertain outcome and requires skillful negotiation of the relationship. Although care provision was personalised, there was scope to include the patients as 'experts on their own illness' to a greater extent as advocated by person-centred care. Currently, provision of person-centred care is not sufficiently addressed in telehealth professional training. Telehealth offers a viable environment for the delivery of person-centred care for patients with long-standing disease. Current telehealth training programmes may be enhanced by teaching person-centred care skills. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  20. The Experience of a Sustainable Large Scale Brazilian Telehealth Network.

    PubMed

    Soriano Marcolino, Milena; Minelli Figueira, Renato; Pereira Afonso Dos Santos, Julia; Silva Cardoso, Clareci; Luiz Ribeiro, Antonio; Alkmim, Maria Beatriz

    2016-11-01

    In Brazil, the majority of healthcare resources are concentrated in the largest cities, whereas most communities lack proper healthcare assistance in primary care and have difficulties accessing specialists and diagnostic examinations. Considering this, the Telehealth Network of Minas Gerais (TNMG) was created. It is a public telehealth initiative that provides support to primary healthcare (PHC), performing teleconsultation and telediagnosis (electrocardiogram [ECG], Holter, ambulatory blood pressure monitoring, spirometry, and retinography analysis) mainly for small and remote cities in the state of Minas Gerais, Brazil. To describe the successful experience of the TNMG in 10 years of activities. The TNMG was created in 2005 and supported PHC in 82 cities as a research project and was progressively expanded. A methodology for implementation and maintenance was developed, including quality control. Nowadays it provides support to 750 cities, 88.0% of Minas Gerais state. The examinations performed by the PHC team, with additional basic clinical data, are transmitted through the Internet to the TNMG specialists for remote interpretation. The TNMG teleconsultations system has been used by the PHC team to address written clinical questions to university staff. Until December 2015, 2,464,999 ECGs and 73,698 teleconsultations have already been performed: on average, 2,000 ECGs and 40 teleconsultations per day in 2015. More than 95% of users have declared to be satisfied or very satisfied with the service. A recent cost-benefit analysis of the project showed that for each dollar invested, 6.1 dollars are saved as a consequence of patient referral reduction. The TNMG is a successful example of a sustainable telehealth service, integrated to primary care centers of remote and small cities. It overcomes geographical barriers to provide specialized healthcare, reducing the number of unnecessary referrals, and contributing to improve the case-resolving capacity and the

  1. Plastic surgery telehealth consultation expedites Emergency Department treatment.

    PubMed

    Paik, Angie M; Granick, Mark S; Scott, Sandra

    2017-02-01

    Plastic surgery is a field that is particularly amenable to a telehealth milieu, as visual exam and radiographs guide proper diagnosis and management. The goals of this study were to evaluate telehealth feedback executed through an iPad app for plastic surgery-related consultations. A Quality Assurance/Quality Improvement (QA/QI) study was conducted over a 1-month period during which patients with hand injuries, facial injuries, or acute wounds presenting to the Emergency Department (ED) of a level-one trauma centre and university hospital were monitored. The study utilized a commercial iPad application through which up to four images and a brief history could be sent to a remote Plastic Surgery Educator (PSE) for evaluation. The PSE would respond with best practice information, references and videos to assist ED point-of-care providers. During the 1-month period of this study, there were 42 ED consultations for plastic surgical conditions. There was a highly significant difference in overall mean response time between consultants and PSEs (48.3 minutes vs. 8.9 minutes respectively, p < 0.001). The agreement between PSEs and consultants regarding patient assessment and care was 85.7% for in-person consultations and 100% for phone consultations. In four cases of telephone consultations, the ED providers placed splints incorrectly on hand-injured patients. Our results show that telehealth consultations to a remote plastic surgeon based on digital images and a brief history were able to produce timely and accurate responses in an emergency care facility. This design may have significant impact in rural areas, underserved populations, or regions abroad.

  2. The design, implementation, and operational management of a comprehensive quality management program to support national telehealth networks.

    PubMed

    Darkins, Adam; Foster, Linda; Anderson, Carla; Goldschmidt, Leonard; Selvin, Gerald

    2013-07-01

    The Veterans Health Administration (VHA) is a large integrated healthcare system with a mission to care for over 5.6 million Veteran patients annually. VHA, like other healthcare organizations, is challenged with providing access to care to those it serves when they live at a distance from a physical site of care. VHA has embraced telehealth as a way of delivering care at a distance and increase access to specialty care services. Since 2003 VHA has developed large national telehealth networks that provided care to 497,342 patients in fiscal year 2012, who received 1,429,424 episodes of care, and is recognized as a national leader in this field. To ensure the safety and effectiveness of its telehealth networks in their delivery of care VHA has implemented a dedicated quality management (QM) program for telehealth. QM data for telehealth are reviewed at 3-month intervals, and the procedures and processes in place to support telehealth in VHA are assessed biannually in an internal accreditation process called "Telehealth Conditions of Participation." This collegial, nonadversarial process has ensured that all designated telehealth programs meet minimal standards and disseminate best practice. As a result of VHA's QM program, telehealth services in VHA meet consistently high clinical outcomes and have received no adverse Joint Commission citations. The Joint Commission regularly assesses patients managed via telehealth under its tracer methodology reviews.

  3. “Real-World” Practical Evaluation Strategies: A Review of Telehealth Evaluation

    PubMed Central

    Masters, Caitlin; Kvedar, Joseph; Jethwani, Kamal

    2014-01-01

    Background Currently, the increasing interest in telehealth and significant technological breakthroughs of the past decade create favorable conditions for the widespread adoption of telehealth services. Therefore, expectations are high that telehealth can help alleviate prevailing challenges in health care delivery. However, in order to translate current research to policy and facilitate adoption by patients and health care providers, there is need for compelling evidence of the effectiveness of telehealth interventions. Such evidence is gathered from rigorously designed research studies, which may not always be practical in many real-world settings. Objective Our aim was to summarize current telehealth evaluation strategies and challenges and to outline practical approaches to conduct evaluation in real-world settings using one of our previously reported telehealth initiatives, the Diabetes Connect program, as a case study. Methods We reviewed commonly used current evaluation frameworks and strategies, as well as best practices based on successful evaluative efforts to date to address commonly encountered challenges in telehealth evaluation. These challenges in telehealth evaluation and commonly used frameworks are described relevant to the evaluation of Diabetes Connect, a 12-month Web-based blood glucose monitoring program. Results Designers of telehealth evaluation frameworks must give careful consideration to the elements of planning, implementation, and impact assessment of interventions. Evaluating performance at each of these phases is critical to the overall success of an intervention. Although impact assessment occurs at the end of a program, our review shows that it should begin at the point of problem definition. Critical to the success of an evaluative strategy is early planning that involves all stakeholders to identify the overall goals of the program and key measures of success at each phase of the program life cycle. This strategy should enable

  4. Feasibility and effectiveness of an automated telehealth intervention to improve illness self-management in people with serious psychiatric and medical disorders.

    PubMed

    Pratt, Sarah I; Bartels, Stephen J; Mueser, Kim T; Naslund, John A; Wolfe, Rosemarie; Pixley, Heather S; Josephson, Louis

    2013-12-01

    Effective monitoring and treatment are needed to address the elevated rates of medical comorbidity among individuals with serious mental illnesses. This study examined the feasibility and potential effectiveness of an automated telehealth intervention, supported by nurse health-care management, among adults with serious mental illnesses and chronic medical conditions. We conducted a single-arm pilot trial with 70 individuals with serious mental illnesses and chronic medical conditions who were medically unstable (determined by treatment team or defined as multiple emergency room visits/hospitalizations within the past year). The telehealth intervention was delivered for 6 months with feasibility and acceptability as the primary outcomes. Measures of illness management self-efficacy, psychiatric symptoms, subjective health status, health indicators, and service use were also collected at baseline and at 6 months. Most individuals (n = 62; 89%) participated in at least 70% of the telehealth sessions. Participation was associated with improvements in self-efficacy for managing depression and diastolic blood pressure. Almost all participants (n = 68; 98%) rated their understanding of their medical condition as "much better" or "somewhat better" postintervention. Among a subgroup of individuals with diabetes, decreases in fasting blood glucose were achieved, and among those with diabetes and major depression or bipolar disorder there were reductions in urgent care and primary care visits. These results demonstrate the feasibility and acceptability of automated telehealth supported by a nurse care manager and the potential effectiveness of this technology in improving self-management of psychiatric symptoms and chronic health conditions among these high-risk individuals. PsycINFO Database Record (c) 2013 APA, all rights reserved.

  5. Are People With Chronic Diseases Interested in Using Telehealth? A Cross-Sectional Postal Survey

    PubMed Central

    Thomas, Clare; Gregory, Alison; Yardley, Lucy; O'Cathain, Alicia; Montgomery, Alan A; Salisbury, Chris

    2014-01-01

    Background There is growing interest in telehealth—the use of technology to support the remote delivery of health care and promote self-management—as a potential alternative to face-to-face care for patients with chronic diseases. However, little is known about what precipitates interest in the use of telehealth among these patients. Objective This survey forms part of a research program to develop and evaluate a telehealth intervention for patients with two exemplar chronic diseases: depression and raised cardiovascular disease (CVD) risk. The survey was designed to explore the key factors that influence interest in using telehealth in these patient groups. Methods Thirty-four general practices were recruited from two different regions within England. Practice records were searched for patients with (1) depression (aged 18+ years) or (2) 10-year risk of CVD ≥20% and at least one modifiable risk factor (aged 40-74 years). Within each general practice, 54 patients in each chronic disease group were randomly selected to receive a postal questionnaire. Questions assessed five key constructs: sociodemographics, health needs, difficulties accessing health care, technology-related factors (availability, confidence using technology, perceived benefits and drawbacks of telehealth), and satisfaction with prior use of telehealth. Respondents also rated their interest in using different technologies for telehealth (phone, email and Internet, or social media). Relationships between the key constructs and interest in using the three mediums of telehealth were examined using multivariable regression models. Results Of the 3329 patients who were sent a study questionnaire, 44.40% completed it (872/1740, 50.11% CVD risk; 606/1589, 38.14% depression). Overall, there was moderate interest in using phone-based (854/1423, 60.01%) and email/Internet-based (816/1425, 57.26%) telehealth, but very little interest in social media (243/1430, 16.99%). After adjusting for health needs

  6. Reusable Launch Vehicle Technology Program

    NASA Technical Reports Server (NTRS)

    Freeman, Delma C., Jr.; Talay, Theodore A.; Austin, R. Eugene

    1996-01-01

    Industry/NASA Reusable Launch Vehicle (RLV) Technology Program efforts are underway to design, test, and develop technologies and concepts for viable commercial launch systems that also satisfy national needs at acceptable recurring costs. Significant progress has been made in understanding the technical challenges of fully reusable launch systems and the accompanying management and operational approaches for achieving a low-cost program. This paper reviews the current status of the Reusable Launch Vehicle Technology Program including the DC-XA, X-33 and X-34 flight systems and associated technology programs. It addresses the specific technologies being tested that address the technical and operability challenges of reusable launch systems including reusable cryogenic propellant tanks, composite structures, thermal protection systems, improved propulsion, and subsystem operability enhancements. The recently concluded DC-XA test program demonstrated some of these technologies in ground and flight tests. Contracts were awarded recently for both the X-33 and X-34 flight demonstrator systems. The Orbital Sciences Corporation X-34 flight test vehicle will demonstrate an air-launched reusable vehicle capable of flight to speeds of Mach 8. The Lockheed-Martin X-33 flight test vehicle will expand the test envelope for critical technologies to flight speeds of Mach 15. A propulsion program to test the X-33 linear aerospike rocket engine using a NASA SR-71 high speed aircraft as a test bed is also discussed. The paper also describes the management and operational approaches that address the challenge of new cost-effective, reusable launch vehicle systems.

  7. Venture Class Launch Services

    NASA Technical Reports Server (NTRS)

    Wiese, Mark

    2016-01-01

    Provide an introduction to the Launch Services Program, and specifically the strategic initiative that drove the Venture Class Launch Services contracts. Provide information from the VCLS request for proposals, as well as the Agency's CubeSat Launch Initiative.

  8. Launch summary for 1978

    NASA Technical Reports Server (NTRS)

    Vostreys, R. W.

    1978-01-01

    Sounding rocket, satellite, and space probe launchings are presented. Time, date, and location of the launches are provided. The sponsoring countries and the institutions responsible for the launch are listed.

  9. Evaluation of a clinical video telehealth pain management clinic.

    PubMed

    Desko, Lauren; Nazario, Mitchell

    2014-12-01

    The objectives of this project were to evaluate patient satisfaction with the clinical video telehealth (CVT) pain management clinic, and to evaluate possible benefits of this clinic. Data collected included the distance from the patient's home to the main Department of Veterans Affairs (VA) medical center, the distance from the patient's home to the community based outpatient clinic (CBOC), travel distance saved for the patient, and travel pay status. Following CVT clinic appointments patients were asked to complete a written feedback assessment to evaluate patient satisfaction. All data were analyzed using descriptive statistics. Veterans saved 8,981 miles in travel distance, and the VA saved $2,317.51 due to averted travel reimbursement. There was a 90% satisfaction rate with the CVT pain management clinic services, and 90% of patients agreed that they would recommend telehealth to other veterans. Overall, patients are satisfied with the CVT pain management clinic. Furthermore, the substantial miles saved for the patients, as well as the cost savings for the VA, indicates that this service has tangible benefits. As this clinic continues to operate, it can be expected that miles saved for patients and cost savings for the VA will continue to grow.

  10. Telemedicine, telehealth, and mobile health applications that work: opportunities and barriers.

    PubMed

    Weinstein, Ronald S; Lopez, Ana Maria; Joseph, Bellal A; Erps, Kristine A; Holcomb, Michael; Barker, Gail P; Krupinski, Elizabeth A

    2014-03-01

    There has been a spike in interest and use of telehealth, catalyzed recently by the anticipated implementation of the Affordable Care Act, which rewards efficiency in healthcare delivery. Advances in telehealth services are in many areas, including gap service coverage (eg, night-time radiology coverage), urgent services (eg, telestroke services and teleburn services), mandated services (eg, the delivery of health care services to prison inmates), and the proliferation of video-enabled multisite group chart rounds (eg, Extension for Community Healthcare Outcomes programs). Progress has been made in confronting traditional barriers to the proliferation of telehealth. Reimbursement by third-party payers has been addressed in 19 states that passed parity legislation to guarantee payment for telehealth services. Medicare lags behind Medicaid, in some states, in reimbursement. Interstate medical licensure rules remain problematic. Mobile health is currently undergoing explosive growth and could be a disruptive innovation that will change the face of healthcare in the future.

  11. Telehealth Applications to Enhance CKD Knowledge and Awareness Among Patients and Providers.

    PubMed

    Tuot, Delphine S; Boulware, L Ebony

    2017-01-01

    CKD affects 13% of the US adult population, causes excess mortality, and is associated with significant sociodemographic disparities. Optimal CKD management slows progression of disease and reduces cardiovascular-related outcomes. Resources for patients and primary care providers, major stakeholders in preventive CKD care, are critically needed to enhance understanding of the disease and to optimize CKD health, particularly because of the asymptomatic nature of kidney disease. Telehealth is defined as the use of electronic communication and telecommunications technology to support long-distance clinical health care, patient and professional health-related education, and public health and health administration. It provides new opportunities to enhance awareness and understanding among these important stakeholders. This review will examine the role of telehealth within existing educational theories, identify telehealth applications that can enhance CKD knowledge and behavior change among patients and primary care providers, and examine the advantages and disadvantages of telehealth vs usual modalities for education.

  12. A step-by-step guide to home telehealth program planning.

    PubMed

    Kinsella, Audrey

    2003-08-01

    Many home health providers have become familiar with the idea of home telehealth service, but planning its optimal delivery nevertheless presents a challenge. This article presents the first steps agencies need to take before the "televisiting" can begin.

  13. [Nursing contributions to the development of the Brazilian Telehealth Lactation Support Program].

    PubMed

    Prado, Cláudia; Silva, Isília Aparecida; Soares, Alda Valéria Neves; Aragaki, Ilva Marico Mizumoto; Shimoda, Gilcéria Tochika; Zaniboni, Vanessa Forte; Padula, Camila Brolezzi; Muller, Fabiana Swain; Salve, Jeanine Maria; Daré, Sergio Junior; Wen, Chao Lung; Peres, Heloísa Helena Ciqueto; Leite, Maria Madalena Januário

    2013-08-01

    The National Telehealth Program was founded by the Ministry of Health, in partnership with the Ministry of Education (Ministério da Educação - MEC) and the Ministry of Science and Technology (Ministério da Ciência e Tecnologia - MCT), to support the development of family healthcare teams throughout the country. The São Paulo Telehealth Center has developed the Telehealth Lactation Support program, which provides primary healthcare professionals with information on diverse aspects of breastfeeding. This paper reports the development of the Lactation Support program and the nursing contributions. Project methodology included the formation of a multidisciplinary group of pediatricians, nurses, speech and language therapists, nutritionists, and dentists. Multimedia teaching resources were prepared for inclusion in the Cybertutor platform. Telehealth Lactation Support is an innovative and promising addition to continuing education for healthcare professionals and provides a framework for the development of other programs.

  14. A qualitative study of Telehealth patient information leaflets (TILs): are we giving patients enough information?

    PubMed

    Kayyali, Reem; Hesso, Iman; Ejiko, Evelyn; Nabhani Gebara, Shereen

    2017-05-19

    The provision of patient information leaflets regarding telehealth has been perceived by potential consumers as a strategy to promote awareness and adoption of telehealth services. However, such leaflets need to be designed carefully if adoption and awareness among potential users is to be promoted. Therefore, the aims of this study were: first, to see how telehealth was portrayed in some of the existing telehealth leaflets (THLs). Second, to explore patients' perceptions of the existing THLs and their engagement with the concept and how THLs can be optimised. A two-step approach was employed to address the aims of this study. The first phase involved the use of discourse analysis to compare 12 electronically and publically available THLs, with the existing THL guidance "Involve Yorkshire and Humber". The second phase involved conducting 14 semi-structured interviews with potential telehealth users/patients to gauge their perception and engagement with the concept, using the two leaflets that were mostly matching with the guidance used. Six interviews were audio-recorded and eight had detailed jotted notes. The interviews were transcribed and thematically analysed to identify key themes. The discourse analysis showed certain gaps and variations within the screened leaflets when addressing the following aspects: cost of the telehealth service, confidentiality, patients' choices in addition to equipment use and technical support. Analysis of the interviews revealed patients' need for having clear and sufficient information about the telehealth service within the THLs; in addition to, patients' preference for the use of simpler terminologies for telehealth description and the provision of clear simple texts with pictorial presentations. The interviews also revealed certain limitations against adoption of telehealth by the participants, such as: lack of privacy and confidentiality of information, fear of technology breakdown and equipment failure, loss of face

  15. Our experience in using telehealth for paediatric plastic surgery in Western Australia.

    PubMed

    Rimal, Debesh; Huang Fu, Ju Hui; Gillett, David

    2017-04-01

    Western Australia accounts for one-third of Australia's total land mass. Princess Margaret Hospital is the only dedicated plastic surgery tertiary referral centre providing services to over 500 000 children across the state. The aim of this study is to share our experience using telehealth for service provision and delivery of care in a geographically challenging setting. A retrospective review was conducted, and data were extracted from patients' notes. The time period was from January 2014 to 31 December 2015 and included all patients registered for plastic surgery telehealth service. There were a total of 194 rural patients (66 males and 128 females), 26 of whom were elective cases. A total of 358 telehealth follow-up consultations were conducted for the 194 patients during the study period. A total of 10 patients were managed via telehealth alone without a clinical review in Perth; 24 patients had their first clinical review in Perth and further follow-up via telehealth, and 99 patients were post-operative cases. Case load ranged from skin lacerations to complex soft tissue and bony injuries as well as elective hand and craniofacial post-operative follow-up cases. Telehealth service was utilized mainly for post-operative follow-up. It is our experience that telehealth provides access to Specialist Plastic Surgery service across the state. We utilize telehealth for a wide scope of functions. Patients in rural areas are managed in their home environments, reducing financial and psychosocial burden with the option of transfer to Princess Margaret Hospital should an intervention be required. © 2017 Royal Australasian College of Surgeons.

  16. What's happening now! Telehealth management of spinal cord injury/disorders

    PubMed Central

    Woo, Christine; Guihan, Marylou; Frick, Christine; Gill, Carol M.; Ho, Chester H.

    2011-01-01

    Context Spinal cord injury and/or disorders (SCI/D) is a costly chronic condition. Impaired mobility, and lengthy travel distances to access specialty providers are barriers that can have adverse impact on expenses and quality of care. Although ample opportunities for use of telehealth technologies exist between medical facilities, and from clinical to home settings, field experience has largely been focused on home telehealth services to promote better patient self-management skills and improve clinical outcomes. Findings This paper provides an overview of published literature on use of telehealth technologies with the SCI/D population. Presentation of case studies describe telehealth as a potential strategy for addressing disparities in providing quality care, and explore comprehensive management of multiple health issues in individuals with SCI/D. Experiences of providers in both private sector health-care systems and VHA medical facilities are described. Development of telehealth clinical protocols and adaptive devices that can be integrated with equipment to accommodate for the functional limitations in the SCI/D population are discussed as necessary for expansion of use of telehealth services. Rigorous research studies are lacking. As use of this technology spreads and issues surrounding implementation are addressed, we look forward to increased research to assess and evaluate its efficacy in the SCI/D population. Conclusion/clinical relevance Telehealth in the home setting appears to be able to help persons with SCI/D remain in the community. As the use of telehealth increases, research will be necessary in both clinical and home settings to assess its efficacy in improving outcomes in the SCI/D population. PMID:21756573

  17. Implementation of video telehealth to improve access to evidence-based psychotherapy for posttraumatic stress disorder.

    PubMed

    Lindsay, Jan A; Kauth, Michael R; Hudson, Sonora; Martin, Lindsey A; Ramsey, David J; Daily, Lawrence; Rader, John

    2015-06-01

    Increasing access to psychotherapy for posttraumatic stress disorder (PTSD) is a primary focus of the Department of Veterans Affairs (VA) healthcare system. Delivery of treatment via video telehealth can expand availability of treatment and be equally effective as in-person treatment. Despite VA efforts, barriers to establishing telehealth services remain, including both provider acceptance and organizational obstacles. Thus, development of specific strategies is needed to implement video telehealth services in complex healthcare systems, like the VA. This project was guided by the Promoting Action on Research Implementation in Health Services framework and used external facilitation to increase access to psychotherapy via video telehealth. The project was conducted at five VA Medical Centers and their associated community clinics across six states in the South Central United States. Over a 21-month period, 27 video telehealth clinics were established to provide greater access to evidence-based psychotherapies for PTSD. Examination of change scores showed that participating sites averaged a 3.2-fold increase in unique patients and a 6.5-fold increase in psychotherapy sessions via video telehealth for PTSD. Differences between participating and nonparticipating sites in both unique patients and encounters were significant (p=0.041 and p=0.009, respectively). Two groups emerged, separated by degree of engagement in the facilitation intervention. Facilitation was perceived as useful by providers. To our knowledge, this is the first prospective study of external facilitation as an implementation strategy for telehealth. Our findings suggest that external facilitation is an effective and acceptable strategy to support providers as they establish clinics and make complex practice changes, such as implementing video telehealth to deliver psychotherapy.

  18. Telehealth exercise-based cardiac rehabilitation: a systematic review and meta-analysis.

    PubMed

    Rawstorn, Jonathan C; Gant, Nicholas; Direito, Artur; Beckmann, Christina; Maddison, Ralph

    2016-08-01

    Despite proven effectiveness, participation in traditional supervised exercise-based cardiac rehabilitation (exCR) remains low. Telehealth interventions that use information and communication technologies to enable remote exCR programme delivery can overcome common access barriers while preserving clinical supervision and individualised exercise prescription. This meta-analysis aimed to determine the benefits of telehealth exCR on exercise capacity and other modifiable cardiovascular risk factors compared with traditional exCR and usual care, among patients with coronary heart disease (CHD). CINAHL, The Cochrane Library, Embase, MEDLINE, PubMed and PsycINFO were searched from inception through 31 May 2015 for randomised controlled trials comparing telehealth exCR with centre-based exCR or usual care among patients with CHD. Outcomes included maximal aerobic exercise capacity, modifiable cardiovascular risk factors and exercise adherence. 11 trials (n=1189) met eligibility criteria and were included in the review. Physical activity level was higher following telehealth exCR than after usual care. Compared with centre-based exCR, telehealth exCR was more effective for enhancing physical activity level, exercise adherence, diastolic blood pressure and low-density lipoprotein cholesterol. Telehealth and centre-based exCR were comparably effective for improving maximal aerobic exercise capacity and other modifiable cardiovascular risk factors. Telehealth exCR appears to be at least as effective as centre-based exCR for improving modifiable cardiovascular risk factors and functional capacity, and could enhance exCR utilisation by providing additional options for patients who cannot attend centre-based exCR. Telehealth exCR must now capitalise on technological advances to provide more comprehensive, responsive and interactive interventions. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  19. Cassini launch contingency effort

    NASA Astrophysics Data System (ADS)

    Chang, Yale; O'Neil, John M.; McGrath, Brian E.; Heyler, Gene A.; Brenza, Pete T.

    2002-01-01

    Cassini launch, JHU/APL's on-station real-time launch contingency activities were implemented. Live news from NASA Select TV of a successful Cassini launch and interplanetary injection precluded any further contingency actions. The Cassini launch contingency effort contributed to mission safety and demonstrated successful cooperation between several agencies. .

  20. STS-53 Launch and Landing

    NASA Technical Reports Server (NTRS)

    1992-01-01

    Footage of various stages of the STS-53 Discovery launch is shown, including shots of the crew at breakfast, getting suited up, and departing to board the Orbiter. The launch is seen from many vantage points, as is the landing. On-orbit activities show the crew performing several medical experiments, such as taking a picture of the retina and measuring the pressure on the eyeball. One crewmember demonstrates how to use the rowing machine in an antigravity environment.

  1. Saturn IB AS-202 Launch

    NASA Technical Reports Server (NTRS)

    1966-01-01

    AS-202, the second Saturn IB launch vehicle developed by the Marshall Space Flight Center, lifts off from Cape Canaveral, Florida, August 25, 1966. Primary mission objectives included the confirmation of projected launch loads, demonstration of spacecraft component separation, and verification of heat shield adequacy at high reentry rates. In all, nine Saturn IB flights were made, ending with the Apollo-Soyuz Test Project (ASTP) in July 1975.

  2. CubeSat Launch Initiative

    NASA Technical Reports Server (NTRS)

    Higginbotham, Scott

    2016-01-01

    The National Aeronautics and Space Administration (NASA) recognizes the tremendous potential that CubeSats (very small satellites) have to inexpensively demonstrate advanced technologies, collect scientific data, and enhance student engagement in Science, Technology, Engineering, and Mathematics (STEM). The CubeSat Launch Initiative (CSLI) was created to provide launch opportunities for CubeSats developed by academic institutions, non-profit entities, and NASA centers. This presentation will provide an overview of the CSLI, its benefits, and its results.

  3. Small Space Launch: Origins & Challenges

    NASA Astrophysics Data System (ADS)

    Freeman, T.; Delarosa, J.

    2010-09-01

    The United States Space Situational Awareness capability continues to be a key element in obtaining and maintaining the high ground in space. Space Situational Awareness satellites are critical enablers for integrated air, ground and sea operations, and play an essential role in fighting and winning conflicts. The United States leads the world space community in spacecraft payload systems from the component level into spacecraft, and in the development of constellations of spacecraft. In the area of launch systems that support Space Situational Awareness, despite the recent development of small launch vehicles, the United States launch capability is dominated by an old, unresponsive and relatively expensive set of launchers in the Expandable, Expendable Launch Vehicles (EELV) platforms; Delta IV and Atlas V. The United States directed Air Force Space Command to develop the capability for operationally responsive access to space and use of space to support national security, including the ability to provide critical space capabilities in the event of a failure of launch or on-orbit capabilities. On 1 Aug 06, Air Force Space Command activated the Space Development & Test Wing (SDTW) to perform development, test and evaluation of Air Force space systems and to execute advanced space deployment and demonstration projects to exploit new concepts and technologies, and rapidly migrate capabilities to the warfighter. The SDTW charged the Launch Test Squadron (LTS) with the mission to develop the capability of small space launch, supporting government research and development space launches and missile defense target missions, with operationally responsive spacelift for Low-Earth-Orbit Space Situational Awareness assets as a future mission. This new mission created new challenges for LTS. The LTS mission tenets of developing space launches and missile defense target vehicles were an evolution from the squadrons previous mission of providing sounding rockets under the Rocket

  4. Integrating telehealth services into a remote allied health service: A pilot study.

    PubMed

    O'Hara, Rebecca; Jackson, Sarah

    2017-02-01

    The continuity of care for people with neurological conditions in a remote northwest Queensland town as services are currently only available intermittently. Mixed methods design using questionnaires and staff review of the program and processes. Intermittent community rehabilitation service for clients with neurological conditions has been offered in Mount Isa and is supported by a similar fulltime service in Townsville. Both services use a unique client-centred, student-assisted, interprofessional model of care. Understanding participant experiences by obtaining feedback from clients, students and allied health professionals (AHPs) regarding their experiences of using telehealth in this setting. Previous clients of the North West Community Rehabilitation service were offered a review assessment using telehealth by an interprofessional team. Using telehealth enabled the client, remote AHP and students in Mount Isa to be connected to expert assistance in Townsville. The findings suggest that telehealth was useful in a community rehabilitation setting to provide review services for clients. This improved continuity of care for these clients because without this telehealth assessment, the clients would have had to wait up to 12 months for the next service period in Mount Isa or travel to a major urban centre to access a similar service. Feedback from clients, students and AHPs was positive; however, some challenges were identified. Recommendations for future service delivery using telehealth are outlined in the paper. © 2015 National Rural Health Alliance Inc.

  5. Telehealth and the recruitment and retention of physicians in rural and remote regions: a Delphi study.

    PubMed

    Duplantie, Julie; Gagnon, Marie-Pierre; Fortin, Jean-Paul; Landry, Réjean

    2007-01-01

    The availability of a medical workforce is a growing concern for rural and remote communities across Canada. In the last decade, various telehealth experiences have highlighted the potential impact of this technology on professional as well as organizational practices. But could telehealth be a strategy to attract and maintain physicians in rural and remote communities? The objective of this study was to identify a reliable list of recruitment and retention factors on which telehealth could have an impact. We conducted 2 literature reviews and a Delphi study among 12 telehealth experts across Canada. The literature reviews identified 7 categories of recruitment and retention factors on which telehealth could have an impact: 1) individual, 2) familial, 3) contextual, 4) professional, 5) organizational, 6) educational, and 7) economic. Experts consulted through the Delphi study reached consensus on 31 out of 34 of the proposed statements about the impact of telehealth. This consensus can now be used as a conceptual model for further studies on the topic.

  6. A systematic review of the use of telehealth in Asian countries.

    PubMed

    Durrani, Hammad; Khoja, Shariq

    2009-01-01

    We conducted a systematic review of the literature on telehealth in Asia. The Medline database was searched, together with three specialist journals, for peer-reviewed articles published in the ten years to June 2007 which were related to any telehealth application involving one or more Asian country. Out of the 1504 abstracts retrieved, 109 articles were selected by two independent reviewers for the final review. The number of published articles on telehealth in Asia increased during the review period. The largest number of studies were conducted in Japan (37%). Most telehealth applications were based on the store-and-forward modality (43%), with 35% using videoconferencing and 15% using a hybrid approach. Most of the studies were descriptive (75%) and only eight included a control group against which telehealth was compared. The most common means of telecommunication was ISDN lines, which were employed in 32% of the studies. Some 40% of the studies mentioned improved quality of health care; about 20% mentioned improved access to health care. Although most studies mentioned cost, only 13 of them assessed resource utilization and cost. The overall findings gave a generally optimistic picture of telehealth in Asia. However, there is a lack of good quality studies.

  7. Older adults' acceptance of a community-based telehealth wellness system.

    PubMed

    Demiris, George; Thompson, Hilaire; Boquet, Jaime; Le, Thai; Chaudhuri, Shomir; Chung, Jane

    2013-01-01

    The development of ongoing assessment tools to monitor older adult health and wellness can support improved quality of life and independence. These technologies have often been employed within private residences. Our work describes a telehealth kiosk system implemented within a community setting, which reduces the costs of installing and maintaining individual systems. Though user acceptance of telehealth systems has been studied within the context of home residences, this has yet to be addressed for community-based systems. Older adults in a retirement community were recruited to use a telehealth system including assessment of vital signs and cognitive performance. With a series of focus groups (N = 12, average age 79.3 years), we examined user perceptions of the telehealth kiosk, addressing issues of usability, effectiveness and privacy. Older adults were favorable towards the collection of health monitoring information, recognizing the utility of these data sources. There were issues of usability, especially regarding ergonomics of the telehealth kiosk. We found no concerns over privacy, with some participants expressing increased preference for the social interactions afforded through the community setting. Understanding the social, technical and human factors involved with a community-based telehealth system can inform the design of cost-effective health monitoring systems.

  8. A review of the efficacy and effectiveness of using telehealth for paediatric speech and language assessment.

    PubMed

    Taylor, Olivia D; Armfield, Nigel R; Dodrill, Pamela; Smith, Anthony C

    2014-10-01

    We reviewed the literature relating to the use of telehealth for paediatric speech and language assessment. Four databases, and relevant reference lists, were searched for articles published between January 2004 and July 2014. A total of 180 articles were identified, of which only five were relevant. All studies assessed efficacy using method comparison techniques; no studies assessed effectiveness. The method comparison studies investigated the validity and/or reliability of speech and language assessment via telehealth, when compared with face-to-face assessment. Studies varied in terms of participant group, assessment tools, statistical analysis and telehealth equipment. The papers reviewed presented some evidence that telehealth can be used to make valid assessments of oromotor function, speech intelligibility and language. Articulation screening via telehealth was found to be valid, but there was conflicting evidence about full articulation assessment. Intra- and inter-rater reliability was good for all speech and language tasks, with the exception of oromotor assessment, which also had reduced reliability when assessed face-to-face. There were discrepancies between the two modalities for individual oromotor tasks, judgement of individual speech sounds, detection of pluralisation, and discriminating between similar sounding words; these have the potential to be clinically important. Evidence regarding satisfaction was extremely limited, with only one study reporting parental satisfaction, and no studies reporting child or clinician satisfaction. Although there is limited evidence to support the validity and reliability of speech and language assessment via telehealth, it is probably not yet sufficient to influence clinical practice or policy development.

  9. Older adults’ acceptance of a community-based telehealth wellness system

    PubMed Central

    Demiris, George; Thompson, Hilaire; Boquet, Jaime; Le, Thai; Chaudhuri, Shomir; Chung, Jane

    2014-01-01

    The development of ongoing assessment tools to monitor older adult health and wellness can support improved quality of life and independence. These technologies have often been employed within private residences. Our work describes a telehealth kiosk system implemented within a community setting, which reduces the costs of installing and maintaining individual systems. Though user acceptance of telehealth systems has been studied within the context of home residences, this has yet to be addressed for community-based systems. Older adults in a retirement community were recruited to use a telehealth system including assessment of vital signs and cognitive performance. With a series of focus groups (N = 12, average age 79.3 years), we examined user perceptions of the telehealth kiosk, addressing issues of usability, effectiveness and privacy. Older adults were favorable towards the collection of health monitoring information, recognizing the utility of these data sources. There were issues of usability, especially regarding ergonomics of the telehealth kiosk. We found no concerns over privacy, with some participants expressing increased preference for the social interactions afforded through the community setting. Understanding the social, technical and human factors involved with a community-based telehealth system can inform the design of cost-effective health monitoring systems. PMID:22571733

  10. Implementing telehealth to support medical practice in rural/remote regions: what are the conditions for success?

    PubMed

    Gagnon, Marie-Pierre; Duplantie, Julie; Fortin, Jean-Paul; Landry, Réjean

    2006-08-24

    Telehealth, as other information and communication technologies (ICTs) introduced to support the delivery of health care services, is considered as a means to answer many of the imperatives currently challenging health care systems. In Canada, many telehealth projects are taking place, mostly targeting rural, remote or isolated populations. So far, various telehealth applications have been implemented and have shown promising outcomes. However, telehealth utilisation remains limited in many settings, despite increased availability of technology and telecommunication infrastructure. A qualitative field study was conducted in four remote regions of Quebec (Canada) to explore perceptions of physicians and managers regarding the impact of telehealth on clinical practice and the organisation of health care services, as well as the conditions for improving telehealth implementation. A total of 54 respondents were interviewed either individually or in small groups. Content analysis of interviews was performed and identified several effects of telehealth on remote medical practice as well as key conditions to ensure the success of telehealth implementation. According to physicians and managers, telehealth benefits include better access to specialised services in remote regions, improved continuity of care, and increased availability of information. Telehealth also improves physicians' practice by facilitating continuing medical education, contacts with peers, and access to a second opinion. At the hospital and health region levels, telehealth has the potential to support the development of regional reference centres, favour retention of local expertise, and save costs. Conditions for successful implementation of telehealth networks include the participation of clinicians in decision-making, the availability of dedicated human and material resources, and a planned diffusion strategy. Interviews with physicians and managers also highlighted the importance of considering

  11. Telehealth Delivery of Mental Health Services: An Analysis of Private Insurance Claims Data in the United States.

    PubMed

    Wilson, Fernando A; Rampa, Sankeerth; Trout, Kate E; Stimpson, Jim P

    2017-09-01

    This study characterizes telehealth claims for mental health and substance abuse (MH/SA) services by using national private claims data. Telehealth-related mental health service claims were identified with private claims data from 2009 to 2013. These data-provided by the Health Care Cost Institute-included claims from Aetna, Humana, and UnitedHealth for more than 50 million individuals per year. In 2009-2013, there were 13,480 MH/SA telehealth provider claims out of 3,986,159 claims, with the majority of telehealth claims submitted by psychiatrists. For telehealth services, there was a decreasing trend for average reimbursements ($54.61 in 2009 to $43.28 in 2013). Average reimbursements for telehealth claims were half those for nontelehealth claims. Reimbursements for nine of the top 10 telehealth services were lower in 2015 dollars than for the same services provided during face-to-face treatment. Widespread adoption and use of costly telehealth technologies for mental health services may be limited by low reimbursements for telehealth services.

  12. Initial Impressions of Community-Dwelling Older Adults and Case Managers about Community-Based Telehealth Kiosks

    PubMed Central

    Courtney, Karen L.; Lingler, Jennifer H.; Mecca, Laurel Person; Garlock, Laurie A.; Schulz, Richard; Dick, Andrew W.; Olshansky, Ellen

    2010-01-01

    Community-based (multi-user) telehealth interventions may be beneficial for older adults, but there is little research regarding community-based telehealth. We used a qualitative descriptive approach to examine the acceptability and perceived value of community-based telehealth kiosks with regard to current health self-management practices of community-dwelling older adults as a first step in feasibility assessment. Participants included residents (n=6) and community agency case managers (n=3) of a HUD-subsidized senior apartment building. Both positive impressions and concerns of each group are presented. Findings helped guide the plans for future telehealth kiosk implementation and training. PMID:20509594

  13. Reusable Launch Vehicle Technology Program

    NASA Technical Reports Server (NTRS)

    Freeman, Delma C., Jr.; Talay, Theodore A.; Austin, R. Eugene

    1997-01-01

    Industry/NASA reusable launch vehicle (RLV) technology program efforts are underway to design, test, and develop technologies and concepts for viable commercial launch systems that also satisfy national needs at acceptable recurring costs. Significant progress has been made in understanding the technical challenges of fully reusable launch systems and the accompanying management and operational approaches for achieving a low cost program. This paper reviews the current status of the RLV technology program including the DC-XA, X-33 and X-34 flight systems and associated technology programs. It addresses the specific technologies being tested that address the technical and operability challenges of reusable launch systems including reusable cryogenic propellant tanks, composite structures, thermal protection systems, improved propulsion and subsystem operability enhancements. The recently concluded DC-XA test program demonstrated some of these technologies in ground and flight test. Contracts were awarded recently for both the X-33 and X-34 flight demonstrator systems. The Orbital Sciences Corporation X-34 flight test vehicle will demonstrate an air-launched reusable vehicle capable of flight to speeds of Mach 8. The Lockheed-Martin X-33 flight test vehicle will expand the test envelope for critical technologies to flight speeds of Mach 15. A propulsion program to test the X-33 linear aerospike rocket engine using a NASA SR-71 high speed aircraft as a test bed is also discussed. The paper also describes the management and operational approaches that address the challenge of new cost effective, reusable launch vehicle systems.

  14. Reusable launch vehicle technology program

    NASA Astrophysics Data System (ADS)

    Freeman, Delma C.; Talay, Theodore A.; Austin, R. Eugene

    Industry/NASA reusable launch vehicle (RLV) technology program efforts are underway to design, test, and develop technologies and concepts for viable commercial launch systems that also satisfy national needs at acceptable recurring costs. Significant progress has been made in understanding the technical challenges of fully reusable launch systems and the accompanying management and operational approaches for achieving a low-cost program. This paper reviews the current status of the RLV technology program including the DC-XA, X-33 and X-34 flight systems and associated technology programs. It addresses the specific technologies being tested that address the technical and operability challenges of reusable launch systems including reusable cryogenic propellant tanks, composite structures, thermal protection systems, improved propulsion, and subsystem operability enhancements. The recently concluded DC-XA test program demonstrated some of these technologies in ground and flight tests. Contracts were awarded recently for both the X-33 and X-34 flight demonstrator systems. The Orbital Sciences Corporation X-34 flight test vehicle will demonstrate an air-launched reusable vehicle capable of flight to speeds of Mach 8. The Lockheed-Martin X-33 flight test vehicle will expand the test envelope for critical technologies to flight speeds of Mach 15. A propulsion program to test the X-33 linear aerospike rocket engine using a NASA SR-71 high speed aircraft as a test bed is also discussed. The paper also describes the management and operational approaches that address the challenge of new cost-effective, reusable launch vehicle systems.

  15. Effectiveness of a telehealth service delivery model for treating attention-deficit/hyperactivity disorder: a community-based randomized controlled trial.

    PubMed

    Myers, Kathleen; Vander Stoep, Ann; Zhou, Chuan; McCarty, Carolyn A; Katon, Wayne

    2015-04-01

    To test the effectiveness of a telehealth service delivery model for the treatment of children with attention-deficit/hyperactivity disorder (ADHD) that provided pharmacological treatment and caregiver behavior training. The Children's ADHD Telemental Health Treatment Study (CATTS) was a randomized controlled trial with 223 children referred by 88 primary care providers (PCPs) in 7 communities. Children randomized to the experimental telehealth service model received 6 sessions over 22 weeks of combined pharmacotherapy, delivered by child psychiatrists through videoconferencing, and caregiver behavior training, provided in person by community therapists who were supervised remotely. Children randomized to the control service delivery model received treatment with their PCPs augmented with a telepsychiatry consultation. Outcomes were diagnostic criteria for ADHD and oppositional defiant disorder (ODD) and role performance on the Vanderbilt ADHD Rating Scale (VADRS) completed by caregivers (VADRS-Caregivers) and teachers (VADRS-Teachers) and impairment on the Columbia Impairment Scale-Parent Version (CIS-P). Measures were completed at 5 assessments over 25 weeks. Children in both service models improved. Children assigned to the telehealth service model improved significantly more than children in the augmented primary care arm for VADRS-Caregiver criteria for inattention (χ(2)[4] = 19.47, p < .001), hyperactivity (χ(2)[4] = 11.91, p = .02), combined ADHD (χ(2)[4] = 14.90, p = .005), ODD (χ(2)[4] = 10.05, p = .04), and VADRS-Caregiver role performance (χ(2) [4] = 12.40, p = .01) and CIS-P impairment (χ(2)[4] = 20.52, p < .001). For the VADRS-Teacher diagnostic criteria, children in the telehealth service model had significantly more improvement in hyperactivity (χ(2)[4] = 11.28, p = .02) and combined ADHD (χ(2)[4] = 9.72, p = .045). The CATTS trial demonstrated the effectiveness of a telehealth service model to treat ADHD in communities with limited access to

  16. STS-120 launch

    NASA Image and Video Library

    2007-10-23

    STS120-S-026 (23 Oct. 2007) --- In the firing room of the Kennedy Space Center in Florida, NASA Shuttle Launch Director Michael Leinbach (second right) and launch managers watch the 11:38 a.m. (EDT) launch of Space Shuttle Discovery. Discovery launched Oct. 23 on a 14-day construction mission to the International Space Station. Photo credit: NASA/Bill Ingalls

  17. A telehealth architecture for networked embedded systems: a case study in in vivo health monitoring.

    PubMed

    Dabiri, Foad; Massey, Tammara; Noshadi, Hyduke; Hagopian, Hagop; Lin, C K; Tan, Robert; Schmidt, Jacob; Sarrafzadeh, Majid

    2009-05-01

    The improvement in processor performance through continuous breakthroughs in transistor technology has resulted in the proliferation of lightweight embedded systems. Advances in wireless technology and embedded systems have enabled remote healthcare and telemedicine. While medical examinations could previously extract only localized symptoms through snapshots, now continuous monitoring can discretely analyze how a patient's lifestyle affects his/her physiological conditions and if additional symptoms occur under various stimuli. We demonstrate how medical applications in particular benefit from a hierarchical networking scheme that will improve the quantity and quality of ubiquitous data collection. Our Telehealth networking infrastructure provides flexibility in terms of functionality and the type of applications that it supports. We specifically present a case study that demonstrates the effectiveness of our networked embedded infrastructure in an in vivo pressure application. Experimental results of the in vivo system demonstrate how it can wirelessly transmit pressure readings measuring from 0 to 1.5 lbf/in (2) with an accuracy of 0.02 lbf/in (2). The challenges in biocompatible packaging, transducer drift, power management, and in vivo signal transmission are also discussed. This research brings researchers a step closer to continuous, real-time systemic monitoring that will allow one to analyze the dynamic human physiology.

  18. Space Shuttle Discovery Launch

    NASA Image and Video Library

    2008-05-31

    NASA Shuttle Launch Director Michael Leinbach, left, STS-124 Assistant Launch Director Ed Mango, center, and Flow Director for Space Shuttle Discovery Stephanie Stilson clap in the the Launch Control Center after the main engine cut off and successful launch of the Space Shuttle Discovery (STS-124) Saturday, May 31, 2008, at the Kennedy Space Center in Cape Canaveral, Fla. The Shuttle lifted off from launch pad 39A at 5:02 p.m. EDT. Photo Credit: (NASA/Bill Ingalls)

  19. Closed end launch tube (CELT)

    NASA Astrophysics Data System (ADS)

    Lueck, Dale E.; Parrish, Clyde F.

    2001-02-01

    As an alternative to magnetic propulsion for launch assist, the authors propose a pneumatic launch assist system. Using off-the-shelf components, coupled with familiar steel and concrete construction, a launch assist system can be brought from the initial feasibility stage, through a flight capable 5000 kg demonstrator to a deployed full size launch assist system in 10 years. The final system would be capable of accelerating a 450,000 kg vehicle to 270 ms-1. The CELT system uses commercially available compressors and valves to build a fail-safe system in less than half the time of a full Mag-Lev (magnetic levitation) system, and at a small fraction of the development cost. The resulting system could be ready in time to support some Gen 2 (Generation 2) vehicles, as well as the proposed Gen 3 vehicle. .

  20. Closed End Launch Tube (CELT)

    NASA Technical Reports Server (NTRS)

    Lueck, Dale E.; Parrish, Clyde F.; Delgado, H. (Technical Monitor)

    2000-01-01

    As an alternative to magnetic propulsion for launch assist, the authors propose a pneumatic launch assist system. Using off the shelf components, coupled with familiar steel and concrete construction, a launch assist system can be brought from the initial feasibility stage, through a flight capable 5000 kg. demonstrator to a deployed full size launch assist system in 10 years. The final system would be capable of accelerating a 450,000 kg. vehicle to 270 meters per second. The CELT system uses commercially available compressors and valves to build a fail-safe system in less than half the time of a full Mag-Lev (magnetic levitation) system, and at a small fraction of the development cost. The resulting system could be ready in time to support some Gen 2 (generation 2) vehicles, as well as the proposed Gen 3 vehicle.

  1. Advanced Launch Development Program status

    NASA Technical Reports Server (NTRS)

    Colgrove, Roger

    1990-01-01

    The Advanced Launch System is a joint NASA - Air Force program originally directed to define the concept for a modular family of launch vehicles, to continue development programs and preliminary design activities focused primarily on low cost to orbit, and to offer maturing technologies to existing systems. The program was restructed in the spring of 1990 as a result of funding reductions and renamed the Advanced Launch Development Program. This paper addresses the program's status following that restructuring and as NASA and the Air Force commence a period of deliberation over future space launch needs and the budgetary resources available to meet those needs. The program is currently poised to protect a full-scale development decision in the mid-1990's through the appropriate application of program resources. These resources are concentrated upon maintaining the phase II system contractor teams, continuing the Space Transportation Engine development activity, and refocusing the Advanced Development Program demonstrated activities.

  2. CE: Telehealth: a case study in disruptive innovation.

    PubMed

    Grady, Janet

    2014-04-01

    Technologic advances in health care have often outpaced our ability to integrate the technology efficiently, establish best practices for its use, and develop policies to regulate and evaluate its effectiveness. However, these may be insufficient reasons to put the brakes on innovation-particularly those "disruptive innovations" that challenge the status quo and have the potential to produce better outcomes in a number of important areas. This article discusses the concept of disruptive innovation and highlights data supporting its necessity within health care in general and nursing in particular. Focusing on telehealth as a case study in disruptive innovation, the author provides examples of its application and reviews literature that examines its effectiveness in both nursing practice and education.

  3. Lessons Learned from Mississippi's Telehealth Approach to Health Disparities.

    PubMed

    deShazo, Richard D; Parker, Sara Bolen

    2017-04-01

    Many people see telemedicine as a solution to the nation's health disparities and in Mississippi as a solution to our last place in health. More than 13 years ago, the University of Mississippi Medical Center developed a successful TelEmergency program that saved rural Critical Access Hospitals and now provides telehealth services throughout the state. This occurred without acrimony because of partnerships that the University of Mississippi Medical Center developed with telecommunications companies, state government, health professions' licensure boards, and private donors. Today, the telemedicine market is exploding across the country with the entry of for-profit corporations into the medical market. These corporations often are more inclined to work with legislators rather than physicians, and some physician groups have attempted to limit their expansion. With the future of telemedicine now determined in part by the courts, rather than the providers, new pitfalls have arisen. The Mississippi experience may be helpful in navigating this new territory.

  4. A telehealth behavioral coaching intervention for neurocognitive disorder family carers

    PubMed Central

    Gant, Judith R.

    2015-01-01

    Objectives This study examined the differential impact of two telehealth programs for women caring for an older adult with a neurocognitive disorder. Outcomes examined were depressive symptoms, upset following disruptive behaviors, anxious and angry mood states, and caregiving self‐efficacy. Methods Women cohabitating with a family member diagnosed with a neurocognitive disorder were assigned via random allocation to either of the following: (1) a 14‐week behavioral intervention using video instructional materials, workbook and telephone coaching in behavioral management, pleasant events scheduling, and relaxation or (2) a basic education guide and telephone support comparison condition. Telephone assessments were conducted by interviewers blind to treatment condition at pre‐intervention, post‐intervention, and 6 months following intervention. Results For those providing in‐home care at post‐treatment, depressive symptoms, upset following disruptive behaviors, and negative mood states were statistically lower in the behavioral coaching condition than in the basic education and support condition. Reliable change index analyses for Beck Depression Inventory II scores favored the behavioral coaching condition. Caregiving self‐efficacy scores for obtaining respite and for managing patient behavioral disturbances were significantly higher in the coaching condition. Effect sizes were moderate but not maintained at the 6‐month follow‐up. Conclusions This study provides some initial evidence for the efficacy of a telehealth behavioral coaching intervention compared with basic education and telephone support. Carers' abilities to maintain strategy use during progressive disorders such as Alzheimer's disease likely require longer intervention contact than provided in the current study. Dementia carers, including those living in rural areas, can benefit from accessible and empirically supported interventions that can be easily disseminated across distances

  5. A telehealth behavioral coaching intervention for neurocognitive disorder family carers.

    PubMed

    Steffen, Ann M; Gant, Judith R

    2016-02-01

    This study examined the differential impact of two telehealth programs for women caring for an older adult with a neurocognitive disorder. Outcomes examined were depressive symptoms, upset following disruptive behaviors, anxious and angry mood states, and caregiving self-efficacy. Women cohabitating with a family member diagnosed with a neurocognitive disorder were assigned via random allocation to either of the following: (1) a 14-week behavioral intervention using video instructional materials, workbook and telephone coaching in behavioral management, pleasant events scheduling, and relaxation or (2) a basic education guide and telephone support comparison condition. Telephone assessments were conducted by interviewers blind to treatment condition at pre-intervention, post-intervention, and 6 months following intervention. For those providing in-home care at post-treatment, depressive symptoms, upset following disruptive behaviors, and negative mood states were statistically lower in the behavioral coaching condition than in the basic education and support condition. Reliable change index analyses for Beck Depression Inventory II scores favored the behavioral coaching condition. Caregiving self-efficacy scores for obtaining respite and for managing patient behavioral disturbances were significantly higher in the coaching condition. Effect sizes were moderate but not maintained at the 6-month follow-up. This study provides some initial evidence for the efficacy of a telehealth behavioral coaching intervention compared with basic education and telephone support. Carers' abilities to maintain strategy use during progressive disorders such as Alzheimer's disease likely require longer intervention contact than provided in the current study. Dementia carers, including those living in rural areas, can benefit from accessible and empirically supported interventions that can be easily disseminated across distances at modest cost. © 2015 The Authors. International

  6. Cost-benefit analysis of telehealth in pre-hospital care.

    PubMed

    Langabeer, James R; Champagne-Langabeer, Tiffany; Alqusairi, Diaa; Kim, Junghyun; Jackson, Adria; Persse, David; Gonzalez, Michael

    2017-09-01

    Objective There has been very little use of telehealth in pre-hospital emergency medical services (EMS), yet the potential exists for this technology to transform the current delivery model. In this study, we explore the costs and benefits of one large telehealth EMS initiative. Methods Using a case-control study design and both micro- and gross-costing data from the Houston Fire Department EMS electronic patient care record system, we conducted a cost-benefit analysis (CBA) comparing costs with potential savings associated with patients treated through a telehealth-enabled intervention. The intervention consisted of telehealth-based consultation between the 911 patient and an EMS physician, to evaluate and triage the necessity for patient transport to a hospital emergency department (ED). Patients with non-urgent, primary care-related conditions were then scheduled and transported by alternative means to an affiliated primary care clinic. We measured CBA as both total cost savings and cost per ED visit averted, in US Dollars ($USD). Results In total, 5570 patients were treated over the first full 12 months with a telehealth-enabled care model. We found a 6.7% absolute reduction in potentially medically unnecessary ED visits, and a 44-minute reduction in total ambulance back-in-service times. The average cost for a telehealth patient was $167, which was a statistically significantly $103 less than the control group ( p < .0001). The programme produced a $928,000 annual cost savings from the societal perspective, or $2468 cost savings per ED visit averted (benefit). Conclusion Patient care enabled by telehealth in a pre-hospital environment, is a more cost effective alternative compared to the traditional EMS 'treat and transport to ED' model.

  7. Are telehealth technologies for hypertension care and self-management effective or simply risky and costly?

    PubMed

    McKoy, June; Fitzner, Karen; Margetts, Miranda; Heckinger, Elizabeth; Specker, James; Roth, Laura; Izenberg, Maxwell; Siegel, Molly; McKinney, Shannon; Moss, Gail

    2015-06-01

    Hypertension is a prevalent chronic disease that requires ongoing management and self-care. The disease affects 31% of American adults and contributed to or caused the deaths of 348,000 Americans in 2008, fewer than 50% of whom effectively self-managed the disease. However, self-management is complex, with patients requiring ongoing support and easy access to care. Telehealth may help foster the knowledge and skills necessary for those with hypertension to engage in successful self-management. This paper considers the applicability, efficacy, associated risks, and cost-effectiveness of telehealth for individuals and populations with hypertension. Telehealth is a broad term, encompassing telemedicine and mobile health that is used for physician-patient interactions, diagnostics, care delivery, education, information sharing, monitoring, and reminders. Telemedicine may have considerable utility for people diagnosed with hypertension who have poor access or social barriers that constrain access, but potential risks exist. Telehealth technology is evolving rapidly, even in the absence of fully proven cost-effectiveness and efficacy. Considering the cost of inpatient and emergency department care for patients with hypertension, telehealth is a highly attractive alternative, but there are risks to consider. Incorporating telehealth, which is increasingly characterized by mobile health, can increase both the capacity of health care providers and the reach of patient support, clinical management, and self-care. Telehealth studies need improvement; long-term outcome data on cardiovascular events must be obtained, and robust risk analyses and economic studies are needed to prospectively evaluate the safety and cost savings for hypertension self-management.

  8. High patient satisfaction with telehealth in Parkinson disease: A randomized controlled study.

    PubMed

    Wilkinson, Jayne R; Spindler, Meredith; Wood, Stephanie M; Marcus, Steven C; Weintraub, Daniel; Morley, James F; Stineman, Margaret G; Duda, John E

    2016-06-01

    Parkinson disease (PD) is a complex neurodegenerative disorder that benefits from specialty care. Telehealth is an innovative resource that can enhance access to this care within a patient-centered framework. Research suggests that telehealth can lead to increased patient satisfaction, equal or better clinical outcomes, and cost savings, but these outcomes have not been well-studied in PD. We conducted a dual active-arm 12-month randomized controlled trial to assess patient satisfaction, clinical outcomes, travel burden, and health care utilization in PD using video telehealth for follow-up care with specialty providers. Telehealth visits took place either at a facility nearer to the patient (satellite clinic arm) or in the patient's home (home arm). Each control group received usual in-person care. Patient satisfaction, assessed by quantitative questionnaires, was the primary outcome. Eighty-six men were enrolled (home arm: 18 active, 18 control; satellite clinic arm: 26 active, 24 control) with a mean age of 73 years (range 42-87). There were no differences in baseline characteristics between the active group and the controls in each arm (p > 0.05). A significant difference in overall patient satisfaction was not found; however, high levels of patient satisfaction were found in all groups. Greater satisfaction for the telehealth modality was found in assessments of convenience and accessibility/distance. Clinical outcomes were similar between groups, travel burden was reduced using telehealth, and health care utilization was largely similar in both groups. As the need for PD subspecialty care increases, innovative patient-centered solutions to overcoming barriers to access, such as video telehealth, will be invaluable to patients and may provide high patient satisfaction.

  9. 14 CFR 417.125 - Launch of an unguided suborbital launch vehicle.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... energy to reach any populated area in any direction from the launch point; or (2) A launch operator demonstrates through the licensing process that the launch will be conducted using a wind weighting safety system that meets the requirements of paragraph (c) of this section. (c) Wind weighting safety system....

  10. Fifth FLTSATCOM to be launched

    NASA Technical Reports Server (NTRS)

    1981-01-01

    Launch of the FLTSATOOM-E, into an elliptical orbit by the Atlas Centaur launch vehicle is announced. The launch and relevant launch operations are described. A chart of the launch sequence for FLTSATCOM-E communication satellite is given.

  11. GFAST Software Demonstration

    NASA Image and Video Library

    2017-03-17

    NASA engineers and test directors gather in Firing Room 3 in the Launch Control Center at NASA's Kennedy Space Center in Florida, to watch a demonstration of the automated command and control software for the agency's Space Launch System (SLS) and Orion spacecraft. In front, far right, is Charlie Blackwell-Thompson, launch director for Exploration Mission 1 (EM-1). The software is called the Ground Launch Sequencer. It will be responsible for nearly all of the launch commit criteria during the final phases of launch countdowns. The Ground and Flight Application Software Team (GFAST) demonstrated the software. It was developed by the Command, Control and Communications team in the Ground Systems Development and Operations (GSDO) Program. GSDO is helping to prepare the center for the first test flight of Orion atop the SLS on EM-1.

  12. Shuttle Era: Launch Directors

    NASA Image and Video Library

    A space shuttle launch director is the leader of the complex choreography that goes into a shuttle liftoff. Ten people have served as shuttle launch directors, making the final decision whether the...

  13. Space Launch System Animation

    NASA Image and Video Library

    NASA is ready to move forward with the development of the Space Launch System -- an advanced heavy-lift launch vehicle that will provide an entirely new national capability for human exploration be...

  14. STS-135 Atlantis Launch

    NASA Image and Video Library

    2011-07-07

    NASA Administrator Charles Bolden, right, participates in the post launch traditional beans and cornbread at the NASA Kennedy Space Center, Launch Control Center (LCC) shortly after the space shuttle Atlantis, STS-135, launched on Friday, July 8, 2011, in Cape Canaveral, Fla. The launch of Atlantis is the final flight of the shuttle program, a 12-day mission to the International Space Station. Photo Credit: (NASA/Bill Ingalls)

  15. Launch Vehicle Operations Simulator

    NASA Technical Reports Server (NTRS)

    Blackledge, J. W.

    1974-01-01

    The Saturn Launch Vehicle Operations Simulator (LVOS) was developed for NASA at Kennedy Space Center. LVOS simulates the Saturn launch vehicle and its ground support equipment. The simulator was intended primarily to be used as a launch crew trainer but it is also being used for test procedure and software validation. A NASA/contractor team of engineers and programmers implemented the simulator after the Apollo XI lunar landing during the low activity periods between launches.

  16. STS-135 Atlantis Launch

    NASA Image and Video Library

    2011-07-07

    NASA Photographer Kim Shiflett, left, and Videographer Glenn Benson capture a group photo of the launch team in Firing Room Four of the NASA Kennedy Space Center Launch Control Center (LCC) shortly after the space shuttle Atlantis, STS-135, launched on Friday, July 8, 2011, in Cape Canaveral, Fla. The launch of Atlantis is the final flight of the shuttle program, a 12-day mission to the International Space Station. Photo Credit: (NASA/Bill Ingalls)

  17. STS-135 Atlantis Launch

    NASA Image and Video Library

    2011-07-07

    NASA Kennedy Space Center worker Dwayne Hutcheson sweeps the Launch Control Center (LCC) lobby floor in preparation for the post launch tradition of corn bread and beans after a successful launch of the space shuttle Atlantis from pad 39A on Friday, July 8, 2011, in Cape Canaveral, Fla. The launch of Atlantis, STS-135, is the final flight of the shuttle program, a 12-day mission to the International Space Station. Photo Credit: (NASA/Bill Ingalls)

  18. Mixed Methods Approach for Measuring the Impact of Video Telehealth on Outpatient Clinic Triage Nurse Workflow

    PubMed Central

    Cady, Rhonda G.; Finkelstein, Stanley M.

    2015-01-01

    Nurse-delivered telephone triage is a common component of outpatient clinic settings. Adding new communication technology to clinic triage has the potential to not only transform the triage process, but also alter triage workflow. Evaluating the impact of new technology on an existing workflow is paramount to maximizing efficiency of the delivery system. This study investigated triage nurse workflow before and after the implementation of video telehealth using a sequential mixed methods protocol that combined ethnography and time-motion study to provide a robust analysis of the implementation environment. Outpatient clinic triage using video telehealth required significantly more time than telephone triage, indicating a reduction in nurse efficiency. Despite the increased time needed to conduct video telehealth, nurses consistently rated it useful in providing triage. Interpretive analysis of the qualitative and quantitative data suggests the increased depth and breadth of data available during video triage alters the assessment triage nurses provide physicians. This in turn could impact the time physicians spend formulating a diagnosis and treatment plan. While the immediate impact of video telehealth is a reduction in triage nurse efficiency, what is unknown is the impact of video telehealth on physician and overall clinic efficiency. Future studies should address this area. PMID:24080753

  19. Direct-To-Consumer Telehealth May Increase Access To Care But Does Not Decrease Spending.

    PubMed

    Ashwood, J Scott; Mehrotra, Ateev; Cowling, David; Uscher-Pines, Lori

    2017-03-01

    The use of direct-to-consumer telehealth, in which a patient has access to a physician via telephone or videoconferencing, is growing rapidly. A key attraction of this type of telehealth for health plans and employers is the potential savings involved in replacing physician office and emergency department visits with less expensive virtual visits. However, increased convenience may tap into unmet demand for health care, and new utilization may increase overall health care spending. We used commercial claims data on over 300,000 patients from three years (2011-13) to explore patterns of utilization and spending for acute respiratory illnesses. We estimated that 12 percent of direct-to-consumer telehealth visits replaced visits to other providers, and 88 percent represented new utilization. Net annual spending on acute respiratory illness increased $45 per telehealth user. Direct-to-consumer telehealth may increase access by making care more convenient for certain patients, but it may also increase utilization and health care spending. Project HOPE—The People-to-People Health Foundation, Inc.

  20. Developing a measure of engagement with telehealth systems: The mHealth Technology Engagement Index.

    PubMed

    Dewar, Alexis R; Bull, Tyler P; Malvey, Donna M; Szalma, James L

    2017-02-01

    Introduction Telehealth systems and mobile health (mHealth) devices allow for the exchange of both physical and mental healthcare data, as well as information from a patient to a practitioner, or care recipient to caregiver; but there has been little research on why users are motivated to engage with telehealth systems. Given this, we sought to create a measure that satisfactorily assesses human motivation to use telehealth devices. Methods 532 survey responses were used in an exploratory factor analysis and confirmatory factor analysis, which tested and retested the feasibility of this new measure. Convergent and divergent validity analyses indicated that the mHealth Technology Engagement Index (mTEI) is a unique measure of motivation. Results The results indicated that autonomy, competence, relatedness, goal attainment, and goal setting underpin motivation to use telehealth systems. Discussion The mTEI shows promise in indexing human motivation to use telehealth technologies. We also discuss the importance of developing measurement tools based on theory and how practitioners can best utilize the mTEI.

  1. Web- vs. telehealth-based delivery of cognitive behavioral therapy for insomnia: a randomized controlled trial.

    PubMed

    Holmqvist, M; Vincent, N; Walsh, K

    2014-02-01

    The purpose of our study was to evaluate and compare two methods of service delivery (web-based and telehealth-based) for chronic insomnia with regard to patient preference, clinical effectiveness, and patient satisfaction. Our study was a randomized controlled trial with manualized telehealth- and web-based delivery conditions (nonblinded). The sample comprised 73 adults with chronic insomnia. Participants received web-based delivery from their homes or telehealth-based delivery from a nearby clinic. Both interventions consisted of identical psychoeducation, sleep hygiene and stimulus control instruction, sleep restriction treatment, relaxation training, cognitive therapy, mindfulness meditation, and medication-tapering assistance. Using a linear mixed model analysis, results showed that both delivery methods produced equivalent changes in insomnia severity, with large effect sizes. Attendance patterns favored telehealth, whereas homework adherence and preference data favored web-based delivery. Web- and telehealth-based delivery are both helpful in treating chronic insomnia in rural-dwelling adults. Copyright © 2013 Elsevier B.V. All rights reserved.

  2. Role of telehealth in seating clinics: a case study of learners' perspectives.

    PubMed

    Khoja, Shariq; Casebeer, Ann; Young, Sybil

    2005-01-01

    We conducted a qualitative case study of the introduction of telehealth in a seating clinic, which was an existing outreach service between two hospitals in Alberta, approximately 300 km apart. Interviews were conducted with the staff who were involved in planning and implementing the telehealth initiative. The study showed that, from the perspective of the staff (who were learners), implementation of telehealth in seating clinics differs from other less tactile telehealth applications in certain ways: (1) the importance of multidisciplinary teams in the procedures, (2) the importance of proper visualization and communication among the staff to convey the pressure changes and measurements to the technicians at the major centre to help them build or adjust the seating devices and (3) the reluctance of staff to trust others' judgements. Planning of service provision and telelearning for seating clinics requires the involvement of staff at all stages. Thus, the implementation of telehealth should be a stepwise process, allowing a highly interactive approach, without affecting the multidisciplinary nature of seating clinics.

  3. Internet-based telehealth assessment of language using the CELF-4.

    PubMed

    Waite, Monique C; Theodoros, Deborah G; Russell, Trevor G; Cahill, Louise M

    2010-10-01

    Telehealth has the potential to improve children's access to speech-language pathology services. Validation of telehealth applications, including the assessment of childhood language disorders, is necessary for telehealth to become an accepted alternative mode of service provision. The aim of this study was to validate an Internet-based telehealth system for assessing childhood language disorders. Twenty-five children ages 5 to 9 years were assessed using the core language subtests of the Clinical Evaluation of Language Fundamentals--4th Edition (CELF-4; Semel, Wiig, & Secord, 2003). Each participant was simultaneously assessed online and face-to-face (FTF). Assessments were administered by either an online or an FTF speech-language pathologist (SLP), but were simultaneously rated by both SLPs. No significant difference was found between the online and FTF total raw scores and scaled scores for each subtest. Weighted kappas revealed very good agreement on the individual items, total raw scores, scaled scores, core language score, and severity level. Intra- and interrater reliability were determined for a sample of online ratings, with intraclass correlation analysis revealing very good agreement on all measures. The results of this study support the validity and reliability of scoring the core language subtests of the CELF-4 via telehealth.

  4. Pediatric Obesity Management in Rural Clinics in California and the Role of Telehealth in Distance Education

    PubMed Central

    Shaikh, Ulfat; Nettiksimmons, Jasmine; Romano, Patrick

    2010-01-01

    Objective To determine health care provider needs related to pediatric obesity management in rural California and to explore strategies to improve care through telehealth. Methods Cross-sectional survey of health care providers who treated children and adolescents at 41 rural clinics with existing telehealth connectivity. Results Most of the 135 respondents were family physicians at designated rural health clinics serving low-income families. Respondents had practiced in rural areas for an average of 10 years. Most providers rated their self-efficacy in managing pediatric obesity as 2 or 3 on a 5-point scale. The barriers most frequently reported by health care providers were lack of local weight management programs, lack of patient motivation, and lack of family involvement in treatment. Providers reported that the resources they would find most helpful were readily accessible patient education materials, strategies to link patients with community treatment programs and training in brief, focused counseling skills. Three-quarters of providers already used telehealth for distance learning. Providers reported very high interest in participating in continuing education on pediatric obesity delivered by telehealth, specifically Internet communication with specialists, web-based education, and interactive video case-conferencing. Conclusions Rural health care providers face several barriers related to pediatric obesity management. Targeted interventions provided via telehealth to rural health care providers may enhance the care of obese children and adolescents. The results of this study provide directions and priorities for the design of appropriate interventions. PMID:21729153

  5. Pediatric obesity management in rural clinics in California and the role of telehealth in distance education.

    PubMed

    Shaikh, Ulfat; Nettiksimmons, Jasmine; Romano, Patrick

    2011-01-01

    To determine health care provider needs related to pediatric obesity management in rural California and to explore strategies to improve care through telehealth. Cross-sectional survey of health care providers who treated children and adolescents at 41 rural clinics with existing telehealth connectivity. Most of the 135 respondents were family physicians at designated rural health clinics serving low-income families. Respondents had practiced in rural areas for an average of 10 years. Most providers rated their self-efficacy in managing pediatric obesity as 2 or 3 on a 5-point scale. The barriers most frequently reported by health care providers were lack of local weight management programs, lack of patient motivation, and lack of family involvement in treatment. Providers reported that the resources they would find most helpful were readily accessible patient education materials, strategies to link patients with community treatment programs and training in brief, focused counseling skills. Three-quarters of providers already used telehealth for distance learning. Providers reported very high interest in participating in continuing education on pediatric obesity delivered by telehealth, specifically Internet communication with specialists, web-based education, and interactive video case-conferencing. Rural health care providers face several barriers related to pediatric obesity management. Targeted interventions provided via telehealth to rural health care providers may enhance the care of obese children and adolescents. The results of this study provide directions and priorities for the design of appropriate interventions. © 2010 National Rural Health Association.

  6. Clinical management of multiple sclerosis through home telehealth monitoring: results of a pilot project.

    PubMed

    Turner, Aaron P; Wallin, Mitchell T; Sloan, Alicia; Maloni, Heidi; Kane, Robert; Martz, Lore; Haselkorn, Jodie K

    2013-01-01

    This study examined the feasibility of using home telehealth monitoring to improve clinical care and promote symptom self-management among veterans with multiple sclerosis (MS). This was a longitudinal cohort study linking mailed survey data at baseline and 6-month follow-up with information from home telehealth monitors. The study was conducted in two large Department of Veterans Affairs (VA) MS clinics in Seattle, Washington, and Washington, DC, and involved 41 veterans with MS. The measures were demographic information and data from a standardized question set using a home telehealth monitor. Participants reported moderate levels of disability (median Expanded Disability Status Scale [EDSS] score, 6.5) and substantial distance from the nearest VA MS clinic (mean distance, 93.6 miles). Of the participants, 61.0% reported current use of MS disease-modifying treatments. A total of 85.4% of participants provided consistent data from home monitoring. Overall satisfaction with home telehealth monitoring was high, with 87.5% of participants rating their experience as good or better. The most frequently reported symptoms at month 1 were fatigue (95.1%), depression (78.0%), and pain (70.7%). All symptoms were reported less frequently by month 6, with the greatest reduction in depression (change of 23.2 percentage points), although these changes were not statistically significant. Home telehealth monitoring is a promising tool for the management of chronic disease, although substantial practical barriers to efficient implementation remain.

  7. Nurses’ and community support workers’ experience of telehealth: a longitudinal case study

    PubMed Central

    2014-01-01

    Background Introduction of telehealth into the healthcare setting has been recognised as a service that might be experienced as disruptive. This paper explores how this disruption is experienced. Methods In a longitudinal qualitative study, we conducted focus group discussions prior to and semi structured interviews post introduction of a telehealth service in Nottingham, U.K. with the community matrons, congestive heart failure nurses, chronic obstructive pulmonary disease nurses and community support workers that would be involved in order to elicit their preconceptions and reactions to the implementation. Results Users experienced disruption due to the implementation of telehealth as threatening. Three main factors add to the experience of threat and affect the decision to use the technology: change in clinical routines and increased workload; change in interactions with patients and fundamentals of face-to-face nursing work; and change in skills required with marginalisation of clinical expertise. Conclusion Since the introduction of telehealth can be experienced as threatening, managers and service providers should aim at minimising the disruption caused by taking the above factors on board. This can be achieved by employing simple yet effective measures such as: providing timely, appropriate and context specific training; provision of adequate technical support; and procedures that allow a balance between the use of telehealth and personal visit by nurses delivering care to their patients. PMID:24721599

  8. New Horizons Launch Contingency Effort

    NASA Astrophysics Data System (ADS)

    Chang, Yale; Lear, Matthew H.; McGrath, Brian E.; Heyler, Gene A.; Takashima, Naruhisa; Owings, W. Donald

    2007-01-01

    describes JHU/APL's roles and responsibilities in the launch contingency effort, and the specific tasks to fulfill those responsibilities. The overall effort contributed to mission safety and demonstrated successful cooperation between several agencies.

  9. Telehealth in audiology: the need and potential to reach underserved communities.

    PubMed

    Swanepoel, De Wet; Clark, Jackie L; Koekemoer, Dirk; Hall, James W; Krumm, Mark; Ferrari, Deborah V; McPherson, Bradley; Olusanya, Bolajoko O; Mars, Maurice; Russo, Iêda; Barajas, Jose J

    2010-03-01

    Permanent hearing loss is a leading global health care burden, with 1 in 10 people affected to a mild or greater degree. A shortage of trained healthcare professionals and associated infrastructure and resource limitations mean that hearing health services are unavailable to the majority of the world population. Utilizing information and communication technology in hearing health care, or tele-audiology, combined with automation offer unique opportunities for improved clinical care, widespread access to services, and more cost-effective and sustainable hearing health care. Tele-audiology demonstrates significant potential in areas such as education and training of hearing health care professionals, paraprofessionals, parents, and adults with hearing disorders; screening for auditory disorders; diagnosis of hearing loss; and intervention services. Global connectivity is rapidly growing with increasingly widespread distribution into underserved communities where audiological services may be facilitated through telehealth models. Although many questions related to aspects such as quality control, licensure, jurisdictional responsibility, certification and reimbursement still need to be addressed; no alternative strategy can currently offer the same potential reach for impacting the global burden of hearing loss in the near and foreseeable future.

  10. Launch Summary for 1979

    NASA Technical Reports Server (NTRS)

    Vostreys, R. W.

    1980-01-01

    Spacecraft launching for 1979 are identified and listed under the categories of (1) sounding rockets, and (2) artificial Earth satellites and space probes. The sounding rockets section includes a listing of the experiments, index of launch sites and tables of the meanings and codes used in the launch listing.

  11. LAUNCH Health Forum

    NASA Image and Video Library

    2010-10-30

    Tom Kalil, Deputy Director of the White House Office of Science and Technology Policy, opens the LAUNCH: Health forum at NASA's Kennedy Space Center in Florida on Saturday, Oct. 30, 2010. LAUNCH: Health provides a forum to discuss accelerating innovation for a sustainable future. LAUNCH: Health partners include NASA, USAID and Nike. Photo Credit: (NASA/Bill Ingalls)

  12. Launch summary for 1980

    NASA Technical Reports Server (NTRS)

    Vostreys, R. W.

    1981-01-01

    Sounding rockets, artificial Earth satellites, and space probes launched betweeen January 1 and December 31, 1980 are listed. Data tabulated for the rocket launchings show launching site, instruments carried, date of launch, agency rocket identification, sponsoring country, experiment discipline, peak altitude, and the experimenter or institution responsible. Tables for satellites and space probes show COSPAR designation, spacecraft name, country, launch date, epoch date, orbit type, apoapsis, periapsis and inclination period. The functions and responsibilities of the World Data Center and the areas of scientific interest at the seven subcenters are defined. An alphabetical listing of experimenters using the sounding rockets is also provided.

  13. The Rockot launch system

    NASA Astrophysics Data System (ADS)

    Stamerjohanns, G.; Kinnersley, M.

    1999-09-01

    EUROCKOT Launch Services GmbH has been founded by Daimler-Benz Aerospace of Germany and Khrunichev State Research and Production Space Center of Russia to offer world-wide cost effective launch services on the Rockot launch system. The Rockot commercial program is described. Rockot can launch satellites weighing up to 1850 kg into polar and other low earth (LEO) orbits. The Rockot launch vehicle is based on the former Russian SS-19 strategic missile. The first and second stages are inherited from the SS-19, the third stage named Breeze is newly developed and has multiple ignition capability. The Rockot launch system is flight proven. In addition to the currently adapted Rockot launch site Plesetsk for high inclinations, EUROCKOT is in the process to also adapt the Baykonur cosmodrome as their complementary Rockot launch site for lower inclinations. The wide range of Rockot performance is provided. The first commercial launch is foreseen in the middle of 1999. The expected launch capacity for Plesetsk and Baykonur will exceed 10 launches per year. The complete Rockot system including performance is presented.

  14. Electron launching voltage monitor

    DOEpatents

    Mendel, Clifford W.; Savage, Mark E.

    1992-01-01

    An electron launching voltage monitor measures MITL voltage using a relationship between anode electric field and electron current launched from a cathode-mounted perturbation. An electron launching probe extends through and is spaced from the edge of an opening in a first MITL conductor, one end of the launching probe being in the gap between the MITL conductor, the other end being adjacent a first side of the first conductor away from the second conductor. A housing surrounds the launching probe and electrically connects the first side of the first conductor to the other end of the launching probe. A detector detects the current passing through the housing to the launching probe, the detected current being representative of the voltage between the conductors.

  15. Electron launching voltage monitor

    DOEpatents

    Mendel, C.W.; Savage, M.E.

    1992-03-17

    An electron launching voltage monitor measures MITL voltage using a relationship between anode electric field and electron current launched from a cathode-mounted perturbation. An electron launching probe extends through and is spaced from the edge of an opening in a first MITL conductor, one end of the launching probe being in the gap between the MITL conductor, the other end being adjacent a first side of the first conductor away from the second conductor. A housing surrounds the launching probe and electrically connects the first side of the first conductor to the other end of the launching probe. A detector detects the current passing through the housing to the launching probe, the detected current being representative of the voltage between the conductors. 5 figs.

  16. Conducting Functional Communication Training via Telehealth to Reduce the Problem Behavior of Young Children with Autism

    PubMed Central

    Wacker, David P.; Lee, John F.; Padilla Dalmau, Yaniz C.; Kopelman, Todd G.; Lindgren, Scott D.; Kuhle, Jennifer; Pelzel, Kelly E.; Dyson, Shannon; Schieltz, Kelly M.; Waldron, Debra B.

    2012-01-01

    Functional communication training (FCT) was conducted by parents of 17 young children with autism spectrum disorders who displayed problem behavior. All procedures were conducted at regional clinics located an average of 15 miles from the families’ homes. Parents received coaching via telehealth from behavior consultants who were located an average of 222 miles from the regional clinics. Parents first conducted functional analyses with telehealth consultation (Wacker, Lee, et al., in press) and then conducted FCT that was matched to the identified function of problem behavior. Parent assistants located at the regional clinics received brief training in the procedures and supported the families during the clinic visits. FCT, conducted within a nonconcurrent multiple baseline design, reduced problem behavior by an average of 93.5%. Results suggested that FCT can be conducted by parents via telehealth when experienced applied behavior analysts provide consultation. PMID:23543855

  17. Telehealth for Expanding the Reach of Early Autism Training to Parents

    PubMed Central

    Vismara, Laurie A.; Young, Gregory S.; Rogers, Sally J.

    2012-01-01

    Although there is consensus that parents should be involved in interventions designed for young children with autism spectrum disorder (ASD), parent participation alone does not ensure consistent, generalized gains in children's development. Barriers such as costly intervention, time-intensive sessions, and family life may prevent parents from using the intervention at home. Telehealth integrates communication technologies to provide health-related services at a distance. A 12 one-hour per week parent intervention program was tested using telehealth delivery with nine families with ASD. The goal was to examine its feasibility and acceptance for promoting child learning throughout families' daily play and caretaking interactions at home. Parents became skilled at using teachable moments to promote children's spontaneous language and imitation skills and were pleased with the support and ease of telehealth learning. Preliminary results suggest the potential of technology for helping parents understand and use early intervention practices more often in their daily interactions with children. PMID:23227334

  18. The effect of telehealth systems and satisfaction with health expenditure among patients with metabolic syndrome.

    PubMed

    Uei, Shu-Lin; Tsai, Chung-Hung; Kuo, Yu-Ming

    2016-04-29

    Telehealth cost analysis has become a crucial issue for governments in recent years. In this study, we examined cases of metabolic syndrome in Hualien County, Taiwan. This research adopted the framework proposed by Marchand to establish a study process. In addition, descriptive statistics, a t test, analysis of variance, and regression analysis were employed to analyze 100 questionnaires. The results of the t$ test revealed significant differences in medical health expenditure, number of clinical visits for medical treatment, average amount of time spent commuting to clinics, amount of time spent undergoing medical treatment, and average number of people accompanying patients to medical care facilities or assisting with other tasks in the past one month, indicating that offering telehealth care services can reduce health expenditure. The statistical analysis results revealed that customer satisfaction has a positive effect on reducing health expenditure. Therefore, this study proves that telehealth care systems can effectively reduce health expenditure and directly improve customer satisfaction with medical treatment.

  19. Developing a strategy for studying critical thinking in a nurse telehealth setting: a participatory approach.

    PubMed

    Tuden, Danica; Gidora, Hanne; Quick, Peter D; Ebdon, Nikki; Glover, Karen; Harmer, Sherrill; Miller, Wendy; Taylor, Mary; Borycki, Elizabeth M

    2013-01-01

    Telehealth nursing is a specialized area of nursing practice that has grown in response to the emergence of new technologies and consumer demand for health care services in the community. HealthLinkBC Nursing Services provides symptom triage and health education to residents of British Columbia and Yukon over the phone. Unlike traditional nursing care, telenurses are limited in terms of information they receive from callers. Therefore, there is a need for critical thinking skills to be developed. The purpose of this paper is to describe a participatory approach towards identifying: (1) the factors that affect telehealth nursing practice including critical thinking, and (2) developing a research strategy aimed at identifying the ways in which critical thinking can be supported in a telehealth nursing environment. A HealthLinkBC working group has begun work in developing a definition of critical thinking specific to nursing, identifying future research opportunities and methodologies.

  20. Usability and feasibility of smartphone video capabilities for telehealth care in the U.S. military.

    PubMed

    Luxton, David D; Mishkind, Matthew C; Crumpton, Rosa M; Ayers, Todd D; Mysliwiec, Vincent

    2012-01-01

    The two-way audio/visual capabilities on the latest smartphone platforms bring new possibilities for the delivery of healthcare services to users. Because this technology is so new, the feasibility and the basic usability of the technology need to be evaluated before more research is conducted on its application in the telehealth field. The purpose of this study was to conduct preliminary usability testing of smartphone two-way video capabilities for potential telehealth use for U.S. military service members. Seven service member volunteers communicated with research staff at a large military installation via Apple's (Cupertino, CA) FaceTime® app on the iPhone® 4 smartphone platform and conducted basic usability testing of the technology. Preferences for potential use of the technology were also assessed. The results showed that the technology has both limitations as well as potential for telehealth applications that warrant additional research.

  1. The Use of Telehealth to Teach Reproductive Health to Female Rural High School Students.

    PubMed

    Yoost, Jennie Lee; Starcher, Rachael Whitley; King-Mallory, Rebecca Ann; Hussain, Nafeeza; Hensley, Christina Ann; Gress, Todd William

    2017-04-01

    To evaluate the use of telehealth to teach reproductive health to rural areas with high rates of teen pregnancy. Prospective cohort study. Two high schools in rural West Virginia. High school female students who attended telehealth sessions. Teleconferencing equipment connected rural high schools to a distal academic institution. Telehealth sessions included reproductive health and life skills topics. Demographic information, session pre- and post-tests, and 6- month assessment was obtained. Reproductive health knowledge, behavior, and self-efficacy were assessed at intervention and at 6 months, along with Likert scale evaluation of telehealth as an educational tool. Fifty-five students participated in the program with an average age of 16.14 (SD 1.24) years. Only 20% (10/50) of subjects' mothers and 12% (6/50) of subjects' fathers had achieved education beyond high school, and 20% (10/50) of subject's mothers had experienced teen pregnancies (age 18 or younger). Sexual activity was reported among 52% (26/50) of subjects, 4/50 (8%) reported desire to become pregnant within the next year, and 4/50 (8%) reported already pregnant. Thirty-seven students completed the 6-month follow-up survey. Reported condom use increased from 20% (10/50) at baseline to 40% (15/37) at 6 months (P = .04) and hormonal contraception use increased from 22% (11/50) to 38% (14/37) (P = .12). Report of human papillomavirus vaccination increased from 38% (10/26) to 70% (26/37) (P = .001) among all subjects. At 6 months, 91.8% (34/37) reported the use of telehealth was "very effective" as a means to teach the material. Telehealth is an effective tool to teach reproductive health to rural areas. Copyright © 2016 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.

  2. STS-120 on Launch Pad

    NASA Technical Reports Server (NTRS)

    2007-01-01

    A photographer used a fisheye lens attached to an electronic still camera to record a series of photos of the Space Shuttle Discovery at the launch pad while the STS-120 crew was at Kennedy Space Center for the Terminal Countdown Demonstration Test in October 2007. The STS-120 mission launched from Kennedy Space Center's launch pad 39A at 11:38:19 a.m. (EDT) on October 23, 2007. The crew included Scott E. Parazynski, Douglas H. Wheelock, Stephanie D. Wilson, all mission specialists; George D. Zamka, pilot; Pamela A. Melroy, commander; Daniel M. Tani, Expedition 16 flight engineer; and Paolo A. Nespoli, mission specialist representing the European Space Agency (ESA). Major objectives included the installation of the P6 solar array of the port truss and delivery and installment of Harmony, the Italian-built U.S. Node 2 on the International Space Station (ISS).

  3. Nanosatellite Launch Adapter System (NLAS)

    NASA Technical Reports Server (NTRS)

    Chartres, James; Cappuccio, Gelsomina

    2015-01-01

    The Nanosatellite Launch Adapter System (NLAS) was developed to increase access to space while simplifying the integration process of miniature satellites, called nanosats or CubeSats, onto launch vehicles. A standard CubeSat measures about 10 cm square, and is referred to as a 1-unit (1U) CubeSat. A single NLAS provides the capability to deploy 24U of CubeSats. The system is designed to accommodate satellites measuring 1U, 1.5U, 2U, 3U and 6U sizes for deployment into orbit. The NLAS may be configured for use on different launch vehicles. The system also enables flight demonstrations of new technologies in the space environment.

  4. Reaching Out to Older Veterans in Need: The Elko Clinic Demonstration Project

    ERIC Educational Resources Information Center

    Juretic, Meghan; Hill, Robert; Luptak, Marilyn; Rupper, Randall; Bair, Byron; Floyd, James; Westfield, Brian; Dailey, Nancy K.

    2010-01-01

    Context: The challenge of providing meaningful health care services to veterans living in rural communities is a major public health concern that involves redefining the traditional facility-based model of care delivery employed in urban areas. Purpose: This paper describes the steps of a demonstration project, the Elko Telehealth Outreach Clinic.…

  5. Reaching Out to Older Veterans in Need: The Elko Clinic Demonstration Project

    ERIC Educational Resources Information Center

    Juretic, Meghan; Hill, Robert; Luptak, Marilyn; Rupper, Randall; Bair, Byron; Floyd, James; Westfield, Brian; Dailey, Nancy K.

    2010-01-01

    Context: The challenge of providing meaningful health care services to veterans living in rural communities is a major public health concern that involves redefining the traditional facility-based model of care delivery employed in urban areas. Purpose: This paper describes the steps of a demonstration project, the Elko Telehealth Outreach Clinic.…

  6. Telehealth delivery of Rapid Syllable Transitions (ReST) treatment for childhood apraxia of speech.

    PubMed

    Thomas, Donna C; McCabe, Patricia; Ballard, Kirrie J; Lincoln, Michelle

    2016-11-01

    Rapid Syllable Transitions (ReST) treatment uses pseudo-word targets with varying lexical stress to target simultaneously articulation, prosodic accuracy and coarticulatory transitions in childhood apraxia of speech (CAS). The treatment is efficacious for the acquisition of imitated pseudo-words, and generalization of skill to untreated pseudo-words and real words. Despite the growing popularity of telehealth as a method of service delivery, there is no research into the efficacy of telehealth treatments for CAS. Telehealth service delivery is associated with compromised audio and visual signal transmission that may affect the efficacy of treatment. To conduct a phase 1 efficacy study of telehealth delivery of ReST treatment for CAS, and to discuss the efficacy with reference to face-to-face ReST treatment. Using a multiple baseline across participants design, five children aged 5-11 years with CAS received ReST treatment four times a week for 3 weeks via video conferencing with Adobe Connect. The children's ability to imitate new pseudo-words, generalize the skills to untreated pseudo-words and real word items, and maintain the skills following treatment were assessed. Both visual and statistical analyses were utilized. All five children significantly improved with their production of the imitated treated pseudo-word items and significantly generalized to similar untreated pseudo-words and real words. Additionally, two of the children showed significant generalization to imitated phrases with the treatment items. Four of the children maintained their treatment gains up to 4 months post-treatment. Telehealth delivery produced similar acquisition of pseudo-words and generalization to untreated behaviours as face-to-face delivery; however, in the 4 months following treatment, the children showed stable rather than improving speech skills. The intra- and inter-judge reliability was similar in telehealth delivery for face-to-face delivery. Caregivers and clinicians

  7. COSMOS Launch Services

    NASA Astrophysics Data System (ADS)

    Kalnins, Indulis

    2002-01-01

    COSMOS-3M is a two stage launcher with liquid propellant rocket engines. Since 1960's COSMOS has launched satellites of up to 1.500kg in both circular low Earth and elliptical orbits with high inclination. The direct SSO ascent is available from Plesetsk launch site. The very high number of 759 launches and the achieved success rate of 97,4% makes this space transportation system one of the most reliable and successful launchers in the world. The German small satellite company OHB System co-operates since 1994 with the COSMOS manufacturer POLYOT, Omsk, in Russia. They have created the joint venture COSMOS International and successfully launched five German and Italian satellites in 1999 and 2000. The next commercial launches are contracted for 2002 and 2003. In 2005 -2007 COSMOS will be also used for the new German reconnaissance satellite launches. This paper provides an overview of COSMOS-3M launcher: its heritage and performance, examples of scientific and commercial primary and piggyback payload launches, the launch service organization and international cooperation. The COSMOS launch service business strategy main points are depicted. The current and future position of COSMOS in the worldwide market of launch services is outlined.

  8. GFAST Software Demonstration

    NASA Image and Video Library

    2017-03-17

    NASA engineers and test directors gather in Firing Room 3 in the Launch Control Center at NASA's Kennedy Space Center in Florida, to watch a demonstration of the automated command and control software for the agency's Space Launch System (SLS) and Orion spacecraft. The software is called the Ground Launch Sequencer. It will be responsible for nearly all of the launch commit criteria during the final phases of launch countdowns. The Ground and Flight Application Software Team (GFAST) demonstrated the software. It was developed by the Command, Control and Communications team in the Ground Systems Development and Operations (GSDO) Program. GSDO is helping to prepare the center for the first test flight of Orion atop the SLS on Exploration Mission 1.

  9. The Delta Launch Vehicle Model 2914 Series

    NASA Technical Reports Server (NTRS)

    Gunn, C. R.

    1973-01-01

    The newest Delta launch vehicle configuration, Model 2914 is described for potential users together with recent flight results. A functional description of the vehicle, its performance, flight profile, flight environment, injection accuracy, spacecraft integration requirements, user organizational interfaces, launch operations, costs and reimbursable users payment plan are provided. The versatile, relatively low cost Delta has a flight demonstrated reliability record of 92 percent that has been established in 96 launches over twelve years while concurrently undergoing ten major upratings to keep pace with the ever increasing performance and reliability requirements of its users. At least 40 more launches are scheduled over the next three years from the Eastern and Western Test Ranges.

  10. Antares Rocket Test Launch

    NASA Image and Video Library

    2013-04-21

    The Orbital Sciences Corporation Antares rocket is seen as it launches from Pad-0A of the Mid-Atlantic Regional Spaceport (MARS) at the NASA Wallops Flight Facility in Virginia, Sunday, April 21, 2013. The test launch marked the first flight of Antares and the first rocket launch from Pad-0A. The Antares rocket delivered the equivalent mass of a spacecraft, a so-called mass simulated payload, into Earth's orbit. Photo Credit: (NASA/Bill Ingalls)

  11. STS-135 Atlantis Launch

    NASA Image and Video Library

    2011-07-07

    NASA Administrator Charles Bolden speaks to visitors at the NASA Kennedy Space Center Banana Creek viewing site prior to going to the Launch Control Center (LCC) for the planned launch of the space shuttle Atlantis from pad 39A on Friday, July 8, 2011, in Cape Canaveral, Fla. The launch of Atlantis, STS-135, is the final flight of the shuttle program, a 12-day mission to the International Space Station. Photo Credit: (NASA/Bill Ingalls)

  12. Launch the Litening Pod!

    DTIC Science & Technology

    2008-02-19

    Launch the LITENING Pod ! EWS Contemporary Issue Paper Submitted by Captain Fausett, Brian M. to Major G.A. Thiele, CG 2 19...TITLE AND SUBTITLE Launch the Litening Pod ! 5a. CONTRACT NUMBER 5b. GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR(S) 5d. PROJECT NUMBER 5e...ABSTRACT unclassified c. THIS PAGE unclassified Standard Form 298 (Rev. 8-98) Prescribed by ANSI Std Z39-18 2 “Launch the LITENING pod

  13. MAVEN Atlas V Launch

    NASA Image and Video Library

    2013-11-18

    The United Launch Alliance Atlas V rocket with NASA’s Mars Atmosphere and Volatile Evolution (MAVEN) spacecraft launches from the Cape Canaveral Air Force Station Space Launch Complex 41, Monday, Nov. 18, 2013, Cape Canaveral, Florida. NASA’s Mars-bound spacecraft, the Mars Atmosphere and Volatile EvolutionN, or MAVEN, is the first spacecraft devoted to exploring and understanding the Martian upper atmosphere. Photo Credit: (NASA/Bill Ingalls)

  14. LAUNCH - STS-4 - KSC

    NASA Image and Video Library

    1982-07-06

    S82-33288 (27 June 1982) --- This horizontal view of the space shuttle Columbia captures the flight of water birds disturbed by the activity at launch Pad 39A. Launch occurred at 10:59:59 a.m. (EDT), June 27, 1982. Astronauts Thomas K. Mattingly II and Henry W. Hartsfield Jr. are aboard for NASA's final orbital flight test before launching into a new space era with the first operational flight planned for fall of this year. Photo credit: NASA

  15. MAVEN Atlas V Launch

    NASA Image and Video Library

    2013-11-18

    The United Launch Alliance Atlas V rocket with NASA’s Mars Atmosphere and Volatile EvolutioN (MAVEN) spacecraft launches from the Cape Canaveral Air Force Station Space Launch Complex 41, Monday, Nov. 18, 2013, Cape Canaveral, Florida. NASA’s Mars-bound spacecraft, the Mars Atmosphere and Volatile EvolutioN, or MAVEN, is the first spacecraft devoted to exploring and understanding the Martian upper atmosphere. Photo Credit: (NASA/Bill Ingalls)

  16. Cancer Survivors' Experience With Telehealth: A Systematic Review and Thematic Synthesis.

    PubMed

    Cox, Anna; Lucas, Grace; Marcu, Afrodita; Piano, Marianne; Grosvenor, Wendy; Mold, Freda; Maguire, Roma; Ream, Emma

    2017-01-09

    Net survival rates of cancer are increasing worldwide, placing a strain on health service provision. There is a drive to transfer the care of cancer survivors-individuals living with and beyond cancer-to the community and encourage them to play an active role in their own care. Telehealth, the use of technology in remote exchange of data and communication between patients and health care professionals (HCPs), is an important contributor to this evolving model of care. Telehealth interventions are "complex," and understanding patient experiences of them is important in evaluating their impact. However, a wider view of patient experience is lacking as qualitative studies detailing cancer survivor engagement with telehealth are yet to be synthesized. To systematically identify, appraise, and synthesize qualitative research evidence on the experiences of adult cancer survivors participating in telehealth interventions, to characterize the patient experience of telehealth interventions for this group. Medline (PubMed), PsychINFO, Cumulative Index for Nursing and Allied Health Professionals (CINAHL), Embase, and Cochrane Central Register of Controlled Trials were searched on August 14, 2015, and March 8, 2016, for English-language papers published between 2006 and 2016. Inclusion criteria were as follows: adult cancer survivors aged 18 years and over, cancer diagnosis, experience of participating in a telehealth intervention (defined as remote communication or remote monitoring with an HCP delivered by telephone, Internet, or hand-held or mobile technology), and reporting qualitative data including verbatim quotes. An adapted Critical Appraisal Skill Programme (CASP) checklist for qualitative research was used to assess paper quality. The results section of each included article was coded line by line, and all papers underwent inductive analysis, involving comparison, reexamination, and grouping of codes to develop descriptive themes. Analytical themes were developed

  17. Cancer Survivors’ Experience With Telehealth: A Systematic Review and Thematic Synthesis

    PubMed Central

    Lucas, Grace; Marcu, Afrodita; Piano, Marianne; Grosvenor, Wendy; Mold, Freda; Maguire, Roma; Ream, Emma

    2017-01-01

    Background Net survival rates of cancer are increasing worldwide, placing a strain on health service provision. There is a drive to transfer the care of cancer survivors—individuals living with and beyond cancer—to the community and encourage them to play an active role in their own care. Telehealth, the use of technology in remote exchange of data and communication between patients and health care professionals (HCPs), is an important contributor to this evolving model of care. Telehealth interventions are “complex,” and understanding patient experiences of them is important in evaluating their impact. However, a wider view of patient experience is lacking as qualitative studies detailing cancer survivor engagement with telehealth are yet to be synthesized. Objective To systematically identify, appraise, and synthesize qualitative research evidence on the experiences of adult cancer survivors participating in telehealth interventions, to characterize the patient experience of telehealth interventions for this group. Methods Medline (PubMed), PsychINFO, Cumulative Index for Nursing and Allied Health Professionals (CINAHL), Embase, and Cochrane Central Register of Controlled Trials were searched on August 14, 2015, and March 8, 2016, for English-language papers published between 2006 and 2016. Inclusion criteria were as follows: adult cancer survivors aged 18 years and over, cancer diagnosis, experience of participating in a telehealth intervention (defined as remote communication or remote monitoring with an HCP delivered by telephone, Internet, or hand-held or mobile technology), and reporting qualitative data including verbatim quotes. An adapted Critical Appraisal Skill Programme (CASP) checklist for qualitative research was used to assess paper quality. The results section of each included article was coded line by line, and all papers underwent inductive analysis, involving comparison, reexamination, and grouping of codes to develop descriptive themes

  18. The influence of a telehealth project on healthcare professional recruitment and retention in remote areas in Mali: A longitudinal study.

    PubMed

    Mbemba, Gisèle Irène Claudine; Bagayoko, Cheick Oumar; Gagnon, Marie-Pierre; Hamelin-Brabant, Louise; Simonyan, David A

    2016-01-01

    The telehealth project EQUI-ResHuS (in French, Les TIC pour un accès Équitable aux Ressources Humaines en Santé) aimed to contribute to more equitable access to care and support practice in remote regions in Mali. This study explored the evolution of perceptions concerning telehealth among healthcare professionals in the four district health centres that participated in the EQUI-ResHus project and identified variables influencing their perceptions of telehealth impact on recruitment and retention of health professionals. One year after a first survey (T1), a second data collection (T2) was carried out among healthcare professionals using a 91-item questionnaire. Questions assessing telehealth use and perceptions and perceived impact on recruitment and retention of healthcare professionals were rated on a 5-point Likert scale. A total of 10 independent variables were considered for the analyses. A Wilcoxon signed-rank test was performed to detect differences between T1 and T2, and a bivariate linear regression model for repeated measures was carried out to assess the impact of independent variables on dependent variables. There were no noticeable changes in perceptions related to telehealth influence on recruitment and retention. Only access to information and communication technology significantly differed between T1 and T2 according the Wilcoxon rank test (p = 0.001). Perceived influence of telehealth on recruitment and retention was mostly explained by attitude towards telehealth, perceived effect on recruitment and retention and barriers to recruitment and retention. Based on our results, telehealth was perceived as having a positive influence but mostly indirect influence on healthcare professional recruitment and retention. Also, there were no major changes after 1 year of telehealth use.

  19. The influence of a telehealth project on healthcare professional recruitment and retention in remote areas in Mali: A longitudinal study

    PubMed Central

    Mbemba, Gisèle Irène Claudine; Bagayoko, Cheick Oumar; Gagnon, Marie-Pierre; Hamelin-Brabant, Louise; Simonyan, David A

    2016-01-01

    Objectives: The telehealth project EQUI-ResHuS (in French, Les TIC pour un accès Équitable aux Ressources Humaines en Santé) aimed to contribute to more equitable access to care and support practice in remote regions in Mali. This study explored the evolution of perceptions concerning telehealth among healthcare professionals in the four district health centres that participated in the EQUI-ResHus project and identified variables influencing their perceptions of telehealth impact on recruitment and retention of health professionals. Methods: One year after a first survey (T1), a second data collection (T2) was carried out among healthcare professionals using a 91-item questionnaire. Questions assessing telehealth use and perceptions and perceived impact on recruitment and retention of healthcare professionals were rated on a 5-point Likert scale. A total of 10 independent variables were considered for the analyses. A Wilcoxon signed-rank test was performed to detect differences between T1 and T2, and a bivariate linear regression model for repeated measures was carried out to assess the impact of independent variables on dependent variables. Results: There were no noticeable changes in perceptions related to telehealth influence on recruitment and retention. Only access to information and communication technology significantly differed between T1 and T2 according the Wilcoxon rank test (p = 0.001). Perceived influence of telehealth on recruitment and retention was mostly explained by attitude towards telehealth, perceived effect on recruitment and retention and barriers to recruitment and retention. Conclusion: Based on our results, telehealth was perceived as having a positive influence but mostly indirect influence on healthcare professional recruitment and retention. Also, there were no major changes after 1 year of telehealth use. PMID:27231552

  20. Effectiveness and cost-effectiveness of a telehealth intervention to support the management of long-term conditions: study protocol for two linked randomized controlled trials

    PubMed Central

    2014-01-01

    the intervention. Discussion This study evaluates a complex telehealth intervention which combines evidence-based components and is delivered by an established healthcare organisation. The study will also analyse health economic information. In doing so, the study hopes to address some of the limitations of previous research by demonstrating the effectiveness and cost-effectiveness of a real world telehealth intervention. Trial registration Current Controlled Trials: Depression trial ISRCTN14172341 and cardiovascular disease risk trial ISRCTN27508731. PMID:24460845

  1. Expedition 27 Launch

    NASA Image and Video Library

    2010-04-01

    The Soyuz TMA-21 launches from the Baikonur Cosmodrome in Kazakhstan on Tuesday, April 5, 2011 carrying Expedition 27 Soyuz Commander Alexander Samokutyaev, NASA Flight Engineer Ron Garan and Russian Flight Engineer Andrey Borisenko to the International Space Station. The Soyuz, which has been dubbed "Gagarin", is launching one week shy of the 50th anniversary of the launch of Yuri Gagarin from the same launch pad in Baikonur on April 12, 1961 to become the first human to fly in space. Photo Credit: (NASA/Victor Zelentsov)

  2. Expedition 27 Launch

    NASA Image and Video Library

    2011-04-04

    The Soyuz TMA-21 launches from the Baikonur Cosmodrome in Kazakhstan on Tuesday, April 5, 2011 carrying Expedition 27 Soyuz Commander Alexander Samokutyaev, NASA Flight Engineer Ron Garan and Russian Flight Engineer Andrey Borisenko to the International Space Station. The Soyuz, which has been dubbed "Gagarin", is launching one week shy of the 50th anniversary of the launch of Yuri Gagarin from the same launch pad in Baikonur on April 12, 1961 to become the first human to fly in space. Photo Credit: (NASA/Carla Cioffi)

  3. Launch Services Safety Overview

    NASA Technical Reports Server (NTRS)

    Loftin, Charles E.

    2008-01-01

    NASA/KSC Launch Services Division Safety (SA-D) services include: (1) Assessing the safety of the launch vehicle (2) Assessing the safety of NASA ELV spacecraft (S/C) / launch vehicle (LV) interfaces (3) Assessing the safety of spacecraft processing to ensure resource protection of: - KSC facilities - KSC VAFB facilities - KSC controlled property - Other NASA assets (4) NASA personnel safety (5) Interfacing with payload organizations to review spacecraft for adequate safety implementation and compliance for integrated activities (6) Assisting in the integration of safety activities between the payload, launch vehicle, and processing facilities

  4. Antares Rocket Test Launch

    NASA Image and Video Library

    2013-04-21

    NASA Administrator Charles Bolden congratulates the Orbital Sciences Corporation launch team and management in the Range Control Center at the NASA Wallops Flight Facility after the successful launch of the Orbital Sciences Antares rocket from the Mid-Atlantic Regional Spaceport (MARS) in Virginia, Sunday, April 21, 2013. The test launch marked the first flight of Antares and the first rocket launch from Pad-0A. The Antares rocket delivered the equivalent mass of a spacecraft, a so-called mass simulated payload, into Earth's orbit. Photo Credit: (NASA/Bill Ingalls)

  5. GPM: Waiting for Launch

    NASA Image and Video Library

    The Global Precipitation Measurement mission's Core Observatory is poised for launch from the Japan Aerospace Exploration Agency's Tanegashima Space Center, scheduled for the afternoon of Feb. 27, ...

  6. Kestrel balloon launch system

    SciTech Connect

    Newman, M.J.

    1991-10-01

    Kestrel is a high-altitude, Helium-gas-filled-balloon system used to launch scientific payloads in winds up to 20 knots, from small platforms or ships, anywhere over land or water, with a minimal crew and be able to hold in standby conditions. Its major components consist of two balloons (a tow balloon and a main balloon), the main deployment system, helium measurement system, a parachute recovery unit, and the scientific payload package. The main scope of the launch system was to eliminate the problems of being dependent of launching on long airfield runways, low wind conditions, and long launch preparation time. These objectives were clearly met with Kestrel 3.

  7. The Use of Telehealth to Reduce Inequalities in Cardiovascular Outcomes in Australia and New Zealand: A Critical Review.

    PubMed

    Wade, Victoria; Stocks, Nigel

    2017-04-01

    Telehealth, the delivery of health care services at a distance using information and communications technology, is one means of redressing inequalities in cardiovascular outcomes for disadvantaged groups in Australia. This critical review argues that there is sufficient evidence to move to larger-scale implementation of telehealth for acute cardiac, acute stroke, and cardiac rehabilitation services. For cardiovascular chronic disease and risk factor management, telehealth-based services can deliver value but the evidence is less compelling, as the outcomes of these programs are variable and depend upon the context of their implementation.

  8. Care Coordination/Home Telehealth: the systematic implementation of health informatics, home telehealth, and disease management to support the care of veteran patients with chronic conditions.

    PubMed

    Darkins, Adam; Ryan, Patricia; Kobb, Rita; Foster, Linda; Edmonson, Ellen; Wakefield, Bonnie; Lancaster, Anne E

    2008-12-01

    Between July 2003 and December 2007, the Veterans Health Administration (VHA) introduced a national home telehealth program, Care Coordination/Home Telehealth (CCHT). Its purpose was to coordinate the care of veteran patients with chronic conditions and avoid their unnecessary admission to long-term institutional care. Demographic changes in the veteran population necessitate VHA increase its noninstitutional care (NIC) services 100% above its 2007 level to provide care for 110,000 NIC patients by 2011. By 2011, CCHT will meet 50% of VHA's anticipated NIC provision. CCHT involves the systematic implementation of health informatics, home telehealth, and disease management technologies. It helps patients live independently at home. Between 2003 and 2007, the census figure (point prevalence) for VHA CCHT patients increased from 2,000 to 31,570 (1,500% growth). CCHT is now a routine NIC service provided by VHA to support veteran patients with chronic conditions as they age. CCHT patients are predominantly male (95%) and aged 65 years or older. Strict criteria determine patient eligibility for enrollment into the program and VHA internally assesses how well its CCHT programs meet standardized clinical, technology, and managerial requirements. VHA has trained 5,000 staff to provide CCHT. Routine analysis of data obtained for quality and performance purposes from a cohort of 17,025 CCHT patients shows the benefits of a 25% reduction in numbers of bed days of care, 19% reduction in numbers of hospital admissions, and mean satisfaction score rating of 86% after enrolment into the program. The cost of CCHT is $1,600 per patient per annum, substantially less than other NIC programs and nursing home care. VHA's experience is that an enterprise-wide home telehealth implementation is an appropriate and cost-effective way of managing chronic care patients in both urban and rural settings.

  9. Expedition 24 Launch Day

    NASA Image and Video Library

    2010-06-14

    Expedition 24 NASA Flight Engineer Shannon Walker has her Russian Sokol suit prepared for launch by technicians at the Baikonur Cosmodrome in Baikonur, Kazakhstan, Tuesday, June 15, 2010. Walker, Soyuz Commander Fyodor Yurchikhin and Flight Engineer Doug Wheelock launched in their Soyuz TMA-19 rocket from the Baikonur Cosmodrome in Kazakhstan on Wednesday, June 16, 2010. (Photo Credit: NASA/Carla Cioffi)

  10. Expedition 24 Launch Day

    NASA Image and Video Library

    2010-06-14

    Expedition 24 NASA Flight Engineer Doug Wheelock, center, has his Russian Sokol suit prepared for launch by a technician at the Baikonur Cosmodrome in Baikonur, Kazakhstan, Tuesday, June 15, 2010. Wheelock, Soyuz Commander Fyodor Yurchikhin and Flight Engineer Shannon Walker launched in their Soyuz TMA-19 rocket from the Baikonur Cosmodrome in Kazakhstan on Wednesday, June 16, 2010. (Photo Credit: NASA/Carla Cioffi)

  11. Expedition 24 Launch Day

    NASA Image and Video Library

    2010-06-14

    Expedition 24 NASA Flight Engineer Doug Wheelock has his Russian Sokol suit prepared for launch by a technician at the Baikonur Cosmodrome in Baikonur, Kazakhstan, Tuesday, June 15, 2010. Wheelock, Soyuz Commander Fyodor Yurchikhin and Flight Engineer Shannon Walker launched in their Soyuz TMA-19 rocket from the Baikonur Cosmodrome in Kazakhstan on Wednesday, June 16, 2010. (Photo Credit: NASA/Carla Cioffi)

  12. Saturn IB Launch

    NASA Technical Reports Server (NTRS)

    1973-01-01

    The Saturn IB launch vehicle lifting off from Launch Complex 39B at 9:01 a.m. EST. The Skylab 4 astronauts Gerald P. Carr, Dr. Edward G. Gibson, and William R. Pogue, were onboard for the third and final mission to the orbiting space station.

  13. Saturn IB Launch Summary

    NASA Technical Reports Server (NTRS)

    1973-01-01

    This chart provides a launch summary of the Saturn IB launch vehicle as of 1973. Developed by the Marshall Space Flight Center (MSFC) as an interim vehicle in MSFC's 'building block' approach to the Saturn rocket development, the Saturn IB utilized Saturn I technology to further develop and refine the larger boosters and the Apollo spacecraft capabilities required for the marned lunar missions.

  14. Expedition 8 Launch Briefing

    NASA Image and Video Library

    2003-10-15

    Expedition 8 Soyuz Commander and Flight Engineer Alexander Kaleri and European Space Agency astronaut Pedro Duque of Spain are briefed on launch procedures from a Russian trainer at their crew quarters in Baikonur, Kazakhstan, Wednesday, Oct. 15, 2003 as they prepare for launch Oct. 18 in a Soyuz TMA-3 vehicle to the International Space Station. Photo Credit (NASA/Bill Ingalls)

  15. Launch Collision Probability

    NASA Technical Reports Server (NTRS)

    Bollenbacher, Gary; Guptill, James D.

    1999-01-01

    This report analyzes the probability of a launch vehicle colliding with one of the nearly 10,000 tracked objects orbiting the Earth, given that an object on a near-collision course with the launch vehicle has been identified. Knowledge of the probability of collision throughout the launch window can be used to avoid launching at times when the probability of collision is unacceptably high. The analysis in this report assumes that the positions of the orbiting objects and the launch vehicle can be predicted as a function of time and therefore that any tracked object which comes close to the launch vehicle can be identified. The analysis further assumes that the position uncertainty of the launch vehicle and the approaching space object can be described with position covariance matrices. With these and some additional simplifying assumptions, a closed-form solution is developed using two approaches. The solution shows that the probability of collision is a function of position uncertainties, the size of the two potentially colliding objects, and the nominal separation distance at the point of closest approach. ne impact of the simplifying assumptions on the accuracy of the final result is assessed and the application of the results to the Cassini mission, launched in October 1997, is described. Other factors that affect the probability of collision are also discussed. Finally, the report offers alternative approaches that can be used to evaluate the probability of collision.

  16. STS-135 Atlantis Launch

    NASA Image and Video Library

    2011-07-08

    Space shuttle Atlantis is seen as it launches from pad 39A on Friday, July 8, 2011, at NASA's Kennedy Space Center in Cape Canaveral, Fla. The launch of Atlantis, STS-135, is the final flight of the shuttle program, a 12-day mission to the International Space Station. Photo Credit: (NASA/Bill Ingalls)

  17. Evaluation of a Telehealth Training Package to Remotely Train Staff to Conduct a Preference Assessment

    ERIC Educational Resources Information Center

    Higgins, William J.; Luczynski, Kevin C.; Carroll, Regina A.; Fisher, Wayne W.; Mudford, Oliver C.

    2017-01-01

    Recent advancements in telecommunication technologies make it possible to conduct a variety of healthcare services remotely (e.g., behavioral-analytic intervention services), thereby bridging the gap between qualified providers and consumers in isolated locations. In this study, web-based telehealth technologies were used to remotely train…

  18. Pediatric Tele-Health Consultation to Rural Schools and Clinics in the Pacific Northwest

    ERIC Educational Resources Information Center

    Sulzbacher, Stephen; Mas, Jennifer; Larson, Eric H.; Shurtleff, David B.

    2004-01-01

    The primary telehealth technology described in these articles is interactive video teleconferencing (IVTC), which allows parties at both ends of the communication to see and hear each other. The author have used this application during the past decade for consultation with rural practitioners and schools, and it has become a primary focus of our…

  19. 77 FR 13195 - Exempting In-Home Video Telehealth From Copayments

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-03-06

    ...), Traumatic Brain Injury (TBI) and Multiple Sclerosis (MS). Clinical video telehealth uses real-time... wound management, psychiatric or psychotherapeutic care, exercise plans, and medication management. The.... VA will consider such comments in developing a subsequent final rule. Effect of Rulemaking Title...

  20. Current Clinical Status of Telehealth in Korea: Categories, Scientific Basis, and Obstacles

    PubMed Central

    Kim, Hun-Sung; Kim, Hyunah; Lee, Suehyun; Lee, Kye Hwa

    2015-01-01

    Objectives Through telehealth, medical services have expanded beyond spatial boundaries and are now available in living spaces outside of hospitals. It can also contribute to patient medical knowledge improvement because patients can access their hospital records and data from home. However, concepts of telehealth are rather vague in Korea. Methods We refer to several clinical reports to determine the current clinical status of and obstacles to telehealth in Korea. Results Patients' health conditions are now reported regularly to doctors remotely, and patients can receive varied assistance. Self-improvement based on minute details that are beyond medical staff's reach is another possible benefit that may be realized with the help of a variety of medical equipment (sensors). The feasibility, clinical effect, and cost-benefit of telehealth have been verified by scientific evidence. Conclusions Patients will be able to improve their treatment adherence by receiving help from various professionals, such as doctors, nurses, nutritionists, and sports therapists. This means that the actual treatment time per patient will increase as well. Ultimately, this will increase the quality of patients' self-administration of care to impede disease progression and prevent complications. PMID:26618030

  1. Utilization of Telehealth Technology to Develop and Implement a Comprehensive Management Initiative for Chronic Diseases

    DTIC Science & Technology

    2012-10-01

    alone or in various combinations . The program indicates which dose or doses of medications should be increased or decreased, when there has been... combined best educational practices with telehealth technology offered a promising solution to this problem. Thus, the CMICD evaluated the... combination of poor access to and compliance with periodic eye examinations that target early detection of sight- threatening eye disease. Even in

  2. Telehealth: New Directions and Technology for Health Care Delivery in the Schools.

    ERIC Educational Resources Information Center

    Miller, Thomas W.

    Advances in technology and health care delivery have included the use of telemedicine and telepsychology for crisis intervention, assessment, treatment, and education of patients. The use of telemedicine and telepsychology is examined for a variety of health care services to rural America. Telehealth has been considered a partial solution to the…

  3. Steps to Offering Low Vision Rehabilitation Services through Clinical Video Telehealth

    ERIC Educational Resources Information Center

    Ihirig, Carolyn

    2016-01-01

    Telehealth clinical applications, which allow medical professionals to use telecommunications technologies to provide services to individuals remotely, continue to expand in areas such as low vision rehabilitation, where evaluations are provided to patients who live in rural areas. As with face-to-face low vision rehabilitation, the goal of…

  4. Pediatric Tele-Health Consultation to Rural Schools and Clinics in the Pacific Northwest

    ERIC Educational Resources Information Center

    Sulzbacher, Stephen; Mas, Jennifer; Larson, Eric H.; Shurtleff, David B.

    2004-01-01

    The primary telehealth technology described in these articles is interactive video teleconferencing (IVTC), which allows parties at both ends of the communication to see and hear each other. The author have used this application during the past decade for consultation with rural practitioners and schools, and it has become a primary focus of our…

  5. Telehealth--an effective delivery method for diabetes self-management education?

    PubMed

    Fitzner, Karen; Moss, Gail

    2013-06-01

    Diabetes is a chronic disease that is often comorbid with cardiovascular disease, hypertension, kidney disease, and neuropathy. Its management is complex, requiring ongoing clinical management, lifestyle changes, and self-care. This article examines recent literature on telehealth and emerging technological tools for supporting self-management of diabetes and identifies best practices. The authors conducted a PubMed search (January 2008-2012) that was supplemented by review of meeting materials and a scan of the Internet to identify emerging technologies. Fifty-eight papers were reviewed; 12 were selected for greater analysis. This review supports earlier findings that the delivery of diabetes self-management and training (DSME/T) via telehealth is useful, appropriate, and acceptable to patients and providers. Best practices are emerging; not all technology is appropriate for all populations--interactive technology needs to be appropriate to the patient's age, abilities, and sensitivities. Telehealth is scalable and sustainable provided that it adds value, does not add to the provider's workload, and is fairly reimbursed. However, there are multiple barriers (patient, provider, health system) to remotely provided DSME/T. DSME/T delivered via telehealth offers effective, efficient, and affordable ways to reach and support underserved minorities and other people with diabetes and related comorbidities. The new generation of smartphones, apps, and other technologies increase access, and the newest interventions are designed to meet patient needs, do not increase workloads, are highly appropriate, enhance self-management, and are desired by patients.

  6. Use of Telehealth for Research and Clinical Measures in Cochlear Implant Recipients: A Validation Study

    ERIC Educational Resources Information Center

    Hughes, Michelle L.; Goehring, Jenny L.; Baudhuin, Jacquelyn L.; Diaz, Gina R.; Sanford, Todd; Harpster, Roger; Valente, Daniel L.

    2012-01-01

    Purpose: The goal of this study was to compare clinical and research-based cochlear implant (CI) measures using telehealth versus traditional methods. Method: This prospective study used an ABA design (A = laboratory, B = remote site). All measures were made twice per visit for the purpose of assessing within-session variability. Twenty-nine adult…

  7. Communication Intervention for Young Children with Severe Neurodevelopmental Disabilities via Telehealth

    ERIC Educational Resources Information Center

    Simacek, Jessica; Dimian, Adele F.; McComas, Jennifer J.

    2017-01-01

    Young children with neurodevelopmental disorders such as autism spectrum disorders (ASD) and Rett syndrome often experience severe communication impairments. This study examined the efficacy of parent-implemented communication assessment and intervention with remote coaching via telehealth on the acquisition of early communication skills of three…

  8. Development of Standardized Clinical Training Cases for Diagnosis of Sexual Abuse using a Secure Telehealth Application

    ERIC Educational Resources Information Center

    Frasier, Lori D.; Thraen, Ioana; Kaplan, Rich; Goede, Patricia

    2012-01-01

    Objectives: The training of physicians, nurse examiners, social workers and other health professional on the evidentiary findings of sexual abuse in children is challenging. Our objective was to develop peer reviewed training cases for medical examiners of child sexual abuse, using a secure web based telehealth application (TeleCAM). Methods:…

  9. The Nature and Requirements of Work in University-Based Telehealth Units: A Qualitative Study

    ERIC Educational Resources Information Center

    Seale, Deborah E.

    2013-01-01

    Telehealth units are one of many university administrative units created to foster innovation in universities over the last 40 years. Despite the proliferation of such units, few organizational studies have examined the work undertaken inside of these units. This qualitative study used a sequential two-part research design to understand the…

  10. Telehealth: New Directions and Technology for Health Care Delivery in the Schools.

    ERIC Educational Resources Information Center

    Miller, Thomas W.

    Advances in technology and health care delivery have included the use of telemedicine and telepsychology for crisis intervention, assessment, treatment, and education of patients. The use of telemedicine and telepsychology is examined for a variety of health care services to rural America. Telehealth has been considered a partial solution to the…

  11. Preliminary Findings of a Telehealth Approach to Parent Training in Autism

    ERIC Educational Resources Information Center

    Vismara, Laurie A.; McCormick, Carolyn; Young, Gregory S.; Nadhan, Anna; Monlux, Katerina

    2013-01-01

    Telehealth or online communication technologies may lessen the gap between intervention requirements for children with autism spectrum disorders (ASDs) and the available resources to provide these services. This study used a video conferencing and self-guided website to provide parent training in the homes of children with ASD. The first eight…

  12. Use of Telehealth for Research and Clinical Measures in Cochlear Implant Recipients: A Validation Study

    ERIC Educational Resources Information Center

    Hughes, Michelle L.; Goehring, Jenny L.; Baudhuin, Jacquelyn L.; Diaz, Gina R.; Sanford, Todd; Harpster, Roger; Valente, Daniel L.

    2012-01-01

    Purpose: The goal of this study was to compare clinical and research-based cochlear implant (CI) measures using telehealth versus traditional methods. Method: This prospective study used an ABA design (A = laboratory, B = remote site). All measures were made twice per visit for the purpose of assessing within-session variability. Twenty-nine adult…

  13. Telehealth-Enabled Emergency Medical Services Program Reduces Ambulance Transport to Urban Emergency Departments.

    PubMed

    Langabeer, James R; Gonzalez, Michael; Alqusairi, Diaa; Champagne-Langabeer, Tiffany; Jackson, Adria; Mikhail, Jennifer; Persse, David

    2016-11-01

    Emergency medical services (EMS) agencies transport a significant majority of patients with low acuity and non-emergent conditions to local emergency departments (ED), affecting the entire emergency care system's capacity and performance. Opportunities exist for alternative models that integrate technology, telehealth, and more appropriately aligned patient navigation. While a limited number of programs have evolved recently, no empirical evidence exists for their efficacy. This research describes the development and comparative effectiveness of one large urban program. The Houston Fire Department initiated the Emergency Telehealth and Navigation (ETHAN) program in 2014. ETHAN combines telehealth, social services, and alternative transportation to navigate primary care-related patients away from the ED where possible. Using a case-control study design, we describe the program and compare differences in effectiveness measures relative to the control group. During the first 12 months, 5,570 patients participated in the telehealth-enabled program, which were compared against the same size control group. We found a 56% absolute reduction in ambulance transports to the ED with the intervention compared to the control group (18% vs. 74%, P<.001). EMS productivity (median time from EMS notification to unit back in service) was 44 minutes faster for the ETHAN group (39 vs. 83 minutes, median). There were no statistically significant differences in mortality or patient satisfaction. We found that mobile technology-driven delivery models are effective at reducing unnecessary ED ambulance transports and increasing EMS unit productivity. This provides support for broader EMS mobile integrated health programs in other regions.

  14. The Effect of Technology and Testing Environment on Speech Perception Using Telehealth with Cochlear Implant Recipients

    ERIC Educational Resources Information Center

    Goehring, Jenny L.; Hughes, Michelle L.; Baudhuin, Jacquelyn L.; Valente, Daniel L.; McCreery, Ryan W.; Diaz, Gina R.; Sanford, Todd; Harpster, Roger

    2012-01-01

    Purpose: In this study, the authors evaluated the effect of remote system and acoustic environment on speech perception via telehealth with cochlear implant recipients. Method: Speech perception was measured in quiet and in noise. Systems evaluated were Polycom visual concert (PVC) and a hybrid presentation system (HPS). Each system was evaluated…

  15. A systematic review of telehealth tools and interventions to support family caregivers

    PubMed Central

    Chi, Nai-Ching; Demiris, George

    2015-01-01

    Summary We conducted a systematic review of studies employing telehealth interventions which focused on family caregivers’ outcomes. The Embase, CINHAL, Cochrane and PubMed databases were searched using combinations of keywords including “telehealth,” “telemedicine,” “telecare,” “telemonitoring,” “caregiver” and “family.” The initial search produced 4205 articles, of which 65 articles met the inclusion criteria. The articles included 52 experimental studies, 11 evaluation studies, one case study and one secondary analysis. Thirty-three articles focused on family caregivers of adult and older patients, while 32 articles focused on parental caregivers of paediatric patients. The technologies included video, web-based, telephone-based and telemetry/remote monitoring. Six main categories of interventions were delivered via technology: education, consultation (including decision support), psychosocial/cognitive behavioural therapy (including problem solving training), social support, data collection and monitoring, and clinical care delivery. More than 95% of the studies reported significant improvements in the caregivers’ outcomes and that caregivers were satisfied and comfortable with telehealth. The review showed that telehealth can positively affect chronic disease care, home and hospice care. PMID:25475220

  16. The Effect of Technology and Testing Environment on Speech Perception Using Telehealth with Cochlear Implant Recipients

    ERIC Educational Resources Information Center

    Goehring, Jenny L.; Hughes, Michelle L.; Baudhuin, Jacquelyn L.; Valente, Daniel L.; McCreery, Ryan W.; Diaz, Gina R.; Sanford, Todd; Harpster, Roger

    2012-01-01

    Purpose: In this study, the authors evaluated the effect of remote system and acoustic environment on speech perception via telehealth with cochlear implant recipients. Method: Speech perception was measured in quiet and in noise. Systems evaluated were Polycom visual concert (PVC) and a hybrid presentation system (HPS). Each system was evaluated…

  17. Maugeri Centre for Telehealth and Telecare: A real-life integrated experience in chronic patients.

    PubMed

    Scalvini, Simonetta; Bernocchi, Palmira; Zanelli, Emanuela; Comini, Laura; Vitacca, Michele

    2017-01-01

    Management of chronic diseases in a progressively aging population is a major issue in western industrialized countries and telehealth is one way to ensure the continuity of care in chronic illness. We describe here our personal experience in a telehealth and telecare centre in Italy. Between January 2000 and December 2015, 1635 elderly patients (71% male) with one or more comorbidities have undergone a telehealth program tailored to their specific disease: chronic obstructive pulmonary disease (COPD)/chronic respiratory insufficiency; amyotrophic lateral sclerosis/neuromuscular diseases; chronic heart failure (CHF); post-stroke; and post-cardiac surgery patients discharged from hospital after an acute event. COPD and CHF represent the majority of patients treated (accounting for 80%). Interventions performed by the nurse tutor account for 39-82% of all activities in the five different programs. Specialist second opinion represents 12-27% of the health staff activities. Previously reported results show a reduction of the re-hospitalization rate and costs, and increase in quality of life and patient satisfaction with the service. A multidisciplinary telehealth and telecare integrated approach can provide efficient management for the growing number of complex patients.

  18. The Nature and Requirements of Work in University-Based Telehealth Units: A Qualitative Study

    ERIC Educational Resources Information Center

    Seale, Deborah E.

    2013-01-01

    Telehealth units are one of many university administrative units created to foster innovation in universities over the last 40 years. Despite the proliferation of such units, few organizational studies have examined the work undertaken inside of these units. This qualitative study used a sequential two-part research design to understand the…

  19. Utilization of Telehealth Technology to Develop and Implement a Comprehensive Management Initiative for Chronic Diseases

    DTIC Science & Technology

    2009-10-21

    age adults, yet it is largely preventable with timely diagnosis and treatment ( Diabetic Retinopathy Study Research Group, 1981; Early Treatment ...macular edema, the telehealth eye care assessments agree substantially with mydriatic seven-standard field Early Treatment Diabetic Retinopathy...with Early Treatment Diabetic Retinopathy Study seven standard field 35-mm stereo color photos for determining level of diabetic retinopathy

  20. 77 FR 50549 - Agency Information Collection: Emergency Submission for OMB Review (Telehealth in the Parkinson's...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-08-21

    ... Disease Research, Education and Clinical Center (PADRECC): The Key to the Patient-Centered Medical Home... ``Telehealth in the Parkinson's Disease Research, Education and Clinical Center (PADRECC): The Key to the Patient-Centered Medical Home?'', VA Form 10-0533. b. Geriatric Depression Scale (GDS) Short Form, VA...

  1. Controversy clarified: an updated review of clinical psychology and tele-health.

    PubMed

    Perle, Jonathan G; Langsam, Leah C; Nierenberg, Barry

    2011-12-01

    One of the most controversial topics in the field of clinical psychology, online tele-health, or the integration of computers and the internet with therapeutic techniques, remains at the forefront of many debates. Despite potential interest, there are numerous factors that a psychologist must consider before integrating an online tele-health intervention into their own practice. This article outlines literature pertinent to the debate. The article begins with a brief history of the use of non-face-to-face interventions as well as the earliest recorded use of "tele-health" before discussing the modern benefits and risks associated with usage. Considerations for the psychologist as well as the client are detailed; incorporating ethical implications. The authors conclude that the utilization of tele-health interventions is an exponentially expanding field that should continue to be explored. Despite many well-conceived studies, a psychologist should educate themselves in all aspects of the new modes of intervention (e.g., ethical, legal, evidence-based treatments) before attempting to implement them into everyday practice. The article ends with a discussion on the acceptance among psychologists, as well as the outlook for the future. Copyright © 2011 Elsevier Ltd. All rights reserved.

  2. 78 FR 76193 - Agency Information Collection (Care Coordination Home Telehealth (CCHT) Patient Satisfaction...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-12-16

    ... AFFAIRS Agency Information Collection (Care Coordination Home Telehealth (CCHT) Patient Satisfaction... (CCHT) Patient Satisfaction Survey, VA Form 10-0481. Type of Review: Extension of a currently approved..., (Regulation on Reduction of Nursing Shortages in State Homes; Application for Assistance for Hiring and...

  3. Home Telehealth for Patients With Chronic Obstructive Pulmonary Disease (COPD)

    PubMed Central

    Franek, J

    2012-01-01

    Executive Summary In July 2010, the Medical Advisory Secretariat (MAS) began work on a Chronic Obstructive Pulmonary Disease (COPD) evidentiary framework, an evidence-based review of the literature surrounding treatment strategies for patients with COPD. This project emerged from a request by the Health System Strategy Division of the Ministry of Health and Long-Term Care that MAS provide them with an evidentiary platform on the effectiveness and cost-effectiveness of COPD interventions. After an initial review of health technology assessments and systematic reviews of COPD literature, and consultation with experts, MAS identified the following topics for analysis: vaccinations (influenza and pneumococcal), smoking cessation, multidisciplinary care, pulmonary rehabilitation, long-term oxygen therapy, noninvasive positive pressure ventilation for acute and chronic respiratory failure, hospital-at-home for acute exacerbations of COPD, and telehealth (including telemonitoring and telephone support). Evidence-based analyses were prepared for each of these topics. For each technology, an economic analysis was also completed where appropriate. In addition, a review of the qualitative literature on patient, caregiver, and provider perspectives on living and dying with COPD was conducted, as were reviews of the qualitative literature on each of the technologies included in these analyses. The Chronic Obstructive Pulmonary Disease Mega-Analysis series is made up of the following reports, which can be publicly accessed at the MAS website at: http://www.hqontario.ca/en/mas/mas_ohtas_mn.html. Chronic Obstructive Pulmonary Disease (COPD) Evidentiary Framework Influenza and Pneumococcal Vaccinations for Patients With Chronic Obstructive Pulmonary Disease (COPD): An Evidence-Based Analysis Smoking Cessation for Patients With Chronic Obstructive Pulmonary Disease (COPD): An Evidence-Based Analysis Community-Based Multidisciplinary Care for Patients With Stable Chronic Obstructive

  4. Launch Pad in a Box

    NASA Technical Reports Server (NTRS)

    Mantovani, J. G.; Tamasy, G. J.; Mueller, R. P.; Townsend, I. I.; Sampson, J. W.; Lane, M. A.

    2016-01-01

    NASA Kennedy Space Center (KSC) is developing a new deployable launch system capability to support a small class of launch vehicles for NASA and commercial space companies to test and launch their vehicles. The deployable launch pad concept was first demonstrated on a smaller scale at KSC in 2012 in support of NASA Johnson Space Center's Morpheus Lander Project. The main objective of the Morpheus Project was to test a prototype planetary lander as a vertical takeoff and landing test-bed for advanced spacecraft technologies using a hazard field that KSC had constructed at the Shuttle Landing Facility (SLF). A steel pad for launch or landing was constructed using a modular design that allowed it to be reconfigurable and expandable. A steel flame trench was designed as an optional module that could be easily inserted in place of any modular steel plate component. The concept of a transportable modular launch and landing pad may also be applicable to planetary surfaces where the effects of rocket exhaust plume on surface regolith is problematic for hardware on the surface that may either be damaged by direct impact of high speed dust particles, or impaired by the accumulation of dust (e.g., solar array panels and thermal radiators). During the Morpheus free flight campaign in 2013-14, KSC performed two studies related to rocket plume effects. One study compared four different thermal ablatives that were applied to the interior of a steel flame trench that KSC had designed and built. The second study monitored the erosion of a concrete landing pad following each landing of the Morpheus vehicle on the same pad located in the hazard field. All surfaces of a portable flame trench that could be directly exposed to hot gas during launch of the Morpheus vehicle were coated with four types of ablatives. All ablative products had been tested by NASA KSC and/or the manufacturer. The ablative thicknesses were measured periodically following the twelve Morpheus free flight tests

  5. Launch Pad in a Box

    NASA Technical Reports Server (NTRS)

    Mantovani, James; Tamasy, Gabor; Mueller, Rob; Townsend, Van; Sampson, Jeff; Lane, Mike

    2016-01-01

    NASA Kennedy Space Center (KSC) is developing a new deployable launch system capability to support a small class of launch vehicles for NASA and commercial space companies to test and launch their vehicles. The deployable launch pad concept was first demonstrated on a smaller scale at KSC in 2012 in support of NASA Johnson Space Center's Morpheus Lander Project. The main objective of the Morpheus Project was to test a prototype planetary lander as a vertical takeoff and landing test-bed for advanced spacecraft technologies using a hazard field that KSC had constructed at the Shuttle Landing Facility (SLF). A steel pad for launch or landing was constructed using a modular design that allowed it to be reconfigurable and expandable. A steel flame trench was designed as an optional module that could be easily inserted in place of any modular steel plate component. The concept of a transportable modular launch and landing pad may also be applicable to planetary surfaces where the effects of rocket exhaust plume on surface regolith is problematic for hardware on the surface that may either be damaged by direct impact of high speed dust particles, or impaired by the accumulation of dust (e.g., solar array panels and thermal radiators). During the Morpheus free flight campaign in 2013-14, KSC performed two studies related to rocket plume effects. One study compared four different thermal ablatives that were applied to the interior of a steel flame trench that KSC had designed and built. The second study monitored the erosion of a concrete landing pad following each landing of the Morpheus vehicle on the same pad located in the hazard field. All surfaces of a portable flame trench that could be directly exposed to hot gas during launch of the Morpheus vehicle were coated with four types of ablatives. All ablative products had been tested by NASA KSC and/or the manufacturer. The ablative thicknesses were measured periodically following the twelve Morpheus free flight tests

  6. Cannon launched electromechanical control actuation system development

    NASA Technical Reports Server (NTRS)

    Johnston, J. G.

    1983-01-01

    The evolution of an electromechanical control actuation system from trade study results through breadboard test and high-g launch demonstration tests is summarized. Primary emphasis is on design, development, integration and test of the gear reduction system.

  7. Improving patient access to specialized health care: the Telehealth Network of Minas Gerais, Brazil

    PubMed Central

    Alkmim, Maria Beatriz; Figueira, Renato Minelli; Marcolino, Milena Soriano; Cardoso, Clareci Silva; Pena de Abreu, Monica; Cunha, Lemuel Rodrigues; da Cunha, Daniel Ferreira; Antunes, Andre Pires; de A Resende, Adélson Geraldo; Resende, Elmiro Santos

    2012-01-01

    Abstract Problem The Brazilian population lacks equitable access to specialized health care and diagnostic tests, especially in remote municipalities, where health professionals often feel isolated and staff turnover is high. Telehealth has the potential to improve patients’ access to specialized health care, but little is known about it in terms of cost-effectiveness, access to services or user satisfaction. Approach In 2005, the State Government of Minas Gerais, Brazil, funded the establishment of the Telehealth Network, intended to connect university hospitals with the state’s remote municipal health departments; support professionals in providing tele-assistance; and perform tele-electrocardiography and teleconsultations. The network uses low-cost equipment and has employed various strategies to overcome the barriers to telehealth use. Local setting The Telehealth Network connects specialists in state university hospitals with primary health-care professionals in 608 municipalities of the large state of Minas Gerais, many of them in remote areas. Relevant changes From June 2006 to October 2011, 782 773 electrocardiograms and 30 883 teleconsultations were performed through the network, and 6000 health professionals were trained in its use. Most of these professionals (97%) were satisfied with the system, which was cost-effective, economically viable and averted 81% of potential case referrals to distant centres. Lessons learnt To succeed, a telehealth service must be part of a collaborative network, meet the real needs of local health professionals, use simple technology and have at least some face-to-face components. If applied to health problems for which care is in high demand, this type of service can be economically viable and can help to improve patient access to specialized health care. PMID:22589571

  8. Implementation of telehealth support for patients with type 2 diabetes using insulin treatment: an exploratory study.

    PubMed

    Turner, Jane; Larsen, Mark; Tarassenko, Lionel; Neil, Andrew; Farmer, Andrew

    2009-01-01

    Initiating and adjusting insulin treatment for people with type 2 diabetes (T2D) requires frequent clinician contacts both face-to-face and by telephone. We explored the use of a telehealth system to offer additional support to these patients. Twenty-three patients with uncontrolled T2D were recruited from nine general practices to assess the feasibility and acceptability of telehealth monitoring and support for insulin initiation and adjustment. The intervention included a standard algorithm for self-titration of insulin dose, a Bluetooth enabled glucose meter linked to a mobile phone, an integrated diary to record insulin dose, feedback of charted blood glucose data and telehealth nurse review with telephone follow-up. Additional contact with patients was initiated when no readings were transmitted for >3 days or when persistent hyper- or hypoglycaemia was identified. Reponses of patients and clinicians to the system were assessed informally. The mean (SD) patient age was 58 years (12) with 78% male. The mean (SD) diabetes duration was 6.4 years (4.5), HbA1c at baseline was 9.5% (2.2), and the decrease in HbA1c at three months was 0.52% (0.91) with an insulin dose increase of 9 units (26). A mean (SD) of 160 (93) blood glucose readings was transmitted per patient in these three months. Practice nurses and general practitioners (GPs) viewed the technology as having the potential to improve patient care. Most patients were able to use the equipment with training and welcomed review of their blood glucose readings by a telehealth nurse. Although the concept of telehealth monitoring is unfamiliar to most patients and practice nurses, the technology improved the support available for T2D patients commencing insulin treatment.

  9. Developing Next-Generation Telehealth Tools and Technologies: Patients, Systems, and Data Perspectives

    PubMed Central

    Filart, Rosemarie; Burgess, Lawrence P.; Lee, Insup; Poropatich, Ronald K.

    2010-01-01

    Abstract The major goals of telemedicine today are to develop next-generation telehealth tools and technologies to enhance healthcare delivery to medically underserved populations using telecommunication technology, to increase access to medical specialty services while decreasing healthcare costs, and to provide training of healthcare providers, clinical trainees, and students in health-related fields. Key drivers for these tools and technologies are the need and interest to collaborate among telehealth stakeholders, including patients, patient communities, research funders, researchers, healthcare services providers, professional societies, industry, healthcare management/economists, and healthcare policy makers. In the development, marketing, adoption, and implementation of these tools and technologies, communication, training, cultural sensitivity, and end-user customization are critical pieces to the process. Next-generation tools and technologies are vehicles toward personalized medicine, extending the telemedicine model to include cell phones and Internet-based telecommunications tools for remote and home health management with video assessment, remote bedside monitoring, and patient-specific care tools with event logs, patient electronic profile, and physician note-writing capability. Telehealth is ultimately a system of systems in scale and complexity. To cover the full spectrum of dynamic and evolving needs of end-users, we must appreciate system complexity as telehealth moves toward increasing functionality, integration, interoperability, outreach, and quality of service. Toward that end, our group addressed three overarching questions: (1) What are the high-impact topics? (2) What are the barriers to progress? and (3) What roles can the National Institutes of Health and its various institutes and centers play in fostering the future development of telehealth? PMID:20043711

  10. Accuracy of Telehealth-Administered Measures to Screen Language in Spanish-Speaking Preschoolers

    PubMed Central

    Rodríguez, Barbara L.; Zajacova, Anna

    2015-01-01

    Abstract Introduction: There is a critical need for telehealth language screening measures for use with Spanish-speaking children because of the shortage of bilingual providers and the current lack of psychometrically sound measures that can be administered via telehealth. The purpose of the current study was to describe the classification accuracy of individual telehealth language screening measures as well as the accuracy of combinations of measures used with Spanish-speaking preschoolers from rural and underserved areas of the country. Materials and Methods: This study applied a hybrid telehealth approach that implemented synchronous videoconferencing, videocasting, and traditional pen and paper measures. Screening measures included a processing efficiency measure (Spanish nonword repetition [NWR]), language sampling, and a developmental language questionnaire. Eighty-two mostly Spanish-speaking preschool-age children and their parents participated. Thirty-four children had language impairment (LI), and 48 had typical language development. Results: Although many of the individual measures were significantly associated with standardized language scores (r=0.27–0.55), not one of the measures had classification values of 0.8 or higher, which is recommended when screening for LI. However, when NWR scores were combined with language sample or parent survey measures, promising classification accuracy values that approached or were higher than 0.8 were obtained. Conclusions: This research provides preliminary evidence showing the effectiveness of a hybrid telehealth model in screening the language development of Spanish-speaking children. A processing efficiency measure, NWR, combined with a parent survey or language sample measure can provide informative and accurate diagnostic information when screening Spanish-speaking preschool-age children for LI. PMID:25942401

  11. Accuracy of Telehealth-Administered Measures to Screen Language in Spanish-Speaking Preschoolers.

    PubMed

    Guiberson, Mark; Rodríguez, Barbara L; Zajacova, Anna

    2015-09-01

    There is a critical need for telehealth language screening measures for use with Spanish-speaking children because of the shortage of bilingual providers and the current lack of psychometrically sound measures that can be administered via telehealth. The purpose of the current study was to describe the classification accuracy of individual telehealth language screening measures as well as the accuracy of combinations of measures used with Spanish-speaking preschoolers from rural and underserved areas of the country. This study applied a hybrid telehealth approach that implemented synchronous videoconferencing, videocasting, and traditional pen and paper measures. Screening measures included a processing efficiency measure (Spanish nonword repetition [NWR]), language sampling, and a developmental language questionnaire. Eighty-two mostly Spanish-speaking preschool-age children and their parents participated. Thirty-four children had language impairment (LI), and 48 had typical language development. Although many of the individual measures were significantly associated with standardized language scores (r=0.27-0.55), not one of the measures had classification values of 0.8 or higher, which is recommended when screening for LI. However, when NWR scores were combined with language sample or parent survey measures, promising classification accuracy values that approached or were higher than 0.8 were obtained. This research provides preliminary evidence showing the effectiveness of a hybrid telehealth model in screening the language development of Spanish-speaking children. A processing efficiency measure, NWR, combined with a parent survey or language sample measure can provide informative and accurate diagnostic information when screening Spanish-speaking preschool-age children for LI.

  12. Telehealth Measures Screening for Developmental Language Disorders in Spanish-Speaking Toddlers.

    PubMed

    Guiberson, Mark

    2016-09-01

    This is the second of two studies that described the use of telehealth language screening measures for use with young Spanish-speaking children. The purpose of this study was to describe the classification accuracy of individual telehealth language screening measures as well as the accuracy of combinations of measures used with Spanish-speaking toddler-age children from rural and underserved areas of the country. This study applied an asynchronous hybrid telehealth approach that implemented parent-structured play activities with a standard set of stimuli, and interaction with a My First Words e-book. These interactions were recorded with a mini camcorder. In addition, a traditional pen and paper parent questionnaire measure was collected. Sixty-two mostly Spanish-speaking preschool-age children and their parents participated. Twenty-two children had developmental language disorders (DLDs) and 40 had typical language development. Although several of the individual measures were significantly and strongly associated with standardized language scores, only reported vocabulary had classification accuracy values that were desirable for screening for DLDs. An improvement was observed when reported vocabulary was combined with a number of different words children produced during interactions with parents. This research provides additional evidence showing the effectiveness of a hybrid telehealth model in screening the language development of Spanish-speaking children. More specifically, reported vocabulary combined with number of different words produced by a child can provide informative and accurate diagnostic information when screening Spanish-speaking toddler-age children for DLDs. These findings replicate the first study in showing that hybrid telehealth approaches that combine the use of video technology and traditional pen and paper surveys yield strong results, and may be a viable screening alternative when face-to-face access to a bilingual provider is not

  13. Telehealth distance education course in Latin America: analysis of an experience involving 15 countries.

    PubMed

    dos Santos, Alaneir de Fátima; Alves, Humberto José; Nogueira, Janaina Teixeira; Torres, Rosoália Mpraes; Melo, Maria do Carmo Barros

    2014-08-01

    Telehealth activities are already going on in many Latin American countries. This article aims to present and evaluate a distance learning telehealth training course in the region. This was a cross-sectional descriptive study. A coordinating committee was formed, composed of medical school faculty from 15 countries, which defined the course's syllabus, teaching model, and mentoring structure. A questionnaire was prepared, using a Likert scale, in order to verify if the parameters of gender, age, professional category, postgraduate degree, and experience in distance education indicated any difference in relation to the course evaluation. The responses were analyzed by chi-squared test, considering as significant a value of p<0.05. Of the 353 enrolled participants, 251 (71.10%) did the basic modules, and 96 (43.91%) completed the full training. In relation to the overall course assessment, it was considered excellent or good by 80.92% of participants, the mentors received positive evaluations by 72.83% of students, the course content was evaluated as excellent or good by 87.4% of students, and 94.40% of participants would recommend it. As for the parameters assessed, only experience in distance education was statistically significant for the evaluation of the tutors. The results presented indicate an important concern on the part of the Latin American countries participating on the course in relation to telehealth training activities. Regarding course assessment, high approval rates in relation to tutoring, educational model, course content, and goals were noted, corroborating literature data. The experience of conducting a Latin American shared telehealth training course was indeed positive, contributing to the development of telehealth actions.

  14. Developing next-generation telehealth tools and technologies: patients, systems, and data perspectives.

    PubMed

    Ackerman, Michael J; Filart, Rosemarie; Burgess, Lawrence P; Lee, Insup; Poropatich, Ronald K

    2010-01-01

    The major goals of telemedicine today are to develop next-generation telehealth tools and technologies to enhance healthcare delivery to medically underserved populations using telecommunication technology, to increase access to medical specialty services while decreasing healthcare costs, and to provide training of healthcare providers, clinical trainees, and students in health-related fields. Key drivers for these tools and technologies are the need and interest to collaborate among telehealth stakeholders, including patients, patient communities, research funders, researchers, healthcare services providers, professional societies, industry, healthcare management/economists, and healthcare policy makers. In the development, marketing, adoption, and implementation of these tools and technologies, communication, training, cultural sensitivity, and end-user customization are critical pieces to the process. Next-generation tools and technologies are vehicles toward personalized medicine, extending the telemedicine model to include cell phones and Internet-based telecommunications tools for remote and home health management with video assessment, remote bedside monitoring, and patient-specific care tools with event logs, patient electronic profile, and physician note-writing capability. Telehealth is ultimately a system of systems in scale and complexity. To cover the full spectrum of dynamic and evolving needs of end-users, we must appreciate system complexity as telehealth moves toward increasing functionality, integration, interoperability, outreach, and quality of service. Toward that end, our group addressed three overarching questions: (1) What are the high-impact topics? (2) What are the barriers to progress? and (3) What roles can the National Institutes of Health and its various institutes and centers play in fostering the future development of telehealth?

  15. Telehealth to improve asthma control in pregnancy: A randomized controlled trial.

    PubMed

    Zairina, Elida; Abramson, Michael J; McDonald, Christine F; Li, Jonathan; Dharmasiri, Thanuja; Stewart, Kay; Walker, Susan P; Paul, Eldho; George, Johnson

    2016-07-01

    Poorly controlled asthma during pregnancy is hazardous for both mother and foetus. Better asthma control may be achieved if patients are involved in regular self-monitoring of symptoms and self-management according to a written asthma action plan. Telehealth applications to optimize asthma management and outcomes in pregnant women have not yet been evaluated. This study evaluated the efficacy of a telehealth programme supported by a handheld respiratory device in improving asthma control during pregnancy. Pregnant women with asthma (n = 72) from two antenatal clinics in Melbourne, Australia, were randomized to one of two groups: (i) intervention-involving a telehealth programme (management of asthma with supportive telehealth of respiratory function in pregnancy (MASTERY(©) )) supported by a handheld respiratory device and an Android smart phone application (Breathe-easy(©) ) and written asthma action plan or (ii) control-usual care. The primary outcome was change in asthma control at 3 and 6 months (prenatal). Secondary outcomes included changes in quality of life and lung function, and perinatal/neonatal outcomes. At baseline, participants' mean (± standard deviation) age was 31.4 ± 4.5 years and gestational age 16.7 ± 3.1 weeks. At 6 months, the MASTERY group had better asthma control (P = 0.02) and asthma-related quality of life (P = 0.002) compared with usual care. There were no significant differences between groups in lung function, unscheduled health-care visits, days off work/study, oral corticosteroid use, or perinatal outcomes. Differences between groups were not significant at 3 months. Telehealth interventions supporting self-management are feasible and could potentially improve asthma control and asthma-related quality of life during pregnancy. © 2016 Asian Pacific Society of Respirology.

  16. Impact of a Telehealth Program That Delivers Remote Consultation and Longitudinal Mentorship to Community HIV Providers

    PubMed Central

    Wood, Brian R.; Unruh, Kenton T.; Martinez-Paz, Natalia; Annese, Mary; Ramers, Christian B.; Harrington, Robert D.; Dhanireddy, Shireesha; Kimmerly, Lisa; Scott, John D.; Spach, David H.

    2016-01-01

    Background. To increase human immunodeficiency virus (HIV) care capacity in our region, we designed a distance mentorship and consultation program based on the Project ECHO (Extension for Community Healthcare Outcomes) model, which uses real-time interactive video to regularly connect community providers with a multidisciplinary team of academic specialists. This analysis will (1) describe key components of our program, (2) report types of clinical problems for which providers requested remote consultation over the first 3.5 years of the program, and (3) evaluate changes in participants′ self-assessed HIV care confidence and knowledge over the study period. Methods. We prospectively tracked types of clinical problems for which providers sought consultation. At baseline and regular intervals, providers completed self-efficacy assessments. We compared means using paired-samples t test and examined the statistical relationship between each survey item and level of participation using analysis of variance. Results. Providers most frequently sought consultation for changing antiretroviral therapy, evaluating acute symptomatology, and managing mental health issues. Forty-five clinicians completed a baseline and at least 1 repeat assessment. Results demonstrated significant increase (P < .05) in participants' self-reported confidence to provide a number of essential elements of HIV care. Significant increases were also reported in feeling part of an HIV community of practice and feeling professionally connected to academic faculty, which correlated with level of program engagement. Conclusions. Community HIV practitioners frequently sought support on clinical issues for which no strict guidelines exist. Telehealth innovation increased providers' self-efficacy and knowledge while decreasing professional isolation. The ECHO model creates a virtual network for peer-to-peer support and longitudinal mentorship, thus strengthening capacity of the HIV workforce. PMID

  17. HIV patient and provider feedback on a telehealth collaborative care for depression intervention.

    PubMed

    Drummond, Karen L; Painter, Jacob T; Curran, Geoffrey M; Stanley, Regina; Gifford, Allen L; Rodriguez-Barradas, Maria; Rimland, David; Monson, Thomas P; Pyne, Jeffrey M

    2017-03-01

    In the HIV Translating Initiatives for Depression into Effective Solutions project, we conducted a randomized controlled effectiveness and implementation trial comparing depression collaborative care with enhanced usual care in Veterans Health Administration HIV clinics in the US. An offsite HIV depression care team including a psychiatrist, a depression care manager (DCM), and a clinical pharmacist provided collaborative care using a stepped-care model of treatment and made recommendations to providers through the electronic health record system. The DCM delivered care management to HIV patients through phone calls, performing routine assessments and providing counseling in self-management and problem-solving. The DCM documented all calls in each patient's electronic medical record. In this paper we present results from interviews conducted with patients and clinical staff in a multi-stage formative evaluation (FE). We conducted semi-structured FE interviews with 26 HIV patients and 30 clinical staff at the three participating sites during and after the trial period to gather their experiences and perspectives concerning the intervention components. Interviews were transcribed verbatim and analyzed using rapid content analysis techniques. Patients reported high satisfaction with the depression care manager (DCM) phone calls. Both HIV and mental health providers reported that the DCM's chart notes in the electronic health record were very helpful, and most felt that a dedicated DCM for HIV patients is ideal to meet patient needs. Sites encountered barriers to achieving and maintaining universal depression screening, but had greater success when such screening was incorporated into routine intake processes. FE results demonstrated that depression care management via telehealth from an offsite team is acceptable and helpful to both HIV patients and their providers. Given that a centralized offsite depression care team can deliver effective, cost-effective, cost

  18. Hype, harmony and human factors: applying user-centered design to achieve sustainable telehealth program adoption and growth.

    PubMed

    Rossos, P G; St-Cyr, O; Purdy, B; Toenjes, C; Masino, C; Chmelnitsky, D

    2015-01-01

    Despite decades of international experience with the use of information and communication technologies in healthcare delivery, widespread telehealth adoption remains limited and progress slow. Escalating health system challenges related to access, cost and quality currently coincide with rapid advancement of affordable and reliable internet based communication technologies creating unprecedented opportunities and incentives for telehealth. In this paper, we will describe how Human Factors Engineering (HFE) and user-centric elements have been incorporated into the establishment of telehealth within a large academic medical center to increase acceptance and sustainability. Through examples and lessons learned we wish to increase awareness of HFE and its importance in the successful implementation, innovation and growth of telehealth programs.

  19. Infectious Diseases Society of America Position Statement on Telehealth and Telemedicine as Applied to the Practice of Infectious Diseases.

    PubMed

    Siddiqui, Javeed; Herchline, Thomas; Kahlon, Summerpal; Moyer, Kay J; Scott, John D; Wood, Brian R; Young, Jeremy

    2017-02-01

    The use of telehealth and telemedicine offers powerful tools for delivering clinical care, conducting medical research, and enhancing access to infectious diseases physicians. The Infectious Diseases Society of America (IDSA) has prepared a position statement to educate members on the use of telehealth and telemedicine technologies. The development of telehealth and telemedicine programs requires the consideration of several issues such as HIPAA, state and local licensure requirements, credentialing and privileging, scope of care, quality, and responsibility and liability. IDSA supports appropriate use of telehealth and telemedicine to provide timely, cost-effective specialty care to resource-limited populations. © The Author 2017. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail journals.permissions@oup.com.

  20. Bauru School of Dentistry Tele-Health League: an educational strategy applied to research, teaching and extension among applications in tele-health

    PubMed Central

    da SILVA, Andressa Sharllene Carneiro; RIZZANTE, Fabio Antonio Piola; PICOLINI, Mirela Machado; de CAMPOS, Karis; CORRÊA, Camila de Castro; FRANCO, Elen Caroline; PARDO-FANTON, Cássia de Souza; BLASCA, Wanderléia Quinhoneiro; BERRETIN-FELIX, Giédre

    2011-01-01

    Tele-health is more than an innovative alternative; it is an excellent tool that enables access to health and education in health, making it possible to minimize distances, optimize time and reduce costs. Based on these advantages, some Brazilian Universities have used these actions in strategies of education, research and extension, aiming at the application of Tele-health in Brazil. In that way, the Bauru School of Dentistry - University of São Paulo (FOB-USP) has applied the use of information and communication technologies in health by means of a "Tele-Health League" (TL), in order to diagnose, prevent and treat diseases, in addition to educate the population and health services. Objective The present study aims to introduce the characteristics of the Tele-Health League of FOB-USP, as well as the development of its projects. Material and Methods The Tele-Health League consisted as a Diffusion Course approved by the Provost of Culture and Academic Extension of the University of São Paulo. It is composed as a large group enclosing professoriate coordinator, academician principal, contributing professors and league members, those, diversified between undergraduates students, graduated, health employees, technology and information areas. The participant members are evaluated by the presence frequency (minimum of 85%), and by the performance of tests and paperwork about the theoretical content provided. Results In four years of activities, the TLFOB-USP obtained a high satisfaction index (90%), an increased number of vacancies due to the interest to become a member, more commitment of the professors of the University and the accomplishment of association with other Brazilian leagues. It is emphasized that the approval percentage of the course results in approval from approximately half of its members. Also, it is important to identify and repair the causes related to the quitting of some members. Conclusions The results showed that the TLFOB-USP members, adjoining

  1. Bauru School of Dentistry Tele-Health League: an educational strategy applied to research, teaching and extension among applications in tele-health.

    PubMed

    Silva, Andressa Sharllene Carneiro da; Rizzante, Fabio Antonio Piola; Picolini, Mirela Machado; Campos, Karis de; Corrêa, Camila de Castro; Franco, Elen Caroline; Pardo-Fanton, Cássia de Souza; Blasca, Wanderléia Quinhoneiro; Berretin-Felix, Giédre

    2011-01-01

    Tele-health is more than an innovative alternative; it is an excellent tool that enables access to health and education in health, making it possible to minimize distances, optimize time and reduce costs. Based on these advantages, some Brazilian Universities have used these actions in strategies of education, research and extension, aiming at the application of Tele-health in Brazil. In that way, the Bauru School of Dentistry - University of São Paulo (FOB-USP) has applied the use of information and communication technologies in health by means of a "Tele-Health League" (TL), in order to diagnose, prevent and treat diseases, in addition to educate the population and health services. The present study aims to introduce the characteristics of the Tele-Health League of FOB-USP, as well as the development of its projects. The Tele-Health League consisted as a Diffusion Course approved by the Provost of Culture and Academic Extension of the University of São Paulo. It is composed as a large group enclosing professoriate coordinator, academician principal, contributing professors and league members, those, diversified between undergraduates students, graduated, health employees, technology and information areas. The participant members are evaluated by the presence frequency (minimum of 85%), and by the performance of tests and paperwork about the theoretical content provided. In four years of activities, the TLFOB-USP obtained a high satisfaction index (90%), an increased number of vacancies due to the interest to become a member, more commitment of the professors of the University and the accomplishment of association with other Brazilian leagues. It is emphasized that the approval percentage of the course results in approval from approximately half of its members. Also, it is important to identify and repair the causes related to the quitting of some members. The results showed that the TLFOB-USP members, adjoining to the professor's participants, develop projects

  2. 65. DETAIL OF ASSISTANT LAUNCH CONTROLLER AND LAUNCH CONTROLLER PANELS ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    65. DETAIL OF ASSISTANT LAUNCH CONTROLLER AND LAUNCH CONTROLLER PANELS LOCATED NEAR CENTER OF SLC-3E CONTROL ROOM. NOTE 30-CHANNEL COMMUNICATIONS PANELS. PAYLOAD ENVIRONMENTAL CONTROL AND MONITORING PANELS (LEFT) AND LAUNCH OPERATORS PANEL (RIGHT) IN BACKGROUND. - Vandenberg Air Force Base, Space Launch Complex 3, Launch Operations Building, Napa & Alden Roads, Lompoc, Santa Barbara County, CA

  3. Telehealth language assessments using consumer grade equipment in rural and urban settings: Feasible, reliable and well tolerated.

    PubMed

    Sutherland, Rebecca; Trembath, David; Hodge, Antoinette; Drevensek, Suzi; Lee, Sabrena; Silove, Natalie; Roberts, Jacqueline

    2017-01-01

    Introduction Telehealth can be an effective way to provide speech pathology intervention to children with speech and language impairments. However, the provision of reliable and feasible standardised language assessments via telehealth to establish children's needs for intervention and to monitor progress has not yet been well established. Further, there is limited information about children's reactions to telehealth. This study aimed to examine the reliability and feasibility of conducting standardised language assessment with school-aged children with known or suspected language impairment via a telehealth application using consumer grade computer equipment within a public school setting. Method Twenty-three children (aged 8-12 years) participated. Each child was assessed using a standardised language assessment comprising six subtests. Two subtests were administered by a speech pathologist face-to-face (local clinician) and four subtests were administered via telehealth. All subtests were completed within a single visit to the clinic service, with a break between the face to face and telehealth sessions. The face-to-face clinician completed behaviour observation checklists in the telehealth and face to face conditions and provided feedback on the audio and video quality of the application from the child's point of view. Parent feedback about their child's experience was elicited via survey. Results There was strong inter-rater reliability in the telehealth and face-to-face conditions (correlation coefficients ranged from r = 0.96-1.0 across the subtests) and good agreement on all measures. Similar levels of attention, distractibility and anxiety were observed in the two conditions. Clinicians rated only one session of 23 as having poor audio quality and no sessions were rated as having poor visual quality. Parent and child reactions to the use of telehealth were largely positive and supportive of using telehealth to assess rural children. Discussion The

  4. Antares Rocket Test Launch

    NASA Image and Video Library

    2013-04-21

    NASA Deputy Administrator Lori Garver and other guests react after having watched the successful launch of the Orbital Sciences Corporation Antares rocket from the Mid-Atlantic Regional Spaceport (MARS) at the NASA Wallops Flight Facility in Virginia, Sunday, April 21, 2013. The test launch marked the first flight of Antares and the first rocket launch from Pad-0A. The Antares rocket delivered the equivalent mass of a spacecraft, a so-called mass simulated payload, into Earth's orbit. Photo Credit: (NASA/Bill Ingalls)

  5. Antares Rocket Test Launch

    NASA Image and Video Library

    2013-04-21

    NASA Administrator Charles Bolden and NASA Deputy Administrator Lori Garver and other guests react after having watched the successful launch of the Orbital Sciences Corporation Antares rocket from the Mid-Atlantic Regional Spaceport (MARS) at the NASA Wallops Flight Facility in Virginia, Sunday, April 21, 2013. The test launch marked the first flight of Antares and the first rocket launch from Pad-0A. The Antares rocket delivered the equivalent mass of a spacecraft, a so-called mass simulated payload, into Earth's orbit. Photo Credit: (NASA/Bill Ingalls)

  6. STS-135 Launch Day

    NASA Image and Video Library

    2011-07-07

    NASA Chief, Astronaut Office, Johnson Space Center Peggy Whitson deals cards during a traditional game that is played at the NASA Kennedy Space Center Operations and Checkout Building with the shuttle crew prior to them leaving for the launch pad, on Friday, July 8, 2011 in Cape Canaveral, Fla. The point of the game is that the commander must use up all his or her bad luck before launch, so the crew can only leave for the pad after the commander loses. The launch of Atlantis, STS-135, is the final flight of the shuttle program, a 12-day mission to the International Space Station. Photo Credit: (NASA/Jerry Ross)

  7. STS-135 Atlantis Launch

    NASA Image and Video Library

    2011-07-08

    Space shuttle Atlantis is seen through the window of a Shuttle Training Aircraft (STA) as it launches from launch pad 39A at Kennedy Space Center on the STS-135 mission, Friday, July 8, 2011 in Cape Canaveral, Fla. Atlantis launched on the final flight of the shuttle program on a 12-day mission to the International Space Station. The STS-135 crew will deliver the Raffaello multipurpose logistics module containing supplies and spare parts for the space station. Photo Credit: (NASA/Dick Clark)

  8. TElehealth in CHronic disease: mixed-methods study to develop the TECH conceptual model for intervention design and evaluation

    PubMed Central

    Thomas, Clare; O'Cathain, Alicia; Rogers, Anne; Pope, Catherine; Yardley, Lucy; Fahey, Tom; Lewis, Glyn; Large, Shirley; Edwards, Louisa; Rowsell, Alison; Segar, Julia; Brownsell, Simon; Montgomery, Alan A

    2015-01-01

    Objective To develop a conceptual model for effective use of telehealth in the management of chronic health conditions, and to use this to develop and evaluate an intervention for people with two exemplar conditions: raised cardiovascular disease risk and depression. Design The model was based on several strands of evidence: a metareview and realist synthesis of quantitative and qualitative evidence on telehealth for chronic conditions; a qualitative study of patients’ and health professionals’ experience of telehealth; a quantitative survey of patients’ interest in using telehealth; and review of existing models of chronic condition management and evidence-based treatment guidelines. Based on these evidence strands, a model was developed and then refined at a stakeholder workshop. Then a telehealth intervention (‘Healthlines’) was designed by incorporating strategies to address each of the model components. The model also provided a framework for evaluation of this intervention within parallel randomised controlled trials in the two exemplar conditions, and the accompanying process evaluations and economic evaluations. Setting Primary care. Results The TElehealth in CHronic Disease (TECH) model proposes that attention to four components will offer interventions the best chance of success: (1) engagement of patients and health professionals, (2) effective chronic disease management (including subcomponents of self-management, optimisation of treatment, care coordination), (3) partnership between providers and (4) patient, social and health system context. Key intended outcomes are improved health, access to care, patient experience and cost-effective care. Conclusions A conceptual model has been developed based on multiple sources of evidence which articulates how telehealth may best provide benefits for patients with chronic health conditions. It can be used to structure the design and evaluation of telehealth programmes which aim to be acceptable to

  9. Can Telehealth Ontario respiratory call volume be used as a proxy for emergency department respiratory visit surveillance by public health?

    PubMed

    van Dijk, Adam; McGuinness, Don; Rolland, Elizabeth; Moore, Kieran M

    2008-01-01

    There is a paucity of information regarding the usefulness of non-traditional data streams for real-time syndromic surveillance systems. The objective of this paper is to examine the temporal relation between Ontario's emergency department (ED) visits and telephone health line (Telehealth) call volume for respiratory illnesses to test the feasibility of using Ontario's Telehealth system for real-time surveillance. Retrospective time-series data from the National Ambulatory Care Reporting System (NACRS) and the Telehealth Ontario program from June 1, 2004, to March 31, 2006, were analyzed. The added value of Telehealth Ontario data was determined by comparing it temporally with NACRS data, which uses the International Classification of Diseases (ICD) 10-Canadian Enhancement coding system for discharge diagnoses. Telehealth Ontario had 216,105 calls for respiratory complaints, while 819,832 ICD-coded complaints from NACRS were identified with a comparable diagnosis of respiratory illness. Telehealth Ontario call volume was heavily weighted for the 0-4 years age group (49%), while the NACRS visits were mainly from those 18-64 years old (44%). The Spearman rank correlation coefficient was calculated to be 0.97, with the time-series analysis also resulting in significant correlations at lags (semi-monthly) 0 and 1, indicating that increases in Telehealth Ontario call volume correlate with increases in NACRS discharge diagnosis data for respiratory illnesses. Telehealth Ontario call volume fluctuation reflects directly on ED respiratory visit data on a provincial basis. These call complaints are a timely, useful and representative data stream that shows promise for integration into a real-time syndromic surveillance system.

  10. Launch of Juno!

    NASA Image and Video Library

    An Atlas V rocket lofted the Juno spacecraft toward Jupiter from Space Launch Complex-41. The 4-ton Juno spacecraft will take five years to reach Jupiter on a mission to study its structure and dec...

  11. Anchor Trial Launch

    Cancer.gov

    NCI has launched a multicenter phase III clinical trial called the ANCHOR Study -- Anal Cancer HSIL (High-grade Squamous Intraepithelial Lesion) Outcomes Research Study -- to determine if treatment of HSIL in HIV-infected individuals can prevent anal canc

  12. Genomic Data Commons launches

    Cancer.gov

    The Genomic Data Commons (GDC), a unified data system that promotes sharing of genomic and clinical data between researchers, launched today with a visit from Vice President Joe Biden to the operations center at the University of Chicago.

  13. Hi-C Launch

    NASA Image and Video Library

    The High resolution Coronal Imager (Hi-C) was launched on a NASA Black Brant IX two-stage rocket from White Sands Missile Range in New Mexico July 11, 2012. The experiment reached a maximum velocit...

  14. Launch - STS-6 - KSC

    NASA Image and Video Library

    1983-04-12

    S83-30222 (4 April 1983) --- The second reusable spacecraft in history successfully launches from Launch Pad 39A at 1:30:00:88 p.m. (EST) on April 4, 1983, and heads for its history making five-day mission in Earth orbit. The space shuttle Challenger, its two solid rocket boosters (SRB), and a new lightweight?external fuel tank were captured on film by an automatically-tripped camera in a protected station nearer to the launch pad than human beings are able to be at launch time. Onboard the spacecraft are astronauts Paul J. Wietz, Karol J. Bobko, Dr. Story Musgrave and Donald H. Peterson. Photo credit: NASA

  15. First Accessible Boat Launch

    EPA Pesticide Factsheets

    This is a story about how the Northwest Indiana urban waters partnership location supported the process to create and open the first handicap accessible canoe and kayak launch in the state of Indiana.

  16. IRVE 3 Launch

    NASA Image and Video Library

    The Inflatable Reentry Vehicle Experiment, or IRVE-3, launched on July 23, 2012, from NASA's Wallops Flight Facility. The purpose of the IRVE-3 test was to show that a space capsule can use an infl...

  17. GPM Launch Coverage

    NASA Image and Video Library

    A Japanese H-IIA rocket with the NASA-Japan Aerospace Exploration Agency (JAXA) Global Precipitation Measurement (GPM) Core Observatory aboard, launched from the Tanegashima Space Center in Japan o...

  18. NASA Now: Glory Launch

    NASA Image and Video Library

    In this episode of NASA Now, Dr. Hal Maring joins us to explain why the upcoming launch of the Glory satellite is so important to further our understanding of climate change. He also will speak on ...

  19. Investigating the preferences of older people for telehealth as a new model of health care service delivery: A discrete choice experiment.

    PubMed

    Kaambwa, Billingsley; Ratcliffe, Julie; Shulver, Wendy; Killington, Maggie; Taylor, Alan; Crotty, Maria; Carati, Colin; Tieman, Jennifer; Wade, Victoria; Kidd, Michael R

    2017-02-01

    Introduction Telehealth approaches to health care delivery can potentially improve quality of care and clinical outcomes, reduce mortality and hospital utilisation, and complement conventional treatments. However, substantial research into the potential for integrating telehealth within health care in Australia, particularly in the provision of services relevant to older people, including palliative care, aged care and rehabilitation, is lacking. Furthermore, to date, no discrete choice experiment (DCE) studies internationally have sought the views and preferences of older people about the basic features that should make up a telehealth approach to these services. Methods Using a DCE, we investigated the relative importance of six salient features of telehealth (what aspects of care are to be pursued during telehealth sessions, distance to the nearest hospital or clinic, clinicians' attitude to telehealth, patients' experience of using technology, what types of assessments should be conducted face-to-face versus via telehealth sessions and the costs associated with receiving telehealth). Data were obtained from an online panel of older people aged 65 years and above, drawn from the Australian general population. Results The mean age for 330 study participants was 69 years. In general, individuals expressed strong preferences for telehealth services that offered all aspects of care, were relatively inexpensive and targeted specifically at individuals living in remote regions without easy access to a hospital or clinic. Participants also preferred telehealth services to be offered to individuals with some prior experience of using technology, provided by clinicians who were positive about telehealth but wanted all or some pre-telehealth health assessments to take place in a hospital or clinic. Preferences only differed by gender. Additionally, respondents did not feel that telehealth led to loss of privacy and confidentiality. Discussion Our findings indicate a

  20. Vertical Launch Alignment Transfer Apparatus.

    DTIC Science & Technology

    A launch mechanism for vertically launching missiles carried in launch tubes disposed in a pod . The launch mechanism includes apparatus for... pod and v-groove elements are secured in the launch tubes and oriented to the northfinder. Rods are secured on opposite sides of each missile and are

  1. 33. Launch Control Center, close view of launch key inserted ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    33. Launch Control Center, close view of launch key inserted in the launch panel. Lyon - Whiteman Air Force Base, Oscar O-1 Minuteman Missile Alert Facility, Southeast corner of Twelfth & Vendenberg Avenues, Knob Noster, Johnson County, MO

  2. STS-130 Launch Attempt

    NASA Image and Video Library

    2010-02-07

    NASA Associate Administrator for Space Operations Bill Gerstenmaier, center, reacts to an updated weather report during the countdown of the launch of the space shuttle Endeavour and the start of the STS-130 mission at NASA Kennedy Space Center in Cape Canaveral, Fla. on Sunday Feb. 7, 2010. Space shuttle Endeavour's launch attempt was scrubbed due to a low cloud ceiling over Kennedy Space Center. Photo Credit: (NASA/Bill Ingalls)

  3. STS-132 Launch Tweetup

    NASA Image and Video Library

    2010-05-12

    Jon Cowart @Rocky_Sci, orbiter engineering manager, Space Shuttle Program, interacts with Tweetup participant, Jen Vargas, @jenvargus, as he speaks to participants at the two-day STS-132 Launch Tweetup at Kennedy Space Center, Thursday, May 13, 2010, in Cape Canaveral, Fla. NASA Twitter followers in attendance will have the opportunity to take a tour of NASA's Kennedy Space Center, view the space shuttle launch and speak with shuttle technicians, engineers, astronauts and managers. Photo Credit: (NASA/Paul E. Alers)

  4. Expedition 23 Launch Day

    NASA Image and Video Library

    2010-04-01

    Expedition 23 Flight Engineer Mikhail Kornienko of the Russia has his Russian Sokol suit prepared for launch by a technician at the Baikonur Cosmodrome in Baikonur, Kazakhstan, Friday, April 2, 2010. Kornienko and fellow Expedition 23 crewmembers Soyuz Commander Alexander Skvortsov and NASA Flight Engineer Tracy Caldwell Dyson of the U.S. launched in their Soyuz TMA-18 rocket from the Baikonur Cosmodrome in Kazakhstan on Friday, April 2, 2010. Photo Credit: (NASA/Carla Cioffi)

  5. Expedition 23 Launch Day

    NASA Image and Video Library

    2010-04-01

    Expedition 23 Soyuz Commander Alexander Skvortsov has his Russian Sokol suit prepared for launch by a technician at the Baikonur Cosmodrome in Baikonur, Kazakhstan, Friday, April 2, 2010. Skvortsov and fellow Expedition 23 crewmembers Flight Engineer Mikhail Kornienko of the Russia and NASA Flight Engineer Tracy Caldwell Dyson of the U.S. launched in their Soyuz TMA-18 rocket from the Baikonur Cosmodrome in Kazakhstan on Friday, April 2, 2010. Photo Credit: (NASA/Carla Cioffi)

  6. Expedition 22 Launch Day

    NASA Image and Video Library

    2009-12-20

    Expedition 22 Flight Engineer Soichi Noguchi of Japan has his Russian Sokol suit prepared for launch by a technician at the Baikonur Cosmodrome in Baikonur, Kazakhstan, Sunday, Dec. 20, 2009. Soichi and fellow Expedition 22 crew members NASA Flight Engineer Timothy J. Creamer of the U.S., Soyuz Commander Oleg Kotov of Russia launched in their Soyuz TMA-17 rocket from the Baikonur Cosmodrome in Kazakhstan on Monday, Dec. 21, 2009. (Photo Credit: NASA/Bill Ingalls)

  7. Expedition 23 Launch Day

    NASA Image and Video Library

    2010-04-01

    Expedition 23 NASA Flight Engineer Tracy Caldwell Dyson, left, talks with Soyuz Commander Alexander Skvortsov of Russia, while Flight Engineer Mikhail Kornienko of Russia has his Russian Sokol suit prepared for launch at the Baikonur Cosmodrome in Baikonur, Kazakhstan, Friday, April 2, 2010. The Expedition 23 crew members launched in their Soyuz TMA-18 rocket from the Baikonur Cosmodrome in Kazakhstan on Friday, April 2, 2010. (Photo Credit: NASA/Bill Ingalls)

  8. Expedition 23 Launch Day

    NASA Image and Video Library

    2010-04-01

    Expedition 23 NASA Flight Engineer Tracy Caldwell Dyson of the U.S. has her Russian Sokol suit prepared for launch by a technician at the Baikonur Cosmodrome in Baikonur, Kazakhstan, Friday, April 2, 2010. Caldwell Dyson and fellow Expedition 23 crew members Soyuz Commander Alexander Skvortsov and Flight Engineer Mikhail Kornienko of Russia launched in their Soyuz TMA-18 rocket from the Baikonur Cosmodrome in Kazakhstan on Friday, April 2, 2010. Photo Credit: (NASA/Carla Cioffi)

  9. Expedition 25 Launch

    NASA Image and Video Library

    2010-10-07

    Expedition 25 NASA Flight Engineer Scott Kelly of the U.S. has his Russian Sokol suit prepared for launch by a technician at the Baikonur Cosmodrome in Baikonur, Kazakhstan, Friday, Oct. 8, 2010. Kelly and fellow Expedition 25 crew members Soyuz Commander Alexander Kaleri and Flight Engineer Oleg Skripochka launched in their Soyuz TMA-01M at 5:10 a.m. Friday morning. (Photo Credit: NASA/Carla Cioffi)

  10. Expedition 25 Launch

    NASA Image and Video Library

    2010-10-07

    The Soyuz TMA-01M rocket launches from the Baikonur Cosmodrome in Kazakhstan on Friday, October 8, 2010 carrying Expedition 25 Soyuz Commander Alexander Kaleri of Russia, NASA Flight Engineer Scott J. Kelly and Russian Flight Engineer Oleg Skripochka to the International Space Station. Their Soyuz TMA-01M rocket launched at 5:10 a.m Kazakhstan time. (Photo Credit: NASA/Carla Cioffi)

  11. Expedition 25 Launch

    NASA Image and Video Library

    2010-10-07

    Expedition 25 NASA Flight Engineer Scott Kelly of the U.S. has his Russian Sokol suit prepared for launch by a technician at the Baikonur Cosmodrome in Kazakhstan, Friday, Oct. 8, 2010. Kelly and fellow Expedition 25 crew members Soyuz Commander Alexander Kaleri and Flight Engineer Oleg Skripochka launched in their Soyuz TMA-01M at 5:10 a.m. Friday morning. (Photo Credit: NASA/Carla Cioffi)

  12. STS-64 launch view

    NASA Technical Reports Server (NTRS)

    1994-01-01

    Passing through some of the trailer clouds of an overcast sky which temporarily postponed its launch, the Space Shuttle Discovery heads for its 19th Earth orbital flight. Several kilometers away, astronaut John H. Casper, Jr., who took this picture, was piloting the Shuttle Training Aircraft (STA) from which the launch and landing area weather was being monitored. Onboard Discovery were astronauts Richard N. Richards, L. Blaine Hammond, Jr., Mark C. Lee, Carl J. Meade, Susan J. Helms, and Jerry M. Linenger.

  13. Orion EFT-1 Launch

    NASA Image and Video Library

    2014-12-05

    A Delta IV Heavy rocket lifts off from Space Launch Complex 37 at Cape Canaveral Air Force Station in Florida carrying NASA's Orion spacecraft on an unpiloted flight test to Earth orbit. Liftoff was at 7:05 a.m. EST. During the two-orbit, four-and-a-half hour mission, engineers will evaluate the systems critical to crew safety, the launch abort system, the heat shield and the parachute system.

  14. Expedition 22 Launch Day

    NASA Image and Video Library

    2009-12-21

    Expedition 22 Soyuz Commander Oleg Kotov of Russia, left, NASA Flight Engineer Timothy J. Creamer of the U.S., back center, and Flight Engineer Soichi Noguchi of Japan are walked from their bus to the soyuz rocket at the launch pad at the Baikonur Cosmodrome in Baikonur, Kazakhstan, Monday, Dec. 21, 2009. Kotov, Creamer and Noguchi launched in their Soyuz TMA-17 rocket from the Baikonur Cosmodrome in Kazakhstan on Monday, Dec. 21, 2009. (Photo Credit: NASA/Bill Ingalls)

  15. Expedition 22 Launch Day

    NASA Image and Video Library

    2009-12-20

    Expedition 22 Soyuz Commander Oleg Kotov of Russia, center, has his Russian Sokol suit prepared for launch while NASA Flight Engineer Timothy J. Creamer of the U.S., left, and Flight Engineer Soichi Noguchi of Japan wait at the Baikonur Cosmodrome in Baikonur, Kazakhstan, Sunday, Dec. 20, 2009. The Expedition 22 crew members launched in their Soyuz TMA-17 rocket from the Baikonur Cosmodrome in Kazakhstan on Monday, Dec. 21, 2009. (Photo Credit: NASA/Bill Ingalls)

  16. Expedition 22 Launch Day

    NASA Image and Video Library

    2009-12-20

    Expedition 22 NASA Flight Engineer Timothy J. Creamer of the U.S. has his Russian Sokol suit prepared for launch by a technician at the Baikonur Cosmodrome in Baikonur, Kazakhstan, Sunday, Dec. 20, 2009. Creamer and fellow Expedition 22 crew members, Soyuz Commander Oleg Kotov of Russia, Flight Engineer Soichi Noguchi of Japan launched in their Soyuz TMA-17 rocket from the Baikonur Cosmodrome in Kazakhstan on Monday, Dec. 21, 2009. (Photo Credit: NASA/Bill Ingalls)

  17. Expedition 22 Launch Day

    NASA Image and Video Library

    2009-12-20

    Expedition 22 NASA Flight Engineer Timothy J. Creamer of the U.S., left, talks with Soyuz Commander Oleg Kotov of Russia, right, while Flight Engineer Soichi Noguchi of Japan has his Russian Sokol suit prepared for launch at the Baikonur Cosmodrome in Baikonur, Kazakhstan, Sunday, Dec. 20, 2009. The Expedition 22 crew members launched in their Soyuz TMA-17 rocket from the Baikonur Cosmodrome in Kazakhstan on Monday, Dec. 21, 2009. (Photo Credit: NASA/Bill Ingalls)

  18. Magnetic Launch Assist

    NASA Technical Reports Server (NTRS)

    Perez, Jose

    2000-01-01

    The objectives of this program are to: (1) To develop a safe, reliable, inexpensive, and minimum operation launch assist system for sending payloads into orbit using ground powered, magnetic suspension and propulsion technologies; (2) Improve safety, reliability, operability for third generation Reusable Launch Vehicles (RLV); (3) Reduce vehicle weight and increase payload capacity; and (4) Support operational testing of Rocket Based Combine Cycle (RBCC) engines.

  19. STS-132 Launch Tweetup

    NASA Image and Video Library

    2010-05-12

    Kendal Van Dyke, a database professional that is followed on Twitter @twitter.com/sqldba, takes part in the two-day STS-132 Launch Tweetup at Kennedy Space Center, Thursday, May 13, 2010, in Cape Canaveral, Fla. NASA Twitter followers in attendance will have the opportunity to take a tour of NASA's Kennedy Space Center, view the space shuttle launch and speak with shuttle technicians, engineers, astronauts and managers. Photo Credit: (NASA/Paul E. Alers)

  20. Expedition 8 Launch Day

    NASA Image and Video Library

    2003-10-18

    Technicians conduct a leak check on the spacesuit of Expedition 8 Soyuz Commander Alexander Kaleri at the Baikonur Cosmodrome, Saturday, Oct. 18, 2003, prior to his departure for the launch pad with Expedition 8 Commander and NASA Science Officer Mike Foale and European Space Agency astronaut Pedro Duque of Spain. The trio were launched on a Soyuz TMA-3 vehicle to the International Space Station, arriving on Oct. 20. Photo Credit (NASA/Bill Ingalls)

  1. Expedition 8 Launch Day

    NASA Image and Video Library

    2003-10-18

    Technicians conduct a leak check on the spacesuit of European Space Agency astronaut Pedro Duque of Spain at the Baikonur Cosmodrome, Saturday, Oct. 18, 2003, prior to his departure for the launch pad with Expedition 8 Commander and NASA Science Officer Mike Foale and Soyuz Commander Alexander Kaleri. The trio were launched on a Soyuz TMA-3 vehicle to the International Space Station, arriving on Oct. 20. Photo Credit (NASA/Bill Ingalls)

  2. Expedition 8 Launch Day

    NASA Image and Video Library

    2003-10-18

    Expedition 8 Commander and NASA Science Officer Michael Foale completes suiting up at the Baikonur Cosmodrome in Kazakhstan, Saturday, Oct. 18, 2003, prior to departing for the launch pad with Expedition 8 Soyuz Commander Alexander Kaleri and European Space Agency astronaut Pedro Duque of Spain. The trio were launched on the Soyuz TMA-3 vehicle to the International Space Station, arriving on Oct. 20. Photo Credit (NASA/Bill Ingalls)

  3. Launch Vehicle Communications

    NASA Technical Reports Server (NTRS)

    Welch, Bryan; Greenfeld, Israel

    2005-01-01

    As the National Aeronautics and Space Administration's (NASA) planning for updated launch vehicle operations progresses, there is a need to consider improved methods. This study considers the use of phased array antennas mounted on launch vehicles and transmitting data to either NASA's Tracking and Data Relay Satellite System (TDRSS) satellites or to the commercial Iridium, Intelsat, or Inmarsat communications satellites. Different data rate requirements are analyzed to determine size and weight of resulting antennas.

  4. STS-135 Atlantis Launch

    NASA Image and Video Library

    2011-07-08

    Guests look on from the terrace of Operations Support Building II as space shuttle Atlantis launches from launch pad 39A on the STS-135 mission Friday, July 8, 2011, at Kennedy Space Center in Cape Canaveral, Fla. Atlantis and its crew will deliver to the International Space Station the Raffaello multipurpose logistics module containing supplies and spare parts for the space station. Photo Credit: (NASA/Carla Cioffi)

  5. STS-135 Atlantis Launch

    NASA Image and Video Library

    2011-07-08

    Space shuttle Atlantis, STS-135, launches skyward on a 12-day mission to the International Space Station (ISS), Friday, July 8, 2011, at NASA's Kennedy Space Center in Cape Canaveral, Fla. The launch of Atlantis is the final flight of the shuttle program and will carry the Raffaello multipurpose logistics module containing supplies and spare parts for the space station. Photo Credit: (NASA/Paul E. Alers)

  6. Orion EFT-1 Launch

    NASA Image and Video Library

    2014-12-05

    A Delta IV Heavy rocket roars to life at Space Launch Complex 37 at Cape Canaveral Air Force Station in Florida. The launch vehicle is carrying NASA's Orion spacecraft on an unpiloted flight test to Earth orbit. Liftoff was at 7:05 a.m. EST. The flight will send Orion 3,600 miles in altitude beyond the Earth's surface on a four-and-a-half hour mission.

  7. STS-132 Launch Tweetup

    NASA Image and Video Library

    2010-05-12

    Ron Woods, an equipment specialist, who has been a space suit designer from Mercury to now speaks to participants at the two-day STS-132 Launch Tweetup at Kennedy Space Center, Thursday, May 13, 2010, in Cape Canaveral, Fla. NASA Twitter followers in attendance will have the opportunity to take a tour of NASA's Kennedy Space Center, view the space shuttle launch and speak with shuttle technicians, engineers, astronauts and managers. Photo Credit: (NASA/Paul E. Alers)

  8. Students Participate in Rocket Launch Project

    NASA Technical Reports Server (NTRS)

    2002-01-01

    Filled with anticipation, students from three Huntsville area high schools: Randolph, Sparkman, and Johnson High Schools, counted down to launch the rockets they designed and built at the Army test site on Redstone Arsenal in Huntsville, Alabama. The projected two-mile high launch culminated more than a year's work and demonstrated the student team's ability to meet the challenge set by the Marshall Space Flight Center's (MSFC) Student Launch Initiative (SLI) program to apply science and math to experience, judgment, and common sense, and proved to NASA officials that they have successfully built reusable launch vehicles (RLVs), another challenge set by NASA's SLI program. MSFC's SLI program is an educational effort that aims to motivate students to pursue careers in science, math, and engineering. It provides hands-on, practical aerospace experience. In this picture, Randolph High School students are assembling their rocket in preparation for launch.

  9. Students Participate in Rocket Launch Project

    NASA Technical Reports Server (NTRS)

    2002-01-01

    Filled with anticipation, students from three Huntsville area high schools: Randolph, Sparkman, and Johnson High Schools, counted down to launch the rockets they designed and built at the Army test site on Redstone Arsenal in Huntsville, Alabama. The projected two-mile high launch culminated more than a year's work and demonstrated the student team's ability to meet the challenge set by the Marshall Space Flight Center's (MSFC) Student Launch Initiative (SLI) program to apply science and math to experience, judgment, and common sense, and proved to NASA officials that they have successfully built reusable launch vehicles (RLVs), another challenge set by NASA's SLI program. MSFC's SLI program is an educational effort that aims to motivate students to pursue careers in science, math, and engineering. It provides hands-on, practical aerospace experience. In this picture, Randolph High School students are assembling their rocket in preparation for launch.

  10. 14 CFR 420.21 - Launch site location review-launch site boundary.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... the debris dispersion radius of the largest launch vehicle type and weight class proposed for the... the debris dispersion radius that represents the maximum distance from a launch point that debris... convincingly demonstrate the validity of its proposed debris dispersion radius. Table 2 of § 420.21—Minimum...

  11. 14 CFR 420.21 - Launch site location review-launch site boundary.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... the debris dispersion radius of the largest launch vehicle type and weight class proposed for the... the debris dispersion radius that represents the maximum distance from a launch point that debris... convincingly demonstrate the validity of its proposed debris dispersion radius. Table 2 of § 420.21—Minimum...

  12. 14 CFR 420.21 - Launch site location review-launch site boundary.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... the debris dispersion radius of the largest launch vehicle type and weight class proposed for the... the debris dispersion radius that represents the maximum distance from a launch point that debris... convincingly demonstrate the validity of its proposed debris dispersion radius. Table 2 of § 420.21—Minimum...

  13. 14 CFR 420.21 - Launch site location review-launch site boundary.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... the debris dispersion radius of the largest launch vehicle type and weight class proposed for the... the debris dispersion radius that represents the maximum distance from a launch point that debris... convincingly demonstrate the validity of its proposed debris dispersion radius. Table 2 of § 420.21—Minimum...

  14. GPM Core Observatory Launch Animation

    NASA Image and Video Library

    This animation depicts the launch of the Global Precipitation Measurement (GPM) Core Observatory satellite from Tanegashima Space Center, Japan. The launch is currently scheduled for Feb. 27, 2014....

  15. Ares Launch Vehicles Overview

    NASA Technical Reports Server (NTRS)

    Vanhooser, Teresa

    2009-01-01

    Since 2005, the Ares Projects have been building the nation s next generation of crew and cargo launch vehicles. As part of the Constellation Program, the Ares vehicles will enable astronauts in the Orion crew exploration vehicle and Altair lunar lander to reach the Moon and beyond. These vehicles draw upon hardware and experienced developed over 50 years of exploration, while also incorporating technology and management practices from today. Ares is concentrating on building the Ares I crew launch vehicle to ensure America s continued ability to send crews to the International Space Station. Progress has been made on design, fabrication, and testing for the first stage, upper stage, upper stage engine, and integrated vehicle. This presentation will provide an overview of the Ares launch vehicles architecture, milestone progress, and top project risks.

  16. STS-133 launch

    NASA Image and Video Library

    2011-02-24

    STS133-S-067 (24 Feb. 2011) --- In Firing Room 4 of the Launch Control Center at NASA's Kennedy Space Center in Florida, NASA's Discovery Flow Director Stephanie Stilson, left, STS-133 Assistant Shuttle Launch Director and lead NASA Test Director Charlie Blackwell-Thompson and Shuttle Launch Director Mike Leinbach watch space shuttle Discovery head toward Earth orbit on the STS-133 mission to the International Space Station. Discovery and its six-member crew are on a mission to deliver the Permanent Multipurpose Module, packed with supplies and critical spare parts, as well as Robonaut 2, the dexterous humanoid astronaut helper, to the orbiting outpost. Discovery is making its 39th mission and is scheduled to be retired following STS-133. This is the 133rd Space Shuttle Program mission and the 35th shuttle voyage to the space station. Photo credit: NASA or National Aeronautics and Space Administration

  17. STS-135 Launch Day

    NASA Image and Video Library

    2011-07-07

    NASA Chief, Astronaut Office, Johnson Space Center Peggy Whitson, center, STS-135 Astronauts, Rex Walheim, left, and Commander Chris Ferguson are seen as the entire crew plays a traditional card game at the NASA Kennedy Space Center Operations and Checkout Building prior to them leaving for the launch pad, on Friday, July 8, 2011 in Cape Canaveral, Fla. The point of the game is that the commander must use up all his or her bad luck before launch, so the crew can only leave for the pad after the commander loses. The launch of Atlantis, STS-135, is the final flight of the shuttle program, a 12-day mission to the International Space Station. Photo Credit: (NASA/Jerry Ross)

  18. Antares Rocket Test Launch

    NASA Image and Video Library

    2013-04-21

    NASA Deputy Administrator Lori Garver talks with CEO and President of Orbital Sciences Corporation David Thompson, left, Executive Vice President and Chief Technical Officer, Orbital Sciences Corporation Antonio Elias, second from left, and Executive Director, Va. Commercial Space Flight Authority Dale Nash, background, in the Range Control Center at the NASA Wallops Flight Facility after the successful launch of the Orbital Sciences Antares rocket from the Mid-Atlantic Regional Spaceport (MARS) in Virginia, Sunday, April 21, 2013. The test launch marked the first flight of Antares and the first rocket launch from Pad-0A. The Antares rocket delivered the equivalent mass of a spacecraft, a so-called mass simulated payload, into Earth's orbit. Photo Credit: (NASA/Bill Ingalls)

  19. AXONOMETRIC, LAUNCH DOOR AND DOOR CYLINDER, LAUNCH PLATFORM ROLLER GUIDE, ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    AXONOMETRIC, LAUNCH DOOR AND DOOR CYLINDER, LAUNCH PLATFORM ROLLER GUIDE, CRIB SUSPENSION SHOCK STRUT, LAUNCH PLATFORM - Dyess Air Force Base, Atlas F Missle Site S-8, Launch Facility, Approximately 3 miles east of Winters, 500 feet southwest of Highway 1770, center of complex, Winters, Runnels County, TX

  20. Communication Intervention for Young Children with Severe Neurodevelopmental Disabilities Via Telehealth.

    PubMed

    Simacek, Jessica; Dimian, Adele F; McComas, Jennifer J

    2017-03-01

    Young children with neurodevelopmental disorders such as autism spectrum disorders (ASD) and Rett syndrome often experience severe communication impairments. This study examined the efficacy of parent-implemented communication assessment and intervention with remote coaching via telehealth on the acquisition of early communication skills of three young children with ASD (2) and Rett syndrome (1). Efficacy of the intervention was evaluated using single-case experimental designs. First, functional assessment was used to identify idiosyncratic/potentially communicative responses and contexts for each child. Next, parents implemented functional communication training (FCT). All of the children acquired the targeted communication responses. The findings support the efficacy of telehealth as a service delivery model to coach parents on intervention strategies for their children's early communication skills.

  1. Telehealth: a perspective approach for visceral leishmaniasis (kala-azar) control in India.

    PubMed

    Bhunia, Gouri Sankar; Kesari, Shreekant; Chatterjee, Nandini; Kumar, Vijay; Das, Pradeep

    2012-07-01

    Visceral leishmaniasis, also known as kala-azar, is a vector borne disease caused by the protozoan parasite, L. donovani. Poor and neglected populations in Indian sub-continent are particularly affected by this disease. Due to the diversity of epidemiological situations, no single diagnosis, treatment, or control will be suitable for all. Control measures through case findings, treatment, and vector control are seldom used, even where they could be useful. Modern tools like telehealth, using space technology, have now come in handy to address issues of disease surveillance, control checking, and evaluation. The present study focuses on telehealth as a current vector control strategy, perspectives on diagnosis, treatment, and control of visceral leishmaniasis as these deserve more attention and research.

  2. Protocol for a Systematic Review of Telehealth Privacy and Security Research to Identify Best Practices

    PubMed Central

    WATZLAF, VALERIE J.M.; DEALMEIDA, DILHARI R.; ZHOU, LEMING; HARTMAN, LINDA M.

    2015-01-01

    Healthcare professionals engaged in telehealth are faced with complex US federal regulations (e.g., HIPAA/HITECH) and could benefit from the guidance provided by best practices in Privacy and Security (P&S). This article describes a systematic review protocol to address this need. The protocol described herein uses the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P). The PRISMA-P contains 17 items that are considered essential, as well as minimum components to include in systematic reviews. PICOS (participants, interventions, comparisons, outcome(s) and study design of the systematic review) are also relevant to the development of best practices in P&S in telehealth systems. A systematic process can best determine what information should be included and how this information should be retrieved, condensed, analyzed, organized, and disseminated. PMID:27563383

  3. Telehealth: a perspective approach for visceral leishmaniasis (kala-azar) control in India

    PubMed Central

    Bhunia, Gouri Sankar; Kesari, Shreekant; Chatterjee, Nandini; Kumar, Vijay; Das, Pradeep

    2012-01-01

    Visceral leishmaniasis, also known as kala-azar, is a vector borne disease caused by the protozoan parasite, L. donovani. Poor and neglected populations in Indian sub-continent are particularly affected by this disease. Due to the diversity of epidemiological situations, no single diagnosis, treatment, or control will be suitable for all. Control measures through case findings, treatment, and vector control are seldom used, even where they could be useful. Modern tools like telehealth, using space technology, have now come in handy to address issues of disease surveillance, control checking, and evaluation. The present study focuses on telehealth as a current vector control strategy, perspectives on diagnosis, treatment, and control of visceral leishmaniasis as these deserve more attention and research. PMID:23265372

  4. Preliminary findings of a telehealth approach to parent training in autism.

    PubMed

    Vismara, Laurie A; McCormick, Carolyn; Young, Gregory S; Nadhan, Anna; Monlux, Katerina

    2013-12-01

    Telehealth or online communication technologies may lessen the gap between intervention requirements for children with autism spectrum disorders (ASDs) and the available resources to provide these services. This study used a video conferencing and self-guided website to provide parent training in the homes of children with ASD. The first eight families to complete the 12-week online intervention and three-month follow up period served as pilot data. Parents' intervention skills and engagement with the website, as well as children's verbal language and joint attention skills were assessed. Preliminary research suggests telehealth may support parental learning and improve child behaviors for some families. This initial assessment of new technologies for making parent training resources available to families with ASD merits further, in-depth study.

  5. Launch of Vanguard

    NASA Technical Reports Server (NTRS)

    1955-01-01

    Launch of a three-stage Vanguard (SLV-7) from Cape Canaveral, Florida, September 18, 1959. Designated Vanguard III, the 100-pound satellite was used to study the magnetic field and radiation belt. In September 1955, the Department of Defense recommended and authorized the new program, known as Project Vanguard, to launch Vanguard booster to carry an upper atmosphere research satellite in orbit. The Vanguard vehicles were used in conjunction with later booster vehicle such as the Thor and Atlas, and the technique of gimbaled (movable) engines for directional control was adapted to other rockets.

  6. Expedition 18 Launch Day

    NASA Image and Video Library

    2008-10-11

    Expedition 18 Flight Engineer Yuri V. Lonchakov, bottom, Expedition 18 Commander Michael Fincke and American spaceflight participant Richard Garriott, top, wave farewell from the steps of the Soyuz launch pad prior to their launch in the Soyuz TMA-13 spacecraft, Sunday, Oct. 12, 2008 from the Baikonur Cosmodrome in Kazakhstan. The three crew members are scheduled to dock with the International Space Station on Oct. 14. Fincke and Lonchakov will spend six months on the station, while Garriott will return to Earth Oct. 24 with two of the Expedition 17 crew members currently on the International Space Station. Photo Credit: (NASA/Bill Ingalls)

  7. LAUNCH - APOLLO 9 - CAPE

    NASA Image and Video Library

    1969-03-03

    S69-25862 (3 March 1969) --- Framed by palm trees in the foreground, the Apollo 9 (Spacecraft 104/Lunar Module 3/ Saturn 504) space vehicle is launched from Pad A, Launch Complex 39, Kennedy Space Center (KSC) at 11 a.m. (EST), March 3, 1969. Aboard the spacecraft are astronauts James A. McDivitt, commander; David R. Scott, command module pilot; and Russell L. Schweickart, lunar module pilot. The Apollo 9 mission will evaluate spacecraft lunar module systems performance during manned Earth-orbital flight. Apollo 9 is the second manned Saturn V mission.

  8. APOLLO VII - LAUNCH - KSC

    NASA Image and Video Library

    1968-10-11

    S68-48662 (11 Oct. 1968) --- The Apollo 7/Saturn IB space vehicle is launched from the Kennedy Space Center's Launch Complex 34 at 11:03 a.m. (EDT), Oct. 11, 1968. Apollo 7 (Spacecraft 101/Saturn 205) is the first of several manned flights aimed at qualifying the spacecraft for the half-million mile round trip to the moon. Aboard the Apollo spacecraft are astronauts Walter M. Schirra Jr., commander; Donn F. Eisele, command module pilot; and Walter Cunningham, lunar module pilot. (This view is framed by palm trees on either side).

  9. NPP Satellite Launch

    NASA Image and Video Library

    2011-10-28

    The Satellite Operations Facility of the National Oceanic and Atmospheric Administration (NOAA) is seen here minutes before the launch of the National Polar-orbiting Operational Environmental Satellite System Preparatory Project (NPP) on Friday, Oct. 28, 2011 in Suitland, Md. NPP is a joint venture between NASA and NOAA, and is the nation's newest Earth-observing satellite, which will provide data on climate change science, allow for accurate weather forecasts and advance warning for severe weather. NPP was launched from Vandenberg Air Force Base in California. Photo Credit: (NASA/Carla Cioffi)

  10. NPP Satellite Launch

    NASA Image and Video Library

    2011-10-28

    Dr. Kathy Sullivan, center, Deputy Administrator of the National Oceanic and Atmospheric Administration (NOAA) and former NASA astronaut is interviewed by a local television network at NOAA's Satellite Operations Facility in Suitland, Md. after the successful launch of the National Polar-orbiting Operational Environmental Satellite System Preparatory Project (NPP) on Friday, Oct. 28, 2011. NPP is a joint venture between NASA and NOAA, and is the nation's newest Earth-observing satellite, which will provide data on climate change science, allow for accurate weather forecasts and advance warning for severe weather. NPP was launched from Vandenberg Air Force Base in California. Photo Credit: (NASA/Carla Cioffi)

  11. NPP Satellite Launch

    NASA Image and Video Library

    2011-10-28

    NASA Deputy Administrator Lori Garver, left, watches the launch of the National Polar-orbiting Operational Environmental Satellite System Preparatory Project (NPP) at the National Oceanic and Atmospheric Administration (NOAA) Satellite Operations Center on Friday, Oct. 28, 2011 in Suitland, Md. U.S Congresswoman Donna Edwards, D-Md., is seen next to Garver. NPP is a joint venture between NASA and NOAA, and is the nation's newest Earth-observing satellite, which will provide data on climate change science, allow for accurate weather forecasts and advance warning for severe weather. NPP was launched from Vandenberg Air Force Base in California. Photo Credit: (NASA/Carla Cioffi)

  12. Expedition 8 Launch Day

    NASA Image and Video Library

    2003-10-18

    With a throng of reporters looking on, the prime and backup crews for the Expedition 8 mission to the International Space Station and the prime and backup European Space Agency Astronauts receive final well-wishes from Russian and U.S. space officials at the Baikonur Cosmodrome in Kazakhstan, Saturday, Oct. 18, 2003, before heading to the launch pad. Expedition 8 Commander and NASA Science Officer Michael Foale, Expedition 8 Soyuz Commander Alexander Kaleri and ESA's Pedro Duque of Spain were launched on a Soyuz TMA-3 vehicle, arriving at the ISS on Oct. 20. Photo Credit (NASA/Bill Ingalls)

  13. LDSD Ready for Launch

    NASA Image and Video Library

    2015-06-05

    NASA's Low-Density Supersonic Decelerator (LDSD) hangs from a launch tower at U.S. Navy's Pacific Missile Range Facility in Kauai, Hawaii. The saucer-shaped vehicle will test two devices for landing heavy payloads on Mars: an inflatable donut-shaped device and a supersonic parachute. The launch tower helps link the vehicle to a balloon; once the balloon floats up, the vehicle is released from the tower and the balloon carries it to high altitudes. The vehicle's rocket takes it to even higher altitudes, to the top of the stratosphere, where the supersonic test begins. http://photojournal.jpl.nasa.gov/catalog/PIA19342

  14. STS-64 launch view

    NASA Technical Reports Server (NTRS)

    1994-01-01

    With a crew of six NASA astronauts aboard, the Space Shuttle Discovery heads for its nineteenth Earth-orbital mission. Launch was delayed because of weather, but all systems were 'go,' and the spacecraft left the launch pad at 6:23 p.m. (EDT) on September 9, 1994. Onboard were astronauts Richard N. Richards, L. Blaine Hammond, Carl J. Meade, Mark C. Lee, Susan J. Helms, and Jerry M. Linenger (051-2); Making a bright reflection in nearby marsh waters, the Space Shuttle Discovery heads for its 19th mission in earth orbit (053).

  15. STS-64 launch view

    NASA Technical Reports Server (NTRS)

    1994-01-01

    With a crew of six NASA astronauts aboard, the Space Shuttle Discovery heads for its nineteenth Earth-orbital mission. Launch was delayed because of weather, but all systems were 'go,' and the spacecraft left the launch pad at 6:23 p.m. (EDT) on September 9, 1994. Onboard were astronauts Richard N. Richards, L. Blaine Hammond, Carl J. Meade, Mark C. Lee, Susan J. Helms, and Jerry M. Linenger (051-2); Making a bright reflection in nearby marsh waters, the Space Shuttle Discovery heads for its 19th mission in earth orbit (053).

  16. Expedition 22 Launch Day

    NASA Image and Video Library

    2009-12-20

    Expedition 22 Flight Engineer Soichi Noguchi of Japan has his Russian Sokol suit prepared for launch by a technician while space agency photographers document the process at the Baikonur Cosmodrome in Baikonur, Kazakhstan, Sunday, Dec. 20, 2009. Soichi and fellow Expedition 22 crew members NASA Flight Engineer Timothy J. Creamer of the U.S., Soyuz Commander Oleg Kotov of Russia launched in their Soyuz TMA-17 rocket from the Baikonur Cosmodrome in Kazakhstan on Monday, Dec. 21, 2009. (Photo Credit: NASA/Bill Ingalls)

  17. Launch - STS-6 - KSC

    NASA Image and Video Library

    1983-04-06

    S83-30134 (7 April 1983) --- Flare from the first launch of the space shuttle Challenger is reflected in the Atlantic Ocean?s Cape Canaveral beach waters shortly after 1:30 p.m. (EST) on April 7, 1983. Only the tips of the orbiter?s wings are visible in this south looking view, as the manned portion of the launch cluster is obscured by its new lightweight external fuel tank (ET) and two solid rocket boosters (SRB). Onboard the spacecraft are astronauts Paul J. Weitz, Karol J. Bobko, Dr. F. Story Musgrave and Donald H. Peterson. Photo credit: NASA

  18. STS-56 Launch

    NASA Technical Reports Server (NTRS)

    1993-01-01

    The second try works like a charm as the Space Shuttle Discovery lifts off from Launch Pad 39B on Mission STS-56 at 1:29:00 a.m., EDT, April 8. First attempt to launch Discovery on its 16th space voyage was halted at T-11 seconds on April 6. Aboard for the second Space Shuttle mission of 1993 are a crew of five and the Atmospheric Laboratory for Applications and Science 2 (ATLAS 2), the second in a series of missions to study the sun's energy output and Earth's middle atmosphere chemical makeup, and how these factors affect levels of ozone.

  19. Speech-language pathology telehealth in rural and remote schools: the experience of school executive and therapy assistants.

    PubMed

    Fairweather, Glenn C; Lincoln, Michelle A; Ramsden, Robyn

    2017-01-01

    Difficulties in accessing allied health services, especially in rural and remote areas, appear to be driving the use of telehealth services to children in schools. The objectives of this study were to investigate the experiences and views of school executive staff and therapy assistants regarding the feasibility and acceptability of a speech-language pathology telehealth program for children attending schools in rural and remote New South Wales, Australia. The program, called Come N See, provided therapy interventions remotely via low-bandwidth videoconferencing, with email follow-up. Over a 12-week period, children were offered therapy blocks of six fortnightly sessions, each lasting a maximum of 30 minutes. School executives (n=5) and therapy assistants (n=6) described factors that promoted or threatened the program's feasibility and acceptability, during semistructured interviews. Thematic content analysis with constant comparison was applied to the transcribed interviews to identify relationships in the data. Emergent themes related to (a) unmet speech pathology needs, (b) building relationships, (c) telehealth's advantages, (d) telehealth's disadvantages, (e) anxiety replaced by joy and confidence in growing skills, and (f) supports. School executive staff and therapy assistants verified that the delivery of the school-based telehealth service was feasible and acceptable. However, the participants saw significant opportunities to enhance this acceptability through building into the program stronger working relationships and supports for stakeholders. These findings are important for the future development of allied health telehealth programs that are sustainable as well as effective and fit the needs of all crucial stakeholders. The results have significant implications for speech pathology clinical practice relating to technology, program planning and teamwork within telehealth programs.

  20. The Contradictions of Telehealth User Experience in Chronic Obstructive Pulmonary Disease (COPD): A Qualitative Meta-Synthesis

    PubMed Central

    Brunton, Lisa; Bower, Peter; Sanders, Caroline

    2015-01-01

    Objective As the global burden of chronic disease rises, policy makers are showing a strong interest in adopting telehealth technologies for use in long term condition management, including COPD. However, there remain barriers to its implementation and sustained use. To date, there has been limited qualitative investigation into how users (both patients/carers and staff) perceive and experience the technology. We aimed to systematically review and synthesise the findings from qualitative studies that investigated user perspectives and experiences of telehealth in COPD management, in order to identify factors which may impact on uptake. Method Systematic review and meta-synthesis of published qualitative studies of user (patients, their carers and clinicians) experience of telehealth technologies for the management of Chronic Obstructive Pulmonary Disease. ASSIA, CINAHL, Embase, Medline, PsychInfo and Web of Knowledge databases were searched up to October 2014. Reference lists of included studies and reference lists of key papers were also searched. Quality appraisal was guided by an adapted version of the CASP qualitative appraisal tool. Findings 705 references (after duplicates removed) were identified and 10 papers, relating to 7 studies were included in the review. Most authors of included studies had identified both positive and negative experiences of telehealth use in the management of COPD. Through a line of argument synthesis we were able to derive new insights from the data to identify three overarching themes that have the ability to either impede or promote positive user experience of telehealth in COPD: the influence on moral dilemmas of help seeking—(enables dependency or self-care); transforming interactions (increases risk or reassurance) and reconfiguration of ‘work’ practices (causes burden or empowerment). Conclusion Findings from this meta-synthesis have implications for the future design and implementation of telehealth services. Future