Telemedicine Applications in Pediatric Retinal Disease

PubMed Central

Pathipati, Akhilesh S.; Moshfeghi, Darius M.

2017-01-01

Teleophthalmology is a developing field that presents diverse opportunities. One of its most successful applications to date has been in pediatric retinal disease, particularly in screening for retinopathy of prematurity (ROP). Many studies have shown that using telemedicine for ROP screening allows a remote ophthalmologist to identify abnormal findings and implement early interventions. Here, we review the literature on uses of telemedicine in pediatric retinal disease and consider future applications. PMID:28333078

Applications and Developments of Telemedicine in Greece.

PubMed

Tsioumanis, Vasileios; Mangita, Andrianna; Diomidous, Marianna

2016-01-01

The need to transmit medical information with images, data and voice from distance via telecommunications has come to our knowledge from ages. The topic has a new interest because of the progress in technology of telecommunications and information systems. The current article makes an effort to inform the reader in a simple way about what Telemedicine is and where it can be used. In this paper is presented the definition and the purpose of telemedicine, followed by the services provide through telemedicine applications. Finally, is analyzed the use of telemedicine in Greece its advantages, benefits and disadvantages, concluding with a final evaluation of it.

VA Telemedicine: An Analysis of Cost and Time Savings.

PubMed

Russo, Jack E; McCool, Ryan R; Davies, Louise

2016-03-01

The Veterans Affairs (VA) healthcare system provides beneficiary travel reimbursement ("travel pay") to qualifying patients for traveling to appointments. Travel pay is a large expense for the VA and hence the U.S. Government, projected to cost nearly $1 billion in 2015. Telemedicine in the VA system has the potential to save money by reducing patient travel and thus the amount of travel pay disbursed. In this study, we quantify this savings and also report trends in VA telemedicine volumes over time. All telemedicine visits based at the VA Hospital in White River Junction, VT between 2005 and 2013 were reviewed (5,695 visits). Travel distance and time saved as a result of telemedicine were calculated. Clinical volume in the mental health department, which has had the longest participation in telemedicine, was analyzed. Telemedicine resulted in an average travel savings of 145 miles and 142 min per visit. This led to an average travel payment savings of $18,555 per year. Telemedicine volume grew significantly over the study period such that by the final year the travel pay savings had increased to $63,804, or about 3.5% of the total travel pay disbursement for that year. The number of mental health telemedicine visits rose over the study period but remained small relative to the number of face-to-face visits. A higher proportion of telemedicine visits involved new patients. Telemedicine at the VA saves travel distance and time, although the reduction in travel payments remains modest at current telemedicine volumes.

Telemedicine in the treatment of patients with inflammatory bowel disease.

PubMed

Aguas, Mariam; Del Hoyo, Javier; Faubel, Raquel; Valdivieso, Bernardo; Nos, Pilar

2017-11-01

Inflammatory bowel disease (IBD) is a chronic and relapsing disorder with significant medical, social and financial impacts. IBD patients require continuous follow-up, and healthcare resource use in this context increases over time. In the last decade, telemedicine has influenced the treatment of chronic diseases like IBD via the application of information and communication technologies to provide healthcare services remotely. Telemedicine and its various applications (telemanagement, teleconsulting and tele-education) enable closer follow-up and provide education resources that promote patient empowerment, encouraging treatment optimisation over the entire course of the disease. We describe the impact of using telemedicine on IBD health outcomes and discuss the limitations of implementing these systems in the real-life management of IBD patients. Copyright © 2017 Elsevier España, S.L.U., AEEH y AEG. All rights reserved.

QoE for telemedicine: challenges and trends

NASA Astrophysics Data System (ADS)

Cavaro-Ménard, Christine; Lu, Zhang Ge; Le Callet, Patrick

2013-09-01

Telemedicine that involves sharing of digital data (i.e. physiological signals, 2D/3D images and videos) should meet the same standards of traditional healthcare in terms of usability, accessibility, efficiency, effectiveness and quality of clinical processes. All these requirements can be seen as elementary components that participate to the quality of experience (QoE) in an ad hoc medical application scenario. Although, the quality of service (QoS) in telemedicine has been quite investigated, QoE is still lacking clear definition in this context. This later should not be assimilated to QoS as it refers clearly to the experience by the user while QoS focuses mostly on the system. QoE has a potential relevancy to optimize and understand the technical transmission chain from the final task point viewpoint which one of the most important factor for adoption of telemedicine. Towards this goal, QoE studies should be conducted with an appropriate methodology incorporating user involvement and digital data and their relation with QoS. As one of the first effort in this field, this paper proposes a survey of some key issues and solutions associated to QoE in telemedicine. We first present the services offered by telemedicine and underline the significance of QoE for tele-diagnosis and tele-surgery. Next, we identify and analyze the influencing factors such as application area, application purpose (emergency care, acquisition assistance, second opinion, education...), content type (data specificities depending on acquisition modality), context of use (offline/real time, interactivity...), and user's state (stress, expertise...), that have to be considered for a relevant QoE assessment in telemedicine.

Teleneurology applications: Report of the Telemedicine Work Group of the American Academy of Neurology.

PubMed

Wechsler, Lawrence R; Tsao, Jack W; Levine, Steven R; Swain-Eng, Rebecca J; Adams, Robert J; Demaerschalk, Bart M; Hess, David C; Moro, Elena; Schwamm, Lee H; Steffensen, Steve; Stern, Barney J; Zuckerman, Steven J; Bhattacharya, Pratik; Davis, Larry E; Yurkiewicz, Ilana R; Alphonso, Aimee L

2013-02-12

To review current literature on neurology telemedicine and to discuss its application to patient care, neurology practice, military medicine, and current federal policy. Review of practice models and published literature on primary studies of the efficacy of neurology telemedicine. Teleneurology is of greatest benefit to populations with restricted access to general and subspecialty neurologic care in rural areas, those with limited mobility, and those deployed by the military. Through the use of real-time audio-visual interaction, imaging, and store-and-forward systems, a greater proportion of neurologists are able to meet the demand for specialty care in underserved communities, decrease the response time for acute stroke assessment, and expand the collaboration between primary care physicians, neurologists, and other disciplines. The American Stroke Association has developed a defined policy on teleneurology, and the American Academy of Neurology and federal health care policy are beginning to follow suit. Teleneurology is an effective tool for the rapid evaluation of patients in remote locations requiring neurologic care. These underserved locations include geographically isolated rural areas as well as urban cores with insufficient available neurology specialists. With this technology, neurologists will be better able to meet the burgeoning demand for access to neurologic care in an era of declining availability. An increase in physician awareness and support at the federal and state level is necessary to facilitate expansion of telemedicine into further areas of neurology.

Telemedicine: a cautious welcome.

PubMed Central

Wootton, R.

1996-01-01

Telemedicine is a major new development. Having become technically and economically feasible, it deserves proper investigation. Rushing into equipment purchase, however, is almost certain to prove counterproductive. Face to face contact is fundamental to health care and enthusiasts of telemedicine should recognise that it is not as good as the real thing (and unlikely ever to be). However, constraints on time and resources will make face to face consultation increasingly expensive, and telemedicine has the potential to produce major efficiencies in the diagnostic process. The goal of current research is therefore to marry medicine with technology, capitalising on the advantages of telemedicine and producing a robust system that delivers an acceptable service at an appropriate price. Images p1375-a p1375-b p1376-a PMID:8956707

Telemedicine: Pediatric Applications

PubMed Central

Burke, Bryan L.; Hall, R. W.

2017-01-01

Telemedicine is a technological tool that is improving the health of children around the world. This report chronicles the use of telemedicine by pediatricians and pediatric medical and surgical specialists to deliver inpatient and outpatient care, educate physicians and patients, and conduct medical research. It also describes the importance of telemedicine in responding to emergencies and disasters and providing access to pediatric care to remote and underserved populations. Barriers to telemedicine expansion are explained, such as legal issues, inadequate payment for services, technology costs and sustainability, and the lack of technology infrastructure on a national scale. Although certain challenges have constrained more widespread implementation, telemedicine’s current use bears testimony to its effectiveness and potential. Telemedicine’s widespread adoption will be influenced by the implementation of key provisions of the Patient Protection and Affordable Care Act, technological advances, and growing patient demand for virtual visits. PMID:26122813

Telemedicine: history, applications, and impact on librarianship.

PubMed Central

Zundel, K M

1996-01-01

This paper traces the uses of telecommunications in health care from the Civil War era to the present. Topics include the National Aeronautics and Space Administration's involvement in the origins of current telemedicine systems and the impact of television. Applications of telemedicine discussed include remote consultation and diagnosis, specialty clinical care (including examples from anesthesia, dermatology, cardiology, psychiatry, radiology, critical care, and oncology), and others (including examples of patient education, home monitoring, and continuing education). The concluding section highlights how telemedicine affects health sciences librarianship, beginning with the development of online computerized literature searching. This section also discusses the medical resources available to health sciences librarians as a result of the Internet. PMID:8938332

Cost and Time Effectiveness Analysis of a Telemedicine Service in Bangladesh.

PubMed

Sorwar, Golam; Rahamn, Md Mustafizur; Uddin, Ramiz; Hoque, Md Rakibul

2016-01-01

Telemedicine has great potential to overcome geographical barriers to providing access to equal health care services, particularly for people living in remote and rural areas in developing countries like Bangladesh. A number of telemedicine systems have been implemented in Bangladesh. However, no significant studies have been conducted to determine either their cost effectiveness or efficiency in reducing travel time required by patients. In addition, very few studies have analyzed the attitude and level of satisfaction of telemedicine service recipients in Bangladesh. The aim of this study was to analyze the cost and time effectiveness of a telemedicine service, implemented through locally developed PC based diagnostic equipment and software in Bangladesh, compared to conventional means of providing those services. The study revealed that the introduced telemedicine service reduced cost and travel time on average by 56% and 94% respectively compared to its counterpart conventional approach. The study also revealed that majority of users were highly satisfied with the newly introduced telemedicine service. Therefore, the introduced telemedicine service can be considered as a low cost and time efficient health service solution to improve health care facilities in the remote rural areas in Bangladesh.

Using off-the-shelf medical devices for biomedical signal monitoring in a telemedicine system for emergency medical services.

PubMed

Thelen, Sebastian; Czaplik, Michael; Meisen, Philipp; Schilberg, Daniel; Jeschke, Sabina

2015-01-01

In order to study new methods of telemedicine usage in the context of emergency medical services, researchers need to prototype integrated telemedicine systems. To conduct a one-year trial phase-intended to study a new application of telemedicine in German emergency medical services-we used off-the-shelf medical devices and software to realize real-time patient monitoring within an integrated telemedicine system prototype. We demonstrate its feasibility by presenting the integrated real-time patient monitoring solution, by studying signal delay and transmission robustness regarding changing communication channel characteristics, and by evaluating issues reported by the physicians during the trial phase. Where standards like HL7 and the IEEE 11073 family are intended to enable interoperability of product grade medical devices, we show that research prototypes benefit from the use of web technologies and simple device interfaces, as they simplify product development for a manufacturer and ease integration efforts for research teams. Embracing this approach for the development of new medical devices eases the constraint to use off-the-shelf products for research trials investigating innovative use of telemedicine.

Lessons learned from the usability assessment of home-based telemedicine systems.

PubMed

Agnisarman, Sruthy Orozhiyathumana; Chalil Madathil, Kapil; Smith, Kevin; Ashok, Aparna; Welch, Brandon; McElligott, James T

2017-01-01

At-home telemedicine visits are quickly becoming an acceptable alternative for in-person patient visits. However, little work has been done to understand the usability of these home-based telemedicine solutions. It is critical for user acceptance and real-world applicability to evaluate available telemedicine solutions within the context-specific needs of the users of this technology. To address this need, this study evaluated the usability of four home-based telemedicine software platforms: Doxy.me, Vidyo, VSee, and Polycom. Using a within-subjects experimental design, twenty participants were asked to complete a telemedicine session involving several tasks using the four platforms. Upon completion of these tasks for each platform, participants completed the IBM computer system usability questionnaire (CSUQ) and the NASA Task Load Index test. Upon completing the tasks on all four platforms, the participants completed a final post-test subjective questionnaire ranking the platforms based on their preference. Of the twenty participants, 19 completed the study. Statistically significant differences among the telemedicine software platforms were found for task completion time, total workload, mental demand, effort, frustration, preference ranking and computer system usability scores. Usability problems with installation and account creation led to high mental demand and task completion time, suggesting the participants preferred a system without such requirements. Majority of the usability issues were identified at the telemedicine initiation phase. The findings from this study can be used by software developers to develop user-friendly telemedicine systems. Copyright © 2016 Elsevier Ltd. All rights reserved.

Network protocols for real-time applications

NASA Technical Reports Server (NTRS)

Johnson, Marjory J.

1987-01-01

The Fiber Distributed Data Interface (FDDI) and the SAE AE-9B High Speed Ring Bus (HSRB) are emerging standards for high-performance token ring local area networks. FDDI was designed to be a general-purpose high-performance network. HSRB was designed specifically for military real-time applications. A workshop was conducted at NASA Ames Research Center in January, 1987 to compare and contrast these protocols with respect to their ability to support real-time applications. This report summarizes workshop presentations and includes an independent comparison of the two protocols. A conclusion reached at the workshop was that current protocols for the upper layers of the Open Systems Interconnection (OSI) network model are inadequate for real-time applications.

Wavelet-based compression of pathological images for telemedicine applications

NASA Astrophysics Data System (ADS)

Chen, Chang W.; Jiang, Jianfei; Zheng, Zhiyong; Wu, Xue G.; Yu, Lun

2000-05-01

In this paper, we present the performance evaluation of wavelet-based coding techniques as applied to the compression of pathological images for application in an Internet-based telemedicine system. We first study how well suited the wavelet-based coding is as it applies to the compression of pathological images, since these images often contain fine textures that are often critical to the diagnosis of potential diseases. We compare the wavelet-based compression with the DCT-based JPEG compression in the DICOM standard for medical imaging applications. Both objective and subjective measures have been studied in the evaluation of compression performance. These studies are performed in close collaboration with expert pathologists who have conducted the evaluation of the compressed pathological images and communication engineers and information scientists who designed the proposed telemedicine system. These performance evaluations have shown that the wavelet-based coding is suitable for the compression of various pathological images and can be integrated well with the Internet-based telemedicine systems. A prototype of the proposed telemedicine system has been developed in which the wavelet-based coding is adopted for the compression to achieve bandwidth efficient transmission and therefore speed up the communications between the remote terminal and the central server of the telemedicine system.

Telemedicine: an emerging health care technology.

PubMed

Myers, Mary R

2003-01-01

Telemedicine uses advanced telecommunication technologies to exchange health information and provide health care services across geographic, time, social, and cultural barriers. All telemedicine applications require the use of the electronic transfer of information. Telemedicine encompasses computer technologies using narrow and high bandwidths for specific types of information transmission, broadcast video, compressed video, full motion video, and even virtual reality. There are many types of common medical devices that have been adapted for use with telemedicine technology, and many clinical services can be provided via telemedicine to patients who live in physician shortage areas. The greatest challenges for telemedicine in the twenty-first century are financing, safety standards, security, and infrastructure.

Technology assessment for an integrated PC-based platform for three telemedicine applications

NASA Astrophysics Data System (ADS)

Tohme, Walid G.; Hayes, Wendelin S.; Dai, Hailei L.; Komo, Darmadi; Pahira, John J.; Abernethy, Darrell R.; Rennert, Wolfgang; Kuehl, Karen S.; Hauser, Gabriel J.; Mun, Seong K.

1996-05-01

This paper investigates the design and technical efficacy of an integrated PC based platform for three different medical applications. The technical efficacy of such a telemedicine platform has not been evaluated in the literature and optimal technical requirements have not been developed. The first application, with the Department of Surgery, Division of Urology, tests the utility of a telemedicine platform including radiology images for a surgical stone disease consultation service from an off site location in West Virginia. The second application, with the Department of Internal Medicine, Division of Clinical Pharmacology, investigates the usefulness of telemedicine when used for a clinical pharmacology consultation service from an off-site location. The third application, with the Department of Pediatrics, will test telemedicine for trauma care triage service first within an off-site location in Virginia and then from there to Georgetown University Medical Center.

Telemedicine in inflammatory bowel disease: opportunities and approaches.

PubMed

Aguas Peris, Mariam; Del Hoyo, Javier; Bebia, Paloma; Faubel, Raquel; Barrios, Alejandra; Bastida, Guillermo; Valdivieso, Bernardo; Nos, Pilar

2015-02-01

This review article summarizes the evidence about telemedicine applications (e.g., telemonitoring, teleconsulting, and tele-education) in the management of patients with inflammatory bowel disease (IBD), and we aim to give an overview of the acceptance and impact of these interventions on health outcomes. Based on the literature search on "inflammatory bowel disease," "Crohn's disease" and "ulcerative colitis" in combination with "e-health," "telemedicine," and "telemanagement," we selected 58 titles and abstracts published up to June 2014 and searched in PubMed, EMBASE, MEDLINE, Cochrane Database, Web of Science and Conference Proceedings. Titles and abstracts were screened for a set of inclusion criteria: e-health intervention, IBD as the main disease, and a primary study performed. Finally, 16 were included for full reading, data extraction, and critical appraisal of the evaluation. Most studies use telemonitoring (home telemanagement system or web portal) and telecare (real-time telephone and image) as telemedicine applications and assessed the feasibility and acceptance of these systems, adherence to treatment, quality of life, and patient knowledge, particularly in patients with ulcerative colitis. Furthermore, some of these studies evaluated the patients' empowerment, health care costs, and safety of telemonitoring in IBD. In conclusion, the health outcomes of telemedicine applications in IBD suggest that these could be implemented in clinical practice because they are safe and feasible applications that are well accepted by the patient and improve adherence, quality of life, and disease knowledge. Further studies with large sample sizes and complex diseases are needed to confirm these results.

Sustainable Telemedicine: Designing and Building Infrastructure to Support a Comprehensive Telemedicine Practice.

PubMed

Kreofsky, Beth L H; Blegen, R Nicole; Lokken, Troy G; Kapraun, Susan M; Bushman, Matthew S; Demaerschalk, Bart M

2018-04-16

Telemedicine services in medical institutions are often developed in isolation of one another and not as part of a comprehensive telemedicine program. The Center for Connected Care is the administrative home for a broad range of telehealth services at Mayo Clinic. This article speaks of real-time video services, referenced as telemedicine throughout. This article discusses how a large healthcare system designed and built the infrastructure to support a comprehensive telemedicine practice. Based on analysis of existing services, Mayo Clinic developed a multifaceted operational plan that addressed high-priority areas and outlined clear roles and responsibilities of the Center for Connected Care and that of the clinical departments. The plan set priorities and a direction that would lead to long-term success. The plan articulated the governing and operational infrastructure necessary to support telemedicine by defining the role of the Center for Connected Care as the owner of core administrative operations and the role of the clinical departments as the owners of clinical telemedicine services. Additional opportunities were identified to develop product selection processes, implementation services, and staffing models that would be applied to ensure successful telemedicine deployment. The telemedicine team within the Center for Connected Care completed 45 business cases resulting in 54 implementations. The standardization of core products along with key operational offerings around implementation services, and the establishment of a 24/7 support model resulted in improved provider satisfaction and fewer reported technical issues. The foundation for long-term scalability and growth was developed by centralizing operations of telemedicine services, implementing sustainable processes, employing dedicated qualified personnel, and deploying robust products.

[Telemedicine in Germany. Status, Barriers, Perspectives].

PubMed

Brauns, H-J; Loos, Wolfgang

2015-10-01

Telemedicine as a subject has reached politics, doctors and patients, but it has still not been able to make the leap from research, development, and testing into real practice. This is generally because of the great barriers to implementation, mainly the lack of telematics infrastructure and of payment regulations in Germany. Telemedicine projects are mainly isolated applications and it has not been possible to integrate them in to nationwide regular health services. Other challenges along the path to standard care include that research-based small-medium enterprise (SME) companies usually face high barriers hindering access to this market, because it is imposible for them to finance all the required evidence-based studies to verify the medical benefits and the econimic efficiency. Additionally, a high market nontransparency is noted. However, the signs of progress are visible, e.g., the E-health initiative of the German government or recent legislative initiatives. However, long processes are observed that do not facilitate the use of telemedicine. Although some federal states, e.g., North Rhine Westphalia, Bavaria, Mecklenburg-Western Pomerania, and Saxony, show exemplary activities, there are still many white areas on the telemedicine map of Germany. The road to standard care will be long, but is not unattainable. The reasons for supporting telemedicine are still strong. The future development of telemedicine applications will contribute to sustainable and high-quality patient care in Germany.

Impact of telemedicine in hospital culture and its consequences on quality of care and safety

PubMed Central

Steinman, Milton; Morbeck, Renata Albaladejo; Pires, Philippe Vieira; Abreu, Carlos Alberto Cordeiro; Andrade, Ana Helena Vicente; Terra, Jose Claudio Cyrineu; Teixeira, José Carlos; Kanamura, Alberto Hideki

2015-01-01

ABSTRACT Objective To describe the impact of the telemedicine application on the clinical process of care and its different effects on hospital culture and healthcare practice. Methods The concept of telemedicine through real time audio-visual coverage was implemented at two different hospitals in São Paulo: a secondary and public hospital, Hospital Municipal Dr. Moysés Deutsch, and a tertiary and private hospital, Hospital Israelita Albert Einstein. Results Data were obtained from 257 teleconsultations records over a 12-month period and were compared to a similar period before telemedicine implementation. For 18 patients (7.1%) telemedicine consultation influenced in diagnosis conclusion, and for 239 patients (92.9%), the consultation contributed to clinical management. After telemedicine implementation, stroke thrombolysis protocol was applied in 11% of ischemic stroke patients. Telemedicine approach reduced the need to transfer the patient to another hospital in 25.9% regarding neurological evaluation. Sepsis protocol were adopted and lead to a 30.4% reduction mortality regarding severe sepsis. Conclusion The application is associated with differences in the use of health services: emergency transfers, mortality, implementation of protocols and patient management decisions, especially regarding thrombolysis. These results highlight the role of telemedicine as a vector for transformation of hospital culture impacting on the safety and quality of care. PMID:26676268

Decreasing patient cost and travel time through pediatric rheumatology telemedicine visits.

PubMed

Kessler, Elizabeth A; Sherman, Ashley K; Becker, Mara L

2016-09-20

There is a critical shortage of pediatric rheumatologists in the US. Substantial travel to clinics can impose time and monetary burdens on families. The aim of this study was to evaluate the cost of in-person pediatric rheumatology visits for families and determine if telemedicine clinics resulted in time and cost savings. Factors associated with interest in telemedicine were also explored. Surveys were offered to parents and guardians of patients in Pediatric Rheumatology follow-up clinics in Kansas City, Missouri, the primary site of in-person care, and at a telemedicine outreach site 160 miles away, in Joplin, Missouri. Survey questions were asked about non-medical, out-of-pocket costs associated with the appointment and interest in a telemedicine clinic. At the primary Kansas City clinic, the median distance traveled one-way was 40 miles [IQR = 18-80]. In the Joplin sample, the median distance traveled to the telemedicine clinic was 60 miles [IQR = 20-85] compared to 175 miles [IQR = 160-200] for the same cohort of patients when seen in Kansas City (p < 0.001). When the Joplin cohort was seen via telemedicine they missed less time from work and school (p = 0.028, p = 0.003, respectively) and a smaller percentage spent money on food compared to when they had traveled to Kansas City (p < 0.001). There was no statistical difference between the Joplin cohort when they had traveled to Kansas City and the Kansas City cohort in terms of miles driven to clinic, time missed from work and school, and percentage of subjects who spent money on food. Traditional in-person visits can result in a financial toll on families, which can be ameliorated by the use of telemedicine. Telemedicine leveled the economic burden of clinic visits so that when the Joplin cohort was seen via telemedicine, they experienced costs similar to the Kansas City cohort.

Commercial applications of telemedicine

NASA Technical Reports Server (NTRS)

Natiello, Thomas A.

1991-01-01

Telemedicine Systems Corporation was established in 1976 and is a private commercial supplier of telemedicine systems. These systems are various combinations of communications and diagnostic technology, designed to allow the delivery of health care services to remote facilities. The technology and the health care services are paid for by the remote facilities, such as prisons.

Telemedicine in the 'Hood.

ERIC Educational Resources Information Center

Elgrably, Jordan

1998-01-01

Telemedicine, the ability to examine patients while physically removed from them by using high-tech virtual treatment, is used increasingly to diagnose and prescribe treatment for patients in nontraditional settings. In Los Angeles (California), Charles R. Drew University of Medicine and King-Drew Medical Center communicate in real time with…

A telemedicine system for wireless home healthcare based on Bluetooth and the Internet.

PubMed

Zhao, Xiaoming; Fei, Ding-Yu; Doarn, Charles R; Harnett, Brett; Merrell, Ronald

2004-01-01

The VitalPoll Telemedicine System (VTS) was designed and developed for wireless home healthcare. The aims of this study were: to design the architecture and communication methods for a telemedicine system; to implement a physiologic routing hub to collect data from different medical devices and sensors; and to evaluate the feasibility of this system for applications in wireless home healthcare. The VTS was built using Bluetooth wireless and Internet technologies with client/server architecture. Several medical devices, which acquire vital signs, such as real-time electrocardiogram signals, heart rate, body temperature, and activity (physical motion), were integrated into the VTS. Medical information and data were transmitted over short-range interface (USB, RS232), wireless communication, and the Internet. The medical results were stored in a database and presented using a web browser. The patient's vital signals can be collected, transmitted, and displayed in real time by the VTS. The experiments verified no data loss during Bluetooth and Internet communication. Bluetooth and the Internet provide enough bandwidth channels to tranmit these vital signs. The experimental results show that VTS may be suitable for a practical telemedicine system in home healthcare.

Quantitative 3-D imaging topogrammetry for telemedicine applications

NASA Technical Reports Server (NTRS)

Altschuler, Bruce R.

1994-01-01

The technology to reliably transmit high-resolution visual imagery over short to medium distances in real time has led to the serious considerations of the use of telemedicine, telepresence, and telerobotics in the delivery of health care. These concepts may involve, and evolve toward: consultation from remote expert teaching centers; diagnosis; triage; real-time remote advice to the surgeon; and real-time remote surgical instrument manipulation (telerobotics with virtual reality). Further extrapolation leads to teledesign and telereplication of spare surgical parts through quantitative teleimaging of 3-D surfaces tied to CAD/CAM devices and an artificially intelligent archival data base of 'normal' shapes. The ability to generate 'topogrames' or 3-D surface numerical tables of coordinate values capable of creating computer-generated virtual holographic-like displays, machine part replication, and statistical diagnostic shape assessment is critical to the progression of telemedicine. Any virtual reality simulation will remain in 'video-game' realm until realistic dimensional and spatial relational inputs from real measurements in vivo during surgeries are added to an ever-growing statistical data archive. The challenges of managing and interpreting this 3-D data base, which would include radiographic and surface quantitative data, are considerable. As technology drives toward dynamic and continuous 3-D surface measurements, presenting millions of X, Y, Z data points per second of flexing, stretching, moving human organs, the knowledge base and interpretive capabilities of 'brilliant robots' to work as a surgeon's tireless assistants becomes imaginable. The brilliant robot would 'see' what the surgeon sees--and more, for the robot could quantify its 3-D sensing and would 'see' in a wider spectral range than humans, and could zoom its 'eyes' from the macro world to long-distance microscopy. Unerring robot hands could rapidly perform machine-aided suturing with

Telemedicine in practice.

PubMed

Thrall, J H; Boland, G

1998-04-01

Telemedicine is defined as the "delivery of health care and sharing of medical knowledge over a distance using telecommunication systems." The concept of telemedicine is not new. Beyond the use of the telephone, there were numerous attempts to develop telemedicine programs in the 1960s mostly based on interactive television. The early experience was conceptionally encouraging but suffered inadequate technology. With a few notable exceptions such as the telemetry of medical data in the space program, there was very little advancement of telemedicine in the 1970s and 1980s. Interest in telemedicine has exploded in the 1990s with the development of medical devices suited to capturing images and other data in digital electronic form and the development and installation of high speed, high bandwidth telecommunication systems around the world. Clinical applications of telemedicine are now found in virtually every specialty. Teleradiology is the most common application followed by cardiology, dermatology, psychiatry, emergency medicine, home health care, pathology, and oncology. The technological basis and the practical issues are highly variable from one clinical application to another. Teleradiology, including telenuclear medicine, is one of the more well-defined telemedicine services. Techniques have been developed for the acquisition and digitization of images, image compression, image transmission, and image interpretation. The American College of Radiology has promulgated standards for teleradiology, including the requirement for the use of high resolution 2000 x 2000 pixel workstations for the interpretation of plain films. Other elements of the standard address image annotation, patient confidentiality, workstation functionality, cathode ray tube brightness, and image compression. Teleradiology systems are now widely deployed in clinical practice. Applications include providing service from larger to smaller institutions, coverage of outpatient clinics, imaging

Online collaboration environments in telemedicine applications of speech therapy.

PubMed

Pierrakeas, C; Georgopoulos, V; Malandraki, G

2005-01-01

The use of telemedicine in speech and language pathology provides patients in rural and remote areas with access to quality rehabilitation services that are sufficient, accessible, and user-friendly leading to new possibilities in comprehensive and long-term, cost-effective diagnosis and therapy. This paper discusses the use of online collaboration environments for various telemedicine applications of speech therapy which include online group speech therapy scenarios, multidisciplinary clinical consulting team, and online mentoring and continuing education.

Multiresource allocation and scheduling for periodic soft real-time applications

NASA Astrophysics Data System (ADS)

Gopalan, Kartik; Chiueh, Tzi-cker

2001-12-01

Real-time applications that utilize multiple system resources, such as CPU, disks, and network links, require coordinated scheduling of these resources in order to meet their end-to-end performance requirements. Most state-of-the-art operating systems support independent resource allocation and deadline-driven scheduling but lack coordination among multiple heterogeneous resources. This paper describes the design and implementation of an Integrated Real-time Resource Scheduler (IRS) that performs coordinated allocation and scheduling of multiple heterogeneous resources on the same machine for periodic soft real-time application. The principal feature of IRS is a heuristic multi-resource allocation algorithm that reserves multiple resources for real-time applications in a manner that can maximize the number of applications admitted into the system in the long run. At run-time, a global scheduler dispatches the tasks of the soft real-time application to individual resource schedulers according to the precedence constraints between tasks. The individual resource schedulers, which could be any deadline based schedulers, can make scheduling decisions locally and yet collectively satisfy a real-time application's performance requirements. The tightness of overall timing guarantees is ultimately determined by the properties of individual resource schedulers. However, IRS maximizes overall system resource utilization efficiency by coordinating deadline assignment across multiple tasks in a soft real-time application.

Telemedicine for Developing Countries

PubMed Central

Combi, Carlo; Pozzani, Gabriele

2016-01-01

Summary Background Developing countries need telemedicine applications that help in many situations, when physicians are a small number with respect to the population, when specialized physicians are not available, when patients and physicians in rural villages need assistance in the delivery of health care. Moreover, the requirements of telemedicine applications for developing countries are somewhat more demanding than for developed countries. Indeed, further social, organizational, and technical aspects need to be considered for successful telemedicine applications in developing countries. Objective We consider all the major projects in telemedicine, devoted to developing countries, as described by the proper scientific literature. On the basis of such literature, we want to define a specific taxonomy that allows a proper classification and a fast overview of telemedicine projects in developing countries. Moreover, by considering both the literature and some recent direct experiences, we want to complete such overview by discussing some design issues to be taken into consideration when developing telemedicine software systems. Methods We considered and reviewed the major conferences and journals in depth, and looked for reports on the telemedicine projects. Results We provide the reader with a survey of the main projects and systems, from which we derived a taxonomy of features of telemedicine systems for developing countries. We also propose and discuss some classification criteria for design issues, based on the lessons learned in this research area. Conclusions We highlight some challenges and recommendations to be considered when designing a telemedicine system for developing countries. PMID:27803948

Integration of Telemedicine in Graduate Medical Informatics Education

PubMed Central

Demiris, George

2003-01-01

An essential part of health informatics is telemedicine, the use of advanced telecommunications technologies to bridge distance and support health care delivery and education. This report discusses the integration of telemedicine into a medical informatics curriculum and, specifically, a framework for a telemedicine course. Within this framework, the objectives and exit competencies are presented and course sections are described: definitions, introduction to technical aspects of telemedicine, evolution of telemedicine and its impact on health care delivery, success and failure factors, and legal and ethical issues. The emphasis is on literature review tools, practical exposure to products and applications, and problem-based learning. Given the rapid advances in the telecommunication field, keeping the course material up to date becomes a challenge for the instructor who at the same time aims to equip students with the knowledge and tools they will need in their future role as decision makers to detect a need for, design, implement, maintain, or evaluate a telemedicine application. PMID:12668696

An 802.11 n wireless local area network transmission scheme for wireless telemedicine applications.

PubMed

Lin, C F; Hung, S I; Chiang, I H

2010-10-01

In this paper, an 802.11 n transmission scheme is proposed for wireless telemedicine applications. IEEE 802.11n standards, a power assignment strategy, space-time block coding (STBC), and an object composition Petri net (OCPN) model are adopted. With the proposed wireless system, G.729 audio bit streams, Joint Photographic Experts Group 2000 (JPEG 2000) clinical images, and Moving Picture Experts Group 4 (MPEG-4) video bit streams achieve a transmission bit error rate (BER) of 10-7, 10-4, and 103 simultaneously. The proposed system meets the requirements prescribed for wireless telemedicine applications. An essential feature of this proposed transmission scheme is that clinical information that requires a high quality of service (QoS) is transmitted at a high power transmission rate with significant error protection. For maximizing resource utilization and minimizing the total transmission power, STBC and adaptive modulation techniques are used in the proposed 802.11 n wireless telemedicine system. Further, low power, direct mapping (DM), low-error protection scheme, and high-level modulation are adopted for messages that can tolerate a high BER. With the proposed transmission scheme, the required reliability of communication can be achieved. Our simulation results have shown that the proposed 802.11 n transmission scheme can be used for developing effective wireless telemedicine systems.

Telemedicine in chronic obstructive pulmonary disease

PubMed Central

Vagheggini, Guido; Mazzoleni, Stefano; Vitacca, Michele

2016-01-01

Telemedicine is a medical application of advanced technology to disease management. This modality may provide benefits also to patients with chronic obstructive pulmonary disease (COPD). Different devices and systems are used. The legal problems associated with telemedicine are still controversial. Economic advantages for healthcare systems, though potentially high, are still poorly investigated. A European Respiratory Society Task Force has defined indications, follow-up, equipment, facilities, legal and economic issues of tele-monitoring of COPD patients including those undergoing home mechanical ventilation. Key points The costs of care assistance in chronic disease patients are dramatically increasing. Telemedicine may be a very useful application of information and communication technologies in high-quality healthcare services. Many remote health monitoring systems are available, ensuring safety, feasibility, effectiveness, sustainability and flexibility to face different patients’ needs. The legal problems associated with telemedicine are still controversial. National and European Union governments should develop guidelines and ethical, legal, regulatory, technical, administrative standards for remote medicine. The economic advantages, if any, of this new approach must be compared to a “gold standard” of homecare that is very variable among different European countries and within each European country. The efficacy of respiratory disease telemedicine projects is promising (i.e. to tailor therapeutic intervention; to avoid useless hospital and emergency department admissions, and reduce general practitioner and specialist visits; and to involve the patients and their families). Different programmes based on specific and local situations, and on specific diseases and levels of severity with a high level of flexibility should be utilised. A European Respiratory Society Task Force produced a statement on commonly accepted clinical criteria for indications

Nine human factors contributing to the user acceptance of telemedicine applications: a cognitive-emotional approach.

PubMed

Buck, Susanne

2009-01-01

Much attention is paid to the technical aspects of telemedicine in the development of new applications, but the enthusiasm about what is technically possible very often leads to the user acceptance of such products being neglected. The number of successful and sustainable telemedicine applications would be much higher if developers concentrated more on matters related to the cognitive-emotional situation of the users involved in telemedicine. The users include the care and cure providers, as well as the care and cure receivers. Based on an informal literature search and discussions with telemedicine implementation staff, nine factors have been identified which are essential for the user acceptance of telemedicine applications. All of them are connected more to the cognitive-emotional than to the cognitive-rational side of information processing. This suggests that in the future the cognitive-emotional side will need more attention. This in turn implies that the nine points mentioned above have to find their way into requirements engineering, development processes and product life cycles.

Real-Time and Near Real-Time Data for Space Weather Applications and Services

NASA Astrophysics Data System (ADS)

Singer, H. J.; Balch, C. C.; Biesecker, D. A.; Matsuo, T.; Onsager, T. G.

2015-12-01

Space weather can be defined as conditions in the vicinity of Earth and in the interplanetary environment that are caused primarily by solar processes and influenced by conditions on Earth and its atmosphere. Examples of space weather are the conditions that result from geomagnetic storms, solar particle events, and bursts of intense solar flare radiation. These conditions can have impacts on modern-day technologies such as GPS or electric power grids and on human activities such as astronauts living on the International Space Station or explorers traveling to the moon or Mars. While the ultimate space weather goal is accurate prediction of future space weather conditions, for many applications and services, we rely on real-time and near-real time observations and model results for the specification of current conditions. In this presentation, we will describe the space weather system and the need for real-time and near-real time data that drive the system, characterize conditions in the space environment, and are used by models for assimilation and validation. Currently available data will be assessed and a vision for future needs will be given. The challenges for establishing real-time data requirements, as well as acquiring, processing, and disseminating the data will be described, including national and international collaborations. In addition to describing how the data are used for official government products, we will also give examples of how these data are used by both the public and private sector for new applications that serve the public.

Systematic Review of Real-time Remote Health Monitoring System in Triage and Priority-Based Sensor Technology: Taxonomy, Open Challenges, Motivation and Recommendations.

PubMed

Albahri, O S; Albahri, A S; Mohammed, K I; Zaidan, A A; Zaidan, B B; Hashim, M; Salman, Omar H

2018-03-22

The new and ground-breaking real-time remote monitoring in triage and priority-based sensor technology used in telemedicine have significantly bounded and dispersed communication components. To examine these technologies and provide researchers with a clear vision of this area, we must first be aware of the utilised approaches and existing limitations in this line of research. To this end, an extensive search was conducted to find articles dealing with (a) telemedicine, (b) triage, (c) priority and (d) sensor; (e) comprehensively review related applications and establish the coherent taxonomy of these articles. ScienceDirect, IEEE Xplore and Web of Science databases were checked for articles on triage and priority-based sensor technology in telemedicine. The retrieved articles were filtered according to the type of telemedicine technology explored. A total of 150 articles were selected and classified into two categories. The first category includes reviews and surveys of triage and priority-based sensor technology in telemedicine. The second category includes articles on the three-tiered architecture of telemedicine. Tier 1 represents the users. Sensors acquire the vital signs of the users and send them to Tier 2, which is the personal gateway that uses local area network protocols or wireless body area network. Medical data are sent from Tier 2 to Tier 3, which is the healthcare provider in medical institutes. Then, the motivation for using triage and priority-based sensor technology in telemedicine, the issues related to the obstruction of its application and the development and utilisation of telemedicine are examined on the basis of the findings presented in the literature.

[Principles for the evaluation of telemedicine applications: Results of a systematic review and consensus process].

PubMed

Arnold, Katrin; Scheibe, Madlen; Müller, Olaf; Schmitt, Jochen

2016-11-01

The limited number of telemedicine applications being transferred to standard medical care in Germany may to some extent be explained by deficits in the current evaluation practice. Effectiveness and cost effectiveness can only be demonstrated to decision makers and potential users with methodologically sound and fully published evaluations. There is a lack of well-founded and mandatory standards for adequate, comparable evaluations of telemedicine applications. As part of the project CCS Telehealth Eastern Saxony (CCS THOS), a systematic review on evaluation concepts for telemedicine applications (search period until September 2014, databases Medline, Embase, HTA-Database, DARE, NHS EED) as well as an additional selective literature search were conducted. Suggestions for evaluation fundamentals were derived from the results. These suggestions were subjected to a formal consensus process (nominal group process) with relevant stakeholder groups (healthcare payers, healthcare providers, health policy representatives, researchers). 19 papers were included in the systematic review. In accordance with the predefined inclusion criteria, each presented an evaluation concept for telemedicine applications that was based upon a systematic review and/or a consensus process. Via a formal consensus process, the suggestions for evaluation principles derived from the review and the selective literature search (23 papers) resulted in ten agreed evaluation principles. Eight of them were unanimously agreed upon, two were arrived at with one abstention each. The principles enclose criteria for the planning, conduct and reporting of telemedicine evaluations. Adherence to them is obligatory for users of the telemedical infrastructure provided by CCS THOS. Furthermore, right from the beginning the intention was very much for these principles to be seized upon by other projects and initiatives. The agreed evaluation principles for telemedicine applications are the first in Germany to be

Urban Telemedicine: The Applicability of Teleburns in the Rehabilitative Phase.

PubMed

Liu, Yuk Ming; Mathews, Katie; Vardanian, Andrew; Bozkurt, Taylan; Schneider, Jeffrey C; Hefner, Jaye; Schulz, John T; Fagan, Shawn P; Goverman, Jeremy

Telemedicine has been successfully used in many areas of medicine, including triage and evaluation of the acute burn patient. The utility of telemedicine during the rehabilitative phase of burn care has yet to be evaluated; therefore, we expanded our telemedicine program to link our burn center with a rehabilitation facility. The goal of this project was to demonstrate cost-effective improvements in the transition and quality of care. A retrospective review was performed on all patients enrolled in our telemedicine/rehabilitation program between March 2013 and March 2014. Data collected included total number of encounters, visits, type of visit, physician time, and readmissions. Transportation costs were based on local ambulance rates between the two facilities. The impact of telemedicine was evaluated with respect to the time saved for the physician, burn center, and burn clinic, as well as rehabilitative days saved. A patient satisfaction survey was also administered. A total of 29 patients participated in 73 virtual visits through the telemedicine project. Virtual visits included new consults, preoperative evaluations, and postoperative follow-ups. A total of 146 ambulance transports were averted during the study period, totaling $101,110. Virtual visits saved 6.8 outpatient burn clinic days, or 73 clinic appointments of 30-min duration. The ability to perform more outpatient surgery resulted in 80 inpatient bed days saved at the burn hospital. The rehabilitation hospital saved an average of 2 to 3 patient days secondary to unnecessary travel. Satisfaction surveys demonstrated patient satisfaction with the encounters, primarily related to time saved. The decrease in travel time for the patient from the rehabilitation hospital to outpatient burn clinic improved adherence to the rehabilitation care plan and resulted in increased throughput at the rehabilitation facility. Videoconferencing between a burn center and rehabilitation hospital streamlined patient care

Seahawk: telemedicine project in the Pacific Northwest

NASA Astrophysics Data System (ADS)

Kim, Yongmin; Cabral, James E., Jr.; Parsons, David M.; Lipski, Gregory L.; Kirchdoerfer, Richard G.; Sado, Anthony; Bender, Gregory N.; Goeringer, Fred

1995-05-01

Telemedicine is becoming increasingly possible due to the confluence of ongoing technical advances in such areas as telecommunications, imaging, multimedia, computers, and information systems. Project Seahawk is a regional telemedicine program in the Pacific Northwest with Madigan Army Medical Center (MAMC) as the hub connecting various military and other federal hospitals and clinics utilizing the state-of-the-art technologies. The first phase of Project Seahawk successfully connected MAMC in Tacoma, Wash. to the University of Washington in Seattle, Wash. through the Western Washington Local Access Transport Area (LATA) Integrated Optical Network (LION) Sonet Ring using asynchronous transfer mode (ATM) and two MediaStation 5000s as a feasibility demonstration. Several telemedicine scenarios were demonstrated including synchronized image manipulation, real- time transmission of ultrasound and medical images, and video and audio teleconferencing, and remote consultation. The second phase implementation will consist of increasing the number of hospitals and clinics with telemedicine capability, e.g., Bremerton Naval Hospital, Oak Harbor Naval Hospital, Seattle VA, and American Lake VA.

Telemedicine in neurosurgical emergency: Indian perspective

PubMed Central

Sinha, Virendra Deo; Tiwari, Rahul Nath; Kataria, Rashim

2012-01-01

Telemedicine is rapidly developing telecommunication technology to provide medical information and services. The importance of telemedicine for neurosurgical emergencies was established with the fact that majority of the neurosurgical specialists are practicing in urban settings and in most of the rural areas, neurosurgical care is far off or non-existing. Countries with inadequate health care must incorporate telemedicine in their health care system. Telemedicine offers real benefits in a country as vast as India, where the majority of the population lives in remote areas with no access to even the most basic healthcare. Issues pertaining security, privacy, maintaining standards, and legal aspects are relevant. A recommended set of standards and guidelines for telemedicine needs to be set in place and constantly refined to promote the integrated growth of telemedicine in the country. The paper discusses various issues, shortcomings, and utility of telemedicine in India. PMID:22870155

Pre-hospital electrocardiogram triage with telemedicine near halves time to treatment in STEMI: A meta-analysis and meta-regression analysis of non-randomized studies.

PubMed

Brunetti, Natale Daniele; De Gennaro, Luisa; Correale, Michele; Santoro, Francesco; Caldarola, Pasquale; Gaglione, Antonio; Di Biase, Matteo

2017-04-01

A shorter time to treatment has been shown to be associated with lower mortality rates in acute myocardial infarction (AMI). Several strategies have been adopted with the aim to reduce any delay in diagnosis of AMI: pre-hospital triage with telemedicine is one of such strategies. We therefore aimed to measure the real effect of pre-hospital triage with telemedicine in case of AMI in a meta-analysis study. We performed a meta-analysis of non-randomized studies with the aim to quantify the exact reduction of time to treatment achieved by pre-hospital triage with telemedicine. Data were pooled and compared by relative time reduction and 95% C.I.s. A meta-regression analysis was performed in order to find possible predictors of shorter time to treatment. Eleven studies were selected and finally evaluated in the study. The overall relative reduction of time to treatment with pre-hospital triage and telemedicine was -38/-40% (p<0.001). Absolute time reduction was significantly correlated to time to treatment in the control groups (p<0.001), while relative time reduction was independent. A non-significant trend toward shorter relative time reductions was observed over years. Pre-hospital triage with telemedicine is associated with a near halved time to treatment in AMI. The benefit is larger in terms of absolute time to treatment reduction in populations with larger delays to treatment. Copyright © 2017 Elsevier B.V. All rights reserved.

The Portable Dynamic Fundus Instrument: Uses in telemedicine and research

NASA Technical Reports Server (NTRS)

Hunter, Norwood; Caputo, Michael; Billica, Roger; Taylor, Gerald; Gibson, C. Robert; Manuel, F. Keith; Mader, Thomas; Meehan, Richard

1994-01-01

For years ophthalmic photographs have been used to track the progression of many ocular diseases such as macular degeneration and glaucoma as well as the ocular manifestations of diabetes, hypertension, and hypoxia. In 1987 a project was initiated at the Johnson Space Center (JSC) to develop a means of monitoring retinal vascular caliber and intracranial pressure during space flight. To conduct telemedicine during space flight operations, retinal images would require real-time transmissions from space. Film-based images would not be useful during in-flight operations. Video technology is beneficial in flight because the images may be acquired, recorded, and transmitted to the ground for rapid computer digital image processing and analysis. The computer analysis techniques developed for this project detected vessel caliber changes as small as 3 percent. In the field of telemedicine, the Portable Dynamic Fundus Instrument demonstrates the concept and utility of a small, self-contained video funduscope. It was used to record retinal images during the Gulf War and to transmit retinal images from the Space Shuttle Columbia during STS-50. There are plans to utilize this device to provide a mobile ophthalmic screening service in rural Texas. In the fall of 1993 a medical team in Boulder, Colorado, will transmit real-time images of the retina during remote consultation and diagnosis. The research applications of this device include the capability of operating in remote locations or small, confined test areas. There has been interest shown utilizing retinal imaging during high-G centrifuge tests, high-altitude chamber tests, and aircraft flight tests. A new design plan has been developed to incorporate the video instrumentation into face-mounted goggle. This design would eliminate head restraint devices, thus allowing full maneuverability to the subjects. Further development of software programs will broaden the application of the Portable Dynamic Fundus Instrument in

International telemedicine consultations for neurodevelopmental disabilities.

PubMed

Pearl, Phillip L; Sable, Craig; Evans, Sarah; Knight, Joseph; Cunningham, Parker; Lotrecchiano, Gaetano R; Gropman, Andrea; Stuart, Sheela; Glass, Penny; Conway, Anne; Ramadan, Issam; Paiva, Tania; Batshaw, Mark L; Packer, Roger J

2014-06-01

A telemedicine program was developed between the Children's National Medical Center (CNMC) in Washington, DC, and the Sheikh Khalifa Bin Zayed Foundation in the United Arab Emirates (UAE). A needs assessment and a curriculum of on-site training conferences were devised preparatory to an ongoing telemedicine consultation program for children with neurodevelopmental disabilities in the underserved eastern region of the UAE. Weekly telemedicine consultations are provided by a multidisciplinary faculty. Patients are presented in the UAE with their therapists and families. Real-time (video over Internet protocol; average connection, 768 kilobits/s) telemedicine conferences are held weekly following previews of medical records. A full consultation report follows each telemedicine session. Between February 29, 2012 and June 26, 2013, 48 weekly 1-h live interactive telemedicine consultations were conducted on 48 patients (28 males, 20 females; age range, 8 months-22 years; median age, 5.4 years). The primary diagnoses were cerebral palsy, neurogenetic disorders, autism, neuromuscular disorders, congenital anomalies, global developmental delay, systemic disease, and epilepsy. Common comorbidities were cognitive impairment, communication disorders, and behavioral disorders. Specific recommendations included imaging and DNA studies, antiseizure management, spasticity management including botulinum toxin protocols, and specific therapy modalities including taping techniques, customized body vests, and speech/language and behavioral therapy. Improved outcomes reported were in clinician satisfaction, achievement of therapy goals for patients, and requests for ongoing sessions. Weekly telemedicine sessions coupled with triannual training conferences were successfully implemented in a clinical program dedicated to patients with neurodevelopmental disabilities by the Center for Neuroscience at CNMC and the UAE government. International consultations in neurodevelopmental

Telemedicine and Plastic Surgery: A Pilot Study.

PubMed

Valente, Denis Souto; Silveira Eifler, Luciano; Carvalho, Lauro Aita; Filho, Gustavo Azambuja Pereira; Ribeiro, Vinicius Weissheimer; Padoin, Alexandre Vontobel

2015-01-01

Background. Telemedicine can be defined as the use of electronic media for transmission of information and medical data from one site to another. The objective of this study is to demonstrate an experience of telemedicine in plastic surgery. Methods. 32 plastic surgeons received a link with password for real-time streaming of a surgery. At the end of the procedure, the surgeons attending the procedure by the Internet answered five questions. The results were analyzed with descriptive statistics. Results. 27 plastic surgeons attended the online procedure in real-time. 96.3% considered the access to the website as good or excellent and 3.7% considered it bad. 14.8% reported that the transmission was bad and 85.2% considered the quality of transmission as good or excellent. 96.3% classified the live broadcasting as a good or excellent learning experience and 3.7% considered it a bad experience. 92.6% reported feeling able to perform this surgery after watching the demo and 7.4% did not feel able. 100% of participants said they would like to participate in other surgical demonstrations over the Internet. Conclusion. We conclude that the use of telemedicine can provide more access to education and medical research, for plastic surgeons looking for medical education from distant regions.

Real-time hyperspectral imaging for food safety applications

USDA-ARS?s Scientific Manuscript database

Multispectral imaging systems with selected bands can commonly be used for real-time applications of food processing. Recent research has demonstrated several image processing methods including binning, noise removal filter, and appropriate morphological analysis in real-time mode can remove most fa...

Telemedicine in the context of different medical specialities. The Polish perspective.

PubMed

Rudowski, Robert

2003-01-01

Two types of telemedicine are considered in the paper: pre-recorded and real-time. The advantages and disadvantages of each type are described.The choice of telemedicine type depends on medical speciality. The separate branch of telemedicine--teleprevention of civilization diseases is discussed and examples of relevant WWW services in Poland are given. The own work examples of the Dept. of Medical Informatics, MUW, namely Onco-service of 200 protocols used in hematology and oncology and Cardio.net--a distributed teleinformation system for cardiology, are presented. the barriers of the development of telemedicine in Poland are caused by the organization of health service--Patients Funds using different software, no messaging standards and different reimbursement systems.

REAL-TIME ENVIRONMENTAL MONITORING: APPLICATIONS FOR HOMELAND SECURITY

EPA Science Inventory

Real-time monitoring technology developed as part of the EMPACT program has a variety of potential applications. These tools can measure a variety of potential contaminants in the air, water, in buildings, or in the soil. Real-time monitoring technology allows these detection sys...

Application of Ethics for Providing Telemedicine Services and Information Technology

PubMed Central

Langarizadeh, Mostafa; Moghbeli, Fatemeh; Aliabadi, Ali

2017-01-01

Introduction: Advanced technology has increased the use of telemedicine and Information Technology (IT) in treating or rehabilitating diseases. An increased use of technology increases the importance of the ethical issues involved. The need for keeping patients’ information confidential and secure, controlling a number of therapists’ inefficiency as well as raising the quality of healthcare services necessitates adequate heed to ethical issues in telemedicine provision. Aim: The goal of this review is gathering all articles that are published through 5 years until now (2012-2017) for detecting ethical issues for providing telemedicine services and Information technology. The reason of this time is improvement of telemedicine and technology through these years. This article is important for clinical practice and also to world, because of knowing ethical issues in telemedicine and technology are always important factors for physician and health providers. Material and methods: the required data in this research were derived from published electronic sources and credible academic articles published in such databases as PubMed, Scopus and Science Direct. The following key words were searched for in separation and combination: tele-health, telemedicine, ethical issues in telemedicine. A total of 503 articles were found. After excluding the duplicates (n= 93), the titles and abstracts of 410 articles were skimmed according to the inclusion criteria. Finally, 64 articles remained. They were reviewed in full text and 36 articles were excluded. At the end, 28 articles were chosen which met our eligibility criteria and were included in this study. Results: Ethics has been of a great significance in IT and telemedicine especially the Internet since there are more chances provided for accessing information. It is, however, accompanied by a threat to patients’ personal information. Therefore, suggestions are made to investigate ethics in technology, to offer standards and

Application of Ethics for Providing Telemedicine Services and Information Technology.

PubMed

Langarizadeh, Mostafa; Moghbeli, Fatemeh; Aliabadi, Ali

2017-10-01

Advanced technology has increased the use of telemedicine and Information Technology (IT) in treating or rehabilitating diseases. An increased use of technology increases the importance of the ethical issues involved. The need for keeping patients' information confidential and secure, controlling a number of therapists' inefficiency as well as raising the quality of healthcare services necessitates adequate heed to ethical issues in telemedicine provision. The goal of this review is gathering all articles that are published through 5 years until now (2012-2017) for detecting ethical issues for providing telemedicine services and Information technology. The reason of this time is improvement of telemedicine and technology through these years. This article is important for clinical practice and also to world, because of knowing ethical issues in telemedicine and technology are always important factors for physician and health providers. the required data in this research were derived from published electronic sources and credible academic articles published in such databases as PubMed, Scopus and Science Direct. The following key words were searched for in separation and combination: tele-health, telemedicine, ethical issues in telemedicine. A total of 503 articles were found. After excluding the duplicates (n= 93), the titles and abstracts of 410 articles were skimmed according to the inclusion criteria. Finally, 64 articles remained. They were reviewed in full text and 36 articles were excluded. At the end, 28 articles were chosen which met our eligibility criteria and were included in this study. Ethics has been of a great significance in IT and telemedicine especially the Internet since there are more chances provided for accessing information. It is, however, accompanied by a threat to patients' personal information. Therefore, suggestions are made to investigate ethics in technology, to offer standards and guidelines to therapists. Due to the advancement in

Internet technologies and requirements for telemedicine

NASA Technical Reports Server (NTRS)

Lamaster, H.; Meylor, J.; Meylor, F.

1997-01-01

Internet technologies are briefly introduced and those applicable for telemedicine are reviewed. Multicast internet technologies are described. The National Aeronautics and Space Administration (NASA) 'Telemedicine Space-bridge to Russia' project is described and used to derive requirements for internet telemedicine. Telemedicine privacy and Quality of Service (QoS) requirements are described.

Telemedicine in veterinary practice.

PubMed

Mars, M; Auer, R E J

2006-06-01

Veterinary surgeons have a long tradition of consulting one another about problem cases and many have unwittingly practised telemedicine when discussing cases by telephone or by sending laboratory reports by telefax. Specific veterinary telemedicine applications have been in use since the early 1980s, but little research has been undertaken in this field. The Pubmed and CAB International databases were searched for the following Boolean logic-linked keywords; veterinary and telemedicine, veterinary and telecare, animal and telemedicine, animal and telecare and veterinary and e-mail and an additional search was made of the worldwide web, using Google Scholar. This returned 25 papers which were reviewed. Of these only 2 report research. Sixteen papers had no references and 1 author was associated with 13 papers. Several themes emerge in the papers reviewed. These include remarks about the use of telemedicine, the benefits that can and are derived from the use of telemedicine, areas of practice in which telemedicine is being used, ethical and legal issues around the practice of telemedicine, image standards required for telemedicine, the equipment that is required for the practice of telemedicine, advice on ways in which digital images can be obtained and educational aspects of telemedicine. These are discussed. Veterinary practice has lagged behind its human counterpart in producing research on the validity and efficacy of telemedicine. This is an important field which requires further research.

Development of Telemedicine Capabilities for a Joint US-Russian Space Biomedical Center for Training and Research

NASA Technical Reports Server (NTRS)

DeBakey, Michael E.

1998-01-01

From the perspective of scheduling, some medical consultations can have asynchronous and synchronous components. Consultations frequently involve the compilation of patient data, its analysis, a consultant's report, and a real-time conference between the referring physician and the consultant. The bandwidth of the Internet with Moscow and advances in the hardware and software of personal computing now make possible telemedicine events with store-and-forward components and real-time components. These are hybrid telemedicine and this paper describes such a case.

Telemedicine in pediatric cardiac critical care.

PubMed

Munoz, Ricardo A; Burbano, Nelson H; Motoa, María V; Santiago, Gabriel; Klevemann, Matthew; Casilli, Jeanne

2012-03-01

To describe our international telemedicine experience in pediatric cardiac critical care. This is a case series of pediatric patients teleassisted from the Cardiac Intensive Care Unit (CICU) at Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, Pittsburgh, PA, to the CICU at Hospital Valle del Lili, Cali, Valle, Colombia, between March and December 2010. An attending intensivist from the CICU in Pittsburgh reviewed cases, monitored real-time vital signs, and gave formal medical advice as requested by the attending physician in Cali. The network connection is a Cisco (San Jose, CA)-based Secure Sockets Layer virtual private network via the Internet that allows access to the web-based interface of the Dräger(®) (Lübeck, Germany) physiological monitor system. The videoconferencing equipment consists of a standard component on a custom-made mobile cart that uses an APC(®) (West Kingston, RI) uninterruptible power supply for portable power and 3Com(®) (Hewlett-Packard, Palo Alto, CA) for wireless connectivity. A post-intervention survey regarding satisfaction with the telemedicine service was conducted. Seventy-one recommendations were given regarding 53 patients. Median age and weight were 10 months and 7.1 kg, respectively. Ventricular septal defect, transposition of the great vessels, and single ventricle accounted for most cases. The most frequent recommendations were related to surgical conduct, management of arrhythmias, and performance of cardiac catheterization studies. No technical difficulties were experienced during the monitoring of the patients. Satisfaction rates were equally high for technical and medical aspects of telemedicine service. Telemedicine is a feasible option for pediatric intensivists seeking experienced assistance in the management of complex cardiac patients. Real-time remote assistance may improve the medical care of pediatric cardiac patients treated in developing countries.

Embracing a Revolution - Telemedicine.

PubMed

Dheer, Ajay; Chaturvedi, R K

2005-01-01

The recent advances in information and communication technologies offer real and practical opportunities to health professionals to share expertise and resources in health care over distances. For a country like India with pockets of medical excellence surrounded by a vast number of badly equipped hospitals with limited specialists, telemedicine could revolutionize health care. The potential of telemedicine seem to be vital in avoiding the frame of travel, in timely getting specialist advise to remote areas, minimizing the cost and of course an opportunity to learn from each other. In developed countries the technological advancement and research aims primarily to satiate the needs of their armed forces and to ensure tactical and technical supremacy. The medical community in the Indian Armed Forces should harness the technologies and embrace this revolution of the information age to provide world class combat casualty care.

The Use of Telemedicine for Penicillin Allergy Skin Testing.

PubMed

Staicu, Mary L; Holly, Anne Marie; Conn, Kelly M; Ramsey, Allison

2018-05-08

Penicillin skin testing (PST) is increasingly used as a tool to evaluate penicillin allergy in patients with a reported history. The limited availability of allergists, however, may be an impeding factor. We sought to assess the clinical utility of telemedicine to facilitate PST. Penicillin-allergic inpatients receiving systemic antibiotics were prospectively identified between April and August 2017. Qualifying patients underwent PST performed by a trained allergy/immunology physician assistant (PA). On completion of PST, a telemedicine consultation, through the use of real-time interactive video conferencing (Microsoft Lync 2013, Redmond, Wash), was performed remotely by an allergist. Patients were surveyed regarding their satisfaction with the telemedicine experience. Fifty patients consented to PST through a telemedicine consultation. The average total time to complete a consultation was 128 minutes (standard deviation [SD] ± 33). Of this, the average PA travel time was 46 minutes (36%) with the remaining time spent on clinical services (82 minutes, 64%). The average physician telemedicine time per patient was 5 minutes (SD ± 2). Patients rated their experience as an average of 4.5 on a scale of 1 (highly unsatisfied) to 5 (highly satisfied). Of the 46 PST-negative patients, 33 were transitioned to a β-lactam antibiotic that reduced the use of vancomycin, metronidazole, aztreonam, aminoglycosides, and clindamycin (P < .05). More than $30,000 was saved throughout the study period. Telemedicine is an effective and novel approach to facilitate PST in the inpatient setting and carries a high degree of patient satisfaction. This method has the potential to optimize and improve access to allergy/immunology resources. Copyright © 2018 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

Telemedicine, virtual reality, and surgery

NASA Technical Reports Server (NTRS)

Mccormack, Percival D.; Charles, Steve

1994-01-01

Two types of synthetic experience are covered: virtual reality (VR) and surgery, and telemedicine. The topics are presented in viewgraph form and include the following: geometric models; physiological sensors; surgical applications; virtual cadaver; VR surgical simulation; telesurgery; VR Surgical Trainer; abdominal surgery pilot study; advanced abdominal simulator; examples of telemedicine; and telemedicine spacebridge.

Telemedicine in Gastroenterohepatology

PubMed Central

Zildzic, Muharem; Salihefendic, Nizama; Krupic, Ferid; Beganovic, Emina; Zunic, Lejla; Masic, Izet

2014-01-01

Telemedicine itself is not the medical profession, it is not a medical specialty, but the way in which the medical profession conduct its activity. Therefore we are talking about tele otorhinolaryngology, tele cardiology or tele pathology. In the definition of a multitude of telemedicine that can be found in the literature is the following: Telemedicine is a system that supports the process of health care by providing ways and means for more efficient exchange of information that allows multitude of activities related to health care, including health care and health personnel, including education, administration and treatment. Telemedicine applications include tele diagnosis, tele consultation, tele monitoring, tele-care, tele consultations and remote access to information contained in one or more databases. It turned out that telemedicine is an important factor in technological, professional, financial and organizational uniformity of development of the health system. Telemedicine, although a new area, to a large extent already changed the ways of providing health care, and even more influence on the ways of designing the future of medicine. PMID:25395732

Adoption of telemedicine: from pilot stage to routine delivery

PubMed Central

2012-01-01

Background Today there is much debate about why telemedicine has stalled. Teleradiology is the only widespread telemedicine application. Other telemedicine applications appear to be promising candidates for widespread use, but they remain in the early adoption stage. The objective of this debate paper is to achieve a better understanding of the adoption of telemedicine, to assist those trying to move applications from pilot stage to routine delivery. Discussion We have investigated the reasons why telemedicine has stalled by focusing on two, high-level topics: 1) the process of adoption of telemedicine in comparison with other technologies; and 2) the factors involved in the widespread adoption of telemedicine. For each topic, we have formulated hypotheses. First, the advantages for users are the crucial determinant of the speed of adoption of technology in healthcare. Second, the adoption of telemedicine is similar to that of other health technologies and follows an S-shaped logistic growth curve. Third, evidence of cost-effectiveness is a necessary but not sufficient condition for the widespread adoption of telemedicine. Fourth, personal incentives for the health professionals involved in service provision are needed before the widespread adoption of telemedicine will occur. Summary The widespread adoption of telemedicine is a major -- and still underdeveloped -- challenge that needs to be strengthened through new research directions. We have formulated four hypotheses, which are all susceptible to experimental verification. In particular, we believe that data about the adoption of telemedicine should be collected from applications implemented on a large-scale, to test the assumption that the adoption of telemedicine follows an S-shaped growth curve. This will lead to a better understanding of the process, which will in turn accelerate the adoption of new telemedicine applications in future. Research is also required to identify suitable financial and

Impact of a University-Based Outpatient Telemedicine Program on Time Savings, Travel Costs, and Environmental Pollutants.

PubMed

Dullet, Navjit W; Geraghty, Estella M; Kaufman, Taylor; Kissee, Jamie L; King, Jesse; Dharmar, Madan; Smith, Anthony C; Marcin, James P

2017-04-01

The objective of this study was to estimate travel-related and environmental savings resulting from the use of telemedicine for outpatient specialty consultations with a university telemedicine program. The study was designed to retrospectively analyze the telemedicine consultation database at the University of California Davis Health System (UCDHS) between July 1996 and December 2013. Travel distances and travel times were calculated between the patient home, the telemedicine clinic, and the UCDHS in-person clinic. Travel cost savings and environmental impact were calculated by determining differences in mileage reimbursement rate and emissions between those incurred in attending telemedicine appointments and those that would have been incurred if a visit to the hub site had been necessary. There were 19,246 consultations identified among 11,281 unique patients. Telemedicine visits resulted in a total travel distance savings of 5,345,602 miles, a total travel time savings of 4,708,891 minutes or 8.96 years, and a total direct travel cost savings of $2,882,056. The mean per-consultation round-trip distance savings were 278 miles, average travel time savings were 245 minutes, and average cost savings were $156. Telemedicine consultations resulted in a total emissions savings of 1969 metric tons of CO 2 , 50 metric tons of CO, 3.7 metric tons of NO x , and 5.5 metric tons of volatile organic compounds. This study demonstrates the positive impact of a health system's outpatient telemedicine program on patient travel time, patient travel costs, and environmental pollutants. Copyright © 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Ultrasound in telemedicine: its impact in high-risk obstetric health care delivery.

PubMed

Long, Megan Chang; Angtuaco, Teresita; Lowery, Curtis

2014-09-01

The aim of this study was to determine the impact of Antenatal and Neonatal Guidelines, Education, and Learning System (ANGELS), a statewide telemedicine project, on health care delivery to patients with high-risk pregnancies in Arkansas. With institutional review board approval, a Health Insurance Portability and Accountability Act-compliant retrospective review, in which the requirement for informed patient consent was waived, was performed. The population studied is the Arkansas maternal Medicaid population. Data for evaluation were collected from maternal Medicaid claims, ANGELS administrative records, and birth records from the Arkansas Vital Statistics record system. Data collected from before the inception of ANGELS (2001-2003) were compared with data collected after the inception of ANGELS (2004-2007).Antenatal and Neonatal Guidelines, Education, and Learning System is a multidisciplinary, multifaceted telemedicine program designed in Arkansas to enhance high-risk obstetric health care delivery across the state. An essential component of the program is real-time interactive targeted level II ultrasound examination of patients. Since the inception of the ANGELS program in 2003, a growing number of telemedicine consultations and real-time ultrasound examinations are being performed every year. The number and percentage of high-risk pregnancies identified each year show a slight decrease since inception of the ANGELS program, and findings suggest that identification of high-risk pregnancies is shifting from the second trimester to the first trimester, but trends vary over time. Antenatal and Neonatal Guidelines, Education, and Learning System has created a telemedicine network across the state that has made possible, among many other things, access to real-time level II ultrasound examinations and consultations. This program has ultimately led to improved prenatal access across the state.

Real-time speech gisting for ATC applications

NASA Astrophysics Data System (ADS)

Dunkelberger, Kirk A.

1995-06-01

Command and control within the ATC environment remains primarily voice-based. Hence, automatic real time, speaker independent, continuous speech recognition (CSR) has many obvious applications and implied benefits to the ATC community: automated target tagging, aircraft compliance monitoring, controller training, automatic alarm disabling, display management, and many others. However, while current state-of-the-art CSR systems provide upwards of 98% word accuracy in laboratory environments, recent low-intrusion experiments in the ATCT environments demonstrated less than 70% word accuracy in spite of significant investments in recognizer tuning. Acoustic channel irregularities and controller/pilot grammar verities impact current CSR algorithms at their weakest points. It will be shown herein, however, that real time context- and environment-sensitive gisting can provide key command phrase recognition rates of greater than 95% using the same low-intrusion approach. The combination of real time inexact syntactic pattern recognition techniques and a tight integration of CSR, gisting, and ATC database accessor system components is the key to these high phase recognition rates. A system concept for real time gisting in the ATC context is presented herein. After establishing an application context, discussion presents a minimal CSR technology context then focuses on the gisting mechanism, desirable interfaces into the ATCT database environment, and data and control flow within the prototype system. Results of recent tests for a subset of the functionality are presented together with suggestions for further research.

Telemedicine is as effective as in-person visits for patients with asthma.

PubMed

Portnoy, Jay M; Waller, Morgan; De Lurgio, Stephen; Dinakar, Chitra

2016-09-01

Access to asthma specialists is a problem, particularly in rural areas, thus presenting an opportunity for management using telemedicine. To compare asthma outcomes during 6 months in children managed by telemedicine vs in-person visits. Children with asthma residing in 2 remote locations were offered the choice of an in-person visit or a telemedicine session at a local clinic. The telemedicine process involved real-time use of a Remote Presence Solution (RPS) equipped with a digital stethoscope, otoscope, and high-resolution camera. A telefacilitator operated the RPS and performed diagnostic and educational procedures, such as spirometry and asthma education. Children in both groups were assessed initially, after 30 days, and at 6 months. Asthma outcome measures included asthma control using validated tools (Asthma Control Test, Childhood Asthma Control Test, and Test for Respiratory and Asthma Control in Kids) and patient satisfaction (telemedicine group only). Noninferiority analysis of asthma control was performed using the minimally important difference of an adjusted asthma control test that combined the 3 age groups. Of 169 children, 100 were seen in-person and 69 via telemedicine. A total of 34 in-person and 40 telemedicine patients completed all 3 visits. All had a small, although statistically insignificant, improvement in asthma control over time. Telemedicine was noninferior to in-person visits. Most of the telemedicine group subjects were satisfied with their experience. Children with asthma seen by telemedicine or in-person visits can achieve comparable degrees of asthma control. Telemedicine can be a viable alternative to traditional in-person physician-based care for the treatment and management of asthma. Copyright © 2016 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

Scheduling in Sensor Grid Middleware for Telemedicine Using ABC Algorithm

PubMed Central

Vigneswari, T.; Mohamed, M. A. Maluk

2014-01-01

Advances in microelectromechanical systems (MEMS) and nanotechnology have enabled design of low power wireless sensor nodes capable of sensing different vital signs in our body. These nodes can communicate with each other to aggregate data and transmit vital parameters to a base station (BS). The data collected in the base station can be used to monitor health in real time. The patient wearing sensors may be mobile leading to aggregation of data from different BS for processing. Processing real time data is compute-intensive and telemedicine facilities may not have appropriate hardware to process the real time data effectively. To overcome this, sensor grid has been proposed in literature wherein sensor data is integrated to the grid for processing. This work proposes a scheduling algorithm to efficiently process telemedicine data in the grid. The proposed algorithm uses the popular swarm intelligence algorithm for scheduling to overcome the NP complete problem of grid scheduling. Results compared with other heuristic scheduling algorithms show the effectiveness of the proposed algorithm. PMID:25548557

[Benefits and disadvantages of telemedicine].

PubMed

Daragó, László; Jung, Zsófia; Ispán, Fanni; Bendes, Rita; Dinya, Elek

2013-07-28

Telemedicine is used more and more frequently worldwide. It is increasingly popular in North America, Australia, South Africa, as well as the Scandinavian countries. However, it is not commonly used in Hungary despite various attempts, which is presumably due to earlier dismissive governmental attitude. In this paper the authors analyze ethical, legal and financial aspects of telemedicine from the viewpoints of physicians and patients, too. The results indicate that it cannot be clearly decided whether telemedicine is worth to apply at present. Further, introduction of telemedicine should be based on experience gained in local application.

[Telemedicine in otorhinolaryngology exemplified by a Tübingen-Leipzig video conference].

PubMed

Plinkert, P K; Plinkert, B; Fuchs, M; Zenner, H P

2000-10-01

"Telemedicine" is a major new development with great potential for improving health care delivery. It therefore affects each department in medicine. There is a great deal of telemedicine activity around the world. However, the term telemedicine is not clear. It describes all forms of medical information, transferred from a relevant distance by an electronic transfer media. An essential condition for communication is the intelligibility between transmitter and receiver. Because of different transmitting technologies and networks in distinct countries, towns, or even academic institutions, satisfactory contact is not possible. In the last decade, the demand for worldwide audiovisual data transmission has led to the standardization of telecommunication media. Therefore it is no longer necessary to transport medical data (or even patients) by conventional manners, e.g., post, car, or aircraft. Telemedicine for diagnosis and management can be bidirectional in real-time, long-distance videoconferencing, in which the patient consults a specialist located at the remote site, or it can be the transmission of either real-time or pre-recorded images and data to a remote expert, as in teleradiology or telepathology. Another application is the use of videoconference systems in the course of meetings. The remote specialist has the opportunity to take part in the session, e.g., with a lecture. Furthermore, the remote specialist can demonstrate special operative techniques for teleteaching purposes, some of which may be specialities of the particular medical unit, e.g., operation in open NMR, telemanipulation, or telerobotic procedures. In this paper, we describe the use and benefit of a videoconference between the departments of otolaryngology and head and neck surgery of the Universities of Tübingen and Leipzig by means of an "ISDN-based videoconference system". During the meeting, the "operating course for reconstructive surgery in the head and neck", the practicability

Telemedicine systems and telecommunications.

PubMed

Harnett, Brett

2006-01-01

Successful telemedicine requires appropriate equipment and some kind of telecommunications medium. However, successful telemedicine requires more than just technology. The three essential components are the personnel, the technology and a liberal measure of perseverance. Before the technology can be selected, it is necessary to consider the nature of the information to be transmitted between the sites and the time frame over which it must be sent to achieve the desired clinical goals, because this will determine the choice of equipment and the telecommunications network. Factors to be considered include the types of information to be transmitted, the quantity of information to be transferred, and security and privacy (e.g. in Europe and the USA there has been recent legislation about data security). The choice of transmission method for any telemedicine application is, in practice, a compromise between what one would like and what one can afford. In practice, various trade-offs have to be made, which include cost, availability of the service (i.e. the coverage), bandwidth, reliability and quality of service. Equipment and the telecommunications medium are a necessary, but not sufficient, pre-requisite for a successful telemedicine programme. The right people are also required and they must be properly trained.

Telemedicine in Leading US Neurology Departments.

PubMed

George, Benjamin P; Scoglio, Nicholas J; Reminick, Jason I; Rajan, Balaraman; Beck, Christopher A; Seidmann, Abraham; Biglan, Kevin M; Dorsey, E Ray

2012-10-01

To determine the current practice and plans for telemedicine at leading US neurology departments. An electronic survey was sent to department chairs, administrators, or faculty involved in telemedicine at 47 neurology departments representing the top 50 hospitals as ranked by U.S. News and World Report. Current use, size, scope, reimbursement, and perceived quality of telemedicine services. A total of 32 individuals from 30 departments responded (64% response rate). The primary respondents were neurology faculty (66%) and department chairs (22%). Of the responding departments, 60% (18 of 30) currently provide telemedicine and most (n = 12) had initiated services within the last 2 years. Two thirds of those not providing telemedicine plan to do so within a year. Departments provide services to patients in state, out of state, and internationally, but only 6 departments had more than 50 consultations in the last year. The principal applications were stroke (n = 14), movement disorders (n = 4), and neurocritical care (n = 3). Most departments (n = 12) received external funding for telemedicine services, but few departments (n = 3) received payment from insurers (eg, Medicare, Medicaid). Reimbursement (n = 21) was the most frequently identified barrier to implementing telemedicine services. The majority of respondents (n = 20) find telemedicine to be equivalent to in-person care. Over 85% of leading US neurology departments currently use or plan to implement telemedicine within the next year. Addressing reimbursement may allow for its broader application.

Telemedicine in Leading US Neurology Departments

PubMed Central

George, Benjamin P.; Scoglio, Nicholas J.; Reminick, Jason I.; Rajan, Balaraman; Beck, Christopher A.; Seidmann, Abraham; Biglan, Kevin M.; Dorsey, E. Ray

2012-01-01

Objective: To determine the current practice and plans for telemedicine at leading US neurology departments. Design and Setting: An electronic survey was sent to department chairs, administrators, or faculty involved in telemedicine at 47 neurology departments representing the top 50 hospitals as ranked by U.S. News and World Report. Main Outcome Measures: Current use, size, scope, reimbursement, and perceived quality of telemedicine services. Results: A total of 32 individuals from 30 departments responded (64% response rate). The primary respondents were neurology faculty (66%) and department chairs (22%). Of the responding departments, 60% (18 of 30) currently provide telemedicine and most (n = 12) had initiated services within the last 2 years. Two thirds of those not providing telemedicine plan to do so within a year. Departments provide services to patients in state, out of state, and internationally, but only 6 departments had more than 50 consultations in the last year. The principal applications were stroke (n = 14), movement disorders (n = 4), and neurocritical care (n = 3). Most departments (n = 12) received external funding for telemedicine services, but few departments (n = 3) received payment from insurers (eg, Medicare, Medicaid). Reimbursement (n = 21) was the most frequently identified barrier to implementing telemedicine services. The majority of respondents (n = 20) find telemedicine to be equivalent to in-person care. Conclusions: Over 85% of leading US neurology departments currently use or plan to implement telemedicine within the next year. Addressing reimbursement may allow for its broader application. PMID:23983876

Multi-purpose HealthCare Telemedicine Systems with mobile communication link support.

PubMed

Kyriacou, E; Pavlopoulos, S; Berler, A; Neophytou, M; Bourka, A; Georgoulas, A; Anagnostaki, A; Karayiannis, D; Schizas, C; Pattichis, C; Andreou, A; Koutsouris, D

2003-03-24

The provision of effective emergency telemedicine and home monitoring solutions are the major fields of interest discussed in this study. Ambulances, Rural Health Centers (RHC) or other remote health location such as Ships navigating in wide seas are common examples of possible emergency sites, while critical care telemetry and telemedicine home follow-ups are important issues of telemonitoring. In order to support the above different growing application fields we created a combined real-time and store and forward facility that consists of a base unit and a telemedicine (mobile) unit. This integrated system: can be used when handling emergency cases in ambulances, RHC or ships by using a mobile telemedicine unit at the emergency site and a base unit at the hospital-expert's site, enhances intensive health care provision by giving a mobile base unit to the ICU doctor while the telemedicine unit remains at the ICU patient site and enables home telemonitoring, by installing the telemedicine unit at the patient's home while the base unit remains at the physician's office or hospital. The system allows the transmission of vital biosignals (3-12 lead ECG, SPO2, NIBP, IBP, Temp) and still images of the patient. The transmission is performed through GSM mobile telecommunication network, through satellite links (where GSM is not available) or through Plain Old Telephony Systems (POTS) where available. Using this device a specialist doctor can telematically "move" to the patient's site and instruct unspecialized personnel when handling an emergency or telemonitoring case. Due to the need of storing and archiving of all data interchanged during the telemedicine sessions, we have equipped the consultation site with a multimedia database able to store and manage the data collected by the system. The performance of the system has been technically tested over several telecommunication means; in addition the system has been clinically validated in three different countries using a

End-User Applications of Real-Time Earthquake Information in Europe

NASA Astrophysics Data System (ADS)

Cua, G. B.; Gasparini, P.; Giardini, D.; Zschau, J.; Filangieri, A. R.; Reakt Wp7 Team

2011-12-01

The primary objective of European FP7 project REAKT (Strategies and Tools for Real-Time Earthquake Risk Reduction) is to improve the efficiency of real-time earthquake risk mitigation methods and their capability of protecting structures, infrastructures, and populations. REAKT aims to address the issues of real-time earthquake hazard and response from end-to-end, with efforts directed along the full spectrum of methodology development in earthquake forecasting, earthquake early warning, and real-time vulnerability systems, through optimal decision-making, and engagement and cooperation of scientists and end users for the establishment of best practices for use of real-time information. Twelve strategic test cases/end users throughout Europe have been selected. This diverse group of applications/end users includes civil protection authorities, railway systems, hospitals, schools, industrial complexes, nuclear plants, lifeline systems, national seismic networks, and critical structures. The scale of target applications covers a wide range, from two school complexes in Naples, to individual critical structures, such as the Rion Antirion bridge in Patras, and the Fatih Sultan Mehmet bridge in Istanbul, to large complexes, such as the SINES industrial complex in Portugal and the Thessaloniki port area, to distributed lifeline and transportation networks and nuclear plants. Some end-users are interested in in-depth feasibility studies for use of real-time information and development of rapid response plans, while others intend to install real-time instrumentation and develop customized automated control systems. From the onset, REAKT scientists and end-users will work together on concept development and initial implementation efforts using the data products and decision-making methodologies developed with the goal of improving end-user risk mitigation. The aim of this scientific/end-user partnership is to ensure that scientific efforts are applicable to operational

The Use of Telemedicine in Oral and Maxillofacial Surgery.

PubMed

Wood, Eric W; Strauss, Robert A; Janus, Charles; Carrico, Caroline K

2016-04-01

To determine the perceived utility and demand for the application of telemedicine for improved patient care between nonsurgical dental practitioners (GPs) and oral and maxillofacial surgeons (OMS). Two distinct questionnaires were made, one for GPs and one for OMSs. The GP questionnaire was sent to practicing Virginia Dental Association members on an e-mail list (approximately 2,200). The OMS questionnaire was sent by the Virginia Society of Oral Maxillofacial Surgery to members on an e-mail list (approximately 213). Questionnaires included questions about access to care, benefits of telemedicine consultations, reliability of telemedicine consultations, and perceived barriers against and opportunities for the implementation of telemedicine. The questionnaire was completed by 226 GP and 41 OMS respondents. There was a significant difference among responses of GPs based on practice location: rural patients had a longer average time from referral to OMS consultation (P = .003), rural patients traveled longer distances (P < .0001), rural practitioners referred more patients (P = .0038), and rural GPs referred more single-tooth implant cases (P = .0039). GP respondents moderately agreed to statements about the benefits of telemedicine, whereas OMS respondents were more neutral. GPs responded they would refer more patients (4.4) if consultations could be performed by telemedicine. OMSs agreed that more referrals would influence their decision to provide telemedicine consultations (51%). Practitioners had neutral perceptions about the reliability of telemedicine. OMS respondents agreed they would implement telemedicine in their practice if it provided equally good consultations as in-office visits. According to the present findings, telemedicine could be an important step in the right direction for overcoming current issues with patient access to care and increasing health care costs. The benefits of telemedicine technology have been documented and will continue to be

Establishment of an effective acute stroke telemedicine program for Australia: protocol for the Victorian Stroke Telemedicine project.

PubMed

Cadilhac, Dominique A; Moloczij, Natasha; Denisenko, Sonia; Dewey, Helen; Disler, Peter; Winzar, Bruce; Mosley, Ian; Donnan, Geoffrey A; Bladin, Christopher

2014-02-01

Urgent treatment of acute stroke in rural Australia is problematic partly because of limited access to medical specialists. Utilization of telemedicine could improve delivery of acute stroke treatments in rural communities. The study aims to demonstrate enhanced clinical decision making for use of thrombolysis within 4·5 h of ischemic stroke symptom onset in a rural setting using a telemedicine specialist support model. A formative program evaluation research design was used. The Victorian Stroke Telemedicine program was developed and will be evaluated over five stages to ensure successful implementation. The phases include: (a) preimplementation phase to establish the Victorian Stroke Telemedicine program including the clinical pathway, data collection tools, and technology processes; (b) pilot clinical application phase to test the pathway in up to 10 patients; (c) modification phase to refine the program; (d) full clinical implementation phase where the program is maintained for one-year; and (e) a sustainability phase to assess project outcomes over five-years. Qualitative (clinician interviews) and quantitative data (patient, clinician, costs, and technology processes) are collected in each phase. The primary outcome is to achieve a minimum 10% absolute increase in eligible patients treated with thrombolysis. Secondary outcomes are utilization of the telestroke pathway and improvements in processes of stroke care (e.g., time to brain scan). We will report door to telemedicine consultation time, length of telemedicine consultation, clinical utility and acceptability from the perspective of clinicians, and 90-day patient outcomes. This research will provide evidence for an effective telestroke program for use in regional Australian hospitals. © 2013 The Authors. International Journal of Stroke © 2013 World Stroke Organization.

Telemedicine Support Groups for Home Parenteral Nutrition Users.

PubMed

Nelson, Eve-Lynn; Yadrich, Donna Macan; Thompson, Noreen; Wright, Shawna; Stone, Kathaleen; Adams, Natasia; Werkowitch, Marilyn; Smith, Carol E

2017-12-01

Patients receiving home parenteral nutrition (HPN), a life-sustaining intravenous (IV) infusion that provides nourishment and hydration to patients with short gut or inflammatory bowel diseases, are often isolated and not in visual contact with peers or health providers. One completed clinical trial (Clinical Trials.gov NCT0190028) and 1 ongoing clinical trial (Clinical Trials.gov NCT02987569) are evaluating a mobile videoconferencing-delivered support group intervention for patients on HPN and their caregivers. This home-based telemedicine intervention uses encrypted tablet-based videoconferencing to connect multiple families in real time. The twice-daily IV regimen is challenging for patients who may experience infusion catheter-related bloodstream infections, difficulties with fatigue, loss of sleep, depressive disorders, and worry over the potential life-threatening side effects and the expenses of this therapy. Using secure telemedicine, the facilitated support group intervention aims to enhance HPN home care, daily functioning, and quality of life. The authors provide the rationale for the telemedicine approach with HPN users and caregivers. They provide "how-to" information about the content and process of the facilitated support group sessions via secure videoconferencing. They share lessons learned from the ongoing evaluation of the telemedicine approach.

[Telemedicine in dermatological practice: teledermatology].

PubMed

Danis, Judit; Forczek, Erzsébet; Bari, Ferenc

2016-03-06

Technological advances in the fields of information and telecommunication technologies have affected the health care system in the last decades, and lead to the emergence of a new discipline: telemedicine. The appearance and rise of internet and smart phones induced a rapid progression in telemedicine. Several new applications and mobile devices are published every hour even for medical purposes. Parallel to these changes in the technical fields, medical literature about telemedicine has grown rapidly. Due to its visual nature, dermatology is ideally suited to benefit from this new technology and teledermatology became one of the most dynamically evolving fields of telemedicine by now. Teledermatology is not routinely practiced in Hungary yet, however, it promises the health care system to become better, cheaper and faster, but we have to take notice on the experience and problems faced in teledermatologic applications so far, summarized in this review.

Pharmacists providing care in the outpatient setting through telemedicine models: a narrative review.

PubMed

Littauer, Sydney L; Dixon, Dave L; Mishra, Vimal K; Sisson, Evan M; Salgado, Teresa M

2017-01-01

Telemedicine refers to the delivery of clinical services using technology that allows two-way, real time, interactive communication between the patient and the clinician at a distant site. Commonly, telemedicine is used to improve access to general and specialty care for patients in rural areas. This review aims to provide an overview of existing telemedicine models involving the delivery of care by pharmacists via telemedicine (including telemonitoring and video, but excluding follow-up telephone calls) and to highlight the main areas of chronic-disease management where these models have been applied. Studies within the areas of hypertension, diabetes, asthma, anticoagulation and depression were identified, but only two randomized controlled trials with adequate sample size demonstrating the positive impact of telemonitoring combined with pharmacist care in hypertension were identified. The evidence for the impact of pharmacist-based telemedicine models is sparse and weak, with the studies conducted presenting serious threats to internal and external validity. Therefore, no definitive conclusions about the impact of pharmacist-led telemedicine models can be made at this time. In the Unites States, the increasing shortage of primary care providers and specialists represents an opportunity for pharmacists to assume a more prominent role managing patients with chronic disease in the ambulatory care setting. However, lack of reimbursement may pose a barrier to the provision of care by pharmacists using telemedicine.

Pharmacists providing care in the outpatient setting through telemedicine models: a narrative review

PubMed Central

Littauer, Sydney L.

2017-01-01

Telemedicine refers to the delivery of clinical services using technology that allows two-way, real time, interactive communication between the patient and the clinician at a distant site. Commonly, telemedicine is used to improve access to general and specialty care for patients in rural areas. This review aims to provide an overview of existing telemedicine models involving the delivery of care by pharmacists via telemedicine (including telemonitoring and video, but excluding follow-up telephone calls) and to highlight the main areas of chronic-disease management where these models have been applied. Studies within the areas of hypertension, diabetes, asthma, anticoagulation and depression were identified, but only two randomized controlled trials with adequate sample size demonstrating the positive impact of telemonitoring combined with pharmacist care in hypertension were identified. The evidence for the impact of pharmacist-based telemedicine models is sparse and weak, with the studies conducted presenting serious threats to internal and external validity. Therefore, no definitive conclusions about the impact of pharmacist-led telemedicine models can be made at this time. In the Unites States, the increasing shortage of primary care providers and specialists represents an opportunity for pharmacists to assume a more prominent role managing patients with chronic disease in the ambulatory care setting. However, lack of reimbursement may pose a barrier to the provision of care by pharmacists using telemedicine. PMID:29317927

Telemedicine: An Application in Search of Users

NASA Technical Reports Server (NTRS)

Khandheria, Bijoy K.

1996-01-01

Telemedicine involves the use of telecommunication technologies as a medium for the provision of medical information and services to consumers at sites that are at a distance from the provider. The concept encompasses everything from the telephone system to high-speed, wide-bandwidth transmission with use of fiberoptics, satellites, or a combination of terrestrial and satellite-communication technologies. The peripheral software could be as simple as a typewriter used to type a letter requesting an opinion or as complex as high-capacity parallel processing computers and imaging devices. Although the definition includes telephone, facsimile, and distance learning, the term "Telemedicine" is currently used as a generic label for remote consultation and diagnosis. Telemedicine is not a medical subspecialty but a facilitator of all medical and surgical specialties.

Real-Time Precise Point Positioning (RTPPP) with raw observations and its application in real-time regional ionospheric VTEC modeling

NASA Astrophysics Data System (ADS)

Liu, Teng; Zhang, Baocheng; Yuan, Yunbin; Li, Min

2018-01-01

Precise Point Positioning (PPP) is an absolute positioning technology mainly used in post data processing. With the continuously increasing demand for real-time high-precision applications in positioning, timing, retrieval of atmospheric parameters, etc., Real-Time PPP (RTPPP) and its applications have drawn more and more research attention in recent years. This study focuses on the models, algorithms and ionospheric applications of RTPPP on the basis of raw observations, in which high-precision slant ionospheric delays are estimated among others in real time. For this purpose, a robust processing strategy for multi-station RTPPP with raw observations has been proposed and realized, in which real-time data streams and State-Space-Representative (SSR) satellite orbit and clock corrections are used. With the RTPPP-derived slant ionospheric delays from a regional network, a real-time regional ionospheric Vertical Total Electron Content (VTEC) modeling method is proposed based on Adjusted Spherical Harmonic Functions and a Moving-Window Filter. SSR satellite orbit and clock corrections from different IGS analysis centers are evaluated. Ten globally distributed real-time stations are used to evaluate the positioning performances of the proposed RTPPP algorithms in both static and kinematic modes. RMS values of positioning errors in static/kinematic mode are 5.2/15.5, 4.7/17.4 and 12.8/46.6 mm, for north, east and up components, respectively. Real-time slant ionospheric delays from RTPPP are compared with those from the traditional Carrier-to-Code Leveling (CCL) method, in terms of function model, formal precision and between-receiver differences of short baseline. Results show that slant ionospheric delays from RTPPP are more precise and have a much better convergence performance than those from the CCL method in real-time processing. 30 real-time stations from the Asia-Pacific Reference Frame network are used to model the ionospheric VTECs over Australia in real time

Real-time Data Access to First Responders: A VORB application

NASA Astrophysics Data System (ADS)

Lu, S.; Kim, J. B.; Bryant, P.; Foley, S.; Vernon, F.; Rajasekar, A.; Meier, S.

2006-12-01

Getting information to first responders is not an easy task. The sensors that provide the information are diverse in formats and come from many disciplines. They are also distributed by location, transmit data at different frequencies and are managed and owned by autonomous administrative entities. Pulling such types of data in real-time, needs a very robust sensor network with reliable data transport and buffering capabilities. Moreover, the system should be extensible and scalable in numbers and sensor types. ROADNet is a real- time sensor network project at UCSD gathering diverse environmental data in real-time or near-real-time. VORB (Virtual Object Ring Buffer) is the middleware used in ROADNet offering simple, uniform and scalable real-time data management for discovering (through metadata), accessing and archiving real-time data and data streams. Recent development in VORB, a web API, has offered quick and simple real-time data integration with web applications. In this poster, we discuss one application developed as part of ROADNet. SMER (Santa Margarita Ecological Reserve) is located in interior Southern California, a region prone to catastrophic wildfires each summer and fall. To provide data during emergencies, we have applied the VORB framework to develop a web-based application for providing access to diverse sensor data including weather data, heat sensor information, and images from cameras. Wildfire fighters have access to real-time data about weather and heat conditions in the area and view pictures taken from cameras at multiple points in the Reserve to pinpoint problem areas. Moreover, they can browse archived images and sensor data from earlier times to provide a comparison framework. To show scalability of the system, we have expanded the sensor network under consideration through other areas in Southern California including sensors accessible by Los Angeles County Fire Department (LACOFD) and those available through the High Performance

International Telemedicine/Disaster Medicine Conference: Papers and Presentations

NASA Technical Reports Server (NTRS)

1991-01-01

The first International Telemedicine/Disaster Medicine Conference was held in Dec. 1991. The overall purpose was to convene an international, multidisciplinary gathering of experts to discuss the emerging field of telemedicine and assess its future directions; principally the application of space technology to disaster response and management, but also to clinical medicine, remote health care, public health, and other needs. This collection is intended to acquaint the reader with recent landmark efforts in telemedicine as applied to disaster management and remote health care, the technical requirements of telemedicine systems, the application of telemedicine and telehealth in the U.S. space program, and the social and humanitarian dimensions of this area of medicine.

Evaluation of telemedicine in the management of dentogenous infections.

PubMed

Miladinović, Milan; Mladenović, Dragan; Mihailović, Branko; Djndjić, Goran Tosić Boris; Mladenović, Sanja; Hadzibeti, Mervan; Vujicić, Biljana

2013-06-01

The first written evidence of telemedicine dates back to the times of Sava Nemanjić (the end of 12th and the beginning of 13th century). Nowadays, the use of telemedicine in Serbia gains momentum, and the cause of this lies in the creation of a central telemedicine system XPA3 Online and the establishment of the Center for Telemedicine at the Faculty of Medicine, University of Pristina/Kosovska Mitrovica, Kosovska Mitrovica, Serbia. Dentogenous infections are among the most urgent conditions in dentistry, which may have even a fatal outcome. The aim of this study was to assess the possibility of using telemedicine methods in the pathology of dentogenous infections. This experimental randomized study included 414 patients with suspected dentogenous infection. The patients were enrolled at 7 sites, with systematic photograph-taking, collection, and digitalization of the available anamnestic and laboratory data, tests, and x-rays. Together with clinical findings, the data were uploaded on the XPA3 Online central telemedicine system; after that, 10 teleconsultants reviewed the material, set the diagnosis, and gave their opinion about the treatment. The agreement was determined using the Cohen's kappa (i) coefficient, as well as diagnostic sensitivity (SE), specificity (SP), and efficacy (EFF). Statistical significance and comparisons were done using the z-test, and testing nonparametric properties using the McNemar's X2-test for the significance threshold ofp = 0.05. The results describing agreement of telemedicine diagnosis of the areas primarily involved with infection compared to clinical inspection, indicate an almost complete diagnostic agreement (kappa= 0.971). Diagnostic agreement as to the type of infection was also almost complete (kappa = 0.951), and a similar value was obtained also for the treatment agreement (kappa> =0.892). The method of telemedicine provides us with a tool to make a correct clinical diagnosis of dentogenous infections equally well as in

The promise of telemedicine for chronic neurological disorders: the example of Parkinson's disease.

PubMed

Schneider, Ruth B; Biglan, Kevin M

2017-07-01

Disparities in access to health care, particularly specialist care, exist worldwide. As the prevalence of chronic neurological disorders increases with ageing populations, access to neurologist care is likely to worsen in many regions if there are no changes to models of care. Telemedicine-defined here as the use of real-time, synchronous videoconferencing to deliver medical care-could be used to improve access to neurologist care for patients with a range of chronic neurological disorders. In Parkinson's disease, several studies have shown the feasibility and potential benefits of telemedicine-delivered care. Further research is needed to establish whether telemedicine can deliver on the promise of improved access to neurologist care and whether telemedicine-delivered care is comparable to in-person care in terms of clinical outcomes. Many barriers to widespread implementation of telemedicine services remain to be addressed, including reimbursement, legal considerations, and technological issues. Copyright © 2017 Elsevier Ltd. All rights reserved.

The promise of telemedicine.

PubMed

Newton, Michael J

2014-01-01

We have developed an extraordinary capability to capture and transmit digital ocular imaging, enabling remote interpretation of every aspect of the eye. The issues regarding telemedicine were primarily technical and procedural when this journal first reviewed the topic in 1999. Fourteen years later, telemedicine presents strikingly different challenges-legal, ethical, and professional. Some "tele-ophthalmology" applications have now become a reliable part of daily practice. Although it offers improved health care at lower cost to more people, telemedicine could also radically transform the traditional doctor-patient interaction. Copyright © 2014 Elsevier Inc. All rights reserved.

An overview of telemedicine.

PubMed

Baquet, C R

1997-01-01

Greater attention has been given recently to information technology and telecommunication reforms and their use for the improvement of health care service delivery. Broadly defined, telemedicine is the use of advanced telecommunications technologies for the purposes of making diagnoses, conducting research, transferring patient data, and/or improving disease management and treatment in remote areas. The emphasis is on use of telecommunications technologies at remote sites. This article provides a brief overview of telemedicine, its potential clinical applications, and the various benefits and leading issues surrounding it. It also describes selected telemedicine projects conducted at the University of Maryland School of Medicine in Baltimore.

Effects and effectiveness of telemedicine.

PubMed

Grigsby, J; Kaehny, M M; Sandberg, E J; Schlenker, R E; Shaughnessy, P W

1995-01-01

The use of telemedicine has recently undergone rapid growth and proliferation. Although the feasibility of many applications has been tested for nearly 30 years, data concerning the costs, effects, and effectiveness of telemedicine are limited. Consequently, the development of a strategy for coverage, payment, and utilization policy has been hindered. Telemedicine continues to expand, and pressure for policy development increases in the context of Federal budget cuts and major changes in health service financing. This article reviews the literature on the effects and medical effectiveness of telemedicine. It concludes with several recommendations for research, followed by a discussion of several specific questions, the answers to which might have a bearing on policy development.

Legal interfaces in telemedicine technology.

PubMed

Lott, C M

1996-05-01

Telemedicine, an emerging technology which seeks to use advanced telecommunications equipment to enhance medical care, is progressing rapidly in the Department of Defense health care delivery system. This paper recommends that a cautious, preventive law approach be simultaneously initiated to ensure that the technology does not abridge patients' rights to confidentiality or security of medical records, and that agreement on practice parameters be developed. Seven interfaces, in the areas of informed consent, physician liability, non-physician liability, costs, practice parameters, physician-patient relationships, and ergonomics, are discussed in the context of telemedicine. The author recommends that telemedicine pioneers include the legal community's early input in the application of telemedicine technology to help avoid needless litigation.

Effects and Effectiveness of Telemedicine

PubMed Central

Grigsby, Jim; Kaehny, Margaret M.; Sandberg, Elliot J.; Schlenker, Robert E.; Shaughnessy, Peter W.

1995-01-01

The use of telemedicine has recently undergone rapid growth and proliferation. Although the feasibility of many applications has been tested for nearly 30 years, data concerning the costs, effects, and effectiveness of telemedicine are limited. Consequently, the development of a strategy for coverage, payment, and utilization policy has been hindered. Telemedicine continues to expand, and pressure for policy development increases in the context of Federal budget cuts and major changes in health service financing. This article reviews the literature on the effects and medical effectiveness of telemedicine. It concludes with several recommendations for research, followed by a discussion of several specific questions, the answers to which might have a bearing on policy development. PMID:10153466

Real-time PCR: Advanced technologies and applications

USDA-ARS?s Scientific Manuscript database

This book brings together contributions from 20 experts in the field of PCR, providing a broad perspective of the applications of quantitative real-time PCR (qPCR). The editors state in the preface that the aim is to provide detailed insight into underlying principles and methods of qPCR to provide ...

Telemedicine in Alentejo

PubMed Central

Bayer, Steffen; Gonçalves, Luís; Barlow, James

2014-01-01

Abstract Alentejo covers a third of Portugal, yet it is home to only 5% of the population. Residents of the region are poorer, older, and less educated than the rest of the country. There is a shortage of physicians in several specialties. The low population density, a concentration of specialized services, and a poor public transportation network all create barriers to access. Telemedicine was introduced in 1998 to help address these challenges. In this article, we provide an overview of the program and its current status, focusing on infrastructure, services, and activity volume. We also discuss the impact the program has had from the perspectives of patients and healthcare professionals. From 1998 to 2011, there were 132,546 episodes of service using telemedicine, including real-time teleconsultations, teleradiology, teleultrasound, and telepathology. At present, the network includes 20 primary care units and five hospitals, covering almost 30,000 km2 and 500,000 people. Units have high-resolution videoconferencing equipment, access to patients' clinical records, an image archive, and peripherals, such as electronic dermatoscopes and phonendoscopes. Teleconsultations are available in 15 medical specialties and areas, ranging from neurology to pediatric surgery. In 2008, regional health authorities started a tele-education program, and by the end of 2011, 876 healthcare professionals, across 52 locations, had participated in remote learning sessions. More than a decade since telemedicine was introduced in Alentejo, it is now an integral part of everyday service provision. A comprehensive assessment of the costs and consequences of the program is currently underway. PMID:24180419

Real-time X-ray Diffraction: Applications to Materials Characterization

NASA Technical Reports Server (NTRS)

Rosemeier, R. G.

1984-01-01

With the high speed growth of materials it becomes necessary to develop measuring systems which also have the capabilities of characterizing these materials at high speeds. One of the conventional techniques of characterizing materials was X-ray diffraction. Film, which is the oldest method of recording the X-ray diffraction phenomenon, is not quite adequate in most circumstances to record fast changing events. Even though conventional proportional counters and scintillation counters can provide the speed necessary to record these changing events, they lack the ability to provide image information which may be important in some types of experiment or production arrangements. A selected number of novel applications of using X-ray diffraction to characterize materials in real-time are discussed. Also, device characteristics of some X-ray intensifiers useful in instantaneous X-ray diffraction applications briefly presented. Real-time X-ray diffraction experiments with the incorporation of image X-ray intensification add a new dimension in the characterization of materials. The uses of real-time image intensification in laboratory and production arrangements are quite unlimited and their application depends more upon the ingenuity of the scientist or engineer.

IMS: a new technology to develop a telemedicine system.

PubMed

Uceda, J D; Elena, M; Blasco, S; Tarrida, C L; Quero, J M

2008-01-01

The emergent IMS (Internet Protocol Multimedia Subsystem) technology appears to improve the current communication technologies. Its characteristics, such as Quality of Service (QoS), make it an advantageous system for innovative applications. Providing integrated services to users is one of the main reasons for the existence of IMS. Operators provide the technology as an open source, to be able to use services developed by researchers. Combining and integrating them, users will receive completely new services. Our proposal of use for IMS is the development of a telemedicine platform, designed to support not only remote biological signal monitoring, but value-added services for diagnosis and medical care, both of these working in real time.

Recent advances to obtain real - Time displacements for engineering applications

USGS Publications Warehouse

Celebi, M.

2005-01-01

This paper presents recent developments and approaches (using GPS technology and real-time double-integration) to obtain displacements and, in turn, drift ratios, in real-time or near real-time to meet the needs of the engineering and user community in seismic monitoring and assessing the functionality and damage condition of structures. Drift ratios computed in near real-time allow technical assessment of the damage condition of a building. Relevant parameters, such as the type of connections and story structural characteristics (including geometry) are used in computing drifts corresponding to several pre-selected threshold stages of damage. Thus, drift ratios determined from real-time monitoring can be compared to pre-computed threshold drift ratios. The approaches described herein can be used for performance evaluation of structures and can be considered as building health-monitoring applications.

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

ICU Telemedicine Program Financial Outcomes.

PubMed

Lilly, Craig M; Motzkus, Christine; Rincon, Teresa; Cody, Shawn E; Landry, Karen; Irwin, Richard S

2017-02-01

ICU telemedicine improves access to high-quality critical care, has substantial costs, and can change financial outcomes. Detailed information about financial outcomes and their trends over time following ICU telemedicine implementation and after the addition of logistic center function has not been published to our knowledge. Primary data were collected for consecutive adult patients of a single academic medical center. We compared clinical and financial outcomes across three groups that differed regarding telemedicine support: a group without ICU telemedicine support (pre-ICU intervention group), a group with ICU telemedicine support (ICU telemedicine group), and an ICU telemedicine group with added logistic center functions and support for quality-care standardization (logistic center group). The primary outcome was annual direct contribution margin defined as aggregated annual case revenue minus annual case direct costs (including operating costs of ICU telemedicine and its related programs). All monetary values were adjusted to 2015 US dollars using Producer Price Index for Health-Care Facilities. Annual case volume increased from 4,752 (pre-ICU telemedicine) to 5,735 (ICU telemedicine) and 6,581 (logistic center). The annual direct contribution margin improved from $7,921,584 (pre-ICU telemedicine) to $37,668,512 (ICU telemedicine) to $60,586,397 (logistic center) due to increased case volume, higher case revenue relative to direct costs, and shorter length of stay. The ability of properly modified ICU telemedicine programs to increase case volume and access to high-quality critical care with improved annual direct contribution margins suggests that there is a financial argument to encourage the wider adoption of ICU telemedicine. Copyright © 2016 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

Large holographic displays for real-time applications

NASA Astrophysics Data System (ADS)

Schwerdtner, A.; Häussler, R.; Leister, N.

2008-02-01

Holography is generally accepted as the ultimate approach to display three-dimensional scenes or objects. Principally, the reconstruction of an object from a perfect hologram would appear indistinguishable from viewing the corresponding real-world object. Up to now two main obstacles have prevented large-screen Computer-Generated Holograms (CGH) from achieving a satisfactory laboratory prototype not to mention a marketable one. The reason is a small cell pitch CGH resulting in a huge number of hologram cells and a very high computational load for encoding the CGH. These seemingly inevitable technological hurdles for a long time have not been cleared limiting the use of holography to special applications, such as optical filtering, interference, beam forming, digital holography for capturing the 3-D shape of objects, and others. SeeReal Technologies has developed a new approach for real-time capable CGH using the socalled Tracked Viewing Windows technology to overcome these problems. The paper will show that today's state of the art reconfigurable Spatial Light Modulators (SLM), especially today's feasible LCD panels are suited for reconstructing large 3-D scenes which can be observed from large viewing angles. For this to achieve the original holographic concept of containing information from the entire scene in each part of the CGH has been abandoned. This substantially reduces the hologram resolution and thus the computational load by several orders of magnitude making thus real-time computation possible. A monochrome real-time prototype measuring 20 inches has been built and demonstrated at last year's SID conference and exhibition 2007 and at several other events.

Open-source telemedicine platform for wireless medical video communication.

PubMed

Panayides, A; Eleftheriou, I; Pantziaris, M

2013-01-01

An m-health system for real-time wireless communication of medical video based on open-source software is presented. The objective is to deliver a low-cost telemedicine platform which will allow for reliable remote diagnosis m-health applications such as emergency incidents, mass population screening, and medical education purposes. The performance of the proposed system is demonstrated using five atherosclerotic plaque ultrasound videos. The videos are encoded at the clinically acquired resolution, in addition to lower, QCIF, and CIF resolutions, at different bitrates, and four different encoding structures. Commercially available wireless local area network (WLAN) and 3.5G high-speed packet access (HSPA) wireless channels are used to validate the developed platform. Objective video quality assessment is based on PSNR ratings, following calibration using the variable frame delay (VFD) algorithm that removes temporal mismatch between original and received videos. Clinical evaluation is based on atherosclerotic plaque ultrasound video assessment protocol. Experimental results show that adequate diagnostic quality wireless medical video communications are realized using the designed telemedicine platform. HSPA cellular networks provide for ultrasound video transmission at the acquired resolution, while VFD algorithm utilization bridges objective and subjective ratings.

Open-Source Telemedicine Platform for Wireless Medical Video Communication

PubMed Central

Panayides, A.; Eleftheriou, I.; Pantziaris, M.

2013-01-01

An m-health system for real-time wireless communication of medical video based on open-source software is presented. The objective is to deliver a low-cost telemedicine platform which will allow for reliable remote diagnosis m-health applications such as emergency incidents, mass population screening, and medical education purposes. The performance of the proposed system is demonstrated using five atherosclerotic plaque ultrasound videos. The videos are encoded at the clinically acquired resolution, in addition to lower, QCIF, and CIF resolutions, at different bitrates, and four different encoding structures. Commercially available wireless local area network (WLAN) and 3.5G high-speed packet access (HSPA) wireless channels are used to validate the developed platform. Objective video quality assessment is based on PSNR ratings, following calibration using the variable frame delay (VFD) algorithm that removes temporal mismatch between original and received videos. Clinical evaluation is based on atherosclerotic plaque ultrasound video assessment protocol. Experimental results show that adequate diagnostic quality wireless medical video communications are realized using the designed telemedicine platform. HSPA cellular networks provide for ultrasound video transmission at the acquired resolution, while VFD algorithm utilization bridges objective and subjective ratings. PMID:23573082

Estimating travel reduction associated with the use of telemedicine by patients and healthcare professionals: proposal for quantitative synthesis in a systematic review.

PubMed

Wootton, Richard; Bahaadinbeigy, Kambiz; Hailey, David

2011-08-08

A major benefit offered by telemedicine is the avoidance of travel, by patients, their carers and health care professionals. Unfortunately, there is very little published information about the extent of avoided travel. We propose to undertake a systematic review of literature which reports credible data on the reductions in travel associated with the use of telemedicine. The conventional approach to quantitative synthesis of the results from multiple studies is to conduct a meta analysis. However, too much heterogeneity exists between available studies to allow a meaningful meta analysis of the avoided travel when telemedicine is used across all possible settings. We propose instead to consider all credible evidence on avoided travel through telemedicine by fitting a linear model which takes into account the relevant factors in the circumstances of the studies performed. We propose the use of stepwise multiple regression to identify which factors are significant. Our proposed approach is illustrated by the example of teledermatology. In a preliminary review of the literature we found 20 studies in which the percentage of avoided travel through telemedicine could be inferred (a total of 5199 patients). The mean percentage avoided travel reported in the 12 store-and-forward studies was 43%. In the 7 real-time studies and in a single study with a hybrid technique, 70% of the patients avoided travel. A simplified model based on the modality of telemedicine employed (i.e. real-time or store and forward) explained 29% of the variance. The use of store and forward teledermatology alone was associated with 43% of avoided travel. The increase in the proportion of patients who avoided travel (25%) when real-time telemedicine was employed was significant (P = 0.014). Service planners can use this information to weigh up the costs and benefits of the two approaches.

Estimating travel reduction associated with the use of telemedicine by patients and healthcare professionals: proposal for quantitative synthesis in a systematic review

PubMed Central

2011-01-01

Background A major benefit offered by telemedicine is the avoidance of travel, by patients, their carers and health care professionals. Unfortunately, there is very little published information about the extent of avoided travel. We propose to undertake a systematic review of literature which reports credible data on the reductions in travel associated with the use of telemedicine. Method The conventional approach to quantitative synthesis of the results from multiple studies is to conduct a meta analysis. However, too much heterogeneity exists between available studies to allow a meaningful meta analysis of the avoided travel when telemedicine is used across all possible settings. We propose instead to consider all credible evidence on avoided travel through telemedicine by fitting a linear model which takes into account the relevant factors in the circumstances of the studies performed. We propose the use of stepwise multiple regression to identify which factors are significant. Discussion Our proposed approach is illustrated by the example of teledermatology. In a preliminary review of the literature we found 20 studies in which the percentage of avoided travel through telemedicine could be inferred (a total of 5199 patients). The mean percentage avoided travel reported in the 12 store-and-forward studies was 43%. In the 7 real-time studies and in a single study with a hybrid technique, 70% of the patients avoided travel. A simplified model based on the modality of telemedicine employed (i.e. real-time or store and forward) explained 29% of the variance. The use of store and forward teledermatology alone was associated with 43% of avoided travel. The increase in the proportion of patients who avoided travel (25%) when real-time telemedicine was employed was significant (P = 0.014). Service planners can use this information to weigh up the costs and benefits of the two approaches. PMID:21824388

Telemedicine follow-up facilitates more comprehensive diabetes foot ulcer care: A qualitative study in home-based and specialist health care.

PubMed

Kolltveit, Beate-Christin Hope; Thorne, Sally; Graue, Marit; Gjengedal, Eva; Iversen, Marjolein M; Kirkevold, Marit

2018-03-01

To investigate the application of a telemedicine intervention in diabetes foot ulcer care, and its implications for the healthcare professionals in the clinical field. Contextual factors are found to be important when applying technology in health care and applying telemedicine in home-based care has been identified as particularly complex. We conducted field observations and individual interviews among healthcare professionals in home-based care and specialist health care in a diabetes foot care telemedicine RCT (Clin.Trial.gov: NCT01710774) during 2016. This study was guided by Interpretive Description, an inductive qualitative methodology. Overall, we identified unequal possibilities for applying telemedicine in diabetes foot ulcer care within the hospital and home care contexts. Different circumstances and possibilities in home-based care made the application of telemedicine as intended more difficult. The healthcare professionals in both care contexts perceived the application of telemedicine to facilitate a more comprehensive approach towards the patients, but with different possibilities to enact it. Application of telemedicine in home-based care was more challenging than in the outpatient clinic setting. Introducing more updated equipment and minor structural adjustments in consultation time and resources could make the use of telemedicine in home-based care more robust. Application of telemedicine in diabetes foot ulcer follow-up may enhance the nursing staff's ability to conduct comprehensive assessment and care of the foot ulcer as well as the patient's total situation. Access to adequate equipment and time, particularly in home-based care, is necessary to capitalise on this new technology. © 2017 John Wiley & Sons Ltd.

Suitability of Smartphone Inertial Sensors for Real-Time Biofeedback Applications.

PubMed

Kos, Anton; Tomažič, Sašo; Umek, Anton

2016-02-27

This article studies the suitability of smartphones with built-in inertial sensors for biofeedback applications. Biofeedback systems use various sensors to measure body functions and parameters. These sensor data are analyzed, and the results are communicated back to the user, who then tries to act on the feedback signals. Smartphone inertial sensors can be used to capture body movements in biomechanical biofeedback systems. These sensors exhibit various inaccuracies that induce significant angular and positional errors. We studied deterministic and random errors of smartphone accelerometers and gyroscopes, primarily focusing on their biases. Based on extensive measurements, we determined accelerometer and gyroscope noise models and bias variation ranges. Then, we compiled a table of predicted positional and angular errors under various biofeedback system operation conditions. We suggest several bias compensation options that are suitable for various examples of use in real-time biofeedback applications. Measurements within the developed experimental biofeedback application show that under certain conditions, even uncompensated sensors can be used for real-time biofeedback. For general use, especially for more demanding biofeedback applications, sensor biases should be compensated. We are convinced that real-time biofeedback systems based on smartphone inertial sensors are applicable to many similar examples in sports, healthcare, and other areas.

Suitability of Smartphone Inertial Sensors for Real-Time Biofeedback Applications

PubMed Central

Kos, Anton; Tomažič, Sašo; Umek, Anton

2016-01-01

This article studies the suitability of smartphones with built-in inertial sensors for biofeedback applications. Biofeedback systems use various sensors to measure body functions and parameters. These sensor data are analyzed, and the results are communicated back to the user, who then tries to act on the feedback signals. Smartphone inertial sensors can be used to capture body movements in biomechanical biofeedback systems. These sensors exhibit various inaccuracies that induce significant angular and positional errors. We studied deterministic and random errors of smartphone accelerometers and gyroscopes, primarily focusing on their biases. Based on extensive measurements, we determined accelerometer and gyroscope noise models and bias variation ranges. Then, we compiled a table of predicted positional and angular errors under various biofeedback system operation conditions. We suggest several bias compensation options that are suitable for various examples of use in real-time biofeedback applications. Measurements within the developed experimental biofeedback application show that under certain conditions, even uncompensated sensors can be used for real-time biofeedback. For general use, especially for more demanding biofeedback applications, sensor biases should be compensated. We are convinced that real-time biofeedback systems based on smartphone inertial sensors are applicable to many similar examples in sports, healthcare, and other areas. PMID:26927125

A pilot study for the integration of cytometry reports in digital cytology telemedicine applications.

PubMed

Giansanti, Daniele; Cerroni, Fabio; Amodeo, Rachele; Filoni, Marco; Giovagnoli, Maria Rosaria

2010-01-01

Up to date, tele-pathology in the three different forms of application, "dynamic", "static" and "virtual microscopy" has been mainly based on tele-hystology remote consulting. Today the diffusion of specialized WAN connections is guiding the research of new applications of tele-pathology. A specific analysis has been conducted, focused on digital cytology, in the biomedical laboratory of Sant'Andrea Hospital to investigate the technologies potentially useful to integrate in the LAN/WAN for telemedicine applications. Among the possible tools useful to be integrated in the LAN/WAN for telemedicine applications, the cytometry equipment available in the technical unity of cytometry has been considered important. The study finally provides a proposal for a tele-consulting architecture for the integration of cytometry reports both in the hospital LAN and the WAN for possible cooperative diagnosis and second opinion support.

Telemedicine-Assisted Intubation in Rural Emergency Departments: A National Emergency Airway Registry Study.

PubMed

Van Oeveren, Lucas; Donner, Julie; Fantegrossi, Andrea; Mohr, Nicholas M; Brown, Calvin A

2017-04-01

Intubation in rural emergency departments (EDs) is a high-risk procedure, often with little or no specialty support. Rural EDs are utilizing real-time telemedicine links, connecting providers to an ED physician who may provide clinical guidance. We endeavored to describe telemedicine-assisted intubation in rural EDs that are served by an ED telemedicine network. Prospective data were collected on all patients who had an intubation attempt while on the video telemedicine link from May 1, 2014 to April 30, 2015. We report demographic information, indication, methods, number of attempts, operator characteristics, telemedicine involvement/intervention, adverse events, and clinical outcome by using descriptive statistics. Included were 206 intubations. The most common indication for intubation was respiratory failure. First-pass success rate (postactivation) was 71%, and 96% were eventually intubated. Most attempts (66%) used rapid-sequence intubation. Fifty-four percent of first attempts used video laryngoscopy (VL). Telemedicine providers intervened in 24%, 43%, and 55% of first-third attempts, respectively. First-pass success with VL and direct laryngoscopy was equivalent (70% vs. 71%, p = 0.802). Adverse events were reported in 49 cases (24%), which were most frequently hypoxemia. The impact of telemedicine during emergency intubation is not defined. We showed a 71% first-pass rate post-telemedicine linkage (70% of cases had a previous attempt). Our ultimate success rate was 96%, similar to that in large-center studies. Telemedicine support may contribute to success. Telemedicine-supported endotracheal intubation performed in rural hospitals is feasible, with good success rates. Future research is required to better define the impact of telemedicine providers on emergency airway management.

Telemedicine in wound healing.

PubMed

Jones, Sophie M; Banwell, Paul E; Shakespeare, Peter G

2004-12-01

Better care for patients and improved health care depends on the availability of good information which is accessible when and where it is needed. The development of technology, more specifically the Internet, has expanded the means whereby information can be acquired and transmitted over large distances enabling the concept of telemedicine to become a reality. Telemedicine, defined as the practise of medicine at a distance, encompasses diagnosis, education and treatment. It is a technology that many thought would expand rapidly and change the face of medicine. However, this has not happened and during the last decade although certain telemedicine applications, such as video-consulting and teleradiology, have matured to become essential health care services in some countries, others, such as telepathology, remain the subject of intensive research effort. Telemedicine can be used in almost any medical specialty although the specialties best suited are those with a high visual component. Wound healing and wound management is thus a prime candidate for telemedicine. Development of a suitable telemedical system in this field could have a significant effect on wound care in the community, tertiary referral patterns and hospital admission rates.

Design and Customization of Telemedicine Systems

PubMed Central

Martínez-Alcalá, Claudia I.; Muñoz, Mirna; Monguet-Fierro, Josep

2013-01-01

In recent years, the advances in information and communication technology (ICT) have resulted in the development of systems and applications aimed at supporting rehabilitation therapy that contributes to enrich patients' life quality. This work is focused on the improvement of the telemedicine systems with the purpose of customizing therapies according to the profile and disability of patients. For doing this, as salient contribution, this work proposes the adoption of user-centered design (UCD) methodology for the design and development of telemedicine systems in order to support the rehabilitation of patients with neurological disorders. Finally, some applications of the UCD methodology in the telemedicine field are presented as a proof of concept. PMID:23762191

Improving Mid-Course Flight Through an Application of Real-Time Optimal Control

DTIC Science & Technology

2017-12-01

COURSE FLIGHT THROUGH AN APPLICATION OF REAL- TIME OPTIMAL CONTROL by Mark R. Roncoroni December 2017 Thesis Advisor: Ronald Proulx Co...collection of information is estimated to average 1 hour per response, including the time for reviewing instruction, searching existing data sources...AND DATES COVERED Master’s thesis 4. TITLE AND SUBTITLE IMPROVING MID-COURSE FLIGHT THROUGH AN APPLICATION OF REAL- TIME OPTIMAL CONTROL 5. FUNDING

Real-Time, Interactive Echocardiography Over High-Speed Networks: Feasibility and Functional Requirements

NASA Technical Reports Server (NTRS)

Bobinsky, Eric A.

1998-01-01

Real-time, Interactive Echocardiography Over High Speed Networks: Feasibility and Functional Requirements is an experiment in advanced telemedicine being conducted jointly by the NASA Lewis Research Center, the NASA Ames Research Center, and the Cleveland Clinic Foundation. In this project, a patient undergoes an echocardiographic examination in Cleveland while being diagnosed remotely by a cardiologist in California viewing a real-time display of echocardiographic video images transmitted over the broadband NASA Research and Education Network (NREN). The remote cardiologist interactively guides the sonographer administering the procedure through a two-way voice link between the two sites. Echocardiography is a noninvasive medical technique that applies ultrasound imaging to the heart, providing a "motion picture" of the heart in action. Normally, echocardiographic examinations are performed by a sonographer and cardiologist who are located in the same medical facility as the patient. The goal of telemedicine is to allow medical specialists to examine patients located elsewhere, typically in remote or medically underserved geographic areas. For example, a small, rural clinic might have access to an echocardiograph machine but not a cardiologist. By connecting this clinic to a major metropolitan medical facility through a communications network, a minimally trained technician would be able to carry out the procedure under the supervision and guidance of a qualified cardiologist.

Application of the advanced communications technology satellite for teleradiology and telemedicine

NASA Astrophysics Data System (ADS)

Stewart, Brent K.; Carter, Stephen J.; Rowberg, Alan H.

1995-05-01

The authors have an in-kind grant from NASA to investigate the application of the Advanced Communications Technology Satellite (ACTS) to teleradiology and telemedicine using the JPL developed ACTS Mobile Terminal (AMT) uplink. This experiment involves the transmission of medical imagery (CT, MR, CR, US and digitized radiographs including mammograms), between the ACTS/AMT and the University of Washington. This is accomplished by locating the AMT experiment van in various locations throughout Washington state, Idaho, Montana, Oregon and Hawaii. The medical images are transmitted from the ACTS to the downlink at the NASA Lewis Research Center (LeRC) in Cleveland, Ohio, consisting of AMT equipment and the high burst rate-link evaluation terminal (HBR-LET). These images are then routed from LeRC to the University of Washington School of Medicine (UWSoM) through the Internet and public switched Integrated Serviced Digital Network (ISDN). Once images arrive in the UW Radiology Department, they are reviewed using both video monitor softcopy and laser-printed hardcopy. Compressed video teleconferencing and transmission of real-time ultrasound video between the AMT van and the UWSoM are also tested. Image quality comparisons are made using both subjective diagnostic criteria and quantitative engineering analysis. Evaluation is performed during various weather conditions (including rain to assess rain fade compensation algorithms). Compression techniques also are tested to evaluate their effects on image quality, allowing further evaluation of portable teleradiology/telemedicine at lower data rates and providing useful information for additional applications (e.g., smaller remote units, shipboard, emergency disaster, etc.). The medical images received at the UWSoM over the ACTS are directly evaluated against the original digital images. The project demonstrates that a portable satellite-land connection can provide subspecialty consultation and education for rural and remote

Telemedicine for Developing Countries. A Survey and Some Design Issues.

PubMed

Combi, Carlo; Pozzani, Gabriele; Pozzi, Giuseppe

2016-11-02

Developing countries need telemedicine applications that help in many situations, when physicians are a small number with respect to the population, when specialized physicians are not available, when patients and physicians in rural villages need assistance in the delivery of health care. Moreover, the requirements of telemedicine applications for developing countries are somewhat more demanding than for developed countries. Indeed, further social, organizational, and technical aspects need to be considered for successful telemedicine applications in developing countries. We consider all the major projects in telemedicine, devoted to developing countries, as described by the proper scientific literature. On the basis of such literature, we want to define a specific taxonomy that allows a proper classification and a fast overview of telemedicine projects in developing countries. Moreover, by considering both the literature and some recent direct experiences, we want to complete such overview by discussing some design issues to be taken into consideration when developing telemedicine software systems. We considered and reviewed the major conferences and journals in depth, and looked for reports on the telemedicine projects. We provide the reader with a survey of the main projects and systems, from which we derived a taxonomy of features of telemedicine systems for developing countries. We also propose and discuss some classification criteria for design issues, based on the lessons learned in this research area. We highlight some challenges and recommendations to be considered when designing a telemedicine system for developing countries.

Telemedicine in otolaryngology.

PubMed

Holtel, Michael R; Burgess, Lawrence P A

2002-12-01

More research is needed in otolaryngology telemedicine, but it would be a mistake to stop at only determining if telemedicine is as good as an in-person exam. The digital image recorded in a telemedicine encounter can be manipulated to increase diagnostic information not currently available. Radiologists currently take a chest radiograph in which a chest mass or the tip of an nasogastric tube is difficult to visualize, and by inverting the gray scale or viewing other digital manipulations of that image, the mass or tube tip becomes obvious. Examples in otolaryngology might include images of the larynx manipulated to better demonstrate the inflamed tissue of reflux, or images of the tympanic membrane manipulated to better demonstrate early retraction. Despite dramatic and likely continued decreases, equipment cost is still an issue. Current research points to good consumer acceptance, and certainly with each new generation the technology is more readily accepted. As Nesbitt [4] points out, it is certainly not difficult to look to the future and see ubiquitous broadband with video as common as telephone, or even extreme broadband enabling robotics and virtual reality TV with three-dimensional touch. Robotics and genomics will eventually play a greater role in telemedicine and our lives in general. Applications for remote diagnosis in biologic warfare defense and homeland security are currently raising interest in telemedicine. Telemedicine will be combined with new technological advances such as virtual "fly-through" computerized axial tomography examinations. Instead of performing an exploratory tympanotomy, surgeons will use computer programs to "fly through" and examine all aspects of a patient's middle or even inner ear. Spectral imaging of the eardrum, larynx, or oropharynx will immediately identify bacteria without cultures, or gram stain, and potential malignancy without biopsy. By measuring fluorescence emitted from an oropharynx illuminated with a specific

[Telemedicine and dementia: a need for the 21st century].

PubMed

Vilalta-Franch, J; Garre-Olmo, J; López-Pousa, S; Coll-De Tuero, G; Monserrat-Vila, S

The ongoing process of information and communication technologies in health services implies a change in the conception, organization and management of these services. Telemedicine is a working method that allows health professionals to explore and/or treat a patient from an off-site location. In this review we provide a historical background on telemedicine, the evolution of its bibliometric impact, and its application for people with dementia. Telemedicine's applications have been developed in order to provide greater availability and easier access to healthcare to underserved people. The bibliometric study of telemedicine literature shows an increase in the number of bibliographic references related to telemedicine since 1995. During the last few years in Spain the research and development of telemedicine programs have increased significantly and at present there are telemedicine programs in all regions of the country. Although some of the needs of the patients with dementia may be unsuitable for communication and information technologies, their application could offer an added value to health services. This technology does not attempt to replace face-to-face medical consultations but rather to prevent some difficulties this kind of patients can present and improve their quality of life. Dementia could be an appropriate field in order to implement some telemedicine programs that may improve patient medical care, and reduce medical and management expenses for social and healthcare services.

MediLink: a wearable telemedicine system for emergency and mobile applications.

PubMed

Koval, T; Dudziak, M

1999-01-01

The practical needs of the medical professional faced with critical care or emergency situations differ from those working in many environments where telemedicine and mobile computing have been introduced and tested. One constructive criticism of the telemedicine initiative has been to question what positive benefits are gained from videoconferencing, paperless transactions, and online access to patient record. With a goal of producing a positive answer to such questions an architecture for multipurpose mobile telemedicine applications has been developed. The core technology is based upon a wearable personal computer with a smart-card interface coupled with speech, pen, video input and wireless intranet connectivity. The TransPAC system with the MedLink software system is designed to provide an integrated solution for a broad range of health care functions where mobile and hands-free or limited-access systems are preferred or necessary and where the capabilities of other mobile devices are insufficient or inappropriate. Structured and noise-resistant speech-to-text interfacing plus the use of a web browser-like display, accessible through either a flatpanel, standard, or headset monitor, gives the beltpack TransPAC computer the functions of a complete desktop including PCMCIA card interfaces for internet connectivity and a secure smartcard with 16-bit microprocessor and upwards of 64K memory. The card acts to provide user access control for security, user custom configuration of applications and display and vocabulary, and memory to diminish the need for PC-server communications while in an active session. TransPAC is being implemented for EMT and ER staff usage.

A Computational framework for telemedicine.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Foster, I.; von Laszewski, G.; Thiruvathukal, G. K.

1998-07-01

Emerging telemedicine applications require the ability to exploit diverse and geographically distributed resources. Highspeed networks are used to integrate advanced visualization devices, sophisticated instruments, large databases, archival storage devices, PCs, workstations, and supercomputers. This form of telemedical environment is similar to networked virtual supercomputers, also known as metacomputers. Metacomputers are already being used in many scientific application areas. In this article, we analyze requirements necessary for a telemedical computing infrastructure and compare them with requirements found in a typical metacomputing environment. We will show that metacomputing environments can be used to enable a more powerful and unified computational infrastructure formore » telemedicine. The Globus metacomputing toolkit can provide the necessary low level mechanisms to enable a large scale telemedical infrastructure. The Globus toolkit components are designed in a modular fashion and can be extended to support the specific requirements for telemedicine.« less

Telemedicine in South Africa: success or failure?

PubMed

Gulube, S M; Wynchank, S

2001-01-01

A national telemedicine system for South Africa was planned in 1998. In the first phase, starting in 1999, 28 pilot sites were established in six provinces. The initial applications were teleradiology, tele-ultrasound for antenatal services, telepathology and tele-ophthalmology. Telemedicine equipment was connected by ISDN at 256 kbit/s. From January to September 2000, 2663 radiographic studies were performed at the three Northwest Province teleradiology transmission sites, of which 264 studies (10%) were selected for specialist radiologist reporting by teleradiology. From June to August 2000, nine antenatal care tele-ultrasound consultations were performed in the Northern Cape Province and four transfers were avoided through the use of telemedicine. One area of concern is the relatively low usage of the telemedicine system, which raises questions about its cost-effectiveness. The experience of telemedicine in South Africa confirmed, as others have found, that common problems relate to the technical and organizational challenges of introducing telemedicine.

Characterizing New England Emergency Departments by Telemedicine Use.

PubMed

Zachrison, Kori S; Hayden, Emily M; Schwamm, Lee H; Espinola, Janice A; Sullivan, Ashley F; Boggs, Krislyn M; Raja, Ali S; Camargo, Carlos A

2017-10-01

Telemedicine connects emergency departments (ED) with resources necessary for patient care; its use has not been characterized nationally, or even regionally. Our primary objective was to describe the prevalence of telemedicine use in New England EDs and the clinical applications of use. Secondarily, we aimed to determine if telemedicine use was associated with consultant availability and to identify ED characteristics associated with telemedicine use. We analyzed data from the National Emergency Department Inventory-New England survey, which assessed basic ED characteristics in 2014. The survey queried directors of every ED (n=195) in the six New England states (excluding federal hospitals and college infirmaries). Descriptive statistics characterized ED telemedicine use; multivariable logistic regression identified independent predictors of use. Of the 169 responding EDs (87% response rate), 82 (49%) reported using telemedicine. Telemedicine EDs were more likely to be rural (18% of users vs. 7% of non-users, p=0.03); less likely to be academic (1% of users vs. 11% of non-users, p=0.01); and less likely to have 24/7 access to neurology (p<0.001), neurosurgery (p<0.001), orthopedics (p=0.01), plastic surgery (p=0.01), psychiatry (p<0.001), and hand surgery (p<0.001) consultants. Neuro/stroke (68%), pediatrics (11%), psychiatry (11%), and trauma (10%) were the most commonly reported applications. On multivariable analysis, telemedicine was more likely in rural EDs (odds ratio [OR] 4.39, 95% confidence interval [CI] 1.30-14.86), and less likely in EDs with 24/7 neurologist availability (OR 0.21, 95% CI [0.09-0.49]), and annual volume <20,000 (OR 0.24, 95% CI [0.08-0.68]). Telemedicine is commonly used in New England EDs. In 2014, use was more common among rural EDs and EDs with limited neurology consultant availability. In contrast, telemedicine use was less common among very low-volume EDs.

Medical care from space: Telemedicine.

PubMed

Feliciani, Francesco

2003-05-01

'Telemedicine' can be defined in various ways, but the underlying concept is based on the simple fact that, thanks to modern telecommunications links, diagnostic and therapeutic medical information can be passed between patient and doctor without either of them having to travel. Initially and for quite a long period, voice communication, via telephone or radio, was used to solicit the opinion of a doctor in the case of an emergency, but the potential of Telemedicine was boosted dramatically by the widespread introduction of modern information and communication technology (ICT) into the healthcare sector. Today we are at the point where the boundary separating Telemedicine and medical ICT is somewhat blurred. The prospect of using satellite communications technologies and associated connectivity services to support even wider application of the benefits of Telemedicine was the reason why ESA began actively pursuing activities in this challenging domain back in 1996.

Advanced computer architecture for large-scale real-time applications.

DOT National Transportation Integrated Search

1973-04-01

Air traffic control automation is identified as a crucial problem which provides a complex, real-time computer application environment. A novel computer architecture in the form of a pipeline associative processor is conceived to achieve greater perf...

Modeling Real-Time Applications with Reusable Design Patterns

NASA Astrophysics Data System (ADS)

Rekhis, Saoussen; Bouassida, Nadia; Bouaziz, Rafik

Real-Time (RT) applications, which manipulate important volumes of data, need to be managed with RT databases that deal with time-constrained data and time-constrained transactions. In spite of their numerous advantages, RT databases development remains a complex task, since developers must study many design issues related to the RT domain. In this paper, we tackle this problem by proposing RT design patterns that allow the modeling of structural and behavioral aspects of RT databases. We show how RT design patterns can provide design assistance through architecture reuse of reoccurring design problems. In addition, we present an UML profile that represents patterns and facilitates further their reuse. This profile proposes, on one hand, UML extensions allowing to model the variability of patterns in the RT context and, on another hand, extensions inspired from the MARTE (Modeling and Analysis of Real-Time Embedded systems) profile.

Automated Detection and Analysis of Interplanetary Shocks with Real-Time Application

NASA Astrophysics Data System (ADS)

Vorotnikov, V.; Smith, C. W.; Hu, Q.; Szabo, A.; Skoug, R. M.; Cohen, C. M.

2006-12-01

The ACE real-time data stream provides web-based now-casting capabilities for solar wind conditions upstream of Earth. Our goal is to provide an automated code that finds and analyzes interplanetary shocks as they occur for possible real-time application to space weather nowcasting. Shock analysis algorithms based on the Rankine-Hugoniot jump conditions exist and are in wide-spread use today for the interactive analysis of interplanetary shocks yielding parameters such as shock speed and propagation direction and shock strength in the form of compression ratios. Although these codes can be automated in a reasonable manner to yield solutions not far from those obtained by user-directed interactive analysis, event detection presents an added obstacle and the first step in a fully automated analysis. We present a fully automated Rankine-Hugoniot analysis code that can scan the ACE science data, find shock candidates, analyze the events, obtain solutions in good agreement with those derived from interactive applications, and dismiss false positive shock candidates on the basis of the conservation equations. The intent is to make this code available to NOAA for use in real-time space weather applications. The code has the added advantage of being able to scan spacecraft data sets to provide shock solutions for use outside real-time applications and can easily be applied to science-quality data sets from other missions. Use of the code for this purpose will also be explored.

"Fast" Is Not "Real-Time": Designing Effective Real-Time AI Systems

NASA Astrophysics Data System (ADS)

O'Reilly, Cindy A.; Cromarty, Andrew S.

1985-04-01

Realistic practical problem domains (such as robotics, process control, and certain kinds of signal processing) stand to benefit greatly from the application of artificial intelligence techniques. These problem domains are of special interest because they are typified by complex dynamic environments in which the ability to select and initiate a proper response to environmental events in real time is a strict prerequisite to effective environmental interaction. Artificial intelligence systems developed to date have been sheltered from this real-time requirement, however, largely by virtue of their use of simplified problem domains or problem representations. The plethora of colloquial and (in general) mutually inconsistent interpretations of the term "real-time" employed by workers in each of these domains further exacerbates the difficul-ties in effectively applying state-of-the-art problem solving tech-niques to time-critical problems. Indeed, the intellectual waters are by now sufficiently muddied that the pursuit of a rigorous treatment of intelligent real-time performance mandates the redevelopment of proper problem perspective on what "real-time" means, starting from first principles. We present a simple but nonetheless formal definition of real-time performance. We then undertake an analysis of both conventional techniques and AI technology with respect to their ability to meet substantive real-time performance criteria. This analysis provides a basis for specification of problem-independent design requirements for systems that would claim real-time performance. Finally, we discuss the application of these design principles to a pragmatic problem in real-time signal understanding.

Use of telemedicine in disaster and remote places

PubMed Central

Ajami, Sima; Lamoochi, Parisa

2014-01-01

One of the methods, especially those living in remote areas or have crashed and does not have access to specialists is telemedicine. Telemedicine describes the use of medical information exchanged from one site to another via electronic communications to improve patients’ health status and care. Travel and wait times between the initial consultations with the patient's own general practitioner and referral to specialist can be reduced and specialists have successfully provided remote triage and treatment consults of victims via the robot. The robot proved to be a useful means to extend resources and provide expert consulting if specialists were unable to physically be at the site. In fact, the telemedicine system is providing health care services for individuals who are not available because of geographical and environmental conditions. The aim of this study was to identify telemedicine applications in disaster, and proposed use of this technology in areas where the shortage of specialists in remote areas in disasters. This study was un-systematic (narrative) review. The literature was searched for using of telemedicine in disaster and remote places with the help of libraries, conference proceedings, data bank, and also search engines available at Google, Google scholar. In our searches, we employed the following keywords and their combinations: telemedicine, remote place, earthquake, disaster, war, and telecommunication in the searching areas of title, keyword, abstract, and full text. In this study, more than 85 articles and reports were collected and 26 of them were selected based on their relevancy. This literature review helps define the concept of “components and usages of the Telemedicine in disaster” as the new technology in the present age. PMID:25013819

Telemedicine: the slow revolution.

PubMed

Moncrief, Jack W

2014-01-01

The use of interactive video has been recognized as a means of delivering medical support to isolated areas since the 1950s. The Department of Defense recognized early the capacity of telemedicine to deliver medical care and support to front-line military personnel. In 1989, the Texas Telemedicine Project received grants and support from the then American Telephone and Telegraph Company (now AT&T) and the Meadows Foundation of Dallas, Texas, to establish and evaluate telemedicine delivery in central Texas. That project had 6 connected telemedicine sites: 3 in Austin, Texas, and 3 in Giddings, Texas (a small community 55 miles to the southeast of Austin). The sites in Giddings included a chronic outpatient dialysis facility, an inpatient psychiatric hospital, and the emergency department at Giddings Hospital. Patient contact began in April 1991 and continued through March 1993. During that period, data on the 1500 patient contacts made were recorded. After termination of the Texas Telemedicine Project, AT&T continued to provide the transmission lines, and between 1993 and 1996, another 12,000 patient contacts were made. Approximately 80% were dialysis evaluations and 20% were non-dialysis primary care contacts. The original cost of materials and equipment in the Texas Telemedicine Project exceeded $50,000 per site. Today, a secure Internet connection with full-motion video and wireless data transfer to almost any location in the world is achievable with an iPad. Multiple inexpensive applications with connections for electrocardiogram, otoscope, and stethoscope, among others, make this technology extremely inexpensive and user-friendly. The revolution now is rapidly moving forward, with Medicare reimbursing telemedicine contacts in medically underserved areas. Multiple bills are before Congress to expand Medicare and therefore private insurance payment for this service.

Medical Device Integrated Vital Signs Monitoring Application with Real-Time Clinical Decision Support.

PubMed

Moqeem, Aasia; Baig, Mirza; Gholamhosseini, Hamid; Mirza, Farhaan; Lindén, Maria

2018-01-01

This research involves the design and development of a novel Android smartphone application for real-time vital signs monitoring and decision support. The proposed application integrates market available, wireless and Bluetooth connected medical devices for collecting vital signs. The medical device data collected by the app includes heart rate, oxygen saturation and electrocardiograph (ECG). The collated data is streamed/displayed on the smartphone in real-time. This application was designed by adopting six screens approach (6S) mobile development framework and focused on user-centered approach and considered clinicians-as-a-user. The clinical engagement, consultations, feedback and usability of the application in the everyday practices were considered critical from the initial phase of the design and development. Furthermore, the proposed application is capable to deliver rich clinical decision support in real-time using the integrated medical device data.

Capabilities needed for the next generation of thermo-hydraulic codes for use in real time applications

DOE Office of Scientific and Technical Information (OSTI.GOV)

Arndt, S.A.

1997-07-01

The real-time reactor simulation field is currently at a crossroads in terms of the capability to perform real-time analysis using the most sophisticated computer codes. Current generation safety analysis codes are being modified to replace simplified codes that were specifically designed to meet the competing requirement for real-time applications. The next generation of thermo-hydraulic codes will need to have included in their specifications the specific requirement for use in a real-time environment. Use of the codes in real-time applications imposes much stricter requirements on robustness, reliability and repeatability than do design and analysis applications. In addition, the need for codemore » use by a variety of users is a critical issue for real-time users, trainers and emergency planners who currently use real-time simulation, and PRA practitioners who will increasingly use real-time simulation for evaluating PRA success criteria in near real-time to validate PRA results for specific configurations and plant system unavailabilities.« less

Network and data security design for telemedicine applications.

PubMed

Makris, L; Argiriou, N; Strintzis, M G

1997-01-01

The maturing of telecommunication technologies has ushered in a whole new era of applications and services in the health care environment. Teleworking, teleconsultation, mutlimedia conferencing and medical data distribution are rapidly becoming commonplace in clinical practice. As a result, a set of problems arises, concerning data confidentiality and integrity. Public computer networks, such as the emerging ISDN technology, are vulnerable to eavesdropping. Therefore it is important for telemedicine applications to employ end-to-end encryption mechanisms securing the data channel from unauthorized access of modification. We propose a network access and encryption system that is both economical and easily implemented for integration in developing or existing applications, using well-known and thoroughly tested encryption algorithms. Public-key cryptography is used for session-key exchange, while symmetric algorithms are used for bulk encryption. Mechanisms for session-key generation and exchange are also provided.

Diagnostic ultrasound and telemedicine utilization in the international space station

NASA Astrophysics Data System (ADS)

Carter, Stephen J.; Stewart, Brent K.; Kushmerick, Martin J.; Langer, Steve G.; Schmiedl, Udo P.; Winter, Thomas C.; Conley, Kevin E.; Jubrias, Sharon A.

1999-01-01

Clinical diagnostic ultrasound (US) is experiencing an expanding role that is well suited to application on the International Space Station (ISS). Diagnostic US can be used to reduce the risks associated with long duration human space flight by providing a non-invasive tool with head-to-toe diagnostic capability in both biomedical research and crew health care. General health care of the astronauts will be diagnosed with US, e.g., kidney stones, gall bladder disease, appendicitis, etc. Initial studies will focus on detection of ``ureteral jets'' in the bladder. This is a non-invasive test to rule out obstructive uropathy from kidney stones with minimal requirements for crew training. Biomedical research experiments, focusing on the effects of the microgravity environment, will be performed using both the HHU and the HDI 5000. US will be used to evaluate bone density and muscle mass in this environment. Prolonged or emergency EVAs may occur with the ISS. The hand-held ultrasound unit (HHU) and its telemedicine capability will be used in EVA settings to monitor events such as decompression sickness (DCS) microbubble formation in the cardiovascular system. There will be telemetry links between the HHU and the ATL/Lockheed Martin rack mounted HDI 5000 in the ISS Human Research Facility (HRF), as well as between the HRF and medical expertise on the ground. These links will provide the ISS with both real-time and store-and-forward telemedicine capabilities. The HHU can also be used with the existing telemedicine instrument pack (TIP).

Telemedicine Program

NASA Technical Reports Server (NTRS)

1996-01-01

Since the 1970s, NASA has been involved in the research and demonstration of telemedicine for its potential in the care of astronauts in flight and Earth-bound applications. A combination of NASA funding, expertise and off-the-shelf computer and networking systems made telemedicine possible for a medically underserved hospital in Texas. Through two-way audio/video relay, the program links pediatric oncology specialists at the University of Texas Health Science Center in San Antonio to South Texas Hospital in Harlingen, providing easier access and better care to children with cancer. Additionally, the hospital is receiving teleclinics on pediatric oncology nursing, family counseling and tuberculosis treatment. VTEL Corporation, Sprint, and the Healthcare Open Systems and Trials Consortium also contributed staff and hardware.

The need for economic evaluation of telemedicine to evolve: the experience in Alberta, Canada.

PubMed

Hailey, David; Jennett, Penny

2004-01-01

Economic evaluation of telemedicine applications is required to provide decision makers in health care with appropriate information on costs and benefits of this information and communications technology. The level of economic evaluation should evolve as telemedicine applications mature. At the basic level, economic evaluation may include basic cost analysis and primarily observational data on nonmonetary benefits. The focus will change as telemedicine programs develop. At this intermediate level, practice patterns and workforce issues are addressed as they affect utilization and costs of telemedicine services. Longer-term economic evaluation, thus far not achieved in telemedicine assessment, should focus on assessment of health outcomes and economic impact. Alberta, Canada has made progress assessing telemedicine applications in psychiatry, radiology, rheumatology, and rehabilitation. Data availability and analytic resources continue to present challenges to economic assessment of telemedicine.

Clinicians' Knowledge and Perception of Telemedicine Technology.

PubMed

Ayatollahi, Haleh; Sarabi, Fatemeh Zahra Pourfard; Langarizadeh, Mostafa

2015-01-01

Telemedicine is an application of information and communication technology in the healthcare environment. This study aimed to compare knowledge and perceptions of telemedicine technology among different groups of clinicians. This survey study was conducted in 2013. The potential participants included 532 clinicians who worked in two hospitals and three clinics in a northern province of Iran. Data were collected using a five-point Likert-scale questionnaire. The content validity of the questionnaire was checked, and the reliability was calculated using Cronbach's alpha coefficient (α = 0.73). The results showed that most of the clinicians (96.1 percent) had little knowledge about telemedicine. They perceived the advantages of telemedicine at a moderate level and its disadvantages at a low level. The knowledge of dentists about this technology was less than that of other groups, and as a result they were less positive about the advantages of telemedicine compared to nurses, general physicians, and specialists. The limited knowledge of clinicians about telemedicine seems to have influenced their perceptions of the technology. Therefore, providing healthcare professionals with more information about new technologies in healthcare, such as telemedicine, can help to gain a more realistic picture of their perceptions.

Telemedicine and electronic health information for clinical continuity in a mobile surgery program.

PubMed

Mora, Francisco; Cone, Stephen; Rodas, Edgar; Merrell, Ronald C

2006-06-01

An intermittent surgical services program in rural Ecuador was able to benefit from close collaboration between surgeons and primary care physicians through the use of telemedicine technologies. Inexpensive telemedicine workstations capable of patient documentation, imaging, and video-conferencing at extremely low bandwidth were established in collaborative primary care sites in rural Ecuador. Patients were screened for intermittent surgical services by primary caregivers according to the surgeons' guidelines. Real-time and store-and-forward telemedicine allowed appropriate collaborative, informed decision-making. Surgery was performed, and postoperative care was similarly handled by on-site, familiar primary caregivers. To date, this system has been used in more than 124 patient encounters (74 preoperative and 50 postoperative visits). The system allowed advance screening of patients on the part of the surgeons, leading to cancellations for 9 patients. Postoperatively, the system allowed 100% concurrence in postoperative diagnoses between the primary caregivers and the surgeons. Inexpensive, low-bandwidth telemedicine solutions can support intermittent surgical services by providing patients to have contact with specialist care through their familiar, local primary caregivers.

[Telemedicine in thrombotic microangiopathies: A way forward in rare diseases requiring emergency care].

PubMed

Coppo, P; Corre, E; Rondeau, E; Benhamou, Y; Bachet, A; Stépanian, A; Veyradier, A

2016-08-01

Thrombotic microangiopathies (TMA) represent rare diseases requiring a high skill for their management that deserved in France the identification of a dedicated National reference center. TMA are short-term life-threatening diseases; however, with an adapted management, their prognosis can be excellent. It is therefore mandatory to recognize and treat them rapidly according to standard guidelines. Telemedicine is a specialized hub consisting of highly skilled staff trained in a specific domain of medicine. The telemedicine activity of a reference center is an important representative indicator of its expertise and recourse ability. It requires to be accurately evaluated and promoted. In this work, we report the French reference center for TMA telemedicine activity since its setting-up. TMA represent an interesting model of diseases that required a specific organization of telemedicine activity to adapt to clinicians demand, which includes particularly the need to answer resorts in real time 24/7. Copyright © 2015 Société Nationale Française de Médecine Interne (SNFMI). Published by Elsevier SAS. All rights reserved.

A telemedicine wound care model using 4G with smart phones or smart glasses

PubMed Central

Ye, Junna; Zuo, Yanhai; Xie, Ting; Wu, Minjie; Ni, Pengwen; Kang, Yutian; Yu, Xiaoping; Sun, Xiaofang; Huang, Yao; Lu, Shuliang

2016-01-01

Abstract To assess the feasibility of a wound care model using 4th-generation mobile communication technology standards (4G) with smart phones or smart glasses for wound management. This wound care model is an interactive, real-time platform for implementing telemedicine changing wound dressings, or doing operations. It was set up in March 2015 between Jinhua in Zhejiang province and Shanghai, China, which are 328 km apart. It comprised of a video application (APP), 4G net, smart phones or smart glasses, and a central server. This model service has been used in 30 patients with wounds on their lower extremities for 109 times in 1 month. Following a short learning curve, the service worked well and was deemed to be user-friendly. Two (6.7%) patients had wounds healed, while others still required wound dressing changes after the study finished. Both local surgeons and patients showed good acceptance of this model (100% and 83.33%, respectively). This telemedicine model is feasible and valuable because it provides an opportunity of medical service about wound healing in remote areas where specialists are scarce. PMID:27495023

A flexible software architecture for scalable real-time image and video processing applications

NASA Astrophysics Data System (ADS)

Usamentiaga, Rubén; Molleda, Julio; García, Daniel F.; Bulnes, Francisco G.

2012-06-01

Real-time image and video processing applications require skilled architects, and recent trends in the hardware platform make the design and implementation of these applications increasingly complex. Many frameworks and libraries have been proposed or commercialized to simplify the design and tuning of real-time image processing applications. However, they tend to lack flexibility because they are normally oriented towards particular types of applications, or they impose specific data processing models such as the pipeline. Other issues include large memory footprints, difficulty for reuse and inefficient execution on multicore processors. This paper presents a novel software architecture for real-time image and video processing applications which addresses these issues. The architecture is divided into three layers: the platform abstraction layer, the messaging layer, and the application layer. The platform abstraction layer provides a high level application programming interface for the rest of the architecture. The messaging layer provides a message passing interface based on a dynamic publish/subscribe pattern. A topic-based filtering in which messages are published to topics is used to route the messages from the publishers to the subscribers interested in a particular type of messages. The application layer provides a repository for reusable application modules designed for real-time image and video processing applications. These modules, which include acquisition, visualization, communication, user interface and data processing modules, take advantage of the power of other well-known libraries such as OpenCV, Intel IPP, or CUDA. Finally, we present different prototypes and applications to show the possibilities of the proposed architecture.

Hospital Views of Factors Affecting Telemedicine Use.

PubMed

Merchant, Kimberly A S; Ward, Marcia M; Mueller, Keith J

2015-04-01

Telemedicine (also known as telehealth) is a means to increase access to care, one of the foundations of the Triple Aim. However, the expansion of telemedicine services in the United States has been relatively slow. We previously examined the extent of uptake of hospital based telemedicine using the 2013 HIMSS (Healthcare Information and Management Systems Society) Analytics national database of 4,727 non-specialty hospitals. Our analysis indicated that the largest percentage of operational telemedicine implementations (15.7 percent) was in radiology departments, with a substantial number in emergency/trauma care (7.5 percent) and cardiology/stroke/heart attack programs (6.8 percent). However, existing databases are limited because they do not identify whether a respondent hospital is a "hub" (providing telemedicine services) or a "spoke" (receiving telemedicine services). Therefore, we used data from interviews with hospital representatives to deepen the research and understanding of telemedicine use and the factors affecting that use. Interviews were conducted with key informants at 18 hub hospitals and 18 spoke hospitals to explore their perceptions of barriers and motivators to telemedicine adoption and expansion. Key Findings. (1) Respondents from both hub and spoke hospitals reported that telemedicine helps them meet their mission, enhances access, keeps lower-acuity patients closer to home, and helps head off competition. (2) Respondents from both hub and spoke hospitals reported licensing and credentialing to be significant barriers to telemedicine expansion. Thus, half of hubs provide services only within their state. (3) A variety of one-time funding sources have been used to initiate and grow telemedicine services among hubs and spokes. However, reimbursement issues have impeded the development of workable business models for sustainability. Hub hospitals shoulder the responsibility for identifying sustainable business models. (4) Although respondents

Telemedicine in dermatology during external operations.

PubMed

Morand, J J

2017-11-01

Telemedicine makes it possible to refer clinical, laboratory, and radiological questions to distant experts, sometimes in real time. This study examines a selection of internet messages sent by physicians carrying out overseas missions or assigned to remote locations and analyzes the interest but also the limitations of teleconsultations in dermatology. The effectiveness of the response depended on the quality of the message, including correct symptom descriptions, thorough history-taking, and the definition of the attached images, as well as the field experience of the specialists receiving the message. Feedback is also of fundamental importance in improving remote expert assessment. The main problem is that conclusive diagnosis is often prevented by the lack of equipment and follow-up available in the field, i.e., inability to perform confirmatory testing or obtain sufficient follow-up information to evaluate the outcome of trial treatments. Training of doctors and nurses in the French Army Medical Service in telemedicine and in clearer better structured messages can contribute to the effectiveness of this mode of communication.

Telemedicine in support of peacekeeping operations overseas: an audit.

PubMed

Navein, J; Hagmann, J; Ellis, J

1997-01-01

Since 1993, the Department of Defense has augmented the medical support for Army units on peacekeeping operations in Macedonia through the medium of telemedicine. This project, known as Operation Primetime 1, was the first satellite-based telemedicine system deployed in support of remote primary-care physician in the U.S. military. Its declared aims are: (1) to improve the standard of care; (2) to reduce evacuations; (3) to support junior physicians in the field; and (4) to improve the military effectiveness of the deployed units. This paper audits the success in attaining those goals for the period January 1994 to April 1995. A log was collated from the referring units and questionnaires completed by both referring and consulting physicians. The referring physicians were interviewed on their return from Macedonia, and a more detailed study was undertaken of cases in which a change in outcome was noted. Follow-up interview of consultants was not possible. A total of 53 consults were undertaken on 47 patients. The use of telemedicine affected the decision to evacuate 13 times (13/47), with a net reduction of 9 evacuations. Management of individual cases was changed in 30 of the 47 cases in which telemedicine was used. Physician confidence and military effectiveness were also improved. The level of utilization of the system was largely dependent on a training and sustainment program. Units and General Medical Officers who were trained in the clinical use of telemedicine and the technical sustainment of the equipment used the system; those who were not, did not. Most patients (45/47) were treated satisfactorily with a single consult. Telemedicine under these circumstances seems to be cost effective. The deployed sites chose the referral centers that provided the best service. Telemedicine is a valuable tool capable of augmenting medical support to deployed military units. A successful deployed telemedicine project requires an integrated support package that includes

Using Telemedicine to Conduct Behavioral Assessments

PubMed Central

Barretto, Anjali; Wacker, David P; Harding, Jay; Lee, John; Berg, Wendy K

2006-01-01

We describe the use of telemedicine by the Biobehavioral Service at the University of Iowa Hospitals and Clinics to conduct brief functional analyses for children with developmental and behavioral disorders who live in rural areas of Iowa. Instead of being served at our outpatient facility, participants received initial behavioral assessments in their local schools or social service agencies via videoconference. Case descriptions for 2 participants whose evaluations were conducted via telemedicine, and a brief summary of all outpatient assessments conducted over a 4-year period by the Biobehavioral Service, are provided. This report extends previous applications of functional analysis procedures by examining brief behavioral assessments conducted via telemedicine. PMID:17020213

Quality of Service for Real-Time Applications Over Next Generation Data Networks

NASA Technical Reports Server (NTRS)

Ivancic, William; Atiquzzaman, Mohammed; Bai, Haowei; Su, Hongjun; Jain, Raj; Duresi, Arjan; Goyal, Mukyl; Bharani, Venkata; Liu, Chunlei; Kota, Sastri

2001-01-01

This project, which started on January 1, 2000, was funded by NASA Glenn Research Center for duration of one year. The deliverables of the project included the following tasks: Study of QoS mapping between the edge and core networks envisioned in the Next Generation networks will provide us with the QoS guarantees that can be obtained from next generation networks. Buffer management techniques to provide strict guarantees to real-time end-to-end applications through preferential treatment to packets belonging to real-time applications. In particular, use of ECN to help reduce the loss on high bandwidth-delay product satellite networks needs to be studied. Effect of Prioritized Packet Discard to increase goodput of the network and reduce the buffering requirements in the ATM switches. Provision of new IP circuit emulation services over Satellite IP backbones using MPLS will be studied. Determine the architecture and requirements for internetworking ATN and the Next Generation Internet for real-time applications.

Efficacy of site-independent telemedicine in the STRokE DOC trial: a randomised, blinded, prospective study

PubMed Central

Meyer, Brett C.; Raman, Rema; Hemmen, Thomas; Obler, Richard; Zivin, Justin A.; Rao, Ramesh; Thomas, Ronald G.; Lyden, Patrick D.

2009-01-01

Background To increase effective use of rt-PA for acute stroke, vascular neurology expertise must be disseminated more widely. We prospectively assessed whether telemedicine (real-time, 2 way audio/video and DICOM interpretation) or telephone was superior for decision-making in acute telemedicine consultations. Methods Acute stroke patients were randomized to telemedicine or telephone consultation. Primary outcome measure was whether the thrombolytic treatment decision was correct, as determined by central adjudication. Secondary outcomes included rt-PA use-rate, 90 day functional outcomes, hemorrhages, and technical observations. Findings Two hundred thirty-four patients were prospectively evaluated. Mean NIHSS score was 9.5 (11.4±8.7 telemedicine, 7.7±7.0 telephone; p=0.0020). One telemedicine consult (0.9%) was aborted for technical reasons, though was included in intention-to-treat analyses. Correct treatment decision was made more often in telemedicine (98.2% telemedicine, 82% telephone; OR 10.9; 95%CI 2.7-44.6; p=0.0009). IV rt-PA use-rate was 25% (28% telemedicine, 23% telephone; OR 1.3; 95%CI 0.7-2.5; p=0.4248). Ninety day functional outcomes were not different for BI(95–100) (OR 0.6; 95%CI 0.4-1.1; p=0.1268) or for mRS (OR 0.6; 95%CI 0.3-1.1; p=0.0898). There was no mortality difference (OR 1.6; 95%CI 0.8-3.4; p=0.2690). Post-rt-PA ICH rates were not different (7% telemedicine, 8% telephone; OR 0.8; 95%CI 0.1-6.3; p=1.0). There was a difference noted for amount of non-completed data (3.1% telemedicine, 12.0% telephone; OR 0.2; 95%CI 0.1-0.3; p<0.001). Interpretation This trial reports that stroke telemedicine consultations result in more accurate decision making, compared to telephone, and can serve as a model for the effective use of telemedicine in other medical fields. The more appropriate decisions, high rt-PA userates, improved data collection, low ICH rates, low technical complications, and favorable time requirements all support telemedicine�

ASSESSMENT OF MAST IN EUROPEAN PATIENT-CENTERED TELEMEDICINE PILOTS.

PubMed

Ekeland, Anne Granstrøm; Grøttland, Astrid

2015-01-01

Model for ASsessment of Telemedicine Applications (MAST) is a health technology assessment (HTA) inspired framework for assessing the effectiveness and contribution to quality of telemedicine applications based on rigorous, scientific data. This study reports from a study of how it was used and perceived in twenty-one pilots of the European project RENEWING HEALTH (RH). The objectives of RH were to implement large-scale, real-life test beds for the validation and subsequent evaluation of innovative patient-centered telemedicine services. The study is a contribution to the appraisal of HTA methods. A questionnaire was administered for project leaders of the pilots. It included questions about use and usefulness of MAST for (i) preceding considerations, (ii) evaluation of outcomes within seven domains, and (iii) considerations of transferability. Free text spaces allowed for proposals of improvement. The responses covered all pilots. A quantitative summary of use and a qualitative analysis of usefulness were performed. MAST was used and considered useful for pilot evaluations. Challenges included problems to scientifically determine alternative service options and outcome within the seven domains. Proposals for improvement included process studies and adding domains of technological usability, responsible innovation, health literacy, behavior change, caregiver perspectives and motivational issues of professionals. MAST was used according to its structure. Its usefulness in patient centered pilots can be improved by adding new stakeholder groups. Interdependencies between scientific rigor, resources and timeliness should be addressed. Operational options for improvements include process studies, literature reviews and sequential mini-HTAs for identification of areas for more elaborate investigations.

Web-based home telemedicine system for orthopedics

NASA Astrophysics Data System (ADS)

Lau, Christopher; Churchill, Sean; Kim, Janice; Matsen, Frederick A., III; Kim, Yongmin

2001-05-01

Traditionally, telemedicine systems have been designed to improve access to care by allowing physicians to consult a specialist about a case without sending the patient to another location, which may be difficult or time-consuming to reach. The cost of the equipment and network bandwidth needed for this consultation has restricted telemedicine use to contact between physicians instead of between patients and physicians. Recently, however, the wide availability of Internet connectivity and client and server software for e- mail, world wide web, and conferencing has made low-cost telemedicine applications feasible. In this work, we present a web-based system for asynchronous multimedia messaging between shoulder replacement surgery patients at home and their surgeons. A web browser plug-in was developed to simplify the process of capturing video and transferring it to a web site. The video capture plug-in can be used as a template to construct a plug-in that captures and transfers any type of data to a web server. For example, readings from home biosensor instruments (e.g., blood glucose meters and spirometers) that can be connected to a computing platform can be transferred to a home telemedicine web site. Both patients and doctors can access this web site to monitor progress longitudinally. The system has been tested with 3 subjects for the past 7 weeks, and we plan to continue testing in the foreseeable future.

Value of Telemonitoring and Telemedicine in Heart Failure Management.

PubMed

Gensini, Gian Franco; Alderighi, Camilla; Rasoini, Raffaele; Mazzanti, Marco; Casolo, Giancarlo

2017-11-01

The use of telemonitoring and telemedicine is a relatively new but quickly developing area in medicine. As new digital tools and applications are being created and used to manage medical conditions such as heart failure, many implications require close consideration and further study, including the effectiveness and safety of these telemonitoring tools in diagnosing, treating and managing heart failure compared to traditional face-to-face doctor-patient interaction. When compared to multidisciplinary intervention programs which are frequently hindered by economic, geographic and bureaucratic barriers, non-invasive remote monitoring could be a solution to support and promote the care of patients over time. Therefore it is crucial to identify the most relevant biological parameters to monitor, which heart failure sub-populations may gain real benefits from telehealth interventions and in which specific healthcare subsets these interventions should be implemented in order to maximise value.

Considerations in development of expert systems for real-time space applications

NASA Technical Reports Server (NTRS)

Murugesan, S.

1988-01-01

Over the years, demand on space systems has increased tremendously and this trend will continue for the near future. Enhanced capabilities of space systems, however, can only be met with increased complexity and sophistication of onboard and ground systems. Artificial Intelligence and expert system techniques have great potential in space applications. Expert systems could facilitate autonomous decision making, improve in-orbit fault diagnosis and repair, enhance performance and reduce reliance on ground support. However, real-time expert systems, unlike conventional off-line consultative systems, have to satisfy certain special stringent requirements before they could be used for onboard space applications. Challenging and interesting new environments are faced while developing expert system space applications. This paper discusses the special characteristics, requirements and typical life cycle issues for onboard expert systems. Further, it also describes considerations in design, development, and implementation which are particularly important to real-time expert systems for space applications.

Adaptation of Control Center Software to Commerical Real-Time Display Applications

NASA Technical Reports Server (NTRS)

Collier, Mark D.

1994-01-01

NASA-Marshall Space Flight Center (MSFC) is currently developing an enhanced Huntsville Operation Support Center (HOSC) system designed to support multiple spacecraft missions. The Enhanced HOSC is based upon a distributed computing architecture using graphic workstation hardware and industry standard software including POSIX, X Windows, Motif, TCP/IP, and ANSI C. Southwest Research Institute (SwRI) is currently developing a prototype of the Display Services application for this system. Display Services provides the capability to generate and operate real-time data-driven graphic displays. This prototype is a highly functional application designed to allow system end users to easily generate complex data-driven displays. The prototype is easy to use, flexible, highly functional, and portable. Although this prototype is being developed for NASA-MSFC, the general-purpose real-time display capability can be reused in similar mission and process control environments. This includes any environment depending heavily upon real-time data acquisition and display. Reuse of the prototype will be a straight-forward transition because the prototype is portable, is designed to add new display types easily, has a user interface which is separated from the application code, and is very independent of the specifics of NASA-MSFC's system. Reuse of this prototype in other environments is a excellent alternative to creation of a new custom application, or for environments with a large number of users, to purchasing a COTS package.

Real-Time PCR in Clinical Microbiology: Applications for Routine Laboratory Testing

PubMed Central

Espy, M. J.; Uhl, J. R.; Sloan, L. M.; Buckwalter, S. P.; Jones, M. F.; Vetter, E. A.; Yao, J. D. C.; Wengenack, N. L.; Rosenblatt, J. E.; Cockerill, F. R.; Smith, T. F.

2006-01-01

Real-time PCR has revolutionized the way clinical microbiology laboratories diagnose many human microbial infections. This testing method combines PCR chemistry with fluorescent probe detection of amplified product in the same reaction vessel. In general, both PCR and amplified product detection are completed in an hour or less, which is considerably faster than conventional PCR detection methods. Real-time PCR assays provide sensitivity and specificity equivalent to that of conventional PCR combined with Southern blot analysis, and since amplification and detection steps are performed in the same closed vessel, the risk of releasing amplified nucleic acids into the environment is negligible. The combination of excellent sensitivity and specificity, low contamination risk, and speed has made real-time PCR technology an appealing alternative to culture- or immunoassay-based testing methods for diagnosing many infectious diseases. This review focuses on the application of real-time PCR in the clinical microbiology laboratory. PMID:16418529

Recommendations for the Improved Effectiveness and Reporting of Telemedicine Programs in Developing Countries: Results of a Systematic Literature Review.

PubMed

Khanal, Sumesh; Burgon, Joseph; Leonard, Saoirse; Griffiths, Matthew; Eddowes, Lucy A

2015-11-01

A lack of decisive evidence on the impact of telemedicine on financial and clinical outcomes has not prohibited significant investment in developing countries. Understanding characteristics that facilitate effective telemedicine programs is required to allow telemedicine to be used to its full potential. This systematic review aimed to identify organizational, technological, and financial features of successful telemedicine programs providing direct clinical care in developing countries. Databases were searched, and the results were reviewed systematically according to predefined inclusion/exclusion criteria. Information on location(s), measure of success, and organizational, technological, and financial characteristics were extracted. This review was impeded by inadequate program reporting, and so a concise checklist was developed to aid improved reporting, enabling future reviews to identify key characteristics of effective programs. This systematic review identified 46 articles reporting 36 programs that fulfilled the inclusion/exclusion criteria. Programs were distributed globally, including regional, national, and international programs. Technological modalities included synchronous technology, real-time teleconsultations, and asynchronous technology. Program integration with existing systems and twinning of international institutions were identified as factors enabling program success. Other factors included simple and easy-to-use technology, ability to reduce the burden on healthcare professionals, and technology able to maintain functionality in challenging environmental circumstances. Reports describing effectiveness and costs were limited. This systematic review identified key factors associated with telemedicine program success. However, inconsistencies in reporting represent an obstacle to establishment of successful programs in developing countries by limiting the application of previous experiences. Adhering to the guidelines suggested here may allow

Fast underdetermined BSS architecture design methodology for real time applications.

PubMed

Mopuri, Suresh; Reddy, P Sreenivasa; Acharyya, Amit; Naik, Ganesh R

2015-01-01

In this paper, we propose a high speed architecture design methodology for the Under-determined Blind Source Separation (UBSS) algorithm using our recently proposed high speed Discrete Hilbert Transform (DHT) targeting real time applications. In UBSS algorithm, unlike the typical BSS, the number of sensors are less than the number of the sources, which is of more interest in the real time applications. The DHT architecture has been implemented based on sub matrix multiplication method to compute M point DHT, which uses N point architecture recursively and where M is an integer multiples of N. The DHT architecture and state of the art architecture are coded in VHDL for 16 bit word length and ASIC implementation is carried out using UMC 90 - nm technology @V DD = 1V and @ 1MHZ clock frequency. The proposed architecture implementation and experimental comparison results show that the DHT design is two times faster than state of the art architecture.

Operation Joint Endeavor in Bosnia: telemedicine systems and case reports.

PubMed

Calcagni, D E; Clyburn, C A; Tomkins, G; Gilbert, G R; Cramer, T J; Lea, R K; Ehnes, S G; Zajtchuk, R

1996-01-01

For the last several years the U.S. Department of Defense (DoD) has operated a telemedicine test bed at the U.S. Army Medical Research and Material Command's Medical Advanced Technology Management Office. The goal of this test bed is to reengineer the military health service system from the most forward deployed forces to tertiary care teaching medical centers within the United States by exploiting emerging telemedicine technologies. The test bed has conducted numerous proof-of-concept telemedicine demonstrations as part of military exercises and in support of real-world troop deployments. The most ambitious of those demonstrations is Primetime III, an ongoing effort to provide telemedicine and other advanced technology support to medical units supporting Operation Joint Endeavor in Bosnia. Several of the first instances of the clinical use of the Primetime III systems are presented as case reports in this paper. These reports demonstrate capabilities and limitations of telemedicine. The Primetime III system demonstrates the technical ability to provide current telecommunications capabilities to medical units stationed in the remote, austere, difficult-to-serve environment of Bosnia. Telemedicine capabilities cannot be used without adequate training, operations, and sustainment support. Video consultations have eliminated the need for some evacuations. The system has successfully augmented the clinical capability of physicians assigned to these medical units. Fullest clinical utilization of telemedicine technologies requires adjustment of conventional clinical practice patterns.

A literature review of email-based telemedicine.

PubMed

Caffery, Liam J; Smith, Anthony C

2010-01-01

A structured analysis of peer-reviewed literature about the delivery of health services by email was undertaken for this review. A total of 185 articles were included in the analysis. These articles were thematically categorised for medical specialty, participants, sub-topic, study design and service-delivery application. It was shown that email-based telemedicine can be practiced in a large number of medical specialties and has application in primary consultation, second opinion consultation, telediagnosis and administrative roles (e.g. e-referral). Email has niche applications in low-bandwidth, image-based specialties (e.g. dermatology, pathology, wound care and ophthalmology) where attached digital camera images were used for telediagnosis. Diagnostic accuracy of these images was the predominant topic of research and results show email as a valid means of delivering these medical services. Email is also often used in general practice as an adjunct for face-to-face consultation. Further, a number of organisations have significantly improved the efficiency of their outpatient services when using email as a triage or e-referral system. Email-based telemedicine provides specialist medical opinion in the majority of reviewed services and is most likely to be instigated by the patient's primary care giver. However, email-consultations between patient and primary care and patient and secondary care are not uncommon. Most email services are implemented using ordinary email. However, a number of organisations have developed purpose-written email applications to support their telemedicine service due to impediments of using ordinary email. These impediments include lack of management tools for: the allocation and auditing of cases for a timely response and the co-ordination of effort in a multi-clinician, multi-disciplinary service. The ability to encrypt ordinary email thereby securing patient confidentiality is also regarded as difficult when using ordinary email. Hence

Usability in telemedicine systems-A literature survey.

PubMed

Klaassen, B; van Beijnum, B J F; Hermens, H J

2016-09-01

The rapid development of sensors and communication technologies enable the growth of new innovative services in healthcare, such as Telemedicine. An essential ingredient in the development of a telemedicine system and its final acceptance by end users are usability studies. The principles of usability engineering, evaluations and telemedicine are well established, and it may contribute to the adoption and eventually deployment of such systems and services. An in-depth usability analysis, including performance and attitude measures, requires knowledge about available usability techniques, and is depending on the amount of resources. Therefore it is worth investigating how usability methods are applied in developing telemedicine systems. Our hypothesis is: with increasing research and development of telemedicine systems, we expect that various usability methods are more equally employed for different end-user groups and applications. A literature survey was conducted to find telemedicine systems that have been evaluated for usability or ease of use. The elements of the PICO framework were used as a basis for the selection criteria in the literature search. The search was not limited by year. Two independent reviewers screened all search results first by title, and then by abstract for inclusion. Articles were included up to May 2015. In total, 127 publications were included in this survey. The number of publications on telemedicine systems significantly increased after 2008. Older adults and end-users with cardiovascular conditions were among largest target end-user groups. Remote monitoring systems were found the most, in 90 publications. Questionnaires are the most common means for evaluating telemedicine systems, and were found in 88 publications. Questionnaires are used frequently in studies focusing on cardiovascular diseases, Parkinson's disease and older adult conditions. Interviews are found the most in publications related to stroke. In total 71% of the

Narrative review of telemedicine consultation in medical practice

PubMed Central

Di Cerbo, Alessandro; Morales-Medina, Julio Cesar; Palmieri, Beniamino; Iannitti, Tommaso

2015-01-01

Background The use of telemedicine has grown across several medical fields, due to the increasing number of “e-patients”. Objective This narrative review gives an overview of the growing use of telemedicine in different medical specialties, showing how its use can improve medical care. Methods A PubMed/Medline, Embase, Web of Science, and Scopus search was performed using the following keywords: telemedicine, teleconsultation, telehealth, e-health, and e-medicine. Selected papers from 1996 to 2014 were chosen on the basis of their content (quality and novelty). Results Telemedicine has already been applied to different areas of medical practice, and it is as effective as face-to-face medical care, at least for the diagnosis and treatment of some pathological conditions. Conclusion Telemedicine is time- and cost-effective for both patients and health care professionals, encouraging its use on a larger scale. Telemedicine provides specialist medical care to patients who have poor access to hospitals, and ensures continuity of care and optimal use of available health resources. The use of telemedicine opens new perspectives for patients seeking a medical second opinion for their pathology, since they can have remote access to medical resources that would otherwise require enormous costs and time. PMID:25609928

Organizational readiness for telemedicine: implications for success and failure.

PubMed

Jennett, Penny; Yeo, Maryann; Pauls, Monica; Graham, Jennifer

2003-01-01

The use of telemedicine brings about change in health-care organizations and opens up new possibilities for service delivery. The organizational environment is often crucial in determining whether or not telemedicine applications will be successful. To examine the concept of 'organizational readiness for telemedicine' as a factor to explain why telemedicine initiatives succeed or fail, the results were used of interviews with key informants, conducted in two studies: the Alliance for Building Capacity project and the National Initiative for Telehealth guidelines project. The data indicate that organizational readiness for telemedicine is a multifaceted concept that is related to planning and the workplace environment. A greater understanding of the factors within organizational readiness could help to avoid costly implementation errors. 'Readiness' needs to be systematically assessed and is important for long-term success.

A Systematic Review of the Use of Telemedicine in Plastic and Reconstructive Surgery and Dermatology.

PubMed

Vyas, Krishna S; Hambrick, H Rhodes; Shakir, Afaaf; Morrison, Shane D; Tran, Duy C; Pearson, Keon; Vasconez, Henry C; Mardini, Samir; Gosman, Amanda A; Dobke, Marek; Granick, Mark S

2017-06-01

Telemedicine, the use of information technology and telecommunication to provide healthcare at a distance, is a burgeoning field with applications throughout medicine. Given the visual nature of plastic surgery and dermatology, telemedicine has a myriad of potential applications within the field. A comprehensive literature review of articles published on telemedicine since January 2010 was performed. Articles were selected for their relevance to plastic and reconstructive surgery and dermatology, and then reviewed for their discussion of the applications, benefits, and limitations of telemedicine in practice. A total of 3119 articles were identified in the initial query. Twenty-three articles met the inclusion criteria in plastic surgery (7 wound management, 5 burn management, 5 trauma, 4 free flap care, 2 in cleft lip/palate repair). Twenty-three (100%) reported a benefit of telemedicine often related to improved postoperative monitoring, increased access to expertise in rural settings, and cost savings, either predicted or actualized. Eight (35%) reported limitations and barriers to the application of telemedicine, including overdiagnosis and dependence on functional telecommunication systems. Sixty-six articles focused on telemedicine in dermatology and also demonstrated significant promise. Telemedicine holds special promise in increasing the efficiency of postoperative care for microsurgical procedures, improving care coordination and management of burn wounds, facilitating interprofessional collaboration across time and space, eliminating a significant number of unnecessary referrals, and connecting patients located far from major medical centers with professional expertise without impinging on-and in some cases improving-the quality or accuracy of care provided. Teledermatology consultation was found to be safe and has a comparable or superior efficacy to the traditional in-patient consultation. The system was consistently rated as convenient and easy to use

Application and API for Real-time Visualization of Ground-motions and Tsunami

NASA Astrophysics Data System (ADS)

Aoi, S.; Kunugi, T.; Suzuki, W.; Kubo, T.; Nakamura, H.; Azuma, H.; Fujiwara, H.

2015-12-01

Due to the recent progress of seismograph and communication environment, real-time and continuous ground-motion observation becomes technically and economically feasible. K-NET and KiK-net, which are nationwide strong motion networks operated by NIED, cover all Japan by about 1750 stations in total. More than half of the stations transmit the ground-motion indexes and/or waveform data in every second. Traditionally, strong-motion data were recorded by event-triggering based instruments with non-continues telephone line which is connected only after an earthquake. Though the data from such networks mainly contribute to preparations for future earthquakes, huge amount of real-time data from dense network are expected to directly contribute to the mitigation of ongoing earthquake disasters through, e.g., automatic shutdown plants and helping decision-making for initial response. By generating the distribution map of these indexes and uploading them to the website, we implemented the real-time ground motion monitoring system, Kyoshin (strong-motion in Japanese) monitor. This web service (www.kyoshin.bosai.go.jp) started in 2008 and anyone can grasp the current ground motions of Japan. Though this service provides only ground-motion map in GIF format, to take full advantage of real-time strong-motion data to mitigate the ongoing disasters, digital data are important. We have developed a WebAPI to provide real-time data and related information such as ground motions (5 km-mesh) and arrival times estimated from EEW (earthquake early warning). All response data from this WebAPI are in JSON format and are easy to parse. We also developed Kyoshin monitor application for smartphone, 'Kmoni view' using the API. In this application, ground motions estimated from EEW are overlapped on the map with the observed one-second-interval indexes. The application can playback previous earthquakes for demonstration or disaster drill. In mobile environment, data traffic and battery are

Telemedicine in a pediatric headache clinic: A prospective survey.

PubMed

Qubty, William; Patniyot, Irene; Gelfand, Amy

2018-05-08

The aim of this prospective study was to survey our patients about their experience with our clinic's telemedicine program to better understand telemedicine's utility for families, and to improve patient satisfaction and ultimately patient care. This was a prospective survey study of patients and their families who had a routine telemedicine follow-up visit with the University of California San Francisco Pediatric Headache Program. The survey was administered to patients and a parent(s) following their telemedicine visit. Fifty-one of 69 surveys (74%) were completed. All (51/51) patients and families thought that (1) telemedicine was more convenient compared to a clinic visit, (2) telemedicine caused less disruption of their daily routine, and (3) they would choose to do telemedicine again. The mean round-trip travel time from home to clinic was 6.8 hours (SD ± 8.6 hours). All participants thought telemedicine was more cost-effective than a clinic visit. Parents estimated that participating in a telemedicine visit instead of a clinic appointment saved them on average $486. This prospective, pediatric headache telemedicine study shows that telemedicine is convenient, perceived to be cost-effective, and patient-centered. Providing the option of telemedicine for routine pediatric headache follow-up visits results in high patient and family satisfaction. © 2018 American Academy of Neurology.

Mapping telemedicine efforts: surveying regional initiatives in Denmark.

PubMed

Kierkegaard, Patrick

2015-05-01

The aim of this study is to survey telemedicine services currently in operation across Denmark. The study specifically seeks to answer the following questions: What initiatives are deployed within the different regions? What are the motivations behind the projects? What technologies are being utilized? What medical disciplines are being supported using telemedicine systems? All data were surveyed from the Telemedicinsk Landkort, a newly created database designed to provide a comprehensive and systematic overview of all telemedicine technologies in Denmark. The results of this study suggest that a growing numbers of telemedicine initiatives are currently in operation across Denmark but that considerable variations exist in terms of regional efforts as the number of operational telemedicine projects varied from region to region. The results of this study provide a timely picture of the factors that are shaping the telemedicine landscape of Denmark and suggest potential strategies to help policymakers increase and improve national telemedicine deployment.

A Novel Real-time Carbon Dioxide Analyzer for Health and Environmental Applications

PubMed Central

Zhao, Di; Miller, Dylan; Xian, Xiaojun; Tsow, Francis

2014-01-01

To be able to detect carbon dioxide (CO2) with high accuracy and fast response time is critical for many health and environmental applications. We report on a pocket-sized CO2 sensor for real-time analysis of end-tidal CO2, and environmental CO2. The sensor shows fast and reversible response to CO2 over a wide concentration range, covering the needs of both environmental and health applications. It is also immune to the presence of various interfering gases in ambient or expired air. Furthermore, the sensor has been used for real-time breath analysis, and the results are in good agreement with those from a commercial CO2 detector. PMID:24659857

A Novel Real-time Carbon Dioxide Analyzer for Health and Environmental Applications.

PubMed

Zhao, Di; Miller, Dylan; Xian, Xiaojun; Tsow, Francis; Forzani, Erica S

2014-05-01

To be able to detect carbon dioxide (CO 2 ) with high accuracy and fast response time is critical for many health and environmental applications. We report on a pocket-sized CO 2 sensor for real-time analysis of end-tidal CO 2, and environmental CO 2 . The sensor shows fast and reversible response to CO 2 over a wide concentration range, covering the needs of both environmental and health applications. It is also immune to the presence of various interfering gases in ambient or expired air. Furthermore, the sensor has been used for real-time breath analysis, and the results are in good agreement with those from a commercial CO 2 detector.

Data Centric Sensor Stream Reduction for Real-Time Applications in Wireless Sensor Networks

PubMed Central

Aquino, Andre Luiz Lins; Nakamura, Eduardo Freire

2009-01-01

This work presents a data-centric strategy to meet deadlines in soft real-time applications in wireless sensor networks. This strategy considers three main aspects: (i) The design of real-time application to obtain the minimum deadlines; (ii) An analytic model to estimate the ideal sample size used by data-reduction algorithms; and (iii) Two data-centric stream-based sampling algorithms to perform data reduction whenever necessary. Simulation results show that our data-centric strategies meet deadlines without loosing data representativeness. PMID:22303145

High-Intensity Telemedicine Decreases Emergency Department Use by Senior Living Community Residents.

PubMed

Shah, Manish N; Wasserman, Erin B; Wang, Hongyue; Gillespie, Suzanne M; Noyes, Katia; Wood, Nancy E; Nelson, Dallas; Dozier, Ann; McConnochie, Kenneth M

2016-03-01

The failure to provide timely acute illness care can lead to adverse consequences or emergency department (ED) use. We evaluated the effect on ED use of a high-intensity telemedicine program that provides acute illness care for senior living community (SLC) residents. We performed a prospective cohort study over 3.5 years. Six SLCs cared for by a primary care geriatrics practice were intervention facilities, with the remaining 16 being controls. Consenting patients at intervention facilities could access telemedicine for acute illness care. Patients were provided patient-to-provider, real-time, or store-and-forward high-intensity telemedicine (i.e., technician-assisted with resources beyond simple videoconferencing) to diagnose and treat acute illnesses. The primary outcome was the rate of ED use. We enrolled 494 of 705 (70.1%) subjects/proxies in the intervention group; 1,058 subjects served as controls. Control and intervention subjects visited the ED 2,238 and 725 times, respectively, with 47.3% of control and 43.4% of intervention group visits resulting in discharge home. Among intervention subjects, ED use decreased at an annualized rate of 18% (rate ratio [RR]=0.82; 95% confidence interval [CI], 0.70-0.95), whereas in the control group there was no statistically significant change in ED use (RR=1.01; 95% CI, 0.95-1.07; p=0.009 for group-by-time interaction). Primary care use and mortality were not significantly different. High-intensity telemedicine significantly reduced ED use among SLC residents without increasing other utilization or mortality. This alternative to traditional acute illness care can enhance access to acute illness care and should be integrated into population health programs.

[The role of Integrating the Healthcare Enterprise (IHE) in telemedicine].

PubMed

Bergh, B; Brandner, A; Heiß, J; Kutscha, U; Merzweiler, A; Pahontu, R; Schreiweis, B; Yüksekogul, N; Bronsch, T; Heinze, O

2015-10-01

Telemedicine systems are today already used in a variety of areas to improve patient care. The lack of standardization in those solutions creates a lack of interoperability of the systems. Internationally accepted standards can help to solve the lack of system interoperability. With Integrating the Healthcare Enterprise (IHE), a worldwide initiative of users and vendors is working on the use of defined standards for specific use cases by describing those use cases in so called IHE Profiles. The aim of this work is to determine how telemedicine applications can be implemented using IHE profiles. Based on a literature review, exemplary telemedicine applications are described and technical abilities of IHE Profiles are evaluated. These IHE Profiles are examined for their usability and are then evaluated in exemplary telemedicine application architectures. There are IHE Profiles which can be identified as being useful for intersectoral patient records (e.g. PEHR at Heidelberg), as well as for point to point communication where no patient record is involved. In the area of patient records, the IHE Profile "Cross-Enterprise Document Sharing (XDS)" is often used. The point to point communication can be supported using the IHE "Cross-Enterprise Document Media Interchange (XDM)". IHE-based telemedicine applications offer caregivers the possibility to be informed about their patients using data from intersectoral patient records, but also there are possible savings by reusing the standardized interfaces in other scenarios.

Application of real-time database to LAMOST control system

NASA Astrophysics Data System (ADS)

Xu, Lingzhe; Xu, Xinqi

2004-09-01

The QNX based real time database is one of main features for Large sky Area Multi-Object fiber Spectroscopic Telescope's (LAMOST) control system, which serves as a storage and platform for data flow, recording and updating timely various status of moving components in the telescope structure as well as environmental parameters around it. The database joins harmonically in the administration of the Telescope Control System (TCS). The paper presents methodology and technique tips in designing the EMPRESS database GUI software package, such as the dynamic creation of control widgets, dynamic query and share memory. The seamless connection between EMPRESS and the graphical development tool of QNX"s Photon Application Builder (PhAB) has been realized, and so have the Windows look and feel yet under Unix-like operating system. In particular, the real time feature of the database is analyzed that satisfies the needs of the control system.

Telemedicine in healthcare. 1: Exploring its uses, benefits and disadvantages.

PubMed

Sarhan, Firas

This first in a two part series on telemedicine in healthcare outlines the background and context for using this technology. It discusses the levels of telemedicine and its possible applications in healthcare, and examines its advantages and disadvantages.

Geomagnetic Observatory Data for Real-Time Applications

NASA Astrophysics Data System (ADS)

Love, J. J.; Finn, C. A.; Rigler, E. J.; Kelbert, A.; Bedrosian, P.

2015-12-01

The global network of magnetic observatories represents a unique collective asset for the scientific community. Historically, magnetic observatories have supported global magnetic-field mapping projects and fundamental research of the Earth's interior and surrounding space environment. More recently, real-time data streams from magnetic observatories have become an important contributor to multi-sensor, operational monitoring of evolving space weather conditions, especially during magnetic storms. In this context, the U.S. Geological Survey (1) provides real-time observatory data to allied space weather monitoring projects, including those of NOAA, the U.S. Air Force, NASA, several international agencies, and private industry, (2) collaborates with Schlumberger to provide real-time geomagnetic data needed for directional drilling for oil and gas in Alaska, (3) develops products for real-time evaluation of hazards for the electric-power grid industry that are associated with the storm-time induction of geoelectric fields in the Earth's conducting lithosphere. In order to implement strategic priorities established by the USGS Natural Hazards Mission Area and the National Science and Technology Council, and with a focus on developing new real-time products, the USGS is (1) leveraging data management protocols already developed by the USGS Earthquake Program, (2) developing algorithms for mapping geomagnetic activity, a collaboration with NASA and NOAA, (3) supporting magnetotelluric surveys and developing Earth conductivity models, a collaboration with Oregon State University and the NSF's EarthScope Program, (4) studying the use of geomagnetic activity maps and Earth conductivity models for real-time estimation of geoelectric fields, (5) initiating geoelectric monitoring at several observatories, (6) validating real-time estimation algorithms against historical geomagnetic and geoelectric data. The success of these long-term projects is subject to funding constraints

Application of Telemedicine Technologies to Long Term Spaceflight Support

NASA Astrophysics Data System (ADS)

Orlov, O. I.; Grigoriev, A. I.

projects on space biology and medicine at the modern high level. In spite of the ISS international cooperation transparency space research programs require to follow the biomedicine ethics and provide confidentiality of the special medical information exchange. That can be achieved in the telemedicine support system built on the network principle. Presently we have all technical facilities needed to create such a system. In Russia activities on space telemedicicine support improvement are carried out by the State Scientific Center of the Russian Federation - Institute for Biomedical Problems of the Russian Academy of Sciences, Mission Control Center of the Russian Aviation and Space Agency, Space Biomedical Center for Training and Research and Yu. Gagarin Cosmonaut Training Center. Communications development and next generation Internet systems creation almost eliminate differences in the types of information technologies implementation both in the earth-based and near-earth space conditions. In prospect of the information community creation the telecommunication system of the near-earth space objects and its telemedicine element will become a natural part of the Earth unified information field that will open unlimited perspectives for flight support system improvement and space biomedical research conducting. Russia has unique data of numerous investigations on simulation of long, up to a year, effects of space flight factors on the human body. The sphere of situations studied by space medicine specialists embraced orbit manned space flights of the escalating duration (438 days in 1995). However a number of biomedical problems related to space flights didn't face optimal solutions. It's evident that during a space flight to Mars biomedical problems will be much more difficult in comparison with those of the orbit flights of the same duration. The summed up factors of such flights specify a level of the total medical risk that require assessment and application of

Value of Telemonitoring and Telemedicine in Heart Failure Management

PubMed Central

Alderighi, Camilla; Rasoini, Raffaele; Mazzanti, Marco; Casolo, Giancarlo

2017-01-01

The use of telemonitoring and telemedicine is a relatively new but quickly developing area in medicine. As new digital tools and applications are being created and used to manage medical conditions such as heart failure, many implications require close consideration and further study, including the effectiveness and safety of these telemonitoring tools in diagnosing, treating and managing heart failure compared to traditional face-to-face doctor–patient interaction. When compared to multidisciplinary intervention programs which are frequently hindered by economic, geographic and bureaucratic barriers, non-invasive remote monitoring could be a solution to support and promote the care of patients over time. Therefore it is crucial to identify the most relevant biological parameters to monitor, which heart failure sub-populations may gain real benefits from telehealth interventions and in which specific healthcare subsets these interventions should be implemented in order to maximise value. PMID:29387464

Quality of Service for Real-Time Applications Over Next Generation Data Networks

NASA Technical Reports Server (NTRS)

Atiquzzaman, Mohammed; Jain, Raj

2001-01-01

This project, which started on January 1, 2000, was funded by the NASA Glenn Research Center for duration of one year. The deliverables of the project included the following tasks: (1) Study of QoS mapping between the edge and core networks envisioned in the Next Generation networks will provide us with the QoS guarantees that can be obtained from next generation networks; (2) Buffer management techniques to provide strict guarantees to real-time end-to-end applications through preferential treatment to packets belonging to real-time applications. In particular, use of ECN to help reduce the loss on high bandwidth-delay product satellite networks needs to be studied; (3) Effect of Prioritized Packet Discard to increase goodput of the network and reduce the buffering requirements in the ATM switches; (4) Provision of new IP circuit emulation services over Satellite IP backbones using MPLS will be studied; and (5) Determine the architecture and requirements for internetworking ATN and the Next Generation Internet for real-time applications. The project has been completed on time. All the objectives and deliverables of the project have been completed. Research results obtained from this project have been published in a number of papers in journals, conferences, and technical reports, included in this document.

MARTe: A Multiplatform Real-Time Framework

NASA Astrophysics Data System (ADS)

Neto, André C.; Sartori, Filippo; Piccolo, Fabio; Vitelli, Riccardo; De Tommasi, Gianmaria; Zabeo, Luca; Barbalace, Antonio; Fernandes, Horacio; Valcarcel, Daniel F.; Batista, Antonio J. N.

2010-04-01

Development of real-time applications is usually associated with nonportable code targeted at specific real-time operating systems. The boundary between hardware drivers, system services, and user code is commonly not well defined, making the development in the target host significantly difficult. The Multithreaded Application Real-Time executor (MARTe) is a framework built over a multiplatform library that allows the execution of the same code in different operating systems. The framework provides the high-level interfaces with hardware, external configuration programs, and user interfaces, assuring at the same time hard real-time performances. End-users of the framework are required to define and implement algorithms inside a well-defined block of software, named Generic Application Module (GAM), that is executed by the real-time scheduler. Each GAM is reconfigurable with a set of predefined configuration meta-parameters and interchanges information using a set of data pipes that are provided as inputs and required as output. Using these connections, different GAMs can be chained either in series or parallel. GAMs can be developed and debugged in a non-real-time system and, only once the robustness of the code and correctness of the algorithm are verified, deployed to the real-time system. The software also supplies a large set of utilities that greatly ease the interaction and debugging of a running system. Among the most useful are a highly efficient real-time logger, HTTP introspection of real-time objects, and HTTP remote configuration. MARTe is currently being used to successfully drive the plasma vertical stabilization controller on the largest magnetic confinement fusion device in the world, with a control loop cycle of 50 ?s and a jitter under 1 ?s. In this particular project, MARTe is used with the Real-Time Application Interface (RTAI)/Linux operating system exploiting the new ?86 multicore processors technology.

Biomedical applications of a real-time terahertz color scanner

PubMed Central

Schirmer, Markus; Fujio, Makoto; Minami, Masaaki; Miura, Jiro; Araki, Tsutomu; Yasui, Takeshi

2010-01-01

A real-time THz color scanner has the potential to further expand the application scope of THz spectral imaging based on its rapid image acquisition rate. We demonstrated three possible applications of a THz color scanner in the biomedical field: imaging of pharmaceutical tablets, human teeth, and human hair. The first application showed the scanner’s potential in total inspection for rapid quality control of pharmaceutical tablets moving on a conveyor belt. The second application demonstrated that the scanner can be used to identify a potential indicator for crystallinity of dental tissue. In the third application, the scanner was successfully used to visualize the drying process of wet hairs. These demonstrations indicated the high potential of the THz color scanner for practical applications in the biomedical field. PMID:21258472

Changes in the job situation due to telemedicine.

PubMed

Aas, I H Monrad

2002-01-01

Little is known either about how telemedicine changes the job situation or about how the working environment might be improved for those involved in telemedicine. To investigate these issues, qualitative interviews were carried out with 30 people in Norway working with telepsychiatry (12 respondents), teledermatology (six respondents), a telepathology frozen-section service (10 respondents) and tele-otolaryngology (two respondents). The median annual number of remote consultations in telepsychiatry was nine, in teledermatology 81 and in the telepathology frozen-section service nine. The positive aspects of working with telemedicine included less travelling, which gave more time for other work, less need to travel in poor weather, new contacts, an increased sense of professional security (because support was readily available) and the satisfaction of seeing partners in communication. At its present volume, telemedicine generally fits into daily work patterns quite well. Problems do occur, but they can be solved by appropriate organizational measures. Long-term scheduling of telemedical sessions may be important. Many telemedicine workers want to have the equipment in their own office. Working with telemedicine can be tiring and those interviewed wanted to limit the number of hours per week. A solution may be to use large clinics, such as university clinics, where the telemedical work could be distributed between several specialists. Large telemedicine clinics with a full-time dedicated staff would need careful consideration of working practices.

Impact of telemedicine on the practice of pediatric cardiology in community hospitals.

PubMed

Sable, Craig A; Cummings, Susan D; Pearson, Gail D; Schratz, Lorraine M; Cross, Russell C; Quivers, Eric S; Rudra, Harish; Martin, Gerard R

2002-01-01

Tele-echocardiography has the potential to bring real-time diagnoses to neonatal facilities without in-house pediatric cardiologists. Many neonates in rural areas, smaller cities, and community hospitals do not have immediate access to pediatric sonographers or echocardiogram interpretation by pediatric cardiologists. This can result in suboptimal echocardiogram quality, delay in initiation of medical intervention, unnecessary patient transport, and increased medical expenditures. Telemedicine has been used with increased frequency to improve efficiency of pediatric cardiology care in hospitals that are not served by pediatric cardiologists. Initial reports suggest that telecardiology is accurate, improves patient care, is cost-effective, enhances echocardiogram quality, and prevents unnecessary transports of neonates in locations that are not served by pediatric cardiologists. We report the largest series to evaluate the impact of telemedicine on delivery of pediatric cardiac care in community hospitals. We hypothesized that live telemedicine guidance and interpretation of neonatal echocardiograms from community hospitals is accurate, improves patient care, enhances sonographer proficiency, allows for more efficient physician time management, increases patient referrals, and does not result in increased utilization of echocardiography. Using desktop videoconferencing computers, pediatric cardiologists guided and interpreted pediatric echocardiograms from 2 community hospital nurseries 15 miles from a tertiary care center. Studies were transmitted in real-time using the H.320 videoconferencing protocol over 3 integrated services digital network lines (384 kilobits per second). This resulted in a frame rate of 23 to 30 frames per second. Sonographers who primarily scanned adult patients but had received additional training in echocardiography of infants performed the echocardiograms. Additional views were suggested as deemed necessary by the interpreting physician

Characterization of real-time computers

NASA Technical Reports Server (NTRS)

Shin, K. G.; Krishna, C. M.

1984-01-01

A real-time system consists of a computer controller and controlled processes. Despite the synergistic relationship between these two components, they have been traditionally designed and analyzed independently of and separately from each other; namely, computer controllers by computer scientists/engineers and controlled processes by control scientists. As a remedy for this problem, in this report real-time computers are characterized by performance measures based on computer controller response time that are: (1) congruent to the real-time applications, (2) able to offer an objective comparison of rival computer systems, and (3) experimentally measurable/determinable. These measures, unlike others, provide the real-time computer controller with a natural link to controlled processes. In order to demonstrate their utility and power, these measures are first determined for example controlled processes on the basis of control performance functionals. They are then used for two important real-time multiprocessor design applications - the number-power tradeoff and fault-masking and synchronization.

A real-time architecture for time-aware agents.

PubMed

Prouskas, Konstantinos-Vassileios; Pitt, Jeremy V

2004-06-01

This paper describes the specification and implementation of a new three-layer time-aware agent architecture. This architecture is designed for applications and environments where societies of humans and agents play equally active roles, but interact and operate in completely different time frames. The architecture consists of three layers: the April real-time run-time (ART) layer, the time aware layer (TAL), and the application agents layer (AAL). The ART layer forms the underlying real-time agent platform. An original online, real-time, dynamic priority-based scheduling algorithm is described for scheduling the computation time of agent processes, and it is shown that the algorithm's O(n) complexity and scalable performance are sufficient for application in real-time domains. The TAL layer forms an abstraction layer through which human and agent interactions are temporally unified, that is, handled in a common way irrespective of their temporal representation and scale. A novel O(n2) interaction scheduling algorithm is described for predicting and guaranteeing interactions' initiation and completion times. The time-aware predicting component of a workflow management system is also presented as an instance of the AAL layer. The described time-aware architecture addresses two key challenges in enabling agents to be effectively configured and applied in environments where humans and agents play equally active roles. It provides flexibility and adaptability in its real-time mechanisms while placing them under direct agent control, and it temporally unifies human and agent interactions.

Telemedicine: the invisible legal barriers to the health care of the future.

PubMed

Daly, H L

2000-01-01

Telemedicine has the potential to transform the world of health care just as the Internet transformed the world of commerce. Ms. Daly examines two legal obstacles to expanding the use of telemedicine: licensure and liability. She defines telemedicine and discusses its common applications and significant benefits. Licensure laws and liability rules result in formidable barriers to the expanded use of telemedicine, while also failing to provide sufficient protection for consumers. Ms. Daly argues that for the benefits of telemedicine to reach those most in need, mutual recognition of licensing laws coupled with a universal standard of care is necessary.

Knowledge management model for teleconsulting in telemedicine.

PubMed

Pico, Lilia Edith Aparicio; Cuenca, Orlando Rodriguez; Alvarez, Daniel José Salas; Salgado, Piere Augusto Peña

2008-01-01

The present article shows a study about requirements for teleconsulting in a telemedicine solution in order to create a knowledge management system. Several concepts have been found related to the term teleconsulting in telemedicine which will serve to clear up their corresponding applications, potentialities, and scope. Afterwards, different theories about the art state in knowledge management have been considered by exploring methodologies and architectures to establish the trends of knowledge management and the possibilities of using them in teleconsulting. Furthermore, local and international experiences have been examined to assess knowledge management systems focused on telemedicine. The objective of this study is to obtain a model for developing teleconsulting systems in Colombia because we have many health-information management systems but they don't offer telemedicine services for remote areas. In Colombia there are many people in rural areas with different necessities and they don't have medicine services, teleconsulting will be a good solution to this problem. Lastly, a model of a knowledge system is proposed for teleconsulting in telemedicine. The model has philosophical principles and architecture that shows the fundamental layers for its development.

Real-time teleophthalmology versus face-to-face consultation: A systematic review.

PubMed

Tan, Irene J; Dobson, Lucy P; Bartnik, Stephen; Muir, Josephine; Turner, Angus W

2017-08-01

Introduction Advances in imaging capabilities and the evolution of real-time teleophthalmology have the potential to provide increased coverage to areas with limited ophthalmology services. However, there is limited research assessing the diagnostic accuracy of face-to-face teleophthalmology consultation. This systematic review aims to determine if real-time teleophthalmology provides comparable accuracy to face-to-face consultation for the diagnosis of common eye health conditions. Methods A search of PubMed, Embase, Medline and Cochrane databases and manual citation review was conducted on 6 February and 7 April 2016. Included studies involved real-time telemedicine in the field of ophthalmology or optometry, and assessed diagnostic accuracy against gold-standard face-to-face consultation. The revised quality assessment of diagnostic accuracy studies (QUADAS-2) tool assessed risk of bias. Results Twelve studies were included, with participants ranging from four to 89 years old. A broad number of conditions were assessed and include corneal and retinal pathologies, strabismus, oculoplastics and post-operative review. Quality assessment identified a high or unclear risk of bias in patient selection (75%) due to an undisclosed recruitment processes. The index test showed high risk of bias in the included studies, due to the varied interpretation and conduct of real-time teleophthalmology methods. Reference standard risk was overall low (75%), as was the risk due to flow and timing (75%). Conclusion In terms of diagnostic accuracy, real-time teleophthalmology was considered superior to face-to-face consultation in one study and comparable in six studies. Store-and-forward image transmission coupled with real-time videoconferencing is a suitable alternative to overcome poor internet transmission speeds.

A systematic review of the methodologies used to evaluate telemedicine service initiatives in hospital facilities.

PubMed

AlDossary, Sharifah; Martin-Khan, Melinda G; Bradford, Natalie K; Smith, Anthony C

2017-01-01

The adoption of telemedicine into mainstream health services has been slower than expected. Many telemedicine projects tend not to progress beyond the trial phase; there are a large number of pilot or project publications and fewer 'service' publications. This issue has been noted since 1999 and continues to be acknowledged in the literature. While overall telemedicine uptake has been slow, some services have been successful. The reporting and evaluation of these successful services may help to improve future uptake and sustainability. The aim of this literature review was to identify peer-reviewed publications of deployed telemedicine services in hospital facilities; and to report, and appraise, the methodology used to evaluate these services. Computerised literature searches of bibliographic databases were performed using the MeSH terms for "Telemedicine" and "Hospital Services" or "Hospital", for papers published up to May 2016. A total of 164 papers were identified, representing 137 telemedicine services. The majority of reported telemedicine services were based in the United States of America (n=61, 44.5%). Almost two thirds of the services (n=86, 62.7%) were delivered by real time telemedicine. Of the reviewed studies, almost half (n=81, 49.3%) assessed their services from three different evaluation perspectives: clinical outcomes, economics and satisfaction. While the remaining half (n=83, 50.6%) described their service and its activities without reporting any evaluation measures. Only 30 (18.2%) studies indicated a two-step implementation and evaluation process. There was limited information in all reported studies regarding description of a structured planning strategy. Our systematic review identified only 137 telemedicine services. This suggests either telemedicine service implementation is still not a part of mainstream clinical services, or it is not being reported in the peer-reviewed literature. The depth and the quality of information were variable

Metamorphoses of ONAV console operations: From prototype to real time application

NASA Technical Reports Server (NTRS)

Millis, Malise; Wang, Lui

1991-01-01

The ONAV (Onboard Navigation) Expert System is being developed as a real time console assistant to the ONAV flight controller for use in the Mission Control Center at the Johnson Space Center. Currently the entry and rendezvous systems are in verification, and the ascent is being prototyped. To arrive at this stage, from a prototype to real world application, the ONAV project has had to deal with not only AI issues but operating environment issues. The AI issues included the maturity of AI languages and the debugging tools, what is verification, and availability, stability, and the size of the expert pool. The environmental issues included real time data acquisition, hardware stability, and how to achieve acceptance by users and management.

ICU Telemedicine Comanagement Methods and Length of Stay.

PubMed

Hawkins, Helen A; Lilly, Craig M; Kaster, David A; Groves, Robert H; Khurana, Hargobind

2016-08-01

Studies have identified processes that are associated with more favorable length of stay (LOS) outcomes when an ICU telemedicine program is implemented. Despite these studies, the relation of the acceptance of ICU telemedicine management services by individual ICUs to LOS outcomes is unknown. This is a single ICU telemedicine center study that compares LOS outcomes among three groups of intensivist-staffed mixed medical-surgical ICUs that used alternative comanagement strategies. The proportion of provider orders recorded by an ICU telemedicine provider to all recorded orders was compared among ICUs that used a monitor and notify comanagement approach, a direct intervention with timely notification process, and ICUs that used a mix of these two approaches. The primary outcome was acuity-adjusted hospital LOS. ICUs that used the direct intervention with timely notification strategy had a significantly larger proportion of provider orders recorded by ICU telemedicine physicians than the mixed methods of comanagement group, which had a larger proportion than ICUs that used the monitor and notify method (P < .001). Acuity-adjusted hospital LOS was significantly lower for the direct intervention with timely notification comanagement strategy (0.68; 0.65-0.70) compared with the mixed methods group (0.70 [0.69-0.72]; P = .01), which was significantly lower than the monitor and notify group (0.83 [0.80-0.86]; P < .001). Direct intervention with timely notification strategies of ICU telemedicine comanagement were associated with shorter LOS outcomes than monitor and notify comanagement strategies. Copyright © 2016 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

NASA's telemedicine testbeds: Commercial benefit

NASA Astrophysics Data System (ADS)

Doarn, Charles R.; Whitten, Raymond

1998-01-01

The National Aeronautics and Space Administration (NASA) has been developing and applying telemedicine to support space flight since the Agency's beginning. Telemetry of physiological parameters from spacecraft to ground controllers is critical to assess the health status of humans in extreme and remote environments. Requisite systems to support medical care and maintain readiness will evolve as mission duration and complexity increase. Developing appropriate protocols and procedures to support multinational, multicultural missions is a key objective of this activity. NASA has created an Agency-wide strategic plan that focuses on the development and integration of technology into the health care delivery systems for space flight to meet these challenges. In order to evaluate technology and systems that can enhance inflight medical care and medical education, NASA has established and conducted several testbeds. Additionally, in June of 1997, NASA established a Commercial Space Center (CSC) for Medical Informatics and Technology Applications at Yale University School of Medicine. These testbeds and the CSC foster the leveraging of technology and resources between government, academia and industry to enhance health care. This commercial endeavor will influence both the delivery of health care in space and on the ground. To date, NASA's activities in telemedicine have provided new ideas in the application of telecommunications and information systems to health care. NASA's Spacebridge to Russia, an Internet-based telemedicine testbed, is one example of how telemedicine and medical education can be conducted using the Internet and its associated tools. Other NASA activities, including the development of a portable telemedicine workstation, which has been demonstrated on the Crow Indian Reservation and in the Texas Prison System, show promise in serving as significant adjuncts to the delivery of health care. As NASA continues to meet the challenges of space flight, the

Clinical Components of Telemedicine Programs for Diabetic Retinopathy.

PubMed

Horton, Mark B; Silva, Paolo S; Cavallerano, Jerry D; Aiello, Lloyd Paul

2016-12-01

Diabetic retinopathy is a leading cause of new-onset vision loss worldwide. Treatments supported by large clinical trials are effective in preserving vision, but many persons do not receive timely diagnosis and treatment of diabetic retinopathy, which is typically asymptomatic when most treatable. Telemedicine evaluation to identify diabetic retinopathy has the potential to improve access to care, but there are no universal standards regarding camera choice or protocol for ocular telemedicine. We review the literature regarding the impact of imaging device, number and size of retinal images, pupil dilation, type of image grader, and diagnostic accuracy on telemedicine assessment for diabetic retinopathy. Telemedicine assessment of diabetic retinopathy has the potential to preserve vision, but further development of telemedicine specific technology and standardization of operations are needed to better realize its potential.

Practical and secure telemedicine systems for user mobility.

PubMed

Rezaeibagha, Fatemeh; Mu, Yi

2018-02-01

The application of wireless devices has led to a significant improvement in the quality delivery of care in telemedicine systems. Patients who live in a remote area are able to communicate with the healthcare provider and benefit from the doctor consultations. However, it has been a challenge to provide a secure telemedicine system, which captures users (patients and doctors) mobility and patient privacy. In this work, we present several secure protocols for telemedicine systems, which ensure the secure communication between patients and doctors who are located in different geographical locations. Our protocols are the first of this kind featured with confidentiality of patient information, mutual authentication, patient anonymity, data integrity, freshness of communication, and mobility. Our protocols are based on symmetric-key schemes and capture all desirable security requirements in order to better serve our objectives of research for secure telemedicine services; therefore, they are very efficient in implementation. A comparison with related works shows that our work contributes first comprehensive solution to capture user mobility and patient privacy for telemedicine systems. Copyright © 2018 Elsevier Inc. All rights reserved.

QoS Negotiation in Real-Time Systems and its Application to Automated Flight Control

DTIC Science & Technology

2000-11-01

QoS Negotiation in Real - Time Systems and Its Application to Automated Flight Control Tarek F. Abdelzaher, Member, IEEE, Ella M. Atkins, Member, IEEE...been committed to those that arrived earlier. In hard- real - time systems , a static analysis may be performed to guarantee a priori that all requests be...DATE 2000 2. REPORT TYPE 3. DATES COVERED 00-00-2000 to 00-00-2000 4. TITLE AND SUBTITLE QoS Negotiation in Real - Time Systems and its

Adoption of routine telemedicine in Norwegian hospitals: progress over 5 years.

PubMed

Zanaboni, Paolo; Wootton, Richard

2016-09-20

Although Norway is well known for its early use of telemedicine to provide services for people in rural and remote areas in the Arctic, little is known about the pace of telemedicine adoption in Norway. The aim of the present study was to explore the statewide implementation of telemedicine in Norwegian hospitals over time, and analyse its adoption and level of use. Data on outpatient visits and telemedicine consultations delivered by Norwegian hospitals from 2009 to 2013 were collected from the national health registry. Data were stratified by health region, hospital, year, and clinical specialty. All four health regions used telemedicine, i.e. there was 100 % adoption at the regional level. The use of routine telemedicine differed between health regions, and telemedicine appeared to be used mostly in the regions of lower centrality and population density, such as Northern Norway. Only Central Norway seemed to be atypical. Twenty-one out of 28 hospitals reported using telemedicine, i.e. there was 75 % adoption at the hospital level. Neurosurgery and rehabilitation were the clinical specialties where telemedicine was used most frequently. Despite the growing trend and the high adoption, the relative use of telemedicine compared to that of outpatient visits was low. Adoption of telemedicine is Norway was high, with all the health regions and most of the hospitals reporting using telemedicine. The use of telemedicine appeared to increase over the 5-year study period. However, the proportion of telemedicine consultations relative to the number of outpatient visits was low. The use of telemedicine in Norway was low in comparison with that reported in large-scale telemedicine networks in other countries. To facilitate future comparisons, data on adoption and utilisation over time should be reported routinely by statewide or network-based telemedicine services.

Characterization and application of droplet spray ionization for real-time reaction monitoring.

PubMed

Zhang, Hong; Li, Na; Li, Xiao-di; Jiang, Jie; Zhao, Dan-Dan; You, Hong

2016-08-01

The ionization source for real-time reaction monitoring has attracted tremendous interest in recent years. We have previously reported a reliable approach in which droplet spray ionization (DSI) was used for monitoring chemical reactions in real-time. Herein, we systematically investigated the characterization and application of DSI for real-time reaction monitoring. Analyte ions are generated by loading a sample solution onto a corner of a microscope cover glass positioned in front of the MS inlet and applying a high voltage to the sample. The tolerance to positioning, solvent effect, spray angle and spray time were investigated. Extension to real-time monitoring of macromolecule reactions was also demonstrated by the charge state change of cytochrome c in the presence of acetic acid. The corner could be positioned within an area of approximately 10 × 6 × 5 mm (x, y, z) in front of the MS inlet. The broad polarities of solvents from methanol to PhF were suitable for DSI. It featured monitoring real-time changes in reactions on the time scale of seconds to minutes. A real-time charge state change of cytochrome c was captured. DSI-MS features ease of use, durability of the spray platform and reusability of the ion source. Eliminating the need for a sample transport capillary, DSI opens a new avenue for the in situ analysis and real-time monitoring of short-lived key reaction intermediates even at subsecond dead times. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

Trusting telemedicine: A discussion on risks, safety, legal implications and liability of involved stakeholders.

PubMed

Parimbelli, E; Bottalico, B; Losiouk, E; Tomasi, M; Santosuosso, A; Lanzola, G; Quaglini, S; Bellazzi, R

2018-04-01

The main purpose of the article is to raise awareness among all the involved stakeholders about the risks and legal implications connected to the development and use of modern telemedicine systems. Particular focus is given to the class of "active" telemedicine systems, that imply a real-world, non-mediated, interaction with the final user. A secondary objective is to give an overview of the European legal framework that applies to these systems, in the effort to avoid defensive medicine practices and fears, which might be a barrier to their broader adoption. We leverage on the experience gained during two international telemedicine projects, namely MobiGuide (pilot studies conducted in Spain and Italy) and AP@home (clinical trials enrolled patients in Italy, France, the Netherlands, United Kingdom, Austria and Germany), whose development our group has significantly contributed to in the last 4 years, to create a map of the potential criticalities of active telemedicine systems and comment upon the legal framework that applies to them. Two workshops have been organized in December 2015 and March 2016 where the topic has been discussed in round tables with system developers, researchers, physicians, nurses, legal experts, healthcare economists and administrators. We identified 8 features that generate relevant risks from our example use cases. These features generalize to a broad set of telemedicine applications, and suggest insights on possible risk mitigation strategies. We also discuss the relevant European legal framework that regulate this class of systems, providing pointers to specific norms and highlighting possible liability profiles for involved stakeholders. Patients are more and more willing to adopt telemedicine systems to improve home care and day-by-day self-management. An essential step towards a broader adoption of these systems consists in increasing their compliance with existing regulations and better defining responsibilities for all the

Telemedicine on the move: health care heads down the information superhighway.

PubMed

Berek, B; Canna, M

1994-01-01

Telemedicine has drawn increasing attention as one of the emerging new service delivery vehicles that will run on the information superhighway. In reality, remote diagnosis and consultation through the application of telecommunications technology have been practiced for many years. But advances in technology and reform imperatives to extend access beyond traditional boundaries are pushing telemedicine into new applications. This is evidenced by the explosion in the number of pilot projects begun within the last 12 months. While demonstrating telemedicine's growing capabilities--for education and administration, as well as medical practice--these projects also raise a number of legal, clinical, and technical questions that must be answered before government and other payers will routinely reimburse for remote services. Academic and industry consortia are springing up to deal with the most compelling issues, including documenting telemedicine's safety and efficacy, developing uniform data and transmission standards, and determining the minimum resolution needed to maintain the integrity of clinical transmissions. Almost every type of medical specialty has proved amenable to performing evaluations via telemedicine links; however, specialties with less direct patient contact, like radiology and pathology, are generally identified as better candidates for telemedicine interactions. The telemedicine equipment required for these consults ranges from the simple to the ultra-sophisticated, depending on the type of system used and its clinical application. The most common system configuration involves a base station in the main facility where specialists and other consultants are housed and a number of remote referral sites. Consults are performed by interactively sharing voice, video, or image data. Increasingly, systems are being introduced that use easy-to-learn, intuitive displays and controls. Systems also require the use of any number of different communication media

VERSE - Virtual Equivalent Real-time Simulation

NASA Technical Reports Server (NTRS)

Zheng, Yang; Martin, Bryan J.; Villaume, Nathaniel

2005-01-01

Distributed real-time simulations provide important timing validation and hardware in the- loop results for the spacecraft flight software development cycle. Occasionally, the need for higher fidelity modeling and more comprehensive debugging capabilities - combined with a limited amount of computational resources - calls for a non real-time simulation environment that mimics the real-time environment. By creating a non real-time environment that accommodates simulations and flight software designed for a multi-CPU real-time system, we can save development time, cut mission costs, and reduce the likelihood of errors. This paper presents such a solution: Virtual Equivalent Real-time Simulation Environment (VERSE). VERSE turns the real-time operating system RTAI (Real-time Application Interface) into an event driven simulator that runs in virtual real time. Designed to keep the original RTAI architecture as intact as possible, and therefore inheriting RTAI's many capabilities, VERSE was implemented with remarkably little change to the RTAI source code. This small footprint together with use of the same API allows users to easily run the same application in both real-time and virtual time environments. VERSE has been used to build a workstation testbed for NASA's Space Interferometry Mission (SIM PlanetQuest) instrument flight software. With its flexible simulation controls and inexpensive setup and replication costs, VERSE will become an invaluable tool in future mission development.

The Impact of Telemedicine on Pediatric Critical Care Triage.

PubMed

Harvey, Jillian B; Yeager, Brooke E; Cramer, Christina; Wheeler, David; McSwain, S David

2017-11-01

To examine the relationship between pediatric critical care telemedicine consultation to rural emergency departments and triage decisions. We compare the triage location and provider rating of the accuracy of remote assessment for a cohort of patients who receive critical care telemedicine consultations and a similar group of patients receiving telephone consultations. Retrospective evaluation of consultations occurring between April 2012 and March 2016. Pediatric critical care telemedicine and telephone consultations in 52 rural healthcare settings in South Carolina. Pediatric patients receiving critical care telemedicine or telephone consultations. Telemedicine consultations. Data were collected from the consulting provider for 484 total consultations by telephone or telemedicine. We examined the providers' self-reported assessments about the consultation, decision-making, and triage outcomes. We estimate a logit model to predict triage location as a function of telemedicine consult age and sex. For telemedicine patients, the odds of triage to a non-ICU level of care are 2.55 times larger than the odds for patients receiving telephone consultations (p = 0.0005). Providers rated the accuracy of their assessments higher when consultations were provided via telemedicine. When patients were transferred to a non-ICU location following a telemedicine consultation, providers indicated that the use of telemedicine influenced the triage decision in 95.7% of cases (p < 0.001). For patients transferred to a non-ICU location, an increase in transfers to a higher level of care within 24 hours was not observed. Pediatric critical care telemedicine consultation to community hospitals is feasible and results in a reduction in PICU admissions. This study demonstrates an improvement in provider-reported accuracy of patient assessment via telemedicine compared with telephone, which may produce a higher comfort level with transporting patients to a lower level of care. Pediatric

Flexible real-time magnetic resonance imaging framework.

PubMed

Santos, Juan M; Wright, Graham A; Pauly, John M

2004-01-01

The extension of MR imaging to new applications has demonstrated the limitations of the architecture of current real-time systems. Traditional real-time implementations provide continuous acquisition of data and modification of basic sequence parameters on the fly. We have extended the concept of real-time MRI by designing a system that drives the examinations from a real-time localizer and then gets reconfigured for different imaging modes. Upon operator request or automatic feedback the system can immediately generate a new pulse sequence or change fundamental aspects of the acquisition such as gradient waveforms excitation pulses and scan planes. This framework has been implemented by connecting a data processing and control workstation to a conventional clinical scanner. Key components on the design of this framework are the data communication and control mechanisms, reconstruction algorithms optimized for real-time and adaptability, flexible user interface and extensible user interaction. In this paper we describe the various components that comprise this system. Some of the applications implemented in this framework include real-time catheter tracking embedded in high frame rate real-time imaging and immediate switching between real-time localizer and high-resolution volume imaging for coronary angiography applications.

Telemedicine: The Up Side, and . . .

ERIC Educational Resources Information Center

Risser, Joseph

1998-01-01

Explores universities involved with training in telemedicine and medical care provided through technology (International Telemedicine Center Inc. www.int-telemedicine.com/univ.html). Discusses the market for telemedicine, companies and university medical centers involved in its development, costs and savings to health care system, barriers to the…

Telemedicine in Greenland: Citizens' Perspectives.

PubMed

Nielsen, Lasse O; Krebs, Hans J; Albert, Nancy M; Anderson, Nick; Catz, Sheryl; Hale, Timothy M; Hansen, John; Hounsgaard, Lise; Kim, Tae Youn; Lindeman, David; Spindler, Helle; Marcin, James P; Nesbitt, Thomas; Young, Heather M; Dinesen, Birthe

2017-05-01

Telemedicine may have the possibility to provide better access to healthcare delivery for the citizens. Telemedicine in arctic remote areas must be tailored according to the needs of the local population. Therefore, we need more knowledge about their needs and their view of telemedicine. The aim of this study has been to explore how citizens living in the Greenlandic settlements experience the possibilities and challenges of telemedicine when receiving healthcare delivery in everyday life. Case study design was chosen as the overall research design. Qualitative interviews (n = 14) were performed and participant observations (n = 80 h) carried out in the local healthcare center in the settlements and towns. A logbook was kept and updated each day during the field research in Greenland. Observations were made of activities in the settlements. Data collected on citizens' views about the possibilities of using telemedicine in Greenland revealed the following findings: Greenlandic citizens are positive toward telemedicine, and telemedicine can help facilitate improved access to healthcare for residents in these Greenlandic settlements. Regarding challenges in using telemedicine in Greenland, the geographical and cultural context hinders accessibility to the Greenlandic healthcare system, and telemedicine equipment is not sufficiently mobile. Greenlandic citizens are positive toward telemedicine and regard telemedicine as a facilitator for improved access for healthcare in the Greenlandic settlements. We have identified challenges, such as geographical and cultural context, that hinder accessibility to the Greenlandic healthcare system.

Telemedicine endurance - empowering care recipients in Asian Telemedicine setup.

PubMed

Bhatia, Jagjit Singh; Sharma, Sagri

2008-01-01

To optimize the medical resources in India and Asia empowering the patients with e-health services in order to justify the multi-specialty healthcare provided to the rural and remote areas is the need of the hour. C-DAC Mohali is working in this direction since 1999 and deployed the technology for the amelioration of the rural Indian population. We bring home the bacon by a broad spectrum of professional quality Telemedicine products and customized solutions that fit within any budget constraint. We're experts in telemedicine conferencing and can help find the right solution to empower the patient with the essentials tools. Through this paper a description of the results from our Telemedicine projects, with substantiating and quantifiable data is put forth. Indian Telemedicine establishments need periodic evaluation to rationalize the main objective of the technology i.e. patient care, patient satisfaction, and patient opinion - in one word - patient empowerment.

Telemedicine: legal and licensure issues

NASA Astrophysics Data System (ADS)

Wood, Michael B.; Whelan, Leo J.

1995-10-01

The National Information Infrastructure program offers a great opportunity for the United States to capitalize on remarkable technological advancements over a broad range of applications benefiting society. One such application, telemedicine, has the potential to offer widespread access to sophisticated medical care, curtailed health care delivery costs, and homogeneous health and health-related educational opportunities. However, there are a variety of barriers to widespread application of telemedicine once the technical infrastructure of the information highway is well established and ubiquitous. These barriers include technical limitations, reimbursement issues, equipment and networking costs, and appropriate scientific studies to document efficacy and cost effectiveness. These issues may prove to be only transient disincentives which can be surmounted. Additional barriers exist, however, that may not be as readily resolved by traditional methods of analysis and more widespread practice applications. These political and regulatory obstacles will require clarification of the issues and solutions based on national consensus. It is the purpose of this discussion to amplify on these particular barriers which include licensure and tort jurisdiction.

Real-time image mosaicing for medical applications.

PubMed

Loewke, Kevin E; Camarillo, David B; Jobst, Christopher A; Salisbury, J Kenneth

2007-01-01

In this paper we describe the development of a robotically-assisted image mosaicing system for medical applications. The processing occurs in real-time due to a fast initial image alignment provided by robotic position sensing. Near-field imaging, defined by relatively large camera motion, requires translations as well as pan and tilt orientations to be measured. To capture these measurements we use 5-d.o.f. sensing along with a hand-eye calibration to account for sensor offset. This sensor-based approach speeds up the mosaicing, eliminates cumulative errors, and readily handles arbitrary camera motions. Our results have produced visually satisfactory mosaics on a dental model but can be extended to other medical images.

Telemedicine Use for Movement Disorders: A Global Survey.

PubMed

Hassan, Anhar; Dorsey, E Ray; Goetz, Christopher G; Bloem, Bastiaan R; Guttman, Mark; Tanner, Caroline M; Mari, Zoltan; Pantelyat, Alexander; Galifianakis, Nicholas B; Bajwa, Jawad A; Gatto, Emilia M; Cubo, Esther

2018-03-22

Telemedicine is increasingly used to care for patients with movement disorders, but data regarding its global use are limited. To obtain baseline international data about telemedicine use among movement disorder clinicians. An online survey was sent to all 6,056 Movement Disorder Society members in 2015. Scope, reimbursement, and perceived quality of telemedicine were assessed. There were 549 respondents (9.1% overall response rate) from 83 countries. Most (85.8%) were physicians, and most (70.9%) worked in an academic or university practice. Half of respondents (n = 287, from 57 countries) used telemedicine for clinical care; activities included e-mail (63.2%), video visits (follow-up [39.7%] and new [35.2%]), and video-based education (35.2%). One hundred five respondents personally conducted video visits, most frequently to outpatient clinics (53.5%), patient homes (30.8%), and hospital inpatients (30.3%). The most common challenges were a limited neurological examination (58.9%) and technological difficulties (53.3%), and the most common benefits were reduced travel time (92.9%) and patient costs (60.1%). The most frequent reimbursements were none (39.0%), public insurance (24.5%), and patient payment (9.3%). Half of respondents planned to use telemedicine in the future, and three-quarters were interested in telemedicine education. More than 250 respondents around the world engage in telemedicine for movement disorders; most perceived benefit for patients, despite challenges and reimbursement for clinicians. Formal instruction on telemedicine is highly desired. Although the survey response was low and possibly biased to over represent those with telemedicine experience, the study provides baseline data for future comparison and to improve telemedicine delivery.

A Real Time Controller For Applications In Smart Structures

NASA Astrophysics Data System (ADS)

Ahrens, Christian P.; Claus, Richard O.

1990-02-01

Research in smart structures, especially the area of vibration suppression, has warranted the investigation of advanced computing environments. Real time PC computing power has limited development of high order control algorithms. This paper presents a simple Real Time Embedded Control System (RTECS) in an application of Intelligent Structure Monitoring by way of modal domain sensing for vibration control. It is compared to a PC AT based system for overall functionality and speed. The system employs a novel Reduced Instruction Set Computer (RISC) microcontroller capable of 15 million instructions per second (MIPS) continuous performance and burst rates of 40 MIPS. Advanced Complimentary Metal Oxide Semiconductor (CMOS) circuits are integrated on a single 100 mm by 160 mm printed circuit board requiring only 1 Watt of power. An operating system written in Forth provides high speed operation and short development cycles. The system allows for implementation of Input/Output (I/O) intensive algorithms and provides capability for advanced system development.

[Evaluation of telemedicine systems for impacted third molars diagnosis].

PubMed

Duka, Milos; Mihailović, Branko; Miladinović, Milan; Janković, Aleksandar; Vujicić, Biljana

2009-12-01

approach was equal to the real-time assessment of clinical diagnosis. Telemedicine, and teledentistry as its branch, represent the present and even more the future of this field of health care.

Reconfigurable vision system for real-time applications

NASA Astrophysics Data System (ADS)

Torres-Huitzil, Cesar; Arias-Estrada, Miguel

2002-03-01

Recently, a growing community of researchers has used reconfigurable systems to solve computationally intensive problems. Reconfigurability provides optimized processors for systems on chip designs, and makes easy to import technology to a new system through reusable modules. The main objective of this work is the investigation of a reconfigurable computer system targeted for computer vision and real-time applications. The system is intended to circumvent the inherent computational load of most window-based computer vision algorithms. It aims to build a system for such tasks by providing an FPGA-based hardware architecture for task specific vision applications with enough processing power, using the minimum amount of hardware resources as possible, and a mechanism for building systems using this architecture. Regarding the software part of the system, a library of pre-designed and general-purpose modules that implement common window-based computer vision operations is being investigated. A common generic interface is established for these modules in order to define hardware/software components. These components can be interconnected to develop more complex applications, providing an efficient mechanism for transferring image and result data among modules. Some preliminary results are presented and discussed.

StarBase: A Firm Real-Time Database Manager for Time-Critical Applications

DTIC Science & Technology

1995-01-01

Mellon University [IO]. StarBase differs from previous RT-DBMS work [l, 2, 31 in that a) it relies on a real - time operating system which provides...simulation studies, StarBase uses a real - time operating system to provide basic real-time functionality and deals with issues beyond transaction...re- source scheduling provided by the underlying real - time operating system . Issues of data contention are dealt with by use of a priority

An Internal Data Non-hiding Type Real-time Kernel and its Application to the Mechatronics Controller

NASA Astrophysics Data System (ADS)

Yoshida, Toshio

For the mechatronics equipment controller that controls robots and machine tools, high-speed motion control processing is essential. The software system of the controller like other embedded systems is composed of three layers software such as real-time kernel layer, middleware layer, and application software layer on the dedicated hardware. The application layer in the top layer is composed of many numbers of tasks, and application function of the system is realized by the cooperation between these tasks. In this paper we propose an internal data non-hiding type real-time kernel in which customizing the task control is possible only by change in the program code of the task side without any changes in the program code of real-time kernel. It is necessary to reduce the overhead caused by the real-time kernel task control for the speed-up of the motion control of the mechatronics equipment. For this, customizing the task control function is needed. We developed internal data non-cryptic type real-time kernel ZRK to evaluate this method, and applied to the control of the multi system automatic lathe. The effect of the speed-up of the task cooperation processing was able to be confirmed by combined task control processing on the task side program code using an internal data non-hiding type real-time kernel ZRK.

Comparative study of internet cloud and cloudlet over wireless mesh networks for real-time applications

NASA Astrophysics Data System (ADS)

Khan, Kashif A.; Wang, Qi; Luo, Chunbo; Wang, Xinheng; Grecos, Christos

2014-05-01

Mobile cloud computing is receiving world-wide momentum for ubiquitous on-demand cloud services for mobile users provided by Amazon, Google etc. with low capital cost. However, Internet-centric clouds introduce wide area network (WAN) delays that are often intolerable for real-time applications such as video streaming. One promising approach to addressing this challenge is to deploy decentralized mini-cloud facility known as cloudlets to enable localized cloud services. When supported by local wireless connectivity, a wireless cloudlet is expected to offer low cost and high performance cloud services for the users. In this work, we implement a realistic framework that comprises both a popular Internet cloud (Amazon Cloud) and a real-world cloudlet (based on Ubuntu Enterprise Cloud (UEC)) for mobile cloud users in a wireless mesh network. We focus on real-time video streaming over the HTTP standard and implement a typical application. We further perform a comprehensive comparative analysis and empirical evaluation of the application's performance when it is delivered over the Internet cloud and the cloudlet respectively. The study quantifies the influence of the two different cloud networking architectures on supporting real-time video streaming. We also enable movement of the users in the wireless mesh network and investigate the effect of user's mobility on mobile cloud computing over the cloudlet and Amazon cloud respectively. Our experimental results demonstrate the advantages of the cloudlet paradigm over its Internet cloud counterpart in supporting the quality of service of real-time applications.

A real-time phoneme counting algorithm and application for speech rate monitoring.

PubMed

Aharonson, Vered; Aharonson, Eran; Raichlin-Levi, Katia; Sotzianu, Aviv; Amir, Ofer; Ovadia-Blechman, Zehava

2017-03-01

Adults who stutter can learn to control and improve their speech fluency by modifying their speaking rate. Existing speech therapy technologies can assist this practice by monitoring speaking rate and providing feedback to the patient, but cannot provide an accurate, quantitative measurement of speaking rate. Moreover, most technologies are too complex and costly to be used for home practice. We developed an algorithm and a smartphone application that monitor a patient's speaking rate in real time and provide user-friendly feedback to both patient and therapist. Our speaking rate computation is performed by a phoneme counting algorithm which implements spectral transition measure extraction to estimate phoneme boundaries. The algorithm is implemented in real time in a mobile application that presents its results in a user-friendly interface. The application incorporates two modes: one provides the patient with visual feedback of his/her speech rate for self-practice and another provides the speech therapist with recordings, speech rate analysis and tools to manage the patient's practice. The algorithm's phoneme counting accuracy was validated on ten healthy subjects who read a paragraph at slow, normal and fast paces, and was compared to manual counting of speech experts. Test-retest and intra-counter reliability were assessed. Preliminary results indicate differences of -4% to 11% between automatic and human phoneme counting. Differences were largest for slow speech. The application can thus provide reliable, user-friendly, real-time feedback for speaking rate control practice. Copyright © 2017 Elsevier Inc. All rights reserved.

Real-time video quality monitoring

NASA Astrophysics Data System (ADS)

Liu, Tao; Narvekar, Niranjan; Wang, Beibei; Ding, Ran; Zou, Dekun; Cash, Glenn; Bhagavathy, Sitaram; Bloom, Jeffrey

2011-12-01

The ITU-T Recommendation G.1070 is a standardized opinion model for video telephony applications that uses video bitrate, frame rate, and packet-loss rate to measure the video quality. However, this model was original designed as an offline quality planning tool. It cannot be directly used for quality monitoring since the above three input parameters are not readily available within a network or at the decoder. And there is a great room for the performance improvement of this quality metric. In this article, we present a real-time video quality monitoring solution based on this Recommendation. We first propose a scheme to efficiently estimate the three parameters from video bitstreams, so that it can be used as a real-time video quality monitoring tool. Furthermore, an enhanced algorithm based on the G.1070 model that provides more accurate quality prediction is proposed. Finally, to use this metric in real-world applications, we present an example emerging application of real-time quality measurement to the management of transmitted videos, especially those delivered to mobile devices.

Shriners Hospitals for Children, Honolulu's experience with telemedicine: program implementation, maintenance, growth, and lessons learned.

PubMed

Ono, Craig M; Lindsey, Jana L

2004-10-01

Shriners Hospitals for Children, Honolulu Telemedicine Program conducts real-time video consultations with remotes sites in Hawaii, Guam, Saipan, American Samoa, the Federated States of Micronesia, and the Republic of the Marshall Islands. The program began in 1999 and has provided over 240 consultations. This report is a summary of the Shriners Hospitals experience and lessons learned regarding program implementation and maintenance.

Critical to quality in telemedicine service management: application of DFSS (Design for Six Sigma) and SERVQUAL).

PubMed

Yun, Eun Kyoung; Chun, Kee Moon

2008-01-01

Telemedicine generally refers to the use of communications and information technologies for the delivery of health care. owever, telemedicine is not merely a simple combination of health care and technology. The researchers propose a systematic approach for assessing needs of telemedicine customers, called critical-to-quality (CTQ) in Six Sigma, with a purpose of continuous quality improvement. The combination approach using DFSS (Design for Six Sigma) and SERVQUAL (Service Quality Framework) was applied to define the critical quality attributes of telemedicine service management and to match them with the current telemedicine process. With a step-by-step procedure, telemedicine service process was reviewed and all the important CTQ candidates identified via a case study. The findings suggest that nurses need further understanding and research methods that will improve and manage the quality of health care service in various medical fields.

Development of a Laboratory Synchrophasor Network and an Application to Estimate Transmission Line Parameters in Real Time

NASA Astrophysics Data System (ADS)

Almiron Bonnin, Rubens Eduardo

The development of an experimental synchrophasors network and application of synchrophasors for real-time transmission line parameter monitoring are presented in this thesis. In the laboratory setup, a power system is simulated in a RTDS real-time digital simulator, and the simulated voltages and currents are input to hardware phasor measurement units (PMUs) through the analog outputs of the simulator. Time synchronizing signals for the PMU devices are supplied from a common GPS clock. The real time data collected from PMUs are sent to a phasor data concentrator (PDC) through Ethernet using the TCP/IP protocol. A real-time transmission line parameter monitoring application program that uses the synchrophasor data provided by the PDC is implemented and validated. The experimental synchrophasor network developed in this thesis is expected to be used in research on synchrophasor applications as well as in graduate and undergraduate teaching.

State Policies Influence Medicare Telemedicine Utilization.

PubMed

Neufeld, Jonathan D; Doarn, Charles R; Aly, Reem

2016-01-01

Medicare policy regarding telemedicine reimbursement has changed little since 2000. Many individual states, however, have added telemedicine reimbursement for either Medicaid and/or commercial payers over the same period. Because telemedicine programs must serve patients from all or most payers, it is likely that these state-level policy changes have significant impacts on telemedicine program viability and utilization of services from all payers, not just those services and payers affected directly by state policy. This report explores the impact of two significant state-level policy changes-one expanding Medicaid telemedicine coverage and the other introducing telemedicine parity for commercial payers-on Medicare utilization in the affected states. Medicare claims data from 2011-2013 were examined for states in the Great Lakes region. All valid claims for live interactive telemedicine professional fees were extracted and linked to their states of origin. Allowed encounters and expenditures were calculated in total and on a per 1,000 members per year basis to standardize against changes in the Medicare population by state and year. Medicare telemedicine encounters and professional fee expenditures grew sharply following changes in state Medicaid and commercial payer policy in the examined states. Medicare utilization in Illinois grew by 173% in 2012 (over 2011) following Medicaid coverage expansion, and Medicare utilization in Michigan grew by 118% in 2013 (over 2012) following adoption of telemedicine parity for commercial payers. By contrast, annual Medicare telemedicine utilization growth in surrounding states (in which there were no significant policy changes during these years) varied somewhat but showed no discernible pattern. Although Medicare telemedicine policy has changed little since its inception, changes in state policies with regard to telemedicine reimbursement appear to have significant impacts on the practical viability of telemedicine programs

Selecting a digital camera for telemedicine.

PubMed

Patricoski, Chris; Ferguson, A Stewart

2009-06-01

The digital camera is an essential component of store-and-forward telemedicine (electronic consultation). There are numerous makes and models of digital cameras on the market, and selecting a suitable consumer-grade camera can be complicated. Evaluation of digital cameras includes investigating the features and analyzing image quality. Important features include the camera settings, ease of use, macro capabilities, method of image transfer, and power recharging. Consideration needs to be given to image quality, especially as it relates to color (skin tones) and detail. It is important to know the level of the photographer and the intended application. The goal is to match the characteristics of the camera with the telemedicine program requirements. In the end, selecting a digital camera is a combination of qualitative (subjective) and quantitative (objective) analysis. For the telemedicine program in Alaska in 2008, the camera evaluation and decision process resulted in a specific selection based on the criteria developed for our environment.

Demonstration of novel, secure, real-time, portable ultrasound transmission from an austere international location.

PubMed

Ogedegbe, Chinwe; Morchel, Herman; Hazelwood, Vikki; Hassler, Cynthia; Feldman, Joseph

2012-01-01

There is not sufficient access to medical care or medical expertise in many parts of the world. An innovative telemedicine system has been developed to provide expert medical guidance to field caregivers [who have less medical expertise but can reach the patient population in need]. Real-time ultrasound video images have been securely transmitted from the Dominican Republic to Hackensack University Medical Center, Hackensack NJ (HackensackUMC), while the expert physician at HackensackUMC maintained direct voice communication with the field caregiver. Utilizing a portable ultrasound machine (Sonosite) integrated with portable broadcasting device (LiveU), extended Focused Assessment Sonography in Trauma (e-FAST) examinations were performed on healthy volunteers and transmitted via the local cellular network. Additionally, two e-FAST examinations were conducted from a remote location without cellular coverage and transmitted via broad ground area network (BGAN) satellites. The demonstration took the technology "out of the lab" and into a real life, austere environment. The conditions of the Dominican Republic ultrasound mission provided experience on how to manage and utilize this innovative technology in areas where reliable communications and medical coverage are not readily available. The resilient transmission capabilities coupled with the security features deem this portable Telesonography (TS) equipment highly useful in the telemedicine forefront by offering healthcare in underdeveloped areas as well as potentially enhancing throughput in disaster situations.

Experience in the application of Java Technologies in telemedicine

PubMed Central

Fedyukin, IV; Reviakin, YG; Orlov, OI; Doarn, CR; Harnett, BM; Merrell, RC

2002-01-01

Java language has been demonstrated to be an effective tool in supporting medical image viewing in Russia. This evaluation was completed by obtaining a maximum of 20 images, depending on the client's computer workstation from one patient using a commercially available computer tomography (CT) scanner. The images were compared against standard CT images that were viewed at the site of capture. There was no appreciable difference. The client side is a lightweight component that provides an intuitive interface for end users. Each image is loaded in its own thread and the user can begin work after the first image has been loaded. This feature is especially useful on slow connection speed, 9.6 Kbps for example. The server side, which is implemented by the Java Servlet Engine works more effective than common gateway interface (CGI) programs do. Advantages of the Java Technology place this program on the next level of application development. This paper presents a unique application of Java in telemedicine. PMID:12459045

Experience in the application of Java Technologies in telemedicine.

PubMed

Fedyukin, IV; Reviakin, YG; Orlov, OI; Doarn, CR; Harnett, BM; Merrell, RC

2002-09-17

Java language has been demonstrated to be an effective tool in supporting medical image viewing in Russia. This evaluation was completed by obtaining a maximum of 20 images, depending on the client's computer workstation from one patient using a commercially available computer tomography (CT) scanner. The images were compared against standard CT images that were viewed at the site of capture. There was no appreciable difference. The client side is a lightweight component that provides an intuitive interface for end users. Each image is loaded in its own thread and the user can begin work after the first image has been loaded. This feature is especially useful on slow connection speed, 9.6 Kbps for example. The server side, which is implemented by the Java Servlet Engine works more effective than common gateway interface (CGI) programs do. Advantages of the Java Technology place this program on the next level of application development. This paper presents a unique application of Java in telemedicine.

Engaging Elderly People in Telemedicine Through Gamification.

PubMed

de Vette, Frederiek; Tabak, Monique; Dekker-van Weering, Marit; Vollenbroek-Hutten, Miriam

2015-12-18

Telemedicine can alleviate the increasing demand for elderly care caused by the rapidly aging population. However, user adherence to technology in telemedicine interventions is low and decreases over time. Therefore, there is a need for methods to increase adherence, specifically of the elderly user. A strategy that has recently emerged to address this problem is gamification. It is the application of game elements to nongame fields to motivate and increase user activity and retention. This research aims to (1) provide an overview of existing theoretical frameworks for gamification and explore methods that specifically target the elderly user and (2) explore user classification theories for tailoring game content to the elderly user. This knowledge will provide a foundation for creating a new framework for applying gamification in telemedicine applications to effectively engage the elderly user by increasing and maintaining adherence. We performed a broad Internet search using scientific and nonscientific search engines and included information that described either of the following subjects: the conceptualization of gamification, methods to engage elderly users through gamification, or user classification theories for tailored game content. Our search showed two main approaches concerning frameworks for gamification: from business practices, which mostly aim for more revenue, emerge an applied approach, while academia frameworks are developed incorporating theories on motivation while often aiming for lasting engagement. The search provided limited information regarding the application of gamification to engage elderly users, and a significant gap in knowledge on the effectiveness of a gamified application in practice. Several approaches for classifying users in general were found, based on archetypes and reasons to play, and we present them along with their corresponding taxonomies. The overview we created indicates great connectivity between these taxonomies

Successes and Challenges in the Implementation and Application of Telemedicine in the Eastern Province of Saudi Arabia

PubMed Central

El-Mahalli, Azza Ali; El-khafif, Sahar Hafez; Al-Qahtani, Mona Faisal

2012-01-01

Telemedicine is the practice of healthcare using audio, video, and data communications. The aim of this study was to determine the perceptions of health professionals at hospitals adopting and not adopting telemedicine on its benefits and challenges, and their willingness to use it. The study was conducted at one hospital not adopting telemedicine and three hospitals adopting telemedicine. It was a cross-sectional descriptive study, and the target population was health professionals. Data collection methods included two paper-based questionnaires. Nonparametric statistical analysis and descriptive statistics were used. The study concluded that although telemedicine is promising and the Ministry of Health in Saudi Arabia has allocated a huge budget for e-health, the telemedicine modalities used were very limited. The percentage of adoption of telemedicine by health professionals was low in comparison to the high interest of nonadopters. Nonadopters’ perception of benefits was higher than that of adopters. The most frequently cited benefits among adopters were improving the quality of care, enhancing access to healthcare, and providing patient care and management. However, adopters’ perceptions were low for other benefits such as easy use of the network, the use of store-and-forward telemedicine, and the ability to follow up after face-to-face contacts. The greatest barrier as perceived by health providers was the lack of knowledge about telemedicine. Dissemination of information about telemedicine and proper training of health professionals on its use are recommended. PMID:23209455

Rich internet application system for patient-centric healthcare data management using handheld devices.

PubMed

Constantinescu, L; Pradana, R; Kim, J; Gong, P; Fulham, Michael; Feng, D

2009-01-01

Rich Internet Applications (RIAs) are an emerging software platform that blurs the line between web service and native application, and is a powerful tool for handheld device deployment. By democratizing health data management and widening its availability, this software platform has the potential to revolutionize telemedicine, clinical practice, medical education and information distribution, particularly in rural areas, and to make patient-centric medical computing a reality. In this paper, we propose a telemedicine application that leverages the ability of a mobile RIA platform to transcode, organise and present textual and multimedia data, which are sourced from medical database software. We adopted a web-based approach to communicate, in real-time, with an established hospital information system via a custom RIA. The proposed solution allows communication between handheld devices and a hospital information system for media streaming with support for real-time encryption, on any RIA enabled platform. We demonstrate our prototype's ability to securely and rapidly access, without installation requirements, medical data ranging from simple textual records to multi-slice PET-CT images and maximum intensity (MIP) projections.

[Telemedicine and the ageing population].

PubMed

Otto, Ulrich; Brettenhofer, Marlene; Tarnutzer, Silvan

2015-09-01

Telemedicine aims to create new forms of health care delivery by the use of information and communication technologies (ICT),for example, to improve the access to health care for patients in rural regions. There is a need for assistive technologies and innovative technological solutions due to the demographic change. Population trends of western societies show concurrently an ageing population and the wish of elderly people to live at home as long as possible while there is a tendency that older people live in greater distances to their kin nowadays. More complex diseases and multimorbidity urge improved interconnectedness between different health care professionals. Hence, different health systems pursue e-health strategies with the aim to implement electronic patient records (EPR) and similar technological solutions as a first approach to tackle those challenges. Telemedicine represents an open and evolving concept which is subject to a regular process of further development as a consequence of accelerated technological progress. The increased articulated demand for patient centered health care is one driver for the use of telemedicine. In the context of the trend of shorter hospital stays technological solutions can provide an opportunity for better support and care at home to reduce health risks and improve caregiving quality after hospital discharges. Despite the still prevalent reservations of elderly people about the use of ICT research shows that acceptance and the willingness to use technical devices is increasing. The article describes different aspects of telemedicine in the context of the aging population: definitions, an overview of trends and various fields of use with specific practical examples. A synoptic view of research results of evaluations of telemedicine applications regarding their effectiveness and cost-benefit analysis complement the paper.

Telemedicine and ISDN

DOE Office of Scientific and Technical Information (OSTI.GOV)

Akselsen, S.; Eidsvik, A.K.; Folkow, T.

1993-01-01

Telemedicine is not a new concept. Health care professionals have been using the telephone to carry out their services for years. In addition, research efforts have begun utilizing more of the telecommunication repertoire, including speech, text, data, picture, and video communication. Countries with rural areas (e.g., Australia, Canada, and Norway) have been especially active in this field. Telemedicine may be defined in several ways. The use of telecommunications and information technology is central in providing health services - regardless of locations. Thus, a goal for telemedicine has been to eliminate traveling for patients and specialist. The authors have found themore » following definition of telemedicine useful: The investigation, monitoring, and management of patients and the education of patients and staff using systems which allow ready access to expert advice and patient information, no matter where the patient or relevant information is located. In addition to the aspects covered by this definition they also discuss administrative information in this paper. Telemedicine involves a combination of topics from the fields of telecommunication, medicine, and informatics. In 1988, Norwegian Telecom Research (NTR) started a project on telemedicine in North Norway. This area was chosen partly because of the characteristics of the health service in this region. The region is characterized by sparsely populated communities spread over vast distances, and there is a lack of qualified personnel in certain sectors of the health service. The main objective of the project is to use telemedicine to provide equal healthcare services to each individual in Norway, regardless of geography or economic variation in the population. The project systematically explores the potentials provided by new information and communication technologies in improving health care services.« less

Telemedicine in Complex Diabetes Management.

PubMed

McDonnell, Marie E

2018-05-24

Telehealth has the potential to positively transform the quality and cost-effectiveness of complex diabetes management in adults. This review explores the landscape of telemedicine approaches and evidence for incorporation into general practice. Telemedicine for diabetes care is feasible based on over 100 randomized clinical trials. Evidence shows modest benefits in A1c lowering and other clinical outcomes that are better sustained over time vs. usual care. While telemedicine interventions are likely cost-effective in diabetes care, more research is needed using implementation science approaches. Telehealth platforms have been shown to be both feasible and effective for health care delivery in diabetes, although there are many caveats that require tailoring to the institution, clinician, and patient population. Research in diabetes telehealth should focus next on how to increase access to patients who are known to be marginalized from traditional models of health care.

Real-time support for high performance aircraft operation

NASA Technical Reports Server (NTRS)

Vidal, Jacques J.

1989-01-01

The feasibility of real-time processing schemes using artificial neural networks (ANNs) is investigated. A rationale for digital neural nets is presented and a general processor architecture for control applications is illustrated. Research results on ANN structures for real-time applications are given. Research results on ANN algorithms for real-time control are also shown.

Identifying Obstacles and Research Gaps of Telemedicine Projects: Approach for a State-of-the-Art Analysis.

PubMed

Harst, Lorenz; Timpel, Patrick; Otto, Lena; Wollschlaeger, Bastian; Richter, Peggy; Schlieter, Hannes

2018-01-01

This paper presents an approach for an evaluation of finished telemedicine projects using qualitative methods. Telemedicine applications are said to improve the performance of health care systems. While there are countless telemedicine projects, the vast majority never makes the threshold from testing to implementation and diffusion. Projects were collected from German project databases in the area of telemedicine following systematically developed criteria. In a testing phase, ten projects were subject to a qualitative content analysis to identify limitations, need for further research, and lessons learned. Using Mayring's method of inductive category development, six categories of possible future research were derived. Thus, the proposed method is an important contribution to diffusion and translation research regarding telemedicine, as it is applicable to a systematic research of databases.

Time-critical multirate scheduling using contemporary real-time operating system services

NASA Technical Reports Server (NTRS)

Eckhardt, D. E., Jr.

1983-01-01

Although real-time operating systems provide many of the task control services necessary to process time-critical applications (i.e., applications with fixed, invariant deadlines), it may still be necessary to provide a scheduling algorithm at a level above the operating system in order to coordinate a set of synchronized, time-critical tasks executing at different cyclic rates. The scheduling requirements for such applications and develops scheduling algorithms using services provided by contemporary real-time operating systems.

Telemedicine in the Federated States of Micronesia.

PubMed

Rutstein, D

2000-09-01

Telemedicine (other than costly long distance telephone and facsimile messages) in the Federated States of Micronesia (FSM) started approximately 4 years ago with the establishment of Internet access in the State of Yap. A local access, for medical use only, via already established trunk lines maintained by Continental Airlines was established. It provided a connection to CompuServe at a baud rate of 300 bps. FSM TeleCom provided this free service. While this connection was slow, it allowed medical staff at Yap State Hospital to send and receive text based e-mail regarding patient management. By its use interest was generated in both medical and non-medical individuals to develop a commercial full scale Internet service. In March 1996, TeleCom became a full scale commercial Internet Service Provider in Yap. Rates were reasonable and the CompuServe access was phased out. The full scale internet allowed medical personnel to engage in telemedicine activities, including email; email attachments; the search and retrieval of medical literature; transmission to medical specialists of X-rays, ECG's and other images; and real-time teleconferencing over the Internet with both audio and video. In addition, to the improvement of medical care, this allowed for greater efficiency in arranging referral of patients for medical treatment outside of the FSM.

The use of telemedicine in obstetrics: a review of the literature.

PubMed

Magann, Everett F; McKelvey, Samantha S; Hitt, Wilbur C; Smith, Michael V; Azam, Ghazala A; Lowery, Curtis L

2011-03-01

Telemedicine has been advertised for increasing efficiency, extending the scope of obstetric practice, improving pregnancy outcomes, and reducing costs in the healthcare system. The extent of telemedicine use in obstetrics was identified with a literature search. A total of 268 articles were identified of which 60 are the basis for this review. Telemedicine has been used to read ultrasounds, interpret nonstress tests, counsel patients, manage diabetes, manage postpartum depression, and support parents and children postpartum from remote sites. Reductions in time lost from work, transportation costs, more efficiency for the health care providers, and reducing medical costs all have been suggested as benefits of telemedicine. Despite the information published about telemedicine in obstetrics, this technology has not been shown to have adverse effects in obstetrics but neither has it demonstrated unequivocal benefits. Properly structured and powered investigations will be needed to determine the role of telemedicine in the future. Obstetricians & Gynecologists. After completing this CME activity, physicians should be better able to diagnose and treat diabetes using telemedicine techniques; assess the current scope of research in telemedicine in obstetrics; implement clinical telemedicine consultations based on the interaction and the needs of the participants; and the opportunities for further research in telemedicine in obstetrics.

Towards a shared service centre for telemedicine: Telemedicine in Denmark, and a possible way forward.

PubMed

Larsen, Simon Bo; Sørensen, Nanna Skovgaard; Petersen, Matilde Grøndahl; Kjeldsen, Gitte Friis

2016-12-01

Although evidence of the effectiveness of telemedicine is accumulating, knowledge of how to make best use of telemedicine is limited. This article presents results from a multi-stakeholder project that developed a new concept, a 'shared service centre' for telemedicine that is envisioned as working across different telemedical initiatives to support the implementation and wider adoption of telemedicine. One year of participatory design and analysis of the shared service centre concept involved stakeholders, such as clinicians, patients, technicians, policy makers, lawyers, economists and information technology architects. More than 100 people contributed to the findings. Most of the ideas generated for potential centre support for telemedicine could be categorised under four service categories. The need for such support services was verified in the cases investigated, and by agreement among stakeholders from regional health authorities, municipalities, and general practice. Therefore, it is probable that a shared service centre could help enable the wider deployment of telemedicine. In this article, we use 'telemedicine' as an umbrella term for all the 'tele-' labels that are sometimes used rather indiscriminately to denote the use of information and technology to support healthcare services, including 'telehealth', 'telemonitoring', 'telehomecare', 'e-health', and so on. As per our definition, telemedicine may be synchronous and/or asynchronous, and may apply to any information and technology-based means of connecting healthcare actors and the patient, such as video communication, e-mail, electronic monitoring equipment, and Internet portals. Furthermore, the term 'telemedical initiative' covers projects in which telemedicine is conducted by a temporary project organisation, as well as self-contained telemedicine services used in daily, clinical practice in existing organisations. © The Author(s) 2015.

Label-free thioflavin T/G-quadruplex-based real-time strand displacement amplification for biosensing applications.

PubMed

Du, Yi-Chen; Zhu, Li-Na; Kong, De-Ming

2016-12-15

To promote application of strand-displacement amplification (SDA) techniques in biosensing, a label-free, real-time monitoring strategy for isothermal nucleic acid amplification reactions was designed. G-quadruplex structures were introduced into SDA products using specific recognition of G-quadruplexes by the fluorogenic dye thioflavin T. Performance was good for real-time monitoring of traditional SDA by a linear-amplification mechanism and for exponential cross-triggered SDA amplification. The strategy worked on a commercial real-time PCR instrument, making it suitable for biosensing platforms. As examples, two highly sensitive and specific biosensors were designed for analysis of the activity of uracil-DNA glycosylase (UDG) and the restriction endonuclease EcoRI. Detection limits were 6×10(-5)U/mL for UDG and 0.016U/mL for EcoRI. Detection of corresponding targets in complex matrices such as cell lysates or human serum was also demonstrated. Compared to traditional end-point detection methods, real-time SDA-based approaches have the advantages of simple, fast operation; high sensitivity; low risk of carryover contamination; and very high throughput. The introduction of real-time monitoring strategies may promote application of SDA reactions in biosensor design. Copyright © 2016 Elsevier B.V. All rights reserved.

Real-time Graphics Processing Unit Based Fourier Domain Optical Coherence Tomography and Surgical Applications

NASA Astrophysics Data System (ADS)

Zhang, Kang

2011-12-01

In this dissertation, real-time Fourier domain optical coherence tomography (FD-OCT) capable of multi-dimensional micrometer-resolution imaging targeted specifically for microsurgical intervention applications was developed and studied. As a part of this work several ultra-high speed real-time FD-OCT imaging and sensing systems were proposed and developed. A real-time 4D (3D+time) OCT system platform using the graphics processing unit (GPU) to accelerate OCT signal processing, the imaging reconstruction, visualization, and volume rendering was developed. Several GPU based algorithms such as non-uniform fast Fourier transform (NUFFT), numerical dispersion compensation, and multi-GPU implementation were developed to improve the impulse response, SNR roll-off and stability of the system. Full-range complex-conjugate-free FD-OCT was also implemented on the GPU architecture to achieve doubled image range and improved SNR. These technologies overcome the imaging reconstruction and visualization bottlenecks widely exist in current ultra-high speed FD-OCT systems and open the way to interventional OCT imaging for applications in guided microsurgery. A hand-held common-path optical coherence tomography (CP-OCT) distance-sensor based microsurgical tool was developed and validated. Through real-time signal processing, edge detection and feed-back control, the tool was shown to be capable of track target surface and compensate motion. The micro-incision test using a phantom was performed using a CP-OCT-sensor integrated hand-held tool, which showed an incision error less than +/-5 microns, comparing to >100 microns error by free-hand incision. The CP-OCT distance sensor has also been utilized to enhance the accuracy and safety of optical nerve stimulation. Finally, several experiments were conducted to validate the system for surgical applications. One of them involved 4D OCT guided micro-manipulation using a phantom. Multiple volume renderings of one 3D data set were

Acceptability, Feasibility, and Cost of Telemedicine for Nonacute Headaches: A Randomized Study Comparing Video and Traditional Consultations.

PubMed

Müller, Kai Ivar; Alstadhaug, Karl Bjørnar; Bekkelund, Svein Ivar

2016-05-30

The feasibility of telemedicine in diagnosing and treating nonacute headaches, such as primary headaches (migraine and tension-type) and medication-overuse headaches has not been previously investigated. By eliminating the need of travel to specialists, telemedicine may offer significant time and money savings. Our objective was to estimate the acceptance of telemedicine and investigate the feasibility and cost savings of telemedicine consultations in diagnosing and treating nonacute headaches. From September 2012 to March 2015, nonacute headache patients from Northern Norway who were referred to neurologists through an electronic application system were consecutively screened and randomized to participate in either telemedicine or traditional specialist visits. All patients were consulted by two neurologists at the neurological department in Tromsø University Hospital. Feasibility outcomes were compared between telemedicine and traditional groups. Baseline characteristics and costs were then compared between rural and urban patients. Travel costs were calculated by using the probabilistic method of the Norwegian traveling agency: the cheapest means of public transport for each study participant. Loss of pay was calculated based on the Norwegian full-time employee's average salary: < 3.5 hours=a half day's salary, > 3.5 hours spent on travel and consultation=one day's salary. Distance and time spent on travel were estimated by using Google Maps. Of 557 headache patients screened, 479 were found eligible and 402 accepted telemedicine participation (83.9%, 402/479) and were included in the final analyses. Of these, 202 received traditional specialist consultations and 200 received telemedicine. All patients in the telemedicine group were satisfied with the video quality, and 198 (99%, 198/200) were satisfied with the sound quality. The baseline characteristics as well as headache diagnostics and follow-up appointments, and the investigation, advice, and prescription

Integrating Telemedicine in Urban Pediatric Primary Care: Provider Perspectives and Performance

PubMed Central

Wood, Nancy; Herendeen, Neil; ten Hoopen, Cynthia; Denk, Larry; Neuderfer, Judith

2010-01-01

Abstract Background: Health-e-Access, an urban telemedicine service, enabled 6,511 acute-illness telemedicine visits over a 7-year period for children at 22 childcare and school sites in Rochester, NY. Objectives: The aims of this article were to (1) describe provider attitudes and perceptions about efficiency and effectiveness of Health-e-Access and (2) assess hypotheses that (a) providers will complete a large proportion of the telemedicine visits attempted and (b) high levels of continuity with the primary care practice will be achieved. Design/Methods: This descriptive study focused on the 24-month Primary Care Phase in the development of Health-e-Access, initiated by the participation of 10 primary care practices. Provider surveys addressed efficiency, effectiveness, and overall acceptability. Performance measures included completion of telemedicine visits and continuity of care with the medical home. Results: Among survey respondents, the 30 providers who had completed telemedicine visits perceived that decision-making required slightly less time and total time required was slightly greater than for in-person visits. Confidence in diagnosis was somewhat less for telemedicine visits. Providers were comfortable collaborating with telemedicine assistants and confident that communications met parent needs. Among the 2,554 consecutive telemedicine visits attempted during the Primary Care Phase, 2,475 (96.9%) were completed by 47 providers. For visits by children with a participating primary care practice, continuity averaged 83.2% among practices (range, 28.1–92.9%). Conclusions: Providers perceived little or no advantage in efficiency or effectiveness to their practice in using telemedicine to deliver care; yet they used it effectively in serving families, completing almost all telemedicine visits requested, providing high levels of continuity with the medical home, and believing they communicated adequately with parents. PMID:20406114

Automated real-time software development

NASA Technical Reports Server (NTRS)

Jones, Denise R.; Walker, Carrie K.; Turkovich, John J.

1993-01-01

A Computer-Aided Software Engineering (CASE) system has been developed at the Charles Stark Draper Laboratory (CSDL) under the direction of the NASA Langley Research Center. The CSDL CASE tool provides an automated method of generating source code and hard copy documentation from functional application engineering specifications. The goal is to significantly reduce the cost of developing and maintaining real-time scientific and engineering software while increasing system reliability. This paper describes CSDL CASE and discusses demonstrations that used the tool to automatically generate real-time application code.

Adoption of telemedicine in Scottish remote and rural general practices: a qualitative study.

PubMed

King, Gerry; Richards, Helen; Godden, David

2007-01-01

We conducted a qualitative interview study to explore the factors that have facilitated and prevented the adoption of telemedicine in general practice in remote and rural Scotland. Face-to-face interviews were carried out with general practitioners (GPs) and practice nurses in 26 of Scotland's most remote practices and five of the seven most rural health boards. The interview study found that GPs were more positive about the use of computers and telemedicine than nurses. Although electronic access to simple data, such as laboratory results, had become widely accepted, most respondents had very little experience of more sophisticated telemedicine applications, such as videoconferencing. There was widespread scepticism about the potential usefulness of clinical applications of telemedicine, although it was perceived to have potential benefit in facilitating access to educational resources. A number of barriers to the adoption of telemedicine were reported, including concerns that videoconferencing could diminish the quality of communication in educational and clinical settings, and that telemedicine would not fit easily with the organizational routines of the practices. Policy-makers should prioritize strategies to develop educational programmes, as these are more likely to succeed than clinical initiatives. It may then follow that clinicians will see opportunities for use in their clinical work.

Using Telemedicine to Address Crowding in the ED.

PubMed

Guss, Benjamin; Mishkin, David; Sharma, Rahul

2016-11-01

Some health systems are piloting telemedicine solutions in the ED to address crowding and decrease patient wait times. One new program, implemented at the Lisa Perry Emergency Center at New York Presbyterian (NYP) Weill Cornell Medical Center in New York, involves offering low-acuity patients the option of visiting an off-site physician via telemedicine hookup. Administrators note that the approach can get patients in and out of the ED within 30 minutes, and patients have thus far been highly satisfied with the approach. However, an earlier telemedicine program piloted at the University of San Diego Health System’s (UCSD) Hillcrest Hospital in 2013 got bogged down due to administrative and insurance reimbursement hurdles, although the approach showed enough promise that there is interest in restarting the program. In the NYP program, patients are identified as appropriate candidates for the program at triage. They can opt to be seen remotely or through traditional means in the ED’s fast-track section. Administrators note that patients with complex problems requiring extensive workups are not suitable for the telemedicine approach. The most challenging aspect of implementing a successful telemedicine program in the ED is getting the workflows right, according to administrators. An earlier ED-based telemedicine program piloted at UCSD ran into difficulties because the model required the involvement of two physicians, and some insurers did not want to pay for the telemedicine visits. However, patients were receptive.

Research Directions in Real-Time Systems.

DTIC Science & Technology

1996-09-01

This report summarizes a survey of published research in real time systems . Material is presented that provides an overview of the topic, focusing on...communications protocols and scheduling techniques. It is noted that real - time systems deserve special attention separate from other areas because of...formal tools for design and analysis of real - time systems . The early work on applications as well as notable theoretical advances are summarized

Principles of survey development for telemedicine applications.

PubMed

Demiris, George

2006-01-01

Surveys can be used in the evaluation of telemedicine applications but they must be properly designed, consistent and accurate. The purpose of the survey and the resources available will determine the extent of testing that a survey instrument should undergo prior to its use. The validity of an instrument is the correspondence between what is being measured and what was intended to be measured. The reliability of an instrument describes the 'consistency' or 'repeatability' of the measurements made with it. Survey instruments should be designed and tested following basic principles of survey development. The actual survey administration also requires consideration, for example data collection and processing, as well as the interpretation of the findings. Surveys are of two different types. Either they are self-administered, or they are administered by interview. In the latter case, they may be administered by telephone or in a face-to-face meeting. It is important to design a survey instrument based on a detailed definition of what it intends to measure and to test it before administering it to the larger sample.

Clinician Attitudes Toward Adoption of Pediatric Emergency Telemedicine in Rural Hospitals.

PubMed

Ray, Kristin N; Felmet, Kathryn A; Hamilton, Melinda F; Kuza, Courtney C; Saladino, Richard A; Schultz, Brian R; Watson, R Scott; Kahn, Jeremy M

2017-04-01

Although there is growing evidence regarding the utility of telemedicine in providing care for acutely ill children in underserved settings, adoption of pediatric emergency telemedicine remains limited, and little data exist to inform implementation efforts. Among clinician stakeholders, we examined attitudes regarding pediatric emergency telemedicine, including barriers to adoption in rural settings and potential strategies to overcome these barriers. Using a sequential mixed-methods approach, we first performed semistructured interviews with clinician stakeholders using thematic content analysis to generate a conceptual model for pediatric emergency telemedicine adoption. Based on this model, we then developed and fielded a survey to further examine attitudes regarding barriers to adoption and strategies to improve adoption. Factors influencing adoption of pediatric emergency telemedicine were identified and categorized into 3 domains: contextual factors (such as regional geography, hospital culture, and individual experience), perceived usefulness of pediatric emergency telemedicine, and perceived ease of use of pediatric emergency telemedicine. Within the domains of perceived usefulness and perceived ease of use, belief in the relative advantage of telemedicine was the most pronounced difference between telemedicine proponents and nonproponents. Strategies identified to improve adoption of telemedicine included patient-specific education, clinical protocols for use, decreasing response times, and simplifying the technology. More effective adoption of pediatric emergency telemedicine among clinicians will require addressing perceived usefulness and perceived ease of use in the context of local factors. Future studies should examine the impact of specific identified strategies on adoption of pediatric emergency telemedicine and patient outcomes in rural settings.

G2LC: Resources Autoscaling for Real Time Bioinformatics Applications in IaaS.

PubMed

Hu, Rongdong; Liu, Guangming; Jiang, Jingfei; Wang, Lixin

2015-01-01

Cloud computing has started to change the way how bioinformatics research is being carried out. Researchers who have taken advantage of this technology can process larger amounts of data and speed up scientific discovery. The variability in data volume results in variable computing requirements. Therefore, bioinformatics researchers are pursuing more reliable and efficient methods for conducting sequencing analyses. This paper proposes an automated resource provisioning method, G2LC, for bioinformatics applications in IaaS. It enables application to output the results in a real time manner. Its main purpose is to guarantee applications performance, while improving resource utilization. Real sequence searching data of BLAST is used to evaluate the effectiveness of G2LC. Experimental results show that G2LC guarantees the application performance, while resource is saved up to 20.14%.

ControlShell - A real-time software framework

NASA Technical Reports Server (NTRS)

Schneider, Stanley A.; Ullman, Marc A.; Chen, Vincent W.

1991-01-01

ControlShell is designed to enable modular design and impplementation of real-time software. It is an object-oriented tool-set for real-time software system programming. It provides a series of execution and data interchange mechansims that form a framework for building real-time applications. These mechanisms allow a component-based approach to real-time software generation and mangement. By defining a set of interface specifications for intermodule interaction, ControlShell provides a common platform that is the basis for real-time code development and exchange.

Near real-time shadow detection and removal in aerial motion imagery application

NASA Astrophysics Data System (ADS)

Silva, Guilherme F.; Carneiro, Grace B.; Doth, Ricardo; Amaral, Leonardo A.; Azevedo, Dario F. G. de

2018-06-01

This work presents a method to automatically detect and remove shadows in urban aerial images and its application in an aerospace remote monitoring system requiring near real-time processing. Our detection method generates shadow masks and is accelerated by GPU programming. To obtain the shadow masks, we converted images from RGB to CIELCh model, calculated a modified Specthem ratio, and applied multilevel thresholding. Morphological operations were used to reduce shadow mask noise. The shadow masks are used in the process of removing shadows from the original images using the illumination ratio of the shadow/non-shadow regions. We obtained shadow detection accuracy of around 93% and shadow removal results comparable to the state-of-the-art while maintaining execution time under real-time constraints.

Applications for the environment : real-time information synthesis (AERIS). Eco-lanes : operational concept.

DOT National Transportation Integrated Search

2013-10-01

This document serves as an Operational Concept for the Applications for the Environment: Real-Time Information Synthesis (AERIS) Eco-Lanes Transformative Concept. The Eco-Lanes Transformative Concept features dedicated lanes on freeways optimized for...

Timeliness and access to healthcare services via telemedicine for adolescents in state correctional facilities.

PubMed

Fox, Karen C; Somes, Grant W; Waters, Teresa M

2007-08-01

The aim of this study was to examine the effectiveness of a telemedicine program in improving timeliness of and access to healthcare services in adolescent correctional facilities. This study is a pre/post quasi-experimental design comparing time to treatment and healthcare use in the year preceding and the 2 years after the implementation of a telemedicine program in four facilities housing adolescents from 12 to 19. Timeliness of care is measured by time from referral to date of service (for behavioral healthcare only). Access to care is measured by use of outpatient care, emergency department (ED) visits, and inpatient visits. Two of the four state correctional facilities had a significant decrease (24%) in time from referral to treatment after the implementation of the telemedicine intervention. The facilities not showing significant improvements in timeliness experienced difficulty implementing the telemedicine program. The telemedicine program was also associated with significant improvements in access to care. Outpatient visits increased by 40% in the 2 years after implementation of telemedicine. For each 1% increase in telemedicine usage, outpatient visits increased by 1%, whereas emergency room visits decreased by 7%. Telemedicine can have a positive impact on timeliness of and access to care for youth in correctional facilities.

Neurosurgery and Telemedicine in the United States: Assessment of the Risks and Opportunities.

PubMed

Kahn, Elyne N; La Marca, Frank; Mazzola, Catherine A

2016-05-01

Telemedicine has seen substantial growth in the past 20 years, related to technologic advancements and evolving reimbursement policies. The risks and opportunities of neurosurgical telemedicine are nuanced. We reviewed general and peer-reviewed literature as it relates to telemedicine and neurosurgery, with particular attention to best practices, relevant state and federal policy conditions, economic evaluations, and prospective clinical studies. Despite technologic development, growing interest, and increasing reimbursement opportunities, telemedicine's utilization remains limited because of concerns regarding an apparent lack of need for telemedicine services, lack of widespread reimbursement, lack of interstate licensure reciprocity, lack of universal access to necessary technology, concerns about maintaining patient confidentiality, and concerns and limited precedent regarding liability issues. The Veterans Health Administration, a component of the U.S. Department of Veterans Affairs, represents a setting in which these concerns can be largely obviated and is a model for telemedicine best practices. Results from the VA demonstrate substantial cost savings and patient satisfaction with remote care for chronic neurologic conditions. Overall, the economic and clinical benefits of telemedicine will likely come from 1) diminished travel times and lost work time for patients; 2) remote consultation of subspecialty experts, such as neurosurgeons; and 3) remote consultation to assist with triage and care in time-sensitive scenarios, including acute stroke care and "teletrauma." Telemedicine is effective in many health care scenarios and will become more relevant to neurosurgical patient care. We favor proceeding with legislation to reduce barriers to telemedicine's growth. Copyright © 2016 Elsevier Inc. All rights reserved.

Providing emergency medical care to offshore oil and gas platforms in the Gulf of Mexico using telemedicine

NASA Astrophysics Data System (ADS)

Bouabene, Anis

2002-08-01

UTMB is developing with industrial partners the "24/7 telemedicine triage project" to provide emergency medical care to offshore oil and gas rigs and platforms in the Gulf of Mexico. The oil and gas industry is second only to the US department of defense in the number of employees stationed in remote areas. Providing medical care to such populations is logistically complex and expensive. In addition, emergency evacuation is often time-consuming and poses risks for both patients and medical crews. By utilizing high-resolution videoconferencing technology, through a satellite communication, patient visits will be conducted in real time and will provide more informed decisions about the need for more extensive treatment, thereby reducing unnecessary evacuations. In addition, patients who require evacuation will receive a higher standard of care while waiting for transport to a medical facility. UTMB physicians report that 39% of all patients from offshore facilities treated in the emergency department, could have been successfully treated through telemedicine without being evacuated to a hospital. The telemedicine project will employ standard procedures for medical triage, in which patients are directed to appropriate medical experts based on their symptoms or type of injury.

Forecasting Hourly Water Demands With Seasonal Autoregressive Models for Real-Time Application

NASA Astrophysics Data System (ADS)

Chen, Jinduan; Boccelli, Dominic L.

2018-02-01

Consumer water demands are not typically measured at temporal or spatial scales adequate to support real-time decision making, and recent approaches for estimating unobserved demands using observed hydraulic measurements are generally not capable of forecasting demands and uncertainty information. While time series modeling has shown promise for representing total system demands, these models have generally not been evaluated at spatial scales appropriate for representative real-time modeling. This study investigates the use of a double-seasonal time series model to capture daily and weekly autocorrelations to both total system demands and regional aggregated demands at a scale that would capture demand variability across a distribution system. Emphasis was placed on the ability to forecast demands and quantify uncertainties with results compared to traditional time series pattern-based demand models as well as nonseasonal and single-seasonal time series models. Additional research included the implementation of an adaptive-parameter estimation scheme to update the time series model when unobserved changes occurred in the system. For two case studies, results showed that (1) for the smaller-scale aggregated water demands, the log-transformed time series model resulted in improved forecasts, (2) the double-seasonal model outperformed other models in terms of forecasting errors, and (3) the adaptive adjustment of parameters during forecasting improved the accuracy of the generated prediction intervals. These results illustrate the capabilities of time series modeling to forecast both water demands and uncertainty estimates at spatial scales commensurate for real-time modeling applications and provide a foundation for developing a real-time integrated demand-hydraulic model.

Expert systems for real-time monitoring and fault diagnosis

NASA Technical Reports Server (NTRS)

Edwards, S. J.; Caglayan, A. K.

1989-01-01

Methods for building real-time onboard expert systems were investigated, and the use of expert systems technology was demonstrated in improving the performance of current real-time onboard monitoring and fault diagnosis applications. The potential applications of the proposed research include an expert system environment allowing the integration of expert systems into conventional time-critical application solutions, a grammar for describing the discrete event behavior of monitoring and fault diagnosis systems, and their applications to new real-time hardware fault diagnosis and monitoring systems for aircraft.

Real-Time Embedded High Performance Computing: Communications Scheduling.

DTIC Science & Technology

1995-06-01

real - time operating system must explicitly limit the degradation of the timing performance of all processes as the number of processes...adequately supported by a real - time operating system , could compound the development problems encountered in the past. Many experts feel that the... real - time operating system support for an MPP, although they all provide some support for distributed real-time applications. A distributed real

Real-time Experiment Interface for Biological Control Applications

PubMed Central

Lin, Risa J.; Bettencourt, Jonathan; White, John A.; Christini, David J.; Butera, Robert J.

2013-01-01

The Real-time Experiment Interface (RTXI) is a fast and versatile real-time biological experimentation system based on Real-Time Linux. RTXI is open source and free, can be used with an extensive range of experimentation hardware, and can be run on Linux or Windows computers (when using the Live CD). RTXI is currently used extensively for two experiment types: dynamic patch clamp and closed-loop stimulation pattern control in neural and cardiac single cell electrophysiology. RTXI includes standard plug-ins for implementing commonly used electrophysiology protocols with synchronized stimulation, event detection, and online analysis. These and other user-contributed plug-ins can be found on the website (http://www.rtxi.org). PMID:21096883

Applications for the environment : real-time information synthesis low emissions zones : operational concept.

DOT National Transportation Integrated Search

2013-10-01

This document serves as an Operational Concept for the Applications for the Environment: Real-Time Information Synthesis (AERIS) Low Emissions Zones Transformative Concept. The Low Emissions Zone Transformative Concept includes the ability for an ent...

Real-Time Transmission and Storage of Video, Audio, and Health Data in Emergency and Home Care Situations

NASA Astrophysics Data System (ADS)

Barbieri, Ivano; Lambruschini, Paolo; Raggio, Marco; Stagnaro, Riccardo

2007-12-01

The increase in the availability of bandwidth for wireless links, network integration, and the computational power on fixed and mobile platforms at affordable costs allows nowadays for the handling of audio and video data, their quality making them suitable for medical application. These information streams can support both continuous monitoring and emergency situations. According to this scenario, the authors have developed and implemented the mobile communication system which is described in this paper. The system is based on ITU-T H.323 multimedia terminal recommendation, suitable for real-time data/video/audio and telemedical applications. The audio and video codecs, respectively, H.264 and G723.1, were implemented and optimized in order to obtain high performance on the system target processors. Offline media streaming storage and retrieval functionalities were supported by integrating a relational database in the hospital central system. The system is based on low-cost consumer technologies such as general packet radio service (GPRS) and wireless local area network (WLAN or WiFi) for lowband data/video transmission. Implementation and testing were carried out for medical emergency and telemedicine application. In this paper, the emergency case study is described.

A strategic vision for telemedicine and medical informatics in space flight

NASA Technical Reports Server (NTRS)

Williams, D. R.; Bashshur, R. L.; Pool, S. L.; Doarn, C. R.; Merrell, R. C.; Logan, J. S.

2000-01-01

This Workshop was designed to assist in the ongoing development and application of telemedicine and medical informatics to support extended space flight. Participants included specialists in telemedicine and medical/health informatics (terrestrial and space) medicine from NASA, federal agencies, academic centers, and research and development institutions located in the United States and several other countries. The participants in the working groups developed vision statements, requirements, approaches, and recommendations pertaining to developing and implementing a strategy pertaining to telemedicine and medical informatics. Although some of the conclusions and recommendations reflect ongoing work at NASA, others provided new insight and direction that may require a reprioritization of current NASA efforts in telemedicine and medical informatics. This, however, was the goal of the Workshop. NASA is seeking other perspectives and views from leading practitioners in the fields of telemedicine and medical informatics to invigorate an essential and high-priority component of the International Space Station and future extended exploration missions. Subsequent workshops will further define and refine the general findings and recommendations achieved here. NASA's ultimate aim is to build a sound telemedicine and medical informatics operational system to provide the best medical care available for astronauts going to Mars and beyond.

A strategic vision for telemedicine and medical informatics in space flight.

PubMed

Williams, D R; Bashshur, R L; Pool, S L; Doarn, C R; Merrell, R C; Logan, J S

2000-01-01

This Workshop was designed to assist in the ongoing development and application of telemedicine and medical informatics to support extended space flight. Participants included specialists in telemedicine and medical/health informatics (terrestrial and space) medicine from NASA, federal agencies, academic centers, and research and development institutions located in the United States and several other countries. The participants in the working groups developed vision statements, requirements, approaches, and recommendations pertaining to developing and implementing a strategy pertaining to telemedicine and medical informatics. Although some of the conclusions and recommendations reflect ongoing work at NASA, others provided new insight and direction that may require a reprioritization of current NASA efforts in telemedicine and medical informatics. This, however, was the goal of the Workshop. NASA is seeking other perspectives and views from leading practitioners in the fields of telemedicine and medical informatics to invigorate an essential and high-priority component of the International Space Station and future extended exploration missions. Subsequent workshops will further define and refine the general findings and recommendations achieved here. NASA's ultimate aim is to build a sound telemedicine and medical informatics operational system to provide the best medical care available for astronauts going to Mars and beyond.

The Chimera II Real-Time Operating System for advanced sensor-based control applications

NASA Technical Reports Server (NTRS)

Stewart, David B.; Schmitz, Donald E.; Khosla, Pradeep K.

1992-01-01

Attention is given to the Chimera II Real-Time Operating System, which has been developed for advanced sensor-based control applications. The Chimera II provides a high-performance real-time kernel and a variety of IPC features. The hardware platform required to run Chimera II consists of commercially available hardware, and allows custom hardware to be easily integrated. The design allows it to be used with almost any type of VMEbus-based processors and devices. It allows radially differing hardware to be programmed using a common system, thus providing a first and necessary step towards the standardization of reconfigurable systems that results in a reduction of development time and cost.

Real-time Space-time Integration in GIScience and Geography

PubMed Central

Richardson, Douglas B.

2013-01-01

Space-time integration has long been the topic of study and speculation in geography. However, in recent years an entirely new form of space-time integration has become possible in GIS and GIScience: real-time space-time integration and interaction. While real-time spatiotemporal data is now being generated almost ubiquitously, and its applications in research and commerce are widespread and rapidly accelerating, the ability to continuously create and interact with fused space-time data in geography and GIScience is a recent phenomenon, made possible by the invention and development of real-time interactive (RTI) GPS/GIS technology and functionality in the late 1980s and early 1990s. This innovation has since functioned as a core change agent in geography, cartography, GIScience and many related fields, profoundly realigning traditional relationships and structures, expanding research horizons, and transforming the ways geographic data is now collected, mapped, modeled, and used, both in geography and in science and society more broadly. Real-time space-time interactive functionality remains today the underlying process generating the current explosion of fused spatiotemporal data, new geographic research initiatives, and myriad geospatial applications in governments, businesses, and society. This essay addresses briefly the development of these real-time space-time functions and capabilities; their impact on geography, cartography, and GIScience; and some implications for how discovery and change can occur in geography and GIScience, and how we might foster continued innovation in these fields. PMID:24587490

Real-time Space-time Integration in GIScience and Geography.

PubMed

Richardson, Douglas B

2013-01-01

Space-time integration has long been the topic of study and speculation in geography. However, in recent years an entirely new form of space-time integration has become possible in GIS and GIScience: real-time space-time integration and interaction. While real-time spatiotemporal data is now being generated almost ubiquitously, and its applications in research and commerce are widespread and rapidly accelerating, the ability to continuously create and interact with fused space-time data in geography and GIScience is a recent phenomenon, made possible by the invention and development of real-time interactive (RTI) GPS/GIS technology and functionality in the late 1980s and early 1990s. This innovation has since functioned as a core change agent in geography, cartography, GIScience and many related fields, profoundly realigning traditional relationships and structures, expanding research horizons, and transforming the ways geographic data is now collected, mapped, modeled, and used, both in geography and in science and society more broadly. Real-time space-time interactive functionality remains today the underlying process generating the current explosion of fused spatiotemporal data, new geographic research initiatives, and myriad geospatial applications in governments, businesses, and society. This essay addresses briefly the development of these real-time space-time functions and capabilities; their impact on geography, cartography, and GIScience; and some implications for how discovery and change can occur in geography and GIScience, and how we might foster continued innovation in these fields.

Telemedicine at sea and onshore: divergences and convergences.

PubMed

Guitton, Matthieu J

2015-01-01

Telemedical Maritime Assistance Service (TMAS) is one of the fundamental components of medical assistance delivery at sea. However, while onshore telemedicine is undergoing a fast growth, these research and clinical investments unfortunately did not yet benefit for telemedicine at sea. While telemedicine aims at providing distant health care, telemedicine at sea and onshore bear major differences, particularly for merchant vessels, and to a lesser extent for passenger vessels, which can be divided between structural differences, differences of practices, and policy differences. Despite the existence of important divergences between telemedicine at sea and telemedicine onshore, these two major branches of distant health care delivery still converge in some respects. Identifying the convergences between telemedicine at sea and telemedicine onshore might contribute to increase and optimise the transfer from research on onshore telemedicine to maritime telemedicine, and to overcome the relatively low amount of research performed on telemedicine at sea compared to its onshore counterpart.

Floor covering and surface identification for assistive mobile robotic real-time room localization application.

PubMed

Gillham, Michael; Howells, Gareth; Spurgeon, Sarah; McElroy, Ben

2013-12-17

Assistive robotic applications require systems capable of interaction in the human world, a workspace which is highly dynamic and not always predictable. Mobile assistive devices face the additional and complex problem of when and if intervention should occur; therefore before any trajectory assistance is given, the robotic device must know where it is in real-time, without unnecessary disruption or delay to the user requirements. In this paper, we demonstrate a novel robust method for determining room identification from floor features in a real-time computational frame for autonomous and assistive robotics in the human environment. We utilize two inexpensive sensors: an optical mouse sensor for straightforward and rapid, texture or pattern sampling, and a four color photodiode light sensor for fast color determination. We show how data relating floor texture and color obtained from typical dynamic human environments, using these two sensors, compares favorably with data obtained from a standard webcam. We show that suitable data can be extracted from these two sensors at a rate 16 times faster than a standard webcam, and that these data are in a form which can be rapidly processed using readily available classification techniques, suitable for real-time system application. We achieved a 95% correct classification accuracy identifying 133 rooms' flooring from 35 classes, suitable for fast coarse global room localization application, boundary crossing detection, and additionally some degree of surface type identification.

Software-safety and software quality assurance in real-time applications Part 2: Real-time structures and languages

NASA Astrophysics Data System (ADS)

Schoitsch, Erwin

1988-07-01

Our society is depending more and more on the reliability of embedded (real-time) computer systems even in every-day life. Considering the complexity of the real world, this might become a severe threat. Real-time programming is a discipline important not only in process control and data acquisition systems, but also in fields like communication, office automation, interactive databases, interactive graphics and operating systems development. General concepts of concurrent programming and constructs for process-synchronization are discussed in detail. Tasking and synchronization concepts, methods of process communication, interrupt- and timeout handling in systems based on semaphores, signals, conditional critical regions or on real-time languages like Concurrent PASCAL, MODULA, CHILL and ADA are explained and compared with each other and with respect to their potential to quality and safety.

The business of telemedicine: strategy primer.

PubMed

LeRouge, Cynthia; Tulu, Bengisu; Forducey, Pamela

2010-10-01

There is some tacit understanding that telemedicine can provide cost efficiency along with increased access and equality of care for the geographically disadvantaged. However, concrete strategic guidance for healthcare organizations to attain these benefits is fragmented and limited in existing literature. Telemedicine programs need to move from a grant-funded to a profit-centered status to sustain their existence. This article extends work presented at a recent American Telemedicine Association Business and Finance Special Interest Group course to provide a conceptual framework for strategic planning and for effectively implementing telemedicine programs. An expert panel of telemedicine coordinators provides insight and recommendations.

Laser intensity modulated real time monitoring cell growth sensor for bioprocess applications

NASA Astrophysics Data System (ADS)

Kishore, P.; Babu, P. Ravindra; Devi, V. Rama; Maunika, T.; Soujanya, P.; Kishore, P. V. N.; Dinakar, D.

2016-04-01

This article proposes an optical method for monitoring the growth of Escherichia coli in Luria Bertani medium and Saccharomyces cereviciae in YPD. Suitable light is selected which on interaction with the analyte under consideration, gets adsorption / scattered. Required electronic circuitry is designed to drive the laser source and to detect the intensity of light using Photo-detector. All these components are embedded and arranged in a proper way and monitored the growth of the microbs in real time. The sensors results are compared with standard techniques such as colorimeter, Nephelometer and hemocytometer. The experimental results are in good agreement with the existed techniques and well suitable for real time monitoring applications of the growth of the microbs.

Development of a real time activity monitoring Android application utilizing SmartStep.

PubMed

Hegde, Nagaraj; Melanson, Edward; Sazonov, Edward

2016-08-01

Footwear based activity monitoring systems are becoming popular in academic research as well as consumer industry segments. In our previous work, we had presented developmental aspects of an insole based activity and gait monitoring system-SmartStep, which is a socially acceptable, fully wireless and versatile insole. The present work describes the development of an Android application that captures the SmartStep data wirelessly over Bluetooth Low energy (BLE), computes features on the received data, runs activity classification algorithms and provides real time feedback. The development of activity classification methods was based on the the data from a human study involving 4 participants. Participants were asked to perform activities of sitting, standing, walking, and cycling while they wore SmartStep insole system. Multinomial Logistic Discrimination (MLD) was utilized in the development of machine learning model for activity prediction. The resulting classification model was implemented in an Android Smartphone. The Android application was benchmarked for power consumption and CPU loading. Leave one out cross validation resulted in average accuracy of 96.9% during model training phase. The Android application for real time activity classification was tested on a human subject wearing SmartStep resulting in testing accuracy of 95.4%.

G2LC: Resources Autoscaling for Real Time Bioinformatics Applications in IaaS

PubMed Central

Hu, Rongdong; Liu, Guangming; Jiang, Jingfei; Wang, Lixin

2015-01-01

Cloud computing has started to change the way how bioinformatics research is being carried out. Researchers who have taken advantage of this technology can process larger amounts of data and speed up scientific discovery. The variability in data volume results in variable computing requirements. Therefore, bioinformatics researchers are pursuing more reliable and efficient methods for conducting sequencing analyses. This paper proposes an automated resource provisioning method, G2LC, for bioinformatics applications in IaaS. It enables application to output the results in a real time manner. Its main purpose is to guarantee applications performance, while improving resource utilization. Real sequence searching data of BLAST is used to evaluate the effectiveness of G2LC. Experimental results show that G2LC guarantees the application performance, while resource is saved up to 20.14%. PMID:26504488

Designing Telemedicine Systems for Geriatric Patients: A Review of the Usability Studies.

PubMed

Narasimha, Shraddhaa; Madathil, Kapil Chalil; Agnisarman, Sruthy; Rogers, Hunter; Welch, Brandon; Ashok, Aparna; Nair, Aswathi; McElligott, James

2017-06-01

One area where telemedicine may prove to be highly effective is in providing medical care to the geriatric population, an age group predicted to account for 20% of the population in the near future. However, even though telemedicine has certain advantages, the usability of these systems with this population merits investigation. This article reviews the literature published from 2000 to 2016 with the goal of analyzing the characteristics of usability-related studies conducted using geriatric participants and the subsequent usability challenges identified. Articles were found using Web of Knowledge and PubMed citation indexing portals using the keywords (1) Telemedicine* AND Geriatrics* (2) Telemedicine* AND Usability* (3) Telemedicine* AND Usability* AND Older Adults*. A total of 297 articles were obtained from the initial search. After further detailed screening, 16 articles were selected for review based on the inclusion criteria. Of these, 60% of the studies focused on the overall usability of telemedicine systems; 6.25% focused on the usability of a telepresence robot; 12.5% compared a face-to-face medical consultation with the use of telemedicine systems, and 25% focused on the study of other aspects of telemedicine in addition to its usability. Findings reported in the studies included high patient satisfaction with telemedicine in 31.25%, whereas another 31.25% indicated a high acceptance of this method of medical consultation. Care coordination in 6.25% of the studies; confidence in telemedicine in 6.25%; trust, privacy, and reliability in 6.25%; and increased convenience when compared to personal visits in 18.75% were also reported. This review suggests limited research providing scientifically valid and reproducible usability evaluation at various stages of telemedicine system development. Telemedicine system designers need to consider the age-related issues in cognition, perception, and behavior of geriatric patients while designing telemedicine

Coordinated scheduling for dynamic real-time systems

NASA Technical Reports Server (NTRS)

Natarajan, Swaminathan; Zhao, Wei

1994-01-01

In this project, we addressed issues in coordinated scheduling for dynamic real-time systems. In particular, we concentrated on design and implementation of a new distributed real-time system called R-Shell. The design objective of R-Shell is to provide computing support for space programs that have large, complex, fault-tolerant distributed real-time applications. In R-shell, the approach is based on the concept of scheduling agents, which reside in the application run-time environment, and are customized to provide just those resource management functions which are needed by the specific application. With this approach, we avoid the need for a sophisticated OS which provides a variety of generalized functionality, while still not burdening application programmers with heavy responsibility for resource management. In this report, we discuss the R-Shell approach, summarize the achievement of the project, and describe a preliminary prototype of R-Shell system.

X-LUNA: Extending Free/Open Source Real Time Executive for On-Board Space Applications

NASA Astrophysics Data System (ADS)

Braga, P.; Henriques, L.; Zulianello, M.

2008-08-01

In this paper we present xLuna, a system based on the RTEMS [1] Real-Time Operating System that is able to run on demand a GNU/Linux Operating System [2] as RTEMS' lowest priority task. Linux runs in user-mode and in a different memory partition. This allows running Hard Real-Time tasks and Linux applications on the same system sharing the Hardware resources while keeping a safe isolation and the Real-Time characteristics of RTEMS. Communication between both Systems is possible through a loose coupled mechanism based on message queues. Currently only SPARC LEON2 processor with Memory Management Unit (MMU) is supported. The advantage in having two isolated systems is that non critical components are quickly developed or simply ported reducing time-to-market and budget.

Towards a shared service centre for telemedicine: Telemedicine in Denmark, and a possible way forward

PubMed Central

Larsen, Simon Bo; Sørensen, Nanna Skovgaard; Petersen, Matilde Grøndahl; Kjeldsen, Gitte Friis

2015-01-01

Although evidence of the effectiveness of telemedicine is accumulating, knowledge of how to make best use of telemedicine is limited. This article presents results from a multi-stakeholder project that developed a new concept, a ‘shared service centre’ for telemedicine that is envisioned as working across different telemedical initiatives to support the implementation and wider adoption of telemedicine. One year of participatory design and analysis of the shared service centre concept involved stakeholders, such as clinicians, patients, technicians, policy makers, lawyers, economists and information technology architects. More than 100 people contributed to the findings. Most of the ideas generated for potential centre support for telemedicine could be categorised under four service categories. The need for such support services was verified in the cases investigated, and by agreement among stakeholders from regional health authorities, municipalities, and general practice. Therefore, it is probable that a shared service centre could help enable the wider deployment of telemedicine. Definitions In this article, we use ‘telemedicine’ as an umbrella term for all the ‘tele-’ labels that are sometimes used rather indiscriminately to denote the use of information and technology to support healthcare services, including ‘telehealth’, ‘telemonitoring’, ‘telehomecare’, ‘e-health’, and so on. As per our definition, telemedicine may be synchronous and/or asynchronous, and may apply to any information and technology-based means of connecting healthcare actors and the patient, such as video communication, e-mail, electronic monitoring equipment, and Internet portals. Furthermore, the term ‘telemedical initiative’ covers projects in which telemedicine is conducted by a temporary project organisation, as well as self-contained telemedicine services used in daily, clinical practice in existing organisations. PMID:26261216

Acceptability, Feasibility, and Cost of Telemedicine for Nonacute Headaches: A Randomized Study Comparing Video and Traditional Consultations

PubMed Central

Alstadhaug, Karl Bjørnar; Bekkelund, Svein Ivar

2016-01-01

Background The feasibility of telemedicine in diagnosing and treating nonacute headaches, such as primary headaches (migraine and tension-type) and medication-overuse headaches has not been previously investigated. By eliminating the need of travel to specialists, telemedicine may offer significant time and money savings. Objectives Our objective was to estimate the acceptance of telemedicine and investigate the feasibility and cost savings of telemedicine consultations in diagnosing and treating nonacute headaches. Methods From September 2012 to March 2015, nonacute headache patients from Northern Norway who were referred to neurologists through an electronic application system were consecutively screened and randomized to participate in either telemedicine or traditional specialist visits. All patients were consulted by two neurologists at the neurological department in Tromsø University Hospital. Feasibility outcomes were compared between telemedicine and traditional groups. Baseline characteristics and costs were then compared between rural and urban patients. Travel costs were calculated by using the probabilistic method of the Norwegian traveling agency: the cheapest means of public transport for each study participant. Loss of pay was calculated based on the Norwegian full-time employee’s average salary: < 3.5 hours=a half day’s salary, > 3.5 hours spent on travel and consultation=one day’s salary. Distance and time spent on travel were estimated by using Google Maps. Results Of 557 headache patients screened, 479 were found eligible and 402 accepted telemedicine participation (83.9%, 402/479) and were included in the final analyses. Of these, 202 received traditional specialist consultations and 200 received telemedicine. All patients in the telemedicine group were satisfied with the video quality, and 198 (99%, 198/200) were satisfied with the sound quality. The baseline characteristics as well as headache diagnostics and follow-up appointments, and

Real-time three-dimensional digital image correlation for biomedical applications

NASA Astrophysics Data System (ADS)

Wu, Rong; Wu, Hua; Arola, Dwayne; Zhang, Dongsheng

2016-10-01

Digital image correlation (DIC) has been successfully applied for evaluating the mechanical behavior of biological tissues. A three-dimensional (3-D) DIC system has been developed and applied to examining the motion of bones in the human foot. To achieve accurate, real-time displacement measurements, an algorithm including matching between sequential images and image pairs has been developed. The system was used to monitor the movement of markers which were attached to a precisely motorized stage. The accuracy of the proposed technique for in-plane and out-of-plane measurements was found to be -0.25% and 1.17%, respectively. Two biomedical applications were presented. In the experiment involving the foot arch, a human cadaver lower leg and foot specimen were subjected to vertical compressive loads up to 700 N at a rate of 10 N/s and the 3-D motions of bones in the foot were monitored in real time. In the experiment involving distal tibio fibular syndesmosis, a human cadaver lower leg and foot specimen were subjected to a monotonic rotational torque up to 5 Nm at a speed of 5 deg per min and the relative displacements of the tibia and fibula were monitored in real time. Results showed that the system could reach a frequency of up to 16 Hz with 6 points measured simultaneously. This technique sheds new lights on measuring 3-D motion of bones in biomechanical studies.

The Research Agenda in ICU Telemedicine

PubMed Central

Hill, Nicholas S.; Lilly, Craig M.; Angus, Derek C.; Jacobi, Judith; Rubenfeld, Gordon D.; Rothschild, Jeffrey M.; Sales, Anne E.; Scales, Damon C.; Mathers, James A. L.

2011-01-01

ICU telemedicine uses audiovisual conferencing technology to provide critical care from a remote location. Research is needed to best define the optimal use of ICU telemedicine, but efforts are hindered by methodological challenges and the lack of an organized delivery approach. We convened an interdisciplinary working group to develop a research agenda in ICU telemedicine, addressing both methodological and knowledge gaps in the field. To best inform clinical decision-making and health policy, future research should be organized around a conceptual framework that enables consistent descriptions of both the study setting and the telemedicine intervention. The framework should include standardized methods for assessing the preimplementation ICU environment and describing the telemedicine program. This framework will facilitate comparisons across studies and improve generalizability by permitting context-specific interpretation. Research based on this framework should consider the multidisciplinary nature of ICU care and describe the specific program goals. Key topic areas to be addressed include the effect of ICU telemedicine on the structure, process, and outcome of critical care delivery. Ideally, future research should attempt to address causation instead of simply associations and elucidate the mechanism of action in order to determine exactly how ICU telemedicine achieves its effects. ICU telemedicine has significant potential to improve critical care delivery, but high-quality research is needed to best inform its use. We propose an agenda to advance the science of ICU telemedicine and generate research with the greatest potential to improve patient care. PMID:21729894

Engaging Elderly People in Telemedicine Through Gamification

PubMed Central

Tabak, Monique; Dekker - van Weering, Marit; Vollenbroek-Hutten, Miriam

2015-01-01

Background Telemedicine can alleviate the increasing demand for elderly care caused by the rapidly aging population. However, user adherence to technology in telemedicine interventions is low and decreases over time. Therefore, there is a need for methods to increase adherence, specifically of the elderly user. A strategy that has recently emerged to address this problem is gamification. It is the application of game elements to nongame fields to motivate and increase user activity and retention. Objective This research aims to (1) provide an overview of existing theoretical frameworks for gamification and explore methods that specifically target the elderly user and (2) explore user classification theories for tailoring game content to the elderly user. This knowledge will provide a foundation for creating a new framework for applying gamification in telemedicine applications to effectively engage the elderly user by increasing and maintaining adherence. Methods We performed a broad Internet search using scientific and nonscientific search engines and included information that described either of the following subjects: the conceptualization of gamification, methods to engage elderly users through gamification, or user classification theories for tailored game content. Results Our search showed two main approaches concerning frameworks for gamification: from business practices, which mostly aim for more revenue, emerge an applied approach, while academia frameworks are developed incorporating theories on motivation while often aiming for lasting engagement. The search provided limited information regarding the application of gamification to engage elderly users, and a significant gap in knowledge on the effectiveness of a gamified application in practice. Several approaches for classifying users in general were found, based on archetypes and reasons to play, and we present them along with their corresponding taxonomies. The overview we created indicates great

Need and feasibility of telemedicine in non-urban day care centres.

PubMed

Setia, Monika; DelliFraine, Jami L

2010-01-01

There appear to have been no studies of telemedicine in rural day care centres. We have assessed the feasibility of using telemedicine in eight rural day care centres in Pennsylvania, from the day care centres' perspective. The average number of children in these centres was 76 (range 20-150). The centres sent an average of 4.7 children home each month because of illness. Using telephone and face-to-face interviews, we assessed their perceived need for and familiarity with telemedicine, as well as their openness and preparedness for implementing telemedicine. Most day care centres reported a need for telemedicine and were open to learning how to use it. Some centres were concerned about adequate space for the equipment, but overall, the centres felt that their resources were adequate. Telemedicine in rural day care centres appears to be feasible, and would have the potential to save time and money for parents, as well as perhaps improving health care for children in rural areas.

A neuro-fuzzy architecture for real-time applications

NASA Technical Reports Server (NTRS)

Ramamoorthy, P. A.; Huang, Song

1992-01-01

Neural networks and fuzzy expert systems perform the same task of functional mapping using entirely different approaches. Each approach has certain unique features. The ability to learn specific input-output mappings from large input/output data possibly corrupted by noise and the ability to adapt or continue learning are some important features of neural networks. Fuzzy expert systems are known for their ability to deal with fuzzy information and incomplete/imprecise data in a structured, logical way. Since both of these techniques implement the same task (that of functional mapping--we regard 'inferencing' as one specific category under this class), a fusion of the two concepts that retains their unique features while overcoming their individual drawbacks will have excellent applications in the real world. In this paper, we arrive at a new architecture by fusing the two concepts. The architecture has the trainability/adaptibility (based on input/output observations) property of the neural networks and the architectural features that are unique to fuzzy expert systems. It also does not require specific information such as fuzzy rules, defuzzification procedure used, etc., though any such information can be integrated into the architecture. We show that this architecture can provide better performance than is possible from a single two or three layer feedforward neural network. Further, we show that this new architecture can be used as an efficient vehicle for hardware implementation of complex fuzzy expert systems for real-time applications. A numerical example is provided to show the potential of this approach.

Portable emergency telemedicine system over wireless broadband and 3G networks.

PubMed

Hong, SungHye; Kim, SangYong; Kim, JungChae; Lim, DongKyu; Jung, SeokMyung; Kim, DongKeun; Yoo, Sun K

2009-01-01

The telemedicine system aims at monitoring patients remotely without limit in time and space. However the existing telemedicine systems exchange medical information simply in a specified location. Due to increasing speed in processing data and expanding bandwidth of wireless networks, it is possible to perform telemedicine services on personal digital assistants (PDA). In this paper, a telemedicine system on PDA was developed using wideband mobile networks such as Wi-Fi, HSDPA, and WiBro for high speed bandwidths. This system enables to utilize and exchange variety and reliable patient information of video, biosignals, chatting messages, and triage data. By measuring bandwidths of individual data of the system over wireless networks, and evaluating the performance of this system using PDA, we demonstrated the feasibility of the designed portable emergency telemedicine system.

ROADNET: A Real-time Data Aware System for Earth, Oceanographic, and Environmental Applications

NASA Astrophysics Data System (ADS)

Vernon, F.; Hansen, T.; Lindquist, K.; Ludascher, B.; Orcutt, J.; Rajasekar, A.

2003-12-01

The Real-time Observatories, Application, and Data management Network (ROADNet) Program aims to develop an integrated, seamless, and transparent environmental information network that will deliver geophysical, oceanographic, hydrological, ecological, and physical data to a variety of users in real-time. ROADNet is a multidisciplinary, multinational partnership of researchers, policymakers, natural resource managers, educators, and students who aim to use the data to advance our understanding and management of coastal, ocean, riparian, and terrestrial Earth systems in Southern California, Mexico, and well off shore. To date, project activity and funding have focused on the design and deployment of network linkages and on the exploratory development of the real-time data management system. We are currently adapting powerful "Data Grid" technologies to the unique challenges associated with the management and manipulation of real-time data. Current "Grid" projects deal with static data files, and significant technical innovation is required to address fundamental problems of real-time data processing, integration, and distribution. The technologies developed through this research will create a system that dynamically adapt downstream processing, cataloging, and data access interfaces when sensors are added or removed from the system; provide for real-time processing and monitoring of data streams--detecting events, and triggering computations, sensor and logger modifications, and other actions; integrate heterogeneous data from multiple (signal) domains; and provide for large-scale archival and querying of "consolidated" data. The software tools which must be developed do not exist, although limited prototype systems are available. This research has implications for the success of large-scale NSF initiatives in the Earth sciences (EarthScope), ocean sciences (OOI- Ocean Observatories Initiative), biological sciences (NEON - National Ecological Observatory Network) and

Operational Components of Telemedicine Programs for Diabetic Retinopathy.

PubMed

Horton, Mark B; Silva, Paolo S; Cavallerano, Jerry D; Aiello, Lloyd Paul

2016-12-01

Diabetic retinopathy is a leading cause of new-onset vision loss worldwide. Treatments supported by large clinical trials are effective in preserving vision, but many persons do not receive timely diagnosis and treatment of diabetic retinopathy, which is typically asymptomatic when most treatable. Telemedicine evaluation to identify diabetic retinopathy has the potential to improve access to care and improve outcomes, but incomplete implementation of published standards creates a risk to program utility and sustainability. In a prior article, we reviewed the literature regarding the impact of imaging device, number and size of retinal images, pupil dilation, type of image grader, and diagnostic accuracy on telemedicine assessment for diabetic retinopathy. This article reviews the literature regarding the impact of automated image grading, cost effectiveness, program standards, and quality assurance (QA) on telemedicine assessment of diabetic retinopathy. Telemedicine assessment of diabetic retinopathy has the potential to preserve vision, but greater attention to development and implementation of standards is needed to better realize its potential.

Performance Comparison of EPICS IOC and MARTe in a Hard Real-Time Control Application

NASA Astrophysics Data System (ADS)

Barbalace, Antonio; Manduchi, Gabriele; Neto, A.; De Tommasi, G.; Sartori, F.; Valcarcel, D. F.

2011-12-01

EPICS is used worldwide mostly for controlling accelerators and large experimental physics facilities. Although EPICS is well fit for the design and development of automation systems, which are typically VME or PLC-based systems, and for soft real-time systems, it may present several drawbacks when used to develop hard real-time systems/applications especially when general purpose operating systems as plain Linux are chosen. This is in particular true in fusion research devices typically employing several hard real-time systems, such as the magnetic control systems, that may require strict determinism, and high performance in terms of jitter and latency. Serious deterioration of important plasma parameters may happen otherwise, possibly leading to an abrupt termination of the plasma discharge. The MARTe framework has been recently developed to fulfill the demanding requirements for such real-time systems that are alike to run on general purpose operating systems, possibly integrated with the low-latency real-time preemption patches. MARTe has been adopted to develop a number of real-time systems in different Tokamaks. In this paper, we first summarize differences and similarities between EPICS IOC and MARTe. Then we report on a set of performance measurements executed on an x86 64 bit multicore machine running Linux with an IO control algorithm implemented in an EPICS IOC and in MARTe.

Telemedicine Futures Symposium

DTIC Science & Technology

2004-10-01

VanderWerf, Adriana Velazquez 6:00 - 8:30 p.m. Reception and Dinner Presenter: Fawwaz Ulaby, Ph.D., Vice President for Research, University of Michigan...Behavioral Science, 22, 12-21. DeChant HK, Tohme WG, Mun SK, HayesWS, Schulman KA : (1996) Health systems evaluation of telemedicine: A staged approach...applications were described by satisfied clients in literature [KB2003 (several papers), EDOC200 1, KMS 1996, K2001 a, HE 1999, KA 1997, G200 1, SKB200 1, LQS

A Real-Time Health Monitoring System for Remote Cardiac Patients Using Smartphone and Wearable Sensors.

PubMed

Kakria, Priyanka; Tripathi, N K; Kitipawang, Peerapong

2015-01-01

Online telemedicine systems are useful due to the possibility of timely and efficient healthcare services. These systems are based on advanced wireless and wearable sensor technologies. The rapid growth in technology has remarkably enhanced the scope of remote health monitoring systems. In this paper, a real-time heart monitoring system is developed considering the cost, ease of application, accuracy, and data security. The system is conceptualized to provide an interface between the doctor and the patients for two-way communication. The main purpose of this study is to facilitate the remote cardiac patients in getting latest healthcare services which might not be possible otherwise due to low doctor-to-patient ratio. The developed monitoring system is then evaluated for 40 individuals (aged between 18 and 66 years) using wearable sensors while holding an Android device (i.e., smartphone under supervision of the experts). The performance analysis shows that the proposed system is reliable and helpful due to high speed. The analyses showed that the proposed system is convenient and reliable and ensures data security at low cost. In addition, the developed system is equipped to generate warning messages to the doctor and patient under critical circumstances.

A Real-Time Health Monitoring System for Remote Cardiac Patients Using Smartphone and Wearable Sensors

PubMed Central

Kakria, Priyanka; Tripathi, N. K.; Kitipawang, Peerapong

2015-01-01

Online telemedicine systems are useful due to the possibility of timely and efficient healthcare services. These systems are based on advanced wireless and wearable sensor technologies. The rapid growth in technology has remarkably enhanced the scope of remote health monitoring systems. In this paper, a real-time heart monitoring system is developed considering the cost, ease of application, accuracy, and data security. The system is conceptualized to provide an interface between the doctor and the patients for two-way communication. The main purpose of this study is to facilitate the remote cardiac patients in getting latest healthcare services which might not be possible otherwise due to low doctor-to-patient ratio. The developed monitoring system is then evaluated for 40 individuals (aged between 18 and 66 years) using wearable sensors while holding an Android device (i.e., smartphone under supervision of the experts). The performance analysis shows that the proposed system is reliable and helpful due to high speed. The analyses showed that the proposed system is convenient and reliable and ensures data security at low cost. In addition, the developed system is equipped to generate warning messages to the doctor and patient under critical circumstances. PMID:26788055

Constructing a working taxonomy of functional Ada software components for real-time embedded system applications

NASA Technical Reports Server (NTRS)

Wallace, Robert

1986-01-01

A major impediment to a systematic attack on Ada software reusability is the lack of an effective taxonomy for software component functions. The scope of all possible applications of Ada software is considered too great to allow the practical development of a working taxonomy. Instead, for the purposes herein, the scope of Ada software application is limited to device and subsystem control in real-time embedded systems. A functional approach is taken in constructing the taxonomy tree for identified Ada domain. The use of modular software functions as a starting point fits well with the object oriented programming philosophy of Ada. Examples of the types of functions represented within the working taxonomy are real time kernels, interrupt service routines, synchronization and message passing, data conversion, digital filtering and signal conditioning, and device control. The constructed taxonomy is proposed as a framework from which a need analysis can be performed to reveal voids in current Ada real-time embedded programming efforts for Space Station.

[A telemedicine electrocardiography system based on the component-architecture soft].

PubMed

Potapov, I V; Selishchev, S V

2004-01-01

The paper deals with a universal component-oriented architecture for creating the telemedicine applications. The worked-out system ensures the ECG reading, pressure measurements and pulsometry. The system design comprises a central database server and a client telemedicine module. Data can be transmitted via different interfaces--from an ordinary local network to digital satellite phones. The data protection is guaranteed by microchip charts that were used to realize the authentication 3DES algorithm.

Telemedicine Consultations in Oral and Maxillofacial Surgery: A Follow-Up Study.

PubMed

Wood, Eric W; Strauss, Robert A; Janus, Charles; Carrico, Caroline K

2016-02-01

The purpose of this study was to follow up on the previous study in evaluating the efficiency and reliability of telemedicine consultations for preoperative assessment of patients. A retrospective study of 335 patients over a 6-year period was performed to evaluate success rates of telemedicine consultations in adequately assessing patients for surgical treatment under anesthesia. Success or failure of the telemedicine consultation was measured by the ability to triage patients appropriately for the hospital operating room versus the clinic, to provide an accurate diagnosis and treatment plan, and to provide a sufficient medical and physical assessment for planned anesthesia. Data gathered from the average distance traveled and data from a previous telemedicine study performed by the National Institute of Justice were used to estimate the cost savings of using telemedicine consultations over the 6-year period. Practitioners performing the consultation were successful 92.2% of the time in using the data collected to make a diagnosis and treatment plan. Patients were triaged correctly 99.6% of the time for the clinic or hospital operating room. Most patients (98.0%) were given sufficient medical and physical assessment and were able to undergo surgery with anesthesia as planned at the clinic appointment immediately after telemedicine consultation. Most patients (95.9%) were given an accurate diagnosis and treatment plan. The estimated amount saved by providing consultation by telemedicine and eliminating in-office consultation was substantial at $134,640. This study confirms the findings from previous studies that telemedicine consultations are as reliable as those performed by traditional methods. Copyright © 2016 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

Availability of Japanese subsidies for international telemedicine projects.

PubMed

Nakajima, I; Tsurumi, T; Sawada, Y; Juzoji, H; Ogushi, Y

1999-10-01

In this article, the authors report the methods for obtaining subsidies for overseas telemedicine projects from Japanese sources based on their own personal experiences. The Japanese Government is already subsidizing such specialized NGOs (Non-Governmental Organizations) as the Telemedicine Society of Japan and Basic Human Needs and, Japanese trading companies are also hiring telemedicine experts. Prospective methods for obtaining subsidies are outlined as under the following headings: Assistance without compensation, Technology transfer, Grass-roots grant assistance, the Telecommunications Advancement Organization, Postal Savings for International Voluntary Aid, Venture business development funds provided by the Ministry of International Trade and Industry, Mission demonstration satellites by the National Space Development Agency of Japan, the Sasakawa Pacific Island Nations Fund, and International Communications Foundation. Key points of the applications are noted under (1) Degree of contribution to local residents, (2) Significance of project continuation and (3) Novelty and economic impact.

Real-time PCR detection chemistry.

PubMed

Navarro, E; Serrano-Heras, G; Castaño, M J; Solera, J

2015-01-15

Real-time PCR is the method of choice in many laboratories for diagnostic and food applications. This technology merges the polymerase chain reaction chemistry with the use of fluorescent reporter molecules in order to monitor the production of amplification products during each cycle of the PCR reaction. Thus, the combination of excellent sensitivity and specificity, reproducible data, low contamination risk and reduced hand-on time, which make it a post-PCR analysis unnecessary, has made real-time PCR technology an appealing alternative to conventional PCR. The present paper attempts to provide a rigorous overview of fluorescent-based methods for nucleic acid analysis in real-time PCR described in the literature so far. Herein, different real-time PCR chemistries have been classified into two main groups; the first group comprises double-stranded DNA intercalating molecules, such as SYBR Green I and EvaGreen, whereas the second includes fluorophore-labeled oligonucleotides. The latter, in turn, has been divided into three subgroups according to the type of fluorescent molecules used in the PCR reaction: (i) primer-probes (Scorpions, Amplifluor, LUX, Cyclicons, Angler); (ii) probes; hydrolysis (TaqMan, MGB-TaqMan, Snake assay) and hybridization (Hybprobe or FRET, Molecular Beacons, HyBeacon, MGB-Pleiades, MGB-Eclipse, ResonSense, Yin-Yang or displacing); and (iii) analogues of nucleic acids (PNA, LNA, ZNA, non-natural bases: Plexor primer, Tiny-Molecular Beacon). In addition, structures, mechanisms of action, advantages and applications of such real-time PCR probes and analogues are depicted in this review. Copyright © 2014 Elsevier B.V. All rights reserved.

Real-Time Operating System/360

NASA Technical Reports Server (NTRS)

Hoffman, R. L.; Kopp, R. S.; Mueller, H. H.; Pollan, W. D.; Van Sant, B. W.; Weiler, P. W.

1969-01-01

RTOS has a cost savings advantage for real-time applications, such as those with random inputs requiring a flexible data routing facility, display systems simplified by a device independent interface language, and complex applications needing added storage protection and data queuing.

Using architecture information and real-time resource state to reduce power consumption and communication costs in parallel applications.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Brandt, James M.; Devine, Karen Dragon; Gentile, Ann C.

2014-09-01

As computer systems grow in both size and complexity, the need for applications and run-time systems to adjust to their dynamic environment also grows. The goal of the RAAMP LDRD was to combine static architecture information and real-time system state with algorithms to conserve power, reduce communication costs, and avoid network contention. We devel- oped new data collection and aggregation tools to extract static hardware information (e.g., node/core hierarchy, network routing) as well as real-time performance data (e.g., CPU uti- lization, power consumption, memory bandwidth saturation, percentage of used bandwidth, number of network stalls). We created application interfaces that allowedmore » this data to be used easily by algorithms. Finally, we demonstrated the benefit of integrating system and application information for two use cases. The first used real-time power consumption and memory bandwidth saturation data to throttle concurrency to save power without increasing application execution time. The second used static or real-time network traffic information to reduce or avoid network congestion by remapping MPI tasks to allocated processors. Results from our work are summarized in this report; more details are available in our publications [2, 6, 14, 16, 22, 29, 38, 44, 51, 54].« less

A review of telemedicine business models.

PubMed

Chen, Shengnan; Cheng, Alice; Mehta, Khanjan

2013-04-01

Telemedicine has become an increasingly popular option for long-distance/virtual medical care and education, but many telemedicine ventures fail to grow beyond the initial pilot stage. Studying the business models of successful telemedicine ventures can help develop business strategies for upcoming ventures. This article describes business models of eight telemedicine ventures from different regions of the world using Osterwalder's "Business Model Canvas." The ventures are chosen on the basis of their apparent success and their diverse value chains. The business models are compared to draw inferences and lessons regarding their business strategy and contextual factors that influenced it. Key differences between telemedicine business practices in developing and developed countries are also discussed. The purpose of this article is to inform and inspire the business strategy of the next generation of telemedicine ventures to be economically sustainable and to successfully address local healthcare challenges.

Doctor-patient communication: a comparison between telemedicine consultation and face-to-face consultation.

PubMed

Liu, Xiao; Sawada, Yoshie; Takizawa, Takako; Sato, Hiroko; Sato, Mahito; Sakamoto, Hironosuke; Utsugi, Toshihiro; Sato, Kunio; Sumino, Hiroyuki; Okamura, Shinichi; Sakamaki, Tetsuo

2007-01-01

The objective of this study was to compare doctor-patient communications in clinical consultations via telemedicine technology to doctor-patient communications in face-to-face clinical consultations. Five doctors who had been practicing internal medicine for 8 to 18 years, and twenty patients were enrolled in this study; neither doctors nor patients had previous experience of telemedicine. The patients received both a telemedicine consultation and a face-to-face consultation. Three measures--video observation, medical record volume, and participants' satisfaction--were used for the assessment. It was found that the time spent on the telemedicine consultation was substantially longer than the time spent on the face-to-face consultation. No statistically significant differences were found in the number of either closed or open-ended questions asked by doctors between both types of consultation. Empathy-utterances, praise-utterances, and facilitation-utterances were, however, seen less in the telemedicine consultations than in the face-to-face consultations. The volume of the medical records was statistically smaller in the telemedicine consultations than in the face-to-face consultations. Patients were satisfied with the telemedicine consultation, but doctors were dissatisfied with it and felt hampered by the communication barriers. This study suggests that new training programs are needed for doctors to develop improved communication skills and the ability to express empathy in telemedicine consultations.

Floor Covering and Surface Identification for Assistive Mobile Robotic Real-Time Room Localization Application

PubMed Central

Gillham, Michael; Howells, Gareth; Spurgeon, Sarah; McElroy, Ben

2013-01-01

Assistive robotic applications require systems capable of interaction in the human world, a workspace which is highly dynamic and not always predictable. Mobile assistive devices face the additional and complex problem of when and if intervention should occur; therefore before any trajectory assistance is given, the robotic device must know where it is in real-time, without unnecessary disruption or delay to the user requirements. In this paper, we demonstrate a novel robust method for determining room identification from floor features in a real-time computational frame for autonomous and assistive robotics in the human environment. We utilize two inexpensive sensors: an optical mouse sensor for straightforward and rapid, texture or pattern sampling, and a four color photodiode light sensor for fast color determination. We show how data relating floor texture and color obtained from typical dynamic human environments, using these two sensors, compares favorably with data obtained from a standard webcam. We show that suitable data can be extracted from these two sensors at a rate 16 times faster than a standard webcam, and that these data are in a form which can be rapidly processed using readily available classification techniques, suitable for real-time system application. We achieved a 95% correct classification accuracy identifying 133 rooms' flooring from 35 classes, suitable for fast coarse global room localization application, boundary crossing detection, and additionally some degree of surface type identification. PMID:24351647

Delivering High Value Inflammatory Bowel Disease Care Through Telemedicine Visits.

PubMed

Li, Shawn X; Thompson, Kimberly D; Peterson, Tracey; Huneven, Shelley; Carmichael, Jamie; Glazer, Fredric J; Darling, Katelyn; Siegel, Corey A

2017-10-01

Patients with inflammatory bowel disease (IBD) require regular follow-up to manage their care, which requires significant amount of time and out-of-pocket costs. Telemedicine in the form of video virtual visits could serve as an alternative to in-office visits. The aim of this project was to understand if telemedicine can provide high value care (defined as quality/cost) to outpatients with IBD. Patients who participated in the IBD telemedicine clinic in the second half of 2015 were included. Patient-reported survey data before and after the virtual visit were collected. A retrospective review was performed on the study cohort for quality outcome measures a year before and after starting the telemedicine clinic. Outcomes were analyzed using simple descriptive statistics. Differences in quality outcomes were compared using odds ratios. Forty-eight patients were included in the analysis. Most patients travel more than 25 miles each way, take half a day off, and on average incur an additional out-of-pocket cost of $62 for an in-office visit. Most patients (98%) agreed that there was enough time spent with their physician, 91% agreed that they felt like the physician understood their disease state, and 78% reported that they clearly understood the follow-up plan after the visit. Analysis of quality outcome measures did not show any drop in the overall quality of care, after initiating the telemedicine program. Telemedicine offers a low cost and convenient alternative for patients with IBD without compromising quality of care.

Applications of magnetostrictive materials in the real-time monitoring of vehicle suspension components

NASA Astrophysics Data System (ADS)

Estrada, Raul

The purpose of this project is to explore applications of magnetostrictive materials for real-time monitoring of railroad suspension components, in particular bearings. Monitoring of such components typically requires the tracking of temperature vibration and load. In addition, real-time, long-term monitoring can be greatly facilitated through the use of wireless, self-powered sensors. Magnetostrictive materials, such as Terfenol-D, have the potential to address both requirements. Currently, piezoelectrics are used for many load and energy harvesting applications; however, they are fragile and are difficult to use for static load measurements. Magnetostrictive metals are tougher, and their property of variable permeability when stressed can be utilized to measure static loads. A prototype load sensor was successfully fabricated and characterized yielding less than 10% error under normal operating conditions. Energy harvesting experiments generated a little over 80 mW of power, which is sufficient to run low-power condition monitoring systems.

Real-time computational photon-counting LiDAR

NASA Astrophysics Data System (ADS)

Edgar, Matthew; Johnson, Steven; Phillips, David; Padgett, Miles

2018-03-01

The availability of compact, low-cost, and high-speed MEMS-based spatial light modulators has generated widespread interest in alternative sampling strategies for imaging systems utilizing single-pixel detectors. The development of compressed sensing schemes for real-time computational imaging may have promising commercial applications for high-performance detectors, where the availability of focal plane arrays is expensive or otherwise limited. We discuss the research and development of a prototype light detection and ranging (LiDAR) system via direct time of flight, which utilizes a single high-sensitivity photon-counting detector and fast-timing electronics to recover millimeter accuracy three-dimensional images in real time. The development of low-cost real time computational LiDAR systems could have importance for applications in security, defense, and autonomous vehicles.

Telemedicine versus face to face patient care: effects on professional practice and health care outcomes.

PubMed

Currell, R; Urquhart, C; Wainwright, P; Lewis, R

2000-01-01

Telemedicine is the use of telecommunications technology for medical diagnosis and patient care. From its beginnings telemedicine has been used in a variety of health care fields, although widespread interest among healthcare providers has only now become apparent with the development of more sophisticated technology. To assess the effects of telemedicine as an alternative to face-to-face patient care. We searched the Effective Practice and Organisation of Care Group's specialised register, The Cochrane Library, MEDLINE (1966-August 1999), EMBASE (to 1996), Cinahl (to August 1999), Inspec (to August 1996), Healthstar (1983-1996), OCLC, Sigle (to 1999), Assia, SCI (1981-1997), SSCI (1981-1997), DHSS-Data. We hand searched the Journal of Telemedicine and Telecare (1995-1999), Telemedicine Journal (1995-1999) and reference lists of articles. We also hand searched conference proceedings and contacted experts in countries identified as having an interest in telemedicine. Randomised trials, controlled before and after studies and interrupted time series comparing telemedicine with face-to-face patient care. The participants were qualified health professionals and patients receiving care through telemedicine. Two reviewers independently assessed trial quality and extracted data. Seven trials involving more than 800 people were included. One trial was concerned with telemedicine in the emergency department, one with video-consultations between primary health care and the hospital outpatients department, and the remainder were concerned with the provision of home care or patient self-monitoring of chronic disease. The studies appeared to be well conducted, although patient numbers were small in all but one. Although none of the studies showed any detrimental effects from the interventions, neither did they show unequivocal benefits and the findings did not constitute evidence of the safety of telemedicine. None of the studies included formal economic analysis. All the

The Role of Telemedicine in Auditory Rehabilitation: A Systematic Review.

PubMed

Bush, Matthew L; Thompson, Robin; Irungu, Catherine; Ayugi, John

2016-12-01

The purpose of this study was to assess the feasibility and effectiveness of live telemedicine applications in hearing amplification and cochlear implantation. A systematic search was performed in PubMed, MEDLINE, PsychINFO, CINALH, and Web of Science to identify peer-reviewed research. Inclusion criteria were titles containing words from the search terms 1) audiology, otolaryngology, and hearing impairment, 2) rehabilitative methods, and 3) telemedicine. Exclusion criteria were: 1) non-English articles, and 2) non-original research. Twelve eligible studies were identified. The studies employed a prospective design in nine of the articles and retrospective case series in three. The use of telemedicine for the provision of cochlear implant services was examined in eight of the articles and with hearing aids in four of the articles. The types of services include intraoperative cochlear implant telemetry; implant programming and assessment of electrode-specific measures and speech recognition after implantation. Hearing aid programming and remote gain assessments were also reported. Many studies assess patient and provider satisfaction along with encounter time comparison. The studies occurred from 2009 to 2014 and took place in seven countries. This review examined the feasibility of remote telemedicine connection to provide in auditory rehabilitation services through hearing aids and cochlear implants. There are significant concerns regarding Internet bandwidth limitations for remote clinics. There is a paucity of research examining reimbursement and cost-effectiveness for services. Further prospective research investigating cost-effectiveness and bandwidth limitations is warranted to assess long-term sustainability of remote audiological rehabilitative service delivery.

The Role of Telemedicine in Auditory Rehabilitation: A Systematic Review

PubMed Central

Bush, Matthew L.; Thompson, Robin; Irungu, Catherine; Ayugi, John

2016-01-01

Objective The purpose of this study was to assess the feasibility and effectiveness of live telemedicine applications in hearing amplification and cochlear implantation. Data Sources and Study Selection A systematic search was performed in PubMed, MEDLINE, PsychINFO, CINALH, and Web of Science to identify peer-reviewed research. Inclusion criteria were titles containing words from the search terms (1) audiology, otolaryngology, and hearing impairment, (2) rehabilitative methods, and (3) telemedicine. Exclusion criteria were 1) non-English articles, and 2) non-original research. Data Extraction and Synthesis Twelve eligible studies were identified. The studies employed a prospective design in nine of the articles and retrospective case series in three. The use of telemedicine for the provision of cochlear implant services was examined in eight of the articles and with hearing aids in four of the articles. The types of services include intraoperative cochlear implant telemetry; implant programming and assessment of electrode-specific measures and speech recognition after implantation. Hearing aid programming and remote gain assessments were also reported. Many studies assess patient and provider satisfaction along with encounter time comparison. The studies occurred from 2009–2014 and took place in seven countries. Conclusions This review examined the feasibility of remote telemedicine connection to provide in auditory rehabilitation services through hearing aids and cochlear implants. There are significant concerns regarding Internet bandwidth limitations for remote clinics. There is a paucity of research examining reimbursement and cost-effectiveness for services. Further prospective research investigating cost-effectiveness and bandwidth limitations is warranted to assess long-term sustainability of remote audiological rehabilitative service delivery. PMID:27755363

A Double Chaotic Layer Encryption Algorithm for Clinical Signals in Telemedicine.

PubMed

Murillo-Escobar, M A; Cardoza-Avendaño, L; López-Gutiérrez, R M; Cruz-Hernández, C

2017-04-01

Recently, telemedicine offers medical services remotely via telecommunications systems and physiological monitoring devices. This scheme provides healthcare delivery services between physicians and patients conveniently, since some patients can not attend the hospital due to any reason. However, transmission of information over an insecure channel such as internet or private data storing generates a security problem. Therefore, authentication, confidentiality, and privacy are important challenges in telemedicine, where only authorized users should have access to medical or clinical records. On the other hand, chaotic systems have been implemented efficiently in cryptographic systems to provide confidential and privacy. In this work, we propose a novel symmetric encryption algorithm based on logistic map with double chaotic layer encryption (DCLE) in diffusion process and just one round of confusion-diffusion for the confidentiality and privacy of clinical information such as electrocardiograms (ECG), electroencephalograms (EEG), and blood pressure (BP) for applications in telemedicine. The clinical signals are acquired from PhysioBank data base for encryption proposes and analysis. In contrast with recent schemes in literature, we present a secure cryptographic algorithm based on chaos validated with the most complete security analysis until this time. In addition, the cryptograms are validated with the most complete pseudorandomness tests based on National Institute of Standards and Technology (NIST) 800-22 suite. All results are at MATLAB simulations and all them show the effectiveness, security, robustness, and the potential use of the proposed scheme in telemedicine.

Cost Analysis in Telemedicine: Empirical Evidence From Sites in Arizona

ERIC Educational Resources Information Center

de la Torre, Adela; Hernandez-Rodriguez, Clemente; Garcia, Lorena

2004-01-01

Support of telemedicine for largely rural and ethnically diverse populations is premised on expectations that it increases opportunities for appropriate and timely medical services, and that it improves cost-effective service delivery. To understand the cost-effectiveness of telemedicine in 8 small and/or rural sites in Arizona. A cost analysis…

Real-time Fourier transformation of lightwave spectra and application in optical reflectometry.

PubMed

Malacarne, Antonio; Park, Yongwoo; Li, Ming; LaRochelle, Sophie; Azaña, José

2015-12-14

We propose and experimentally demonstrate a fiber-optics scheme for real-time analog Fourier transform (FT) of a lightwave energy spectrum, such that the output signal maps the FT of the spectrum of interest along the time axis. This scheme avoids the need for analog-to-digital conversion and subsequent digital signal post-processing of the photo-detected spectrum, thus being capable of providing the desired FT processing directly in the optical domain at megahertz update rates. The proposed concept is particularly attractive for applications requiring FT analysis of optical spectra, such as in many optical Fourier-domain reflectrometry (OFDR), interferometry, spectroscopy and sensing systems. Examples are reported to illustrate the use of the method for real-time OFDR, where the target axial-line profile is directly observed in a single-shot oscilloscope trace, similarly to a time-of-flight measurement, but with a resolution and depth of range dictated by the underlying interferometry scheme.

Fault recovery for real-time, multi-tasking computer system

NASA Technical Reports Server (NTRS)

Hess, Richard (Inventor); Kelly, Gerald B. (Inventor); Rogers, Randy (Inventor); Stange, Kent A. (Inventor)

2011-01-01

System and methods for providing a recoverable real time multi-tasking computer system are disclosed. In one embodiment, a system comprises a real time computing environment, wherein the real time computing environment is adapted to execute one or more applications and wherein each application is time and space partitioned. The system further comprises a fault detection system adapted to detect one or more faults affecting the real time computing environment and a fault recovery system, wherein upon the detection of a fault the fault recovery system is adapted to restore a backup set of state variables.

A meta-analysis of telemedicine success in Africa

PubMed Central

Wamala, Dan S.; Augustine, Kaddu

2013-01-01

The use of information and communication technologies (ICT) tools to improve the efficiency of professionalism at work is increasing every time under the dynamic digital environment. Tools such as telemedicine, tele-education, and health informatics have of late been incorporated in the health sector to enable easy access to essential services, for example, in medical areas from referral centers by the patients on one hand and enabling the doctor to doctor consultations for the benefit of patients. Unfortunately, observations indicate dearth efforts and commitment to optimize use of the tools in the majority of the countries south of the Sahara. Sub-Saharan Africa has been left almost behind the rest of the world in terms of development going through decades of economic exploitation by especially the west through its natural and human resources. These factors, ethnic conflicts and endless wars have continued to ruin sub-Saharan Africa’s socio-economic development. Information was obtained through a network of telemedicine practitioners in different African countries using internet communication, through E-mail and reviewing existing literature of their activities. This information was compiled from representative countries in each African region and the previous authors’experiences as telemedicine practioners. Most of these countries have inadequate ICT infrastructure, which yet creates sub-optimal application. Sub-Saharan Africa, made up of 33 of the 48 global poorest countries has to extend its ICT diffusion and policy to match the ever developing global economy. In some countries such as Ethiopia and South Africa there is significant progress in Telemedicine while in countries such as Burkina Faso and Nigeria the progress is slow because of lack of political support. Almost all reference to Africa is made in due respect to sub-Saharan Africa, one with big social, economic, and political problems with resultant high morbidity and mortality rates. This also

Telemedicine-assisted treatment of patients with intracerebral hemorrhage.

PubMed

Angileri, Filippo F; Cardali, Salvatore; Conti, Alfredo; Raffa, Giovanni; Tomasello, Francesco

2012-04-01

Telemedicine provides a new approach to improve stroke care in community settings, delivering acute stroke expertise to hospitals in rural areas. Given the controversies in many aspects of the treatment of intracerebral hemorrhage (ICH) and the lack of guidelines, a prompt neurosurgical second opinion may facilitate the treatment of patients with ICH. Here, the authors' 8-year experience with the use of telemedicine in the management of ICH is reported. The medical records of patients with ICH treated through a telemedicine system in the district of Messina, Italy, between June 2003 and June 2011 were retrospectively reviewed. Neuroradiological and clinical data for patients were transmitted through a high-technology "hub-and-spoke" telemedicine network. Neurosurgical teleconsulting (at the hub) was available for 7 peripheral hospitals (spokes) serving about 700,000 people. The authors analyzed 1) the time between peripheral hospital admission and the specialized second opinion consultation, 2) primary and secondary transfers to the authors' neurosurgery department, and 3) the treatments (surgical or medical) of patients transferred to the hub. The telemedicine network was used to treat more than 2800 patients, 733 with ICH. A neurosurgical consultation was provided in 38 minutes versus 160 minutes for a consultation without telemedicine. One hundred seventy-six (24%) of 733 patients were primarily transferred to the hub. Ninety-five patients (13%) underwent surgical treatment. The remaining 81 patients (11%) underwent neurointensive care. Eight (1.4%) of 557 patients treated at the spokes needed a secondary transfer for surgical treatment because of a worsening clinical condition and/or CT findings. Considering secondary and inappropriate transfers, the interpretation of data was correct in 96.5% of cases. Telemedicine allowed rapid visualization of neuroradiological and clinical data, providing neurosurgical expertise to community hospitals on demand and within

Do you see what I see? Insights from using google glass for disaster telemedicine triage.

PubMed

Cicero, Mark X; Walsh, Barbara; Solad, Yauheni; Whitfill, Travis; Paesano, Geno; Kim, Kristin; Baum, Carl R; Cone, David C

2015-02-01

Disasters are high-stakes, low-frequency events. Telemedicine may offer a useful adjunct for paramedics performing disaster triage. The objective of this study was to determine the feasibility of telemedicine in disaster triage, and to determine whether telemedicine has an effect on the accuracy of triage or the time needed to perform triage. This is a feasibility study in which an intervention team of two paramedics used the mobile device Google Glass (Google Inc; Mountain View, California USA) to communicate with an off-site physician disaster expert. The paramedic team triaged simulated disaster victims at the triennial drill of a commercial airport. The simulated victims had preassigned expected triage levels. The physician had an audio-video interface with the paramedic team and was able to observe the victims remotely. A control team of two paramedics performed disaster triage in the usual fashion. Both teams used the SMART Triage System (TSG Associates LLP; Halifax, England), which assigns patients into Red, Yellow, Green, and Black triage categories. The paramedics were video recorded, and their time required to triage was logged. It was determined whether the intervention team and the control team varied regarding accuracy of triage. Finally, the amount of time the intervention team needed to triage patients when telemedicine was used was compared to when that team did not use telemedicine. The two teams triaged the same 20 patients. There was no significant difference between the two groups in overall triage accuracy (85.7% for the intervention group vs 75.9% for the control group; P = .39). Two patients were triaged with telemedicine. For the intervention group, there was a significant difference in time to triage patients with telemedicine versus those without telemedicine (35.5 seconds; 95% CI, 72.5-143.5 vs 18.5 seconds; 95% CI, 13.4-23.6; P = .041). There was no increase in triage accuracy when paramedics evaluating disaster victims used telemedicine

Provision of Telemedicine Services by Community Health Centers

PubMed Central

Sharac, Jessica; Jacobs, Feygele

2014-01-01

The objective of this study was to assess the use of telemedicine services at community health centers. A national survey was distributed to all federally qualified health centers to gather data on their use of health information technology, including telemedicine services. Over a third of responding health centers (37%) provided some type of telemedicine service while 63% provided no telemedicine services. A further analysis that employed ANOVA and chi-square tests to assess differences by the provision of telemedicine services (provided no telemedicine services, provided one telemedicine service, and provided two or more telemedicine services) found that the groups differed by Meaningful Use compliance, location, percentage of elderly patients, mid-level provider, medical, and mental health staffing ratios, the percentage of patients with diabetes with good blood sugar control, and state and local funds per patient and per uninsured patient. This article presents the first national estimate of the use of telemedicine services at community health centers. Further study is needed to determine how to address factors, such as reimbursement and provider shortages, that may serve as obstacles to further expansion of telemedicine services use by community health centers. PMID:25422721

Detection of artery interfaces: a real-time system and its clinical applications

NASA Astrophysics Data System (ADS)

Faita, Francesco; Gemignani, Vincenzo; Bianchini, Elisabetta; Giannarelli, Chiara; Ghiadoni, Lorenzo; Demi, Marcello

2008-03-01

Analyzing the artery mechanics is a crucial issue because of its close relationship with several cardiovascular risk factors, such as hypertension and diabetes. Moreover, most of the work can be carried out by analyzing image sequences obtained with ultrasounds, that is with a non-invasive technique which allows a real-time visualization of the observed structures. For this reason, therefore, an accurate temporal localization of the main vessel interfaces becomes a central task for which the manual approach should be avoided since such a method is rather unreliable and time consuming. Real-time automatic systems are advantageously used to automatically locate the arterial interfaces. The automatic measurement reduces the inter/intra-observer variability with respect to the manual measurement which unavoidably depends on the experience of the operator. The real-time visual feedback, moreover, guides physicians when looking for the best position of the ultrasound probe, thus increasing the global robustness of the system. The automatic system which we developed is a stand-alone video processing system which acquires the analog video signal from the ultrasound equipment, performs all the measurements and shows the results in real-time. The localization algorithm of the artery tunics is based on a new mathematical operator (the first order absolute moment) and on a pattern recognition approach. Various clinical applications have been developed on board and validated through a comparison with gold-standard techniques: the assessment of intima-media thickness, the arterial distension, the flow-mediated dilation and the pulse wave velocity. With this paper, the results obtained on clinical trials are presented.

The way forward for telemedicine in health care delivery.

PubMed

Kwankam, S Yunkap

2013-01-01

Telemedicine has shown substantial growth recently both in terms of financial volume and numbers of people served. It also holds promise for even more growth in the future, driven by both epidemiological conditions and technological advancements. The spread of the mobile telephone into the remotest parts of developing countries, combined with its multiple applications in health and mobile financial services will extend telemedicine to vast swathes of the world's populations. However, some challenges, primarily in dealing with the regulatory environment, will need to be overcome for this potential to be fully realized.

Real-Time Systems

DTIC Science & Technology

1992-02-01

Postgraduate School Autonomous Under Vehicle (AUV) are then examined. Autonomous underwater vehicle (AUV), hard real-time system, real - time operating system , real-time programming language, real-time system, soft real-time system.

Evaluation of the ACEC Benchmark Suite for Real-Time Applications

DTIC Science & Technology

1990-07-23

1.0 benchmark suite waSanalyzed with respect to its measuring of Ada real-time features such as tasking, memory management, input/output, scheduling...and delay statement, Chapter 13 features , pragmas, interrupt handling, subprogram overhead, numeric computations etc. For most of the features that...meant for programming real-time systems. The ACEC benchmarks have been analyzed extensively with respect to their measuring of Ada real-time features

The Arizona Telemedicine Program business model.

PubMed

Barker, Gail P; Krupinski, Elizabeth A; McNeely, Richard A; Holcomb, Michael J; Lopez, Ana Maria; Weinstein, Ronald S

2005-01-01

The Arizona Telemedicine Program (ATP) was established in 1996 when state funding was provided to implement eight telemedicine sites. Since then the ATP has expanded to connect 55 health-care organizations through a membership programme formalized through legal contracts. The ATP's membership model is based on an application service provider (ASP) concept, whereby organizations can share services at lower cost; that is, the ATP acts as a broker for services. The membership fee schedule is flexible, allowing clients to purchase only those services desired. An annual membership fee is paid by every user, based on the services requested. The membership programme income has provided a steady revenue stream for the ATP. The membership-derived revenue represented 30% of the ATP's 2.6 million dollars total income during fiscal year 2003/04.

Prenatal diagnosis and telemedicine consultation of fetal urologic disorders.

PubMed

Rabie, Nader Z; Canon, Stephen; Patel, Ashay; Zamilpa, Ismael; Magann, Everett F; Higley, Jared

2016-06-01

In Arkansas, telemedicine is used commonly in obstetrics through Antenatal and Neonatal Guidelines, Education and Learning System (ANGELS), the existing statewide telemedicine network. This network is used primarily for tele-ultrasound and maternal-fetal medicine consultation. This study is a retrospective case series, describing all the patients who had a prenatally diagnosed urologic anomaly that required prenatal urologic consultation. From 2009-2013, approximately 1300 anomalies were recorded in the Arkansas Fetal Diagnosis and Management (AFDM) database, 14% of which were urologic anomalies. Twenty-six cases required prenatal urologic consultation, 25 of which were conducted via telemedicine. Teleconsultation allowed patients to combine maternal-fetal medicine and urologic consultations in one visit, saving time and effort and ultimately, for most patients, providing reassurance that delivery could be accomplished locally with postnatal follow-up already arranged. While there are several studies reporting the use of telemedicine for various subspecialty consultations, to our knowledge, this is the first to describe the use of telemedicine for prenatal urology consultation. Future research could randomize patients prospectively to allow comparison of both the outcomes as well as the patient experience. © The Author(s) 2015.

Real-time analysis application for identifying bursty local areas related to emergency topics.

PubMed

Sakai, Tatsuhiro; Tamura, Keiichi

2015-01-01

Since social media started getting more attention from users on the Internet, social media has been one of the most important information source in the world. Especially, with the increasing popularity of social media, data posted on social media sites are rapidly becoming collective intelligence, which is a term used to refer to new media that is displacing traditional media. In this paper, we focus on geotagged tweets on the Twitter site. These geotagged tweets are referred to as georeferenced documents because they include not only a short text message, but also the documents' posting time and location. Many researchers have been tackling the development of new data mining techniques for georeferenced documents to identify and analyze emergency topics, such as natural disasters, weather, diseases, and other incidents. In particular, the utilization of geotagged tweets to identify and analyze natural disasters has received much attention from administrative agencies recently because some case studies have achieved compelling results. In this paper, we propose a novel real-time analysis application for identifying bursty local areas related to emergency topics. The aim of our new application is to provide new platforms that can identify and analyze the localities of emergency topics. The proposed application is composed of three core computational intelligence techniques: the Naive Bayes classifier technique, the spatiotemporal clustering technique, and the burst detection technique. Moreover, we have implemented two types of application interface: a Web application interface and an android application interface. To evaluate the proposed application, we have implemented a real-time weather observation system embedded the proposed application. we used actual crawling geotagged tweets posted on the Twitter site. The weather observation system successfully detected bursty local areas related to observed emergency weather topics.

Real-Time MENTAT programming language and architecture

NASA Technical Reports Server (NTRS)

Grimshaw, Andrew S.; Silberman, Ami; Liu, Jane W. S.

1989-01-01

Real-time MENTAT, a programming environment designed to simplify the task of programming real-time applications in distributed and parallel environments, is described. It is based on the same data-driven computation model and object-oriented programming paradigm as MENTAT. It provides an easy-to-use mechanism to exploit parallelism, language constructs for the expression and enforcement of timing constraints, and run-time support for scheduling and exciting real-time programs. The real-time MENTAT programming language is an extended C++. The extensions are added to facilitate automatic detection of data flow and generation of data flow graphs, to express the timing constraints of individual granules of computation, and to provide scheduling directives for the runtime system. A high-level view of the real-time MENTAT system architecture and programming language constructs is provided.

Impact of different cloud deployments on real-time video applications for mobile video cloud users

NASA Astrophysics Data System (ADS)

Khan, Kashif A.; Wang, Qi; Luo, Chunbo; Wang, Xinheng; Grecos, Christos

2015-02-01

The latest trend to access mobile cloud services through wireless network connectivity has amplified globally among both entrepreneurs and home end users. Although existing public cloud service vendors such as Google, Microsoft Azure etc. are providing on-demand cloud services with affordable cost for mobile users, there are still a number of challenges to achieve high-quality mobile cloud based video applications, especially due to the bandwidth-constrained and errorprone mobile network connectivity, which is the communication bottleneck for end-to-end video delivery. In addition, existing accessible clouds networking architectures are different in term of their implementation, services, resources, storage, pricing, support and so on, and these differences have varied impact on the performance of cloud-based real-time video applications. Nevertheless, these challenges and impacts have not been thoroughly investigated in the literature. In our previous work, we have implemented a mobile cloud network model that integrates localized and decentralized cloudlets (mini-clouds) and wireless mesh networks. In this paper, we deploy a real-time framework consisting of various existing Internet cloud networking architectures (Google Cloud, Microsoft Azure and Eucalyptus Cloud) and a cloudlet based on Ubuntu Enterprise Cloud over wireless mesh networking technology for mobile cloud end users. It is noted that the increasing trend to access real-time video streaming over HTTP/HTTPS is gaining popularity among both research and industrial communities to leverage the existing web services and HTTP infrastructure in the Internet. To study the performance under different deployments using different public and private cloud service providers, we employ real-time video streaming over the HTTP/HTTPS standard, and conduct experimental evaluation and in-depth comparative analysis of the impact of different deployments on the quality of service for mobile video cloud users. Empirical

Trends in the growth of literature of telemedicine: A bibliometric analysis.

PubMed

Yang, Ya-Ting; Iqbal, Usman; Ching, Jack Horn-Yu; Ting, Jonathan Bee-Shen; Chiu, Hsien-Tsai; Tamashiro, Hiko; Hsu, Yi-Hsin Elsa

2015-12-01

Over the past two decades, the use of telemedicine as a way to provide medical services has grown as communication technologies advance and patients seek more convenient ways to receive care. Because developments within this field are still rapidly evolving, identifying trends within telemedicine literature is an important task to help delineate future directions of telemedicine research. In this study, we analyzed 7960 telemedicine-related publication records found in the Science Citations Index - Expanded database between 1993 and 2012. Bibliometric analyses revealed that while the total growth in telemedicine literature has been significant in the last twenty years, the publication activity per country and over time has been variable. While the United States led the world in the cumulative number of telemedicine publications, Norway ranked highest when we ordered countries by publications per capita. We also saw that the growth in the number of publications per year has been inconsistent over the past two decades. Our results identified that neuroscience neurology and nursing as two fields of research in telemedicine that have seen considerable growth in interest in this field, and are poised to be the focus of research activity in the near future. Copyright © 2015. Published by Elsevier Ireland Ltd.

Teleneurosonology: a novel application of transcranial and carotid ultrasound.

PubMed

Rubin, Mark N; Barrett, Kevin M; Freeman, W David; Lee Iannotti, Joyce K; Channer, Dwight D; Rabinstein, Alejandro A; Demaerschalk, Bart M

2015-03-01

To demonstrate the technical feasibility of interfacing transcranial Doppler (TCD) and carotid "duplex" ultrasonography (CUS) peripherals with telemedicine end points to provide real-time spectral waveform and duplex imaging data for remote review and interpretation. We performed remote TCD and CUS examinations on a healthy, volunteer employee from our institution without known cerebrovascular disease. The telemedicine end point was stationed in our institution's hospital where the neurosonology examinations took place and the control station was in a dedicated telemedicine room in a separate building. The examinations were performed by a postgraduate level neurohospitalist trainee (M.N.R.) and interpreted by an attending vascular neurologist, both with experience in the performance and interpretation of TCD and CUS. Spectral waveform and duplex ultrasound data were successfully transmitted from TCD and CUS instruments through a telemedicine end point to a remote reviewer at a control station. Image quality was preserved in all cases, and technical failures were not encountered. This proof-of-concept study demonstrates the technical feasibility of interfacing TCD and CUS peripherals with a telemedicine end point to provide real-time spectral waveform and duplex imaging data for remote review and interpretation. Medical diagnostic and telemedicine devices should be equipped with interfaces that allow simple transmission of high-quality audio and video information from the medical devices to the telemedicine technology. Further study is encouraged to determine the clinical impact of teleneurosonology. Copyright © 2015 National Stroke Association. Published by Elsevier Inc. All rights reserved.

Transforming Gastroenterology Care With Telemedicine.

PubMed

Siegel, Corey A

2017-04-01

Health care is changing rapidly, so we must change with the times to develop more efficient, practical, cost-effective, and, importantly, high-quality methods to care for patients. We teach medical students that optimal patient care requires face-to-face interaction to collect information on the patient's history and perform the physical examination. However, management of many patients-especially those with chronic diseases-does not always require physical examination. Telemedicine offers an opportunity to take advantage of technology while leveraging the progressive push toward efficiency and value but also requires the belief that excellent patient care is not always provided in person. Telemedicine can include a variety of aspects of patient care adapted to be performed remotely, such as telemonitoring, tele-education, teleconsultation, and telecare. All of these have been evaluated in gastroenterology practice and have demonstrated feasibility and patient preference but have produced mixed results regarding patient outcomes. By combining telemedicine tools and new care models, we can redesign chronic disease management to include fewer in-person visits when patients are well yet increase access for patients who need to be seen. This change could lead to higher-value care by improving the experience of care, decreasing costs, and improving the health of the population. Barriers include reimbursement, licensing, and fear of litigation. However, if we hope to meet the needs of patients within our changing health care system, telemedicine should be incorporated into our strategy. Copyright © 2017 AGA Institute. Published by Elsevier Inc. All rights reserved.

Novel Membrane-Based Electrochemical Sensor for Real-Time Bio-Applications

PubMed Central

Alatraktchi, Fatima AlZahra'a; Bakmand, Tanya; Dimaki, Maria; Svendsen, Winnie E.

2014-01-01

This article presents a novel membrane-based sensor for real-time electrochemical investigations of cellular- or tissue cultures. The membrane sensor enables recording of electrical signals from a cell culture without any signal dilution, thus avoiding loss of sensitivity. Moreover, the porosity of the membrane provides optimal culturing conditions similar to existing culturing techniques allowing more efficient nutrient uptake and molecule release. The patterned sensor electrodes were fabricated on a porous membrane by electron-beam evaporation. The electrochemical performance of the membrane electrodes was characterized by cyclic voltammetry and chronoamperometry, and the detection of synthetic dopamine was demonstrated down to a concentration of 3.1 pM. Furthermore, to present the membrane-sensor functionality the dopamine release from cultured PC12 cells was successfully measured. The PC12 cells culturing experiments showed that the membrane-sensor was suitable as a cell culturing substrate for bio-applications. Real-time measurements of dopamine exocytosis in cell cultures were performed, where the transmitter release was recorded at the point of release. The developed membrane-sensor provides a new functionality to the standard culturing methods, enabling sensitive continuous in vitro monitoring and closely mimicking the in vivo conditions. PMID:25421738

Hard real-time closed-loop electrophysiology with the Real-Time eXperiment Interface (RTXI)

PubMed Central

George, Ansel; Dorval, Alan D.; Christini, David J.

2017-01-01

The ability to experimentally perturb biological systems has traditionally been limited to static pre-programmed or operator-controlled protocols. In contrast, real-time control allows dynamic probing of biological systems with perturbations that are computed on-the-fly during experimentation. Real-time control applications for biological research are available; however, these systems are costly and often restrict the flexibility and customization of experimental protocols. The Real-Time eXperiment Interface (RTXI) is an open source software platform for achieving hard real-time data acquisition and closed-loop control in biological experiments while retaining the flexibility needed for experimental settings. RTXI has enabled users to implement complex custom closed-loop protocols in single cell, cell network, animal, and human electrophysiology studies. RTXI is also used as a free and open source, customizable electrophysiology platform in open-loop studies requiring online data acquisition, processing, and visualization. RTXI is easy to install, can be used with an extensive range of external experimentation and data acquisition hardware, and includes standard modules for implementing common electrophysiology protocols. PMID:28557998

Evolving telemedicine/ehealth technology.

PubMed

Ferrante, Frank E

2005-06-01

This paper describes emerging technologies to support a rapidly changing and expanding scope of telemedicine/telehealth applications. Of primary interest here are wireless systems, emerging broadband, nanotechnology, intelligent agent applications, and grid computing. More specifically, the paper describes the changes underway in wireless designs aimed at enhancing security; some of the current work involving the development of nanotechnology applications and research into the use of intelligent agents/artificial intelligence technology to establish what are termed "Knowbots"; and a sampling of the use of Web services, such as grid computing capabilities, to support medical applications. In addition, the expansion of these technologies and the need for cost containment to sustain future health care for an increasingly mobile and aging population is discussed.

High-Surety Telemedicine in a Distributed, 'Plug-andPlan' Environment

DOE Office of Scientific and Technical Information (OSTI.GOV)

Craft, Richard L.; Funkhouser, Donald R.; Gallagher, Linda K.

1999-05-17

Commercial telemedicine systems are increasingly functional, incorporating video-conferencing capabilities, diagnostic peripherals, medication reminders, and patient education services. However, these systems (1) rarely utilize information architectures which allow them to be easily integrated with existing health information networks and (2) do not always protect patient confidentiality with adequate security mechanisms. Using object-oriented methods and software wrappers, we illustrate the transformation of an existing stand-alone telemedicine system into `plug-and-play' components that function in a distributed medical information environment. We show, through the use of open standards and published component interfaces, that commercial telemedicine offerings which were once incompatible with electronic patient recordmore » systems can now share relevant data with clinical information repositories while at the same time hiding the proprietary implementations of the respective systems. Additionally, we illustrate how leading-edge technology can secure this distributed telemedicine environment, maintaining patient confidentiality and the integrity of the associated electronic medical data. Information surety technology also encourages the development of telemedicine systems that have both read and write access to electronic medical records containing patient-identifiable information. The win-win approach to telemedicine information system development preserves investments in legacy software and hardware while promoting security and interoperability in a distributed environment.« less

An approach to a real-time distribution system

NASA Technical Reports Server (NTRS)

Kittle, Frank P., Jr.; Paddock, Eddie J.; Pocklington, Tony; Wang, Lui

1990-01-01

The requirements of a real-time data distribution system are to provide fast, reliable delivery of data from source to destination with little or no impact to the data source. In this particular case, the data sources are inside an operational environment, the Mission Control Center (MCC), and any workstation receiving data directly from the operational computer must conform to the software standards of the MCC. In order to supply data to development workstations outside of the MCC, it is necessary to use gateway computers that prevent unauthorized data transfer back to the operational computers. Many software programs produced on the development workstations are targeted for real-time operation. Therefore, these programs must migrate from the development workstation to the operational workstation. It is yet another requirement for the Data Distribution System to ensure smooth transition of the data interfaces for the application developers. A standard data interface model has already been set up for the operational environment, so the interface between the distribution system and the application software was developed to match that model as closely as possible. The system as a whole therefore allows the rapid development of real-time applications without impacting the data sources. In summary, this approach to a real-time data distribution system provides development users outside of the MCC with an interface to MCC real-time data sources. In addition, the data interface was developed with a flexible and portable software design. This design allows for the smooth transition of new real-time applications to the MCC operational environment.

A survey of physicians' acceptance of telemedicine.

PubMed

Sheng, O R; Hu, P J; Chau, P Y; Hjelm, N M; Tam, K Y; Wei, C P; Tse, J

1998-01-01

Physicians' acceptance of telemedicine is an important managerial issue facing health-care organizations that have adopted, or are about to adopt, telemedicine. Most previous investigations of the acceptance of telemedicine have lacked theoretical foundation and been of limited scope. We examined technology acceptance and usage among physicians and specialists from 49 clinical departments at eight public tertiary hospitals in Hong Kong. Out of the 1021 questionnaires distributed, 310 were completed and returned, a 30% response rate. The preliminary findings suggested that use of telemedicine among clinicians in Hong Kong was moderate. While 18% of the respondents were using some form of telemedicine for patient care and management, it accounted for only 6.3% of the services provided. The intensity of their technology usage was also low, accounting for only 6.8% of a typical telemedicine-assisted service. These preliminary findings have managerial implications.

Hard Real-Time: C++ Versus RTSJ

NASA Technical Reports Server (NTRS)

Dvorak, Daniel L.; Reinholtz, William K.

2004-01-01

In the domain of hard real-time systems, which language is better: C++ or the Real-Time Specification for Java (RTSJ)? Although ordinary Java provides a more productive programming environment than C++ due to its automatic memory management, that benefit does not apply to RTSJ when using NoHeapRealtimeThread and non-heap memory areas. As a result, RTSJ programmers must manage non-heap memory explicitly. While that's not a deterrent for veteran real-time programmers-where explicit memory management is common-the lack of certain language features in RTSJ (and Java) makes that manual memory management harder to accomplish safely than in C++. This paper illustrates the problem for practitioners in the context of moving data and managing memory in a real-time producer/consumer pattern. The relative ease of implementation and safety of the C++ programming model suggests that RTSJ has a struggle ahead in the domain of hard real-time applications, despite its other attractive features.

Adaptive Monocular Visual-Inertial SLAM for Real-Time Augmented Reality Applications in Mobile Devices.

PubMed

Piao, Jin-Chun; Kim, Shin-Dug

2017-11-07

Simultaneous localization and mapping (SLAM) is emerging as a prominent issue in computer vision and next-generation core technology for robots, autonomous navigation and augmented reality. In augmented reality applications, fast camera pose estimation and true scale are important. In this paper, we present an adaptive monocular visual-inertial SLAM method for real-time augmented reality applications in mobile devices. First, the SLAM system is implemented based on the visual-inertial odometry method that combines data from a mobile device camera and inertial measurement unit sensor. Second, we present an optical-flow-based fast visual odometry method for real-time camera pose estimation. Finally, an adaptive monocular visual-inertial SLAM is implemented by presenting an adaptive execution module that dynamically selects visual-inertial odometry or optical-flow-based fast visual odometry. Experimental results show that the average translation root-mean-square error of keyframe trajectory is approximately 0.0617 m with the EuRoC dataset. The average tracking time is reduced by 7.8%, 12.9%, and 18.8% when different level-set adaptive policies are applied. Moreover, we conducted experiments with real mobile device sensors, and the results demonstrate the effectiveness of performance improvement using the proposed method.

Adaptive Monocular Visual–Inertial SLAM for Real-Time Augmented Reality Applications in Mobile Devices

PubMed Central

Piao, Jin-Chun; Kim, Shin-Dug

2017-01-01

Simultaneous localization and mapping (SLAM) is emerging as a prominent issue in computer vision and next-generation core technology for robots, autonomous navigation and augmented reality. In augmented reality applications, fast camera pose estimation and true scale are important. In this paper, we present an adaptive monocular visual–inertial SLAM method for real-time augmented reality applications in mobile devices. First, the SLAM system is implemented based on the visual–inertial odometry method that combines data from a mobile device camera and inertial measurement unit sensor. Second, we present an optical-flow-based fast visual odometry method for real-time camera pose estimation. Finally, an adaptive monocular visual–inertial SLAM is implemented by presenting an adaptive execution module that dynamically selects visual–inertial odometry or optical-flow-based fast visual odometry. Experimental results show that the average translation root-mean-square error of keyframe trajectory is approximately 0.0617 m with the EuRoC dataset. The average tracking time is reduced by 7.8%, 12.9%, and 18.8% when different level-set adaptive policies are applied. Moreover, we conducted experiments with real mobile device sensors, and the results demonstrate the effectiveness of performance improvement using the proposed method. PMID:29112143

Worldwide trends in Universal Service Funds and telemedicine.

PubMed

Nakajima, Isao

2010-12-01

A survey of recent worldwide trends in Universal Service Funds (USFs) and the assistance provided for their application indicates that industrialized countries and developing nations alike have offered or plan to offer tax-relief measures or reimbursement for communications costs incurred by telemedicine programs, thus finding a way to actively apply USFs in rural areas. There are three main systems used to calculate the amount of reimbursement from a USF. While many countries adopt a service-area net-loss estimation method, Japan uses a benchmark method and provides financial assistance only to unprofitable areas. The USA has proactively introduced telemedicine to rural areas and isolated islands in order to minimize rapidly rising healthcare costs and to improve the efficiency of healthcare services. In the USA, the USF is used to pay back communications costs incurred through telemedicine programs. For instance, the budget allocated from the USF for reimbursements for telemedicine in Alaska reached USD 30 Mil. in 2007. Developing countries in Africa and Asia are operating various forms of telemedicine on a trial basis, but a tax-relief measure or payback of communications costs, which are a large portion of the running costs, will need to be implemented to ensure sustainable and autonomous operation of telemedicine. In Japan, up until January 2007, the USF system assumed the use of an NTS (non-traffic sensitive cost) system to obtain funds from connection fees, and this system would receive funds from each telecommunications carrier (payer: the telecommunications carriers). The beneficiaries would be limited to two companies, namely NTT East and NTT West. However, the Japanese USF system was revised in February 2007, and a fee is now collected from each telephone number (payer: the user). The collected funds are used to cover losses in unprofitable areas (not limited to remote areas) among 7,000 business areas in Japan. In view of worldwide trends, the author

Design and Prototyping of Hard Real Time Systems

DTIC Science & Technology

1990-06-01

AD’-A254 097 DESIGNadPROTOTYPING (9 lliIlhIIIIIl/IIIIIliIliiiiliii OF HARD REAL TIME SYSTEMS Electronics Research Laboratory - - __University of...e ...*...*... . e * ... , .. * 311 2.9 Design of Real - Time Systems with Application to Robotics...Right now we are looking into possible techniques and the implications on the system architecture and partitioning. 2.9. Design of Real - Time Systems with

Real-time PCR in virology.

PubMed

Mackay, Ian M; Arden, Katherine E; Nitsche, Andreas

2002-03-15

The use of the polymerase chain reaction (PCR) in molecular diagnostics has increased to the point where it is now accepted as the gold standard for detecting nucleic acids from a number of origins and it has become an essential tool in the research laboratory. Real-time PCR has engendered wider acceptance of the PCR due to its improved rapidity, sensitivity, reproducibility and the reduced risk of carry-over contamination. There are currently five main chemistries used for the detection of PCR product during real-time PCR. These are the DNA binding fluorophores, the 5' endonuclease, adjacent linear and hairpin oligoprobes and the self-fluorescing amplicons, which are described in detail. We also discuss factors that have restricted the development of multiplex real-time PCR as well as the role of real-time PCR in quantitating nucleic acids. Both amplification hardware and the fluorogenic detection chemistries have evolved rapidly as the understanding of real-time PCR has developed and this review aims to update the scientist on the current state of the art. We describe the background, advantages and limitations of real-time PCR and we review the literature as it applies to virus detection in the routine and research laboratory in order to focus on one of the many areas in which the application of real-time PCR has provided significant methodological benefits and improved patient outcomes. However, the technology discussed has been applied to other areas of microbiology as well as studies of gene expression and genetic disease.

A New Generation of Real-Time Systems in the JET Tokamak

NASA Astrophysics Data System (ADS)

Alves, Diogo; Neto, Andre C.; Valcarcel, Daniel F.; Felton, Robert; Lopez, Juan M.; Barbalace, Antonio; Boncagni, Luca; Card, Peter; De Tommasi, Gianmaria; Goodyear, Alex; Jachmich, Stefan; Lomas, Peter J.; Maviglia, Francesco; McCullen, Paul; Murari, Andrea; Rainford, Mark; Reux, Cedric; Rimini, Fernanda; Sartori, Filippo; Stephen, Adam V.; Vega, Jesus; Vitelli, Riccardo; Zabeo, Luca; Zastrow, Klaus-Dieter

2014-04-01

Recently, a new recipe for developing and deploying real-time systems has become increasingly adopted in the JET tokamak. Powered by the advent of x86 multi-core technology and the reliability of JET's well established Real-Time Data Network (RTDN) to handle all real-time I/O, an official Linux vanilla kernel has been demonstrated to be able to provide real-time performance to user-space applications that are required to meet stringent timing constraints. In particular, a careful rearrangement of the Interrupt ReQuests' (IRQs) affinities together with the kernel's CPU isolation mechanism allows one to obtain either soft or hard real-time behavior depending on the synchronization mechanism adopted. Finally, the Multithreaded Application Real-Time executor (MARTe) framework is used for building applications particularly optimised for exploring multi-core architectures. In the past year, four new systems based on this philosophy have been installed and are now part of JET's routine operation. The focus of the present work is on the configuration aspects that enable these new systems' real-time capability. Details are given about the common real-time configuration of these systems, followed by a brief description of each system together with results regarding their real-time performance. A cycle time jitter analysis of a user-space MARTe based application synchronizing over a network is also presented. The goal is to compare its deterministic performance while running on a vanilla and on a Messaging Real time Grid (MRG) Linux kernel.

State medical licensure for telemedicine and teleradiology.

PubMed

Hunter, Tim B; Weinstein, Ronald S; Krupinski, Elizabeth A

2015-04-01

Physician medical licensure is state based for historical and constitutional reasons. It may also provide the best method for guaranteeing patient protection from unqualified, incompetent, impaired, or unprofessional practitioners of medicine. However, a significant cost for physicians practicing telemedicine is having to obtain multiple state medical licenses. There is reasonable likelihood that model legislation for the practice of telemedicine across state boundaries will be passed in the next few years, providing physicians with a simpler process for license reciprocity in multiple states via interstate licensing compacts. Physicians would have to be licensed in the state in which the patient resides. Patient complaints would still be adjudicated by the medical licensing board in the state where the patient resides according applicable state legislation.

Differences in public and private sector adoption of telemedicine: Indian case study for sectoral adoption.

PubMed

Sood, Sanjay P; Negash, Solomon; Mbarika, Victor W A; Kifle, Mengistu; Prakash, Nupur

2007-01-01

Telemedicine is the use of communication networks to exchange medical information for providing healthcare services and medical education from one site to another. The application of telemedicine is more promising in economically developing countries with agrarian societies. The American Telemedicine Association (ATA) identifies three healthcare services: clinical medical services, health and medical education, and consumer health information. However, it is not clear how these services can be adopted by different sectors: public and private. This paper looks at four Indian case studies, two each in public and private sectors to understand two research questions: Are there differences in telemedicine adoption between public and private hospitals. If there are differences: What are the differences in telemedicine adoption between public and private sectors? Authors have used the extant literature in telemedicine and healthcare to frame theoretical background, describe the research setting, present the case studies, and provide discussion and conclusions about their findings. Authors believe that as India continues to develop its telemedicine infrastructures, especially with continued government support through subsidies to private telemedicine initiatives, its upward trend in healthcare will continue. This is expected to put India on the path to increase its life expectancy rates, especially for it rural community which constitute over 70% of its populace.

Telemedicine information analysis center.

PubMed

Zajtchuk, Joan T; Zajtchuk, Russ; Petrovic, Joseph J; Gutz, Ryan P; Walrath, Benjamin D

2004-01-01

Congress mandated a pilot project to demonstrate the feasibility of establishing a Department of Defense (DoD) telemedicine information analysis center (TIAC). The project developed a medical information support system to show the core capabilities of a TIAC. The productivity and effectiveness of telemedicine researchers and clinical practitioners can be enhanced by the existence of an information analysis center (IACs) devoted to the collection, analysis, synthesis, and dissemination of worldwide scientific and technical information related to the field of telemedicine. The work conducted under the TIAC pilot project establishes the basic IAC functions and assesses the utility of the TIAC to the military medical departments. The pilot project capabilities are Web-based and include: (1) applying the science of classification (taxonomy) to telemedicine to identify key words; (2) creating a relational database of this taxonomy to a bibliographic database using these key words; (3) developing and disseminating information via a public TIAC Web site; (4) performing a specific baseline technical area task for the U.S. Army Medical Command; and (5) providing analyses by subject matter experts.

Ames Lab 101: Real-Time 3D Imaging

DOE Office of Scientific and Technical Information (OSTI.GOV)

Zhang, Song

2010-08-02

Ames Laboratory scientist Song Zhang explains his real-time 3-D imaging technology. The technique can be used to create high-resolution, real-time, precise, 3-D images for use in healthcare, security, and entertainment applications.

Ames Lab 101: Real-Time 3D Imaging

ScienceCinema

Zhang, Song

2017-12-22

Ames Laboratory scientist Song Zhang explains his real-time 3-D imaging technology. The technique can be used to create high-resolution, real-time, precise, 3-D images for use in healthcare, security, and entertainment applications.

Telemedicine in education: bridging the gap.

PubMed

O'Shea, Jesse; Berger, Ryan; Samra, Cynthia; Van Durme, Daniel

2015-01-01

The increasing cost and inequitable access to quality healthcare, coupled with the merger of the information technology and health service sectors, has given rise to the modern field of telemedicine. Telemedicine, meaning medicine at a distance, allows us to transcend geographic and socioeconomic boundaries to deliver high quality care to remote and/or in-need patients. As technology becomes more affordable and a physician shortage looms, telemedicine is gaining attention as a possible solution to healthcare delivery. Simultaneously, telemedicine holds great promise with regard to medical education. Several studies integrating telemedicine in medical education have shown positive outcomes, demonstrating similar or greater efficacy compared with traditional educational methods with high student-reported enthusiasm. Other domestic and international telemedicine projects, largely spearheaded by universities, have also achieved great success. In a novel approach, by pairing medical schools with in-need partner communities, utilizing similar faculty resources as traditional learning methods with standardized patients, students can gain valuable experience and skills while serving actual patients. This progressive approach to medical education fosters collaboration, communication, longitudinal care and teaches students needed skills for their future practices as 21 st Century healthcare providers.

Designing Home-Based Telemedicine Systems for the Geriatric Population: An Empirical Study.

PubMed

Narasimha, Shraddhaa; Agnisarman, Sruthy; Chalil Madathil, Kapil; Gramopadhye, Anand; McElligott, James T

2018-02-01

Background and Introduction: Telemedicine, the process of providing healthcare remotely using communication devices, has the potential to be useful for the geriatric population when specifically designed for this age group. This study explored the design of four video telemedicine systems currently available and outlined issues with these systems that impact usability among the geriatric population. Based on the results, design suggestions were developed to improve telemedicine systems for this population. Using a between-subjects experimental design, the study considered four telemedicine systems used in Medical University of South Carolina. The study was conducted at a local retirement home. The participant pool consisted of 40 adults, 60 years or older. The dependent measures used were the mean times for telemedicine session initiation and video session, mean number of errors, post-test satisfaction ratings, the NASA-Task Load Index (NASA-TLX) workload measures, and the IBM-Computer Systems Usability Questionnaire measures. Statistical significance was found among the telemedicine systems' initiation times. The analysis of the qualitative data revealed several issues, including lengthy e-mail content, icon placement, and chat box design, which affect the usability of these systems for the geriatric population. Human factor-based design modifications, including short, precise e-mail content, appropriately placed icons, and the inclusion of instructions, are recommended to address the issues found in the qualitative study.

Monte Carlo Simulation Modeling of a Regional Stroke Team's Use of Telemedicine.

PubMed

Torabi, Elham; Froehle, Craig M; Lindsell, Christopher J; Moomaw, Charles J; Kanter, Daniel; Kleindorfer, Dawn; Adeoye, Opeolu

2016-01-01

The objective of this study was to evaluate operational policies that may improve the proportion of eligible stroke patients within a population who would receive intravenous recombinant tissue plasminogen activator (rt-PA) and minimize time to treatment in eligible patients. In the context of a regional stroke team, the authors examined the effects of staff location and telemedicine deployment policies on the timeliness of thrombolytic treatment, and estimated the efficacy and cost-effectiveness of six different policies. A process map comprising the steps from recognition of stroke symptoms to intravenous administration of rt-PA was constructed using data from published literature combined with expert opinion. Six scenarios were investigated: telemedicine deployment (none, all, or outer-ring hospitals only) and staff location (center of region or anywhere in region). Physician locations were randomly generated based on their zip codes of residence and work. The outcomes of interest were onset-to-treatment (OTT) time, door-to-needle (DTN) time, and the proportion of patients treated within 3 hours. A Monte Carlo simulation of the stroke team care-delivery system was constructed based on a primary data set of 121 ischemic stroke patients who were potentially eligible for treatment with rt-PA. With the physician located randomly in the region, deploying telemedicine at all hospitals in the region (compared with partial or no telemedicine) would result in the highest rates of treatment within 3 hours (80% vs. 75% vs. 70%) and the shortest OTT (148 vs. 164 vs. 176 minutes) and DTN (45 vs. 61 vs. 73 minutes) times. However, locating the on-call physician centrally coupled with partial telemedicine deployment (five of the 17 hospitals) would be most cost-effective with comparable eligibility and treatment times. Given the potential societal benefits, continued efforts to deploy telemedicine appear warranted. Aligning the incentives between those who would have to fund

Towards technical interoperability in telemedicine.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Craft, Richard Layne, II

2004-05-01

For telemedicine to realize the vision of anywhere, anytime access to care, the question of how to create a fully interoperable technical infrastructure must be addressed. After briefly discussing how 'technical interoperability' compares with other types of interoperability being addressed in the telemedicine community today, this paper describes reasons for pursuing technical interoperability, presents a proposed framework for realizing technical interoperability, identifies key issues that will need to be addressed if technical interoperability is to be achieved, and suggests a course of action that the telemedicine community might follow to accomplish this goal.

Telemedicine and competitive change in health care.

PubMed

LaMay, C L

1997-01-01

Telemedicine--the delivery of health care services to the underserved through communications technologies--has the potential to bring medical care to remote areas where health care is either inadequate or nonexistent. Telemedicine can be something as simple as a phone call, a network transmission of a radiograph or other diagnostic image, or, much more advanced, realtime video surgical consultations from anywhere on the globe. Telemedicine programs operate throughout Europe, Japan, and Australia. International programs, for profit and nonprofit, serve Asia, Africa, and the Middle East. The United States is also a major telemedicine developer, principally through government agencies such as the Department of Defense and the Office of Rural Health Policy, and, to a lesser extent, the private sector. But telemedicine in the United States has yet to prove itself economically viable, and it faces a number of political and regulatory barriers. Even more significantly, telemedicine's potential to increase overall health care spending by increasing access to health care has deterred private industry from investing heavily in it. In the short term, telemedicine's most important contribution to health care may be raising fundamental questions about United States health care policy.

A human factors methodology for real-time support applications

NASA Technical Reports Server (NTRS)

Murphy, E. D.; Vanbalen, P. M.; Mitchell, C. M.

1983-01-01

A general approach to the human factors (HF) analysis of new or existing projects at NASA/Goddard is delineated. Because the methodology evolved from HF evaluations of the Mission Planning Terminal (MPT) and the Earth Radiation Budget Satellite Mission Operations Room (ERBS MOR), it is directed specifically to the HF analysis of real-time support applications. Major topics included for discussion are the process of establishing a working relationship between the Human Factors Group (HFG) and the project, orientation of HF analysts to the project, human factors analysis and review, and coordination with major cycles of system development. Sub-topics include specific areas for analysis and appropriate HF tools. Management support functions are outlined. References provide a guide to sources of further information.

PERTS: A Prototyping Environment for Real-Time Systems

NASA Technical Reports Server (NTRS)

Liu, Jane W. S.; Lin, Kwei-Jay; Liu, C. L.

1991-01-01

We discuss an ongoing project to build a Prototyping Environment for Real-Time Systems, called PERTS. PERTS is a unique prototyping environment in that it has (1) tools and performance models for the analysis and evaluation of real-time prototype systems, (2) building blocks for flexible real-time programs and the support system software, (3) basic building blocks of distributed and intelligent real time applications, and (4) an execution environment. PERTS will make the recent and future theoretical advances in real-time system design and engineering readily usable to practitioners. In particular, it will provide an environment for the use and evaluation of new design approaches, for experimentation with alternative system building blocks and for the analysis and performance profiling of prototype real-time systems.

High-throughput real-time quantitative reverse transcription PCR.

PubMed

Bookout, Angie L; Cummins, Carolyn L; Mangelsdorf, David J; Pesola, Jean M; Kramer, Martha F

2006-02-01

Extensive detail on the application of the real-time quantitative polymerase chain reaction (QPCR) for the analysis of gene expression is provided in this unit. The protocols are designed for high-throughput, 384-well-format instruments, such as the Applied Biosystems 7900HT, but may be modified to suit any real-time PCR instrument. QPCR primer and probe design and validation are discussed, and three relative quantitation methods are described: the standard curve method, the efficiency-corrected DeltaCt method, and the comparative cycle time, or DeltaDeltaCt method. In addition, a method is provided for absolute quantification of RNA in unknown samples. RNA standards are subjected to RT-PCR in the same manner as the experimental samples, thus accounting for the reaction efficiencies of both procedures. This protocol describes the production and quantitation of synthetic RNA molecules for real-time and non-real-time RT-PCR applications.

Forward and store telemedicine using Motion Pictures Expert Group: a novel approach to pediatric tele-echocardiography.

PubMed

Woodson, Kristina E; Sable, Craig A; Cross, Russell R; Pearson, Gail D; Martin, Gerard R

2004-11-01

Live transmission of echocardiograms over integrated services digital network lines is accurate and has led to improvements in the delivery of pediatric cardiology care. Permanent archiving of the live studies has not previously been reported. Specific obstacles to permanent storage of telemedicine files have included the ability to produce accurate images without a significant increase in storage requirements. We evaluated the accuracy of Motion Pictures Expert Group (MPEG) digitization of incoming video streams and assessed the storage requirements of these files for infants in a real-time pediatric tele-echocardiography program. All major cardiac diagnoses were correctly diagnosed by review of MPEG images. MPEG file size ranged from 11.1 to 182 MB (56.5 +/- 29.9 MB). MPEG digitization during live neonatal telemedicine is accurate and provides an efficient method for storage. This modality has acceptable storage requirements; file sizes are comparable to other digital modalities.

Real Time Conference 2016 Overview

NASA Astrophysics Data System (ADS)

Luchetta, Adriano

2017-06-01

This is a special issue of the IEEE Transactions on Nuclear Science containing papers from the invited, oral, and poster presentation of the 20th Real Time Conference (RT2016). The conference was held June 6-10, 2016, at Centro Congressi Padova “A. Luciani,” Padova, Italy, and was organized by Consorzio RFX (CNR, ENEA, INFN, Università di Padova, Acciaierie Venete SpA) and the Istituto Nazionale di Fisica Nucleare. The Real Time Conference is multidisciplinary and focuses on the latest developments in real-time techniques in high-energy physics, nuclear physics, astrophysics and astroparticle physics, nuclear fusion, medical physics, space instrumentation, nuclear power instrumentation, general radiation instrumentation, and real-time security and safety. Taking place every second year, it is sponsored by the Computer Application in Nuclear and Plasma Sciences technical committee of the IEEE Nuclear and Plasma Sciences Society. RT2016 attracted more than 240 registrants, with a large proportion of young researchers and engineers. It had an attendance of 67 students from many countries.

Telemedicine Facilitates CHF Home Health Care for Those with Systolic Dysfunction

PubMed Central

Seibert, Pennie S.; Whitmore, Tiffany A.; Patterson, Carin; Parker, Patrick D.; Otto, Caitlin; Basom, Jean; Whitener, Nichole; Zimmerman, Christian G.

2008-01-01

An estimated 5 million Americans have congestive heart failure (CHF) and one in five over the age of 40 will develop CHF. There are numerous examples of CHF patients living beyond the years normally expected for people with the disease, usually attributed to taking an active role in disease management. A relatively new alternative for CHF outpatient care is telemedicine and e-health. We investigated the effects of a 6-week in-home telemedicine education and monitoring program for those with systolic dysfunction on the utilization of health care resources. We also measured the effects of the unit 4.5 months after its removal (a total of 6 months post introduction of the unit into the home). Concurrently, we assessed participants' perceptions of the value of having a telemedicine unit. Participants in the telemedicine group reported weighing more times a week with less variability than did the control group. Telemedicine led to a reduction in physician and emergency department visits and those in the experimental group reported the unit facilitating self-care, though this was not significantly different from the control group (possibly due to small sample size). These findings suggest a possibility for improvement in control of CHF when telemedicine is implemented. Our review of the literature also supports the role of telemedicine in facilitating home health care and self-management for CHF patients. There are many challenges still to be addressed before this potential can be reached and further research is needed to identify opportunities in telemedicine. PMID:18369411

Assessing Telemedicine Utilization by Using Medicaid Claims Data.

PubMed

Douglas, Megan Daugherty; Xu, Junjun; Heggs, Akilah; Wrenn, Glenda; Mack, Dominic H; Rust, George

2017-02-01

This study characterized telemedicine utilization among Medicaid enrollees by patients' demographic characteristics, geographic location, enrollment type, eligibility category, and clinical conditions. This study used 2008-2009 Medicaid claims data from 28 states and the District of Columbia to characterize telemedicine claims (indicated by GT for professional fee claims or Q3014 for facility fees) on the basis of patients' demographic characteristics, geographic location, enrollment type, eligibility category, and clinical condition as indicated by ICD-9 codes. States lacking Medicaid telemedicine reimbursement policies were excluded. Chi-square tests were used to compare telemedicine utilization rates and one-way analysis of variance was used to estimate mean differences in number of telemedicine encounters among subgroups. A total of 45,233,602 Medicaid enrollees from the 22 states with telemedicine reimbursement policies were included in the study, and .1% were telemedicine users. Individuals ages 45 to 64 (16.4%), whites (11.3%), males (8.5%), rural residents (26.0%), those with managed care plans (7.9%), and those categorized as aged, blind, and disabled (28.1%) were more likely to receive telemedicine (p<.001). Nearly 95% of telemedicine claims were associated with a behavioral health diagnosis, of which over 50% were for bipolar disorder and attention-deficit disorder or attention-deficit hyperactivity disorder (29.3% and 23.4%, respectively). State-level variation was high, ranging from .0 to 59.91 claims per 10,000 enrollees (Arkansas and Arizona, respectively). Despite the touted potential for telemedicine to improve health care access, actual utilization of telemedicine in Medicaid programs was low. It was predominantly used to treat behavioral health diagnoses. Reimbursement alone is insufficient to support broad utilization for Medicaid enrollees.

AERIS - applications for the environment : real-time information synthesis : eco-lanes operational scenario modeling report.

DOT National Transportation Integrated Search

2014-12-01

This report constitutes the detailed modeling and evaluation results of the Eco-Lanes Operational Scenario defined by the Applications for the Environment: Real-Time Information Synthesis (AERIS) Program. The Operational Scenario constitutes six appl...

Telemedicine: barriers and opportunities in the 21st century.

PubMed

Stanberry, B

2000-06-01

This paper aims to examine how health telematics will develop in the first 10 years of the new millennium and, in particular, to assess what operational, ethical and legal barriers may lie in the way of this development. A description of the key principles and concepts involved in telemedicine and a short historical overview of telemedicine's evolution over the past century are followed by consideration of why empirical research into 'info-ethics' and other deontological and legal issues relating to telemedicine is being necessarily catalysed by, amongst others, the European Commission. Four evolving health telematics applications are examined in some detail: electronic health records; the transmission of visual media in disciplines such as teleradiology, teledermatology, telepathology and teleophthalmology; telesurgery and robotics and the use of call centres and decision-support software. These are discussed in the light of their moral, ethical and cultural implications for clinicians, patients and society at large. The author argues that telemedicine presents unique opportunities for both patients and clinicians where it is implemented in direct response to clear clinical needs, but warns against excessive reliance upon technology to the detriment of traditional clinician-patient relationships and against complacency regarding the risks and responsibilities - many of which are as yet unknown - that distant medical intervention, consultation and diagnosis carry.

A randomized trial of telemedicine efficacy and safety for nonacute headaches.

PubMed

Müller, Kai I; Alstadhaug, Karl B; Bekkelund, Svein I

2017-07-11

To evaluate long-term treatment efficacy and safety of one-time telemedicine consultations for nonacute headaches. We randomized, allocated, and consulted nonacute headache patients via telemedicine (n = 200) or in a traditional manner (n = 202) in a noninferiority trial. Efficacy endpoints, assessed by questionnaires at 3 and 12 months, included change from baseline in Headache Impact Test-6 (HIT-6) (primary endpoint) and pain intensity (visual analogue scale [VAS]) (secondary endpoint). The primary safety endpoint, assessed via patient records, was presence of secondary headache within 12 months after consultation. We found no differences between telemedicine and traditional consultations in HIT-6 ( p = 0.84) or VAS ( p = 0.64) over 3 periods. The absolute difference in HIT-6 from baseline was 0.3 (95% confidence interval [CI] -1.26 to 1.82, p = 0.72) at 3 months and 0.2 (95% CI -1.98 to 1.58, p = 0.83) at 12 months. The absolute change in VAS was 0.4 (95% CI -0.93 to 0.22, p = 0.23) after 3 months and 0.3 (95% CI -0.94 to 0.29, p = 0.30) at 12 months. We found one secondary headache in each group at 12 months. The estimated number of consultations needed to miss one secondary headache with the use of telemedicine was 20,200. Telemedicine consultation for nonacute headache is as efficient and safe as a traditional consultation. NCT02270177. This study provides Class III evidence that a one-time telemedicine consultation for nonacute headache is noninferior to a one-time traditional consultation regarding long-term treatment outcome and safety. Copyright © 2017 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Neurology.

Telemedicine is helping the parents of children with neurodevelopmental disorders living in remote and deprived areas.

PubMed

Stuckey, Ruth; Domingues-Montanari, Sophie

2017-08-01

Telecommunication technologies are advancing rapidly with huge investment to improve infrastructure in rural areas. Telemedicine brings the benefits of telecommunication to healthcare, especially in resource-limited and remote communities. The recent literature on telemedicine in paediatrics will be reviewed, with particular focus on its application to help children with neurodevelopmental disorders and their families living in remote regions and/or low-income countries, and gaps identified for future research. Studies show that telemedicine can enable a family's access to appropriately qualified help that physically may only be available hundreds of miles away, helping to overcome geographic barriers. Telemedicine can also train parents and equip them with the knowledge and skills to better care for their children. Despite some technological barriers to implementation, telemedicine can help transform all stages of autism treatment. However, more studies are required in low- and middle-income countries to fully elucidate the benefits offered by telemedicine to autistic children and their families.

FTA real-time transit information assessment : white paper on literature review of real-time transit information systems.

DOT National Transportation Integrated Search

Real-time transit information systems are key technology applications within the transit industry designed to provide better customer service by disseminating timely and accurate information. Riders use this information to make various decisions abou...

Research and application of embedded real-time operating system

NASA Astrophysics Data System (ADS)

Zhang, Bo

2013-03-01

In this paper, based on the analysis of existing embedded real-time operating system, the architecture of an operating system is designed and implemented. The experimental results show that the design fully complies with the requirements of embedded real-time operating system, can achieve the purposes of reducing the complexity of embedded software design and improving the maintainability, reliability, flexibility. Therefore, this design program has high practical value.

Adoption of routine telemedicine in Norway: the current picture

PubMed Central

Zanaboni, Paolo; Knarvik, Undine; Wootton, Richard

2014-01-01

Background Telemedicine appears to be ready for wider adoption. Although existing research evidence is useful, the adoption of routine telemedicine in healthcare systems has been slow. Objective We conducted a study to explore the current use of routine telemedicine in Norway, at national, regional, and local levels, to provide objective and up-to-date information and to estimate the potential for wider adoption of telemedicine. Design A top-down approach was used to collect official data on the national use of telemedicine from the Norwegian Patient Register. A bottom-up approach was used to collect complementary information on the routine use of telemedicine through a survey conducted at the five largest publicly funded hospitals. Results Results show that routine telemedicine has been adopted in all health regions in Norway and in 68% of hospitals. Despite being widely adopted, the current level of use of telemedicine is low compared to the number of face-to-face visits. Examples of routine telemedicine can be found in several clinical specialties. Most services connect different hospitals in secondary care, and they are mostly delivered as teleconsultations via videoconference. Conclusions Routine telemedicine in Norway has been widely adopted, probably for geographical reasons, as in other settings. However, the level of use of telemedicine in Norway is rather low, and it has significant potential for further development as an alternative to face-to-face outpatient visits. This study is a first attempt to map routine telemedicine at regional, institutional, and clinical levels, and it provides useful information to understand the adoption of telemedicine in routine healthcare and to measure change in future updates. PMID:24433942

Application of troposphere model from NWP and GNSS data into real-time precise positioning

NASA Astrophysics Data System (ADS)

Wilgan, Karina; Hadas, Tomasz; Kazmierski, Kamil; Rohm, Witold; Bosy, Jaroslaw

2016-04-01

The tropospheric delay empirical models are usually functions of meteorological parameters (temperature, pressure and humidity). The application of standard atmosphere parameters or global models, such as GPT (global pressure/temperature) model or UNB3 (University of New Brunswick, version 3) model, may not be sufficient, especially for positioning in non-standard weather conditions. The possible solution is to use regional troposphere models based on real-time or near-real time measurements. We implement a regional troposphere model into the PPP (Precise Point Positioning) software GNSS-WARP (Wroclaw Algorithms for Real-time Positioning) developed at Wroclaw University of Environmental and Life Sciences. The software is capable of processing static and kinematic multi-GNSS data in real-time and post-processing mode and takes advantage of final IGS (International GNSS Service) products as well as IGS RTS (Real-Time Service) products. A shortcoming of PPP technique is the time required for the solution to converge. One of the reasons is the high correlation among the estimated parameters: troposphere delay, receiver clock offset and receiver height. To efficiently decorrelate these parameters, a significant change in satellite geometry is required. Alternative solution is to introduce the external high-quality regional troposphere delay model to constrain troposphere estimates. The proposed model consists of zenith total delays (ZTD) and mapping functions calculated from meteorological parameters from Numerical Weather Prediction model WRF (Weather Research and Forecasting) and ZTDs from ground-based GNSS stations using the least-squares collocation software COMEDIE (Collocation of Meteorological Data for Interpretation and Estimation of Tropospheric Pathdelays) developed at ETH Zurich.

The Current State of Telemedicine in Urology.

PubMed

Miller, Adam; Rhee, Eugene; Gettman, Matthew; Spitz, Aaron

2018-03-01

Telemedicine use in urology is an evolving practice. In this article, the authors review the early experience of telemedicine specifically as it relates to urologic practice and discuss the future implications and the utility of telemedicine as it applies to other fields. Copyright © 2017 Elsevier Inc. All rights reserved.

ALMA Correlator Real-Time Data Processor

NASA Astrophysics Data System (ADS)

Pisano, J.; Amestica, R.; Perez, J.

2005-10-01

The design of a real-time Linux application utilizing Real-Time Application Interface (RTAI) to process real-time data from the radio astronomy correlator for the Atacama Large Millimeter Array (ALMA) is described. The correlator is a custom-built digital signal processor which computes the cross-correlation function of two digitized signal streams. ALMA will have 64 antennas with 2080 signal streams each with a sample rate of 4 giga-samples per second. The correlator's aggregate data output will be 1 gigabyte per second. The software is defined by hard deadlines with high input and processing data rates, while requiring interfaces to non real-time external computers. The designed computer system - the Correlator Data Processor or CDP, consists of a cluster of 17 SMP computers, 16 of which are compute nodes plus a master controller node all running real-time Linux kernels. Each compute node uses an RTAI kernel module to interface to a 32-bit parallel interface which accepts raw data at 64 megabytes per second in 1 megabyte chunks every 16 milliseconds. These data are transferred to tasks running on multiple CPUs in hard real-time using RTAI's LXRT facility to perform quantization corrections, data windowing, FFTs, and phase corrections for a processing rate of approximately 1 GFLOPS. Highly accurate timing signals are distributed to all seventeen computer nodes in order to synchronize them to other time-dependent devices in the observatory array. RTAI kernel tasks interface to the timing signals providing sub-millisecond timing resolution. The CDP interfaces, via the master node, to other computer systems on an external intra-net for command and control, data storage, and further data (image) processing. The master node accesses these external systems utilizing ALMA Common Software (ACS), a CORBA-based client-server software infrastructure providing logging, monitoring, data delivery, and intra-computer function invocation. The software is being developed in tandem

U.S. Geological Survey Real-Time River Data Applications

USGS Publications Warehouse

Morlock, Scott E.

1998-01-01

Real-time river data provided by the USGS originate from streamflow-gaging stations. The USGS operates and maintains a network of more than 7,000 such stations across the nation (Mason and Wieger, 1995). These gaging stations, used to produce records of stage and streamflow data, are operated in cooperation with local, state, and other federal agencies. The USGS office in Indianapolis operates a statewide network of more than 170 gaging stations. The instrumentation at USGS gaging stations monitors and records river information, primarily river stage (fig. 1). As technological advances are made, many USGS gaging stations are being retrofitted with electronic instrumentation to monitor and record river data. Electronic instrumentation facilitates transmission of real-time or near real-time river data for use by government agencies in such flood-related tasks as operating flood-control structures and ordering evacuations.

Telemedicine in emergency evaluation of acute stroke: interrater agreement in remote video examination with a novel multimedia system.

PubMed

Handschu, René; Littmann, Rebekka; Reulbach, Udo; Gaul, Charly; Heckmann, Josef G; Neundörfer, Bernhard; Scibor, Mateusz

2003-12-01

In acute stroke care, rapid but careful evaluation of patients is mandatory but requires an experienced stroke neurologist. Telemedicine offers the possibility of bringing such expertise quickly to more patients. This study tested for the first time whether remote video examination is feasible and reliable when applied in emergency stroke care using the National Institutes of Health Stroke Scale (NIHSS). We used a novel multimedia telesupport system for transfer of real-time video sequences and audio data. The remote examiner could direct the set-top camera and zoom from distant overviews to close-ups from the personal computer in his office. Acute stroke patients admitted to our stroke unit were examined on admission in the emergency room. Standardized examination was performed by use of the NIHSS (German version) via telemedicine and compared with bedside application. In this pilot study, 41 patients were examined. Total examination time was 11.4 minutes on average (range, 8 to 18 minutes). None of the examinations had to be stopped or interrupted for technical reasons, although minor problems (brightness, audio quality) with influence on the examination process occurred in 2 sessions. Unweighted kappa coefficients ranged from 0.44 to 0.89; weighted kappa coefficients, from 0.85 to 0.99. Remote examination of acute stroke patients with a computer-based telesupport system is feasible and reliable when applied in the emergency room; interrater agreement was good to excellent in all items. For more widespread use, some problems that emerge from details like brightness, optimal camera position, and audio quality should be solved.

Real-time fMRI: a tool for local brain regulation.

PubMed

Caria, Andrea; Sitaram, Ranganatha; Birbaumer, Niels

2012-10-01

Real-time fMRI permits simultaneous measurement and observation of brain activity during an ongoing task. One of the most challenging applications of real-time fMRI in neuroscientific and clinical research is the possibility of acquiring volitional control of localized brain activity using real-time fMRI-based neurofeedback protocols. Real-time fMRI allows the experimenter to noninvasively manipulate brain activity as an independent variable to observe the effects on behavior. Real-time fMRI neurofeedback studies demonstrated that learned control of the local brain activity leads to specific changes in behavior. Here, the authors describe the implementation and application of real-time fMRI with particular emphasis on the self-regulation of local brain activity and the investigation of brain-function relationships. Real-time fMRI represents a promising new approach to cognitive neuroscience that could complement traditional neuroimaging techniques by providing more causal insights into the functional role of circumscribed brain regions in behavior.

Real-Time CORBA

DTIC Science & Technology

2000-10-01

control systems and prototyped the approach by porting the ILU ORB from Xerox to the Lynx real - time operating system . They then provided a distributed...compliant real - time operating system , a real-time ORB, and an ODMG-compliant real-time ODBMS [12]. The MITRE system is an infrastructure for...the server’s local operating system can handle. For instance, on a node controlled by the VXWorks real - time operating system with 256 local

PERTS: A Prototyping Environment for Real-Time Systems

NASA Technical Reports Server (NTRS)

Liu, Jane W. S.; Lin, Kwei-Jay; Liu, C. L.

1993-01-01

PERTS is a prototyping environment for real-time systems. It is being built incrementally and will contain basic building blocks of operating systems for time-critical applications, tools, and performance models for the analysis, evaluation and measurement of real-time systems and a simulation/emulation environment. It is designed to support the use and evaluation of new design approaches, experimentations with alternative system building blocks, and the analysis and performance profiling of prototype real-time systems.

Assessing Telemedicine Utilization by Using Medicaid Claims Data

PubMed Central

Douglas, Megan Daugherty; Xu, Junjun; Heggs, Akilah; Wrenn, Glenda; Mack, Dominic H.; Rust, George

2017-01-01

Objective This study characterized telemedicine utilization among Medicaid enrollees by patients’ demographic characteristics, geographic location, enrollment type, eligibility category, and clinical conditions. Methods This study used 2008–2009 Medicaid claims data from 28 states and the District of Columbia to characterize telemedicine claims (indicated by GT for professional fee claims or Q3014 for facility fees) on the basis of patients’ demographic characteristics, geographic location, enrollment type, eligibility category, and clinical condition as indicated by ICD-9 codes. States lacking Medicaid telemedicine reimbursement policies were excluded. Chi-square tests were used to compare telemedicine utilization rates and one-way analysis of variance was used to estimate mean differences in number of telemedicine encounters among subgroups. Results A total of 45,233,602 Medicaid enrollees from the 22 states with telemedicine reimbursement policies were included in the study, and .1% were telemedicine users. Individuals ages 45 to 64 (16.4%), whites (11.3%), males (8.5%), rural residents (26.0%), those with managed care plans (7.9%), and those categorized as aged, blind, and disabled (28.1%) were more likely to receive telemedicine (p<.001). Nearly 95% of telemedicine claims were associated with a behavioral health diagnosis, of which over 50% were for bipolar disorder and attention-deficit disorder or attention-deficit hyperactivity disorder (29.3% and 23.4%, respectively). State-level variation was high, ranging from .0 to 59.91 claims per 10,000 enrollees (Arkansas and Arizona, respectively). Conclusions Despite the touted potential for telemedicine to improve health care access, actual utilization of telemedicine in Medicaid programs was low. It was predominantly used to treat behavioral health diagnoses. Reimbursement alone is insufficient to support broad utilization for Medicaid enrollees. PMID:27691381

Near Real Time Tools for ISS Plasma Science and Engineering Applications

NASA Technical Reports Server (NTRS)

Minow, Joseph I.; Willis, Emily M.; Parker, Linda Neergaard; Shim, Ja Soon; Kuznetsova, Maria M.; Pulkkinen, Antti, A.

2013-01-01

The International Space Station (ISS) program utilizes a plasma environment forecast for estimating electrical charging hazards for crews during extravehicular activity (EVA). The process uses ionospheric electron density (Ne) and temperature (Te) measurements from the ISS Floating Potential Measurement Unit (FPMU) instrument suite with the assumption that the plasma conditions will remain constant for one to fourteen days with a low probability for a space weather event which would significantly change the environment before an EVA. FPMU data is typically not available during EVA's, therefore, the most recent FPMU data available for characterizing the state of the ionosphere during EVA is typically a day or two before the start of an EVA or after the EVA has been completed. Three near real time space weather tools under development for ISS applications are described here including: (a) Ne from ground based ionosonde measurements of foF2 (b) Ne from near real time satellite radio occultation measurements of electron density profiles (c) Ne, Te from a physics based ionosphere model These applications are used to characterize the ISS space plasma environment during EVA periods when FPMU data is not available, monitor for large changes in ionosphere density that could render the ionosphere forecast and plasma hazard assessment invalid, and validate the "persistence of conditions" forecast assumption. In addition, the tools are useful for providing space environment input to science payloads on ISS and anomaly investigations during periods the FPMU is not operating.

Telemedicine services in the Republic of Ireland: an evolving policy context.

PubMed

MacFarlane, Anne; Murphy, Andrew William; Clerkin, Pauline

2006-05-01

The Republic of Ireland is characterised by few urban conurbations and a high rural population, including significant numbers of island dwellers. Information communication technologies (ICT), including telemedicine, present opportunities to address rural health-service delivery issues. As in other countries, the recent National Health Information Strategy is regarded as pivotal to the modernisation of the Irish health care system. There is, however, a dearth of research about telemedicine in Ireland. This paper reports, to the best of our knowledge, the first systematic review of telemedicine in the two regional health boards in the Republic of Ireland. Details of 11 telemedicine services, all initiated by local policy, will be presented. Results of an interview study with service providers about their experiences of the practices and processes involved in telemedicine service delivery are also provided. The focus of our analysis is two-fold. We assess the resonance of these Irish data with the international literature with particular reference to a recently developed model for the normalisation of telemedicine. For the first time, this model which was developed in the United Kingdom is applied to a fresh set of empirical data in a different health care context. We then discuss a number of health information policy issues for Ireland and elsewhere arising from our analysis.

Economic Evaluation of Telemedicine for Patients in ICUs.

PubMed

Yoo, Byung-Kwang; Kim, Minchul; Sasaki, Tomoko; Melnikow, Joy; Marcin, James P

2016-02-01

Despite telemedicine's potential to improve patients' health outcomes and reduce costs in the ICU, hospitals have been slow to introduce telemedicine in the ICU due to high up-front costs and mixed evidence on effectiveness. This study's first aim was to conduct a cost-effectiveness analysis to estimate the incremental cost-effectiveness ratio of telemedicine in the ICU, compared with ICU without telemedicine, from the healthcare system perspective. The second aim was to examine potential cost saving of telemedicine in the ICU through probabilistic analyses and break-even analyses. Simulation analyses performed by standard decision models. Hypothetical ICU defined by the U.S. literature. Hypothetical adult patients in ICU defined by the U.S. literature. The intervention was the introduction of telemedicine in the ICU, which was assumed to affect per-patient per-hospital-stay ICU cost and hospital mortality. Telemedicine in the ICU operation costs included the telemedicine equipment-installation (start-up) costs with 5-year depreciation, maintenance costs, and clinician staffing costs. Telemedicine in the ICU effectiveness was measured by cumulative quality-adjusted life years for 5 years after ICU discharge. The base case cost-effectiveness analysis estimated telemedicine in the ICU to extend 0.011 quality-adjusted life years with an incremental cost of $516 per patient compared with ICU without telemedicine, resulting in an incremental cost-effectiveness ratio of $45,320 per additional quality-adjusted life year (= $516/0.011). The probabilistic cost-effectiveness analysis estimated an incremental cost-effectiveness ratio of $50,265 with a wide 95% CI from a negative value (suggesting cost savings) to $375,870. These probabilistic analyses projected that cost saving is achieved 37% of 1,000 iterations. Cost saving is also feasible if the per-patient per-hospital-stay operational cost and physician cost were less than $422 and less than $155, respectively, based on

Delivering tertiary centre specialty care to ALS patients via telemedicine: a retrospective cohort analysis.

PubMed

Selkirk, Stephen M; Washington, Monique O; McClellan, Frances; Flynn, Broderick; Seton, Jacinta M; Strozewski, Richard

2017-08-01

This study was undertaken to determine if ALS patients evaluated via telemedicine received the same quality of care as patients evaluated by traditional face-to-face encounters. A retrospective cohort study design was used. Participants were patients diagnosed with ALS that received multidisciplinary care at the tertiary Cleveland VA ALS Centre between 1 March 2008- and 31 anuary 2015. Participants were not randomised, but chose telemedicine based on preference, disability level or distance from the clinic. Telemedicine in this study consisted of a video conferencing platform enabling remote rather than face-to-face encounters with participants. There was no significant association between receiving quality ALS care and the mode of care. There was a trend for telemedicine patients to utilise home health care less often than those that received clinic care (AOR 0.50; 95% CI 0.16-1.59). There was no significant difference in survival time between the two groups (log-rank test χ 2  = 3.62, df = 1, p = 0.05). Patients receiving telemedicine had a higher probability of remaining stable or having <30% decrease in ALSFRS-R over time (log-rank test χ 2  = 4.46, df = 1, p = 0.03). There was a significantly lower risk of disease progression for patients receiving telemedicine (HR = 0.39, 95% CI = 0.16-0.93). Patients managed by telemedicine received the same quality of care and had similar outcomes to those patients seen via traditional face-to-face encounters. Telemedicine is an effective platform for delivering high quality tertiary ALS care.

Application of linear array imaging techniques to the real-time inspection of airframe structures and substructures

NASA Technical Reports Server (NTRS)

Miller, James G.

1995-01-01

Development and application of linear array imaging technologies to address specific aging-aircraft inspection issues is described. Real-time video-taped images were obtained from an unmodified commercial linear-array medical scanner of specimens constructed to simulate typical types of flaws encountered in the inspection of aircraft structures. Results suggest that information regarding the characteristics, location, and interface properties of specific types of flaws in materials and structures may be obtained from the images acquired with a linear array. Furthermore, linear array imaging may offer the advantage of being able to compare 'good' regions with 'flawed' regions simultaneously, and in real time. Real-time imaging permits the inspector to obtain image information from various views and provides the opportunity for observing the effects of introducing specific interventions. Observation of an image in real-time can offer the operator the ability to 'interact' with the inspection process, thus providing new capabilities, and perhaps, new approaches to nondestructive inspections.

Real-time interferometric diagnostics of rubidium plasma

NASA Astrophysics Data System (ADS)

Djotyan, G. P.; Bakos, J. S.; Kedves, M. Á.; Ráczkevi, B.; Dzsotjan, D.; Varga-Umbrich, K.; Sörlei, Zs.; Szigeti, J.; Ignácz, P.; Lévai, P.; Czitrovszky, A.; Nagy, A.; Dombi, P.; Rácz, P.

2018-03-01

A method of interferometric real-time diagnostics is developed and applied to rubidium plasma created by strong laser pulses in the femtosecond duration range at different initial rubidium vapor densities using a Michelson-type interferometer. A cosine fit with an exponentially decaying relative phase is applied to the obtained time-dependent interferometry signals to measure the density-length product of the created plasma and its recombination time constant. The presented technique may be applicable for real-time measurements of rubidium plasma dynamics in the AWAKE experiment at CERN, as well as for real-time diagnostics of plasmas created in different gaseous media and on surfaces of solid targets.

Telemedicine and the National Information Infrastructure

PubMed Central

Jones, Mary Gardiner

1997-01-01

Abstract Health care is shifting from a focus on hospital-based acute care toward prevention, promotion of wellness, and maintenance of function in community and home-based facilities. Telemedicine can facilitate this shifted focus, but the bulk of the current projects emphasize academic medical center consultations to rural hospitals. Home-based projects encounter barriers of cost and inadequate infrastructure. The 1996 Telecommunications Act as implemented by the Federal Communications commission holds out significant promise to overcome these barriers, although it has serious limitations in its application to health care providers. Health care advocates must work actively on the federal, state, and local public and private sector levels to address these shortcomings and develop cost effective partnerships with other community-based organizations to build network links to facilitate telemedicine-generated services to the home, where the majority of health care decisions are made. PMID:9391928

QoS for Real Time Applications over Next Generation Data Networks

NASA Technical Reports Server (NTRS)

Ivancic, William; Atiquzzaman, Mohammed; Bai, Haowei; Su, Hongjun; Chitri, Jyotsna; Ahamed, Faruque

2001-01-01

Viewgraphs on Qualtity of Service (QOS) for real time applications over next generation data networks are presented. The progress to date include: Task 1: QoS in Integrated Services over DiffServ networks (UD); Task 2: Interconnecting ATN with the next generation Internet (UD); Task 3: QoS in DiffServ over ATM (UD); Task 4: Improving Explicit Congestion Notification with the Mark-Front Strategy (OSU); Task 5: Multiplexing VBR over VBR (OSU); and Task 6: Achieving QoS for TCP traffic in Satellite Networks with Differentiated Services (OSU).

Teleneurology applications

PubMed Central

Wechsler, Lawrence R.; Tsao, Jack W.; Levine, Steven R.; Swain-Eng, Rebecca J.; Adams, Robert J.; Demaerschalk, Bart M.; Hess, David C.; Moro, Elena; Schwamm, Lee H.; Steffensen, Steve; Stern, Barney J.; Zuckerman, Steven J.; Bhattacharya, Pratik; Davis, Larry E.; Yurkiewicz, Ilana R.; Alphonso, Aimee L.

2013-01-01

Objective: To review current literature on neurology telemedicine and to discuss its application to patient care, neurology practice, military medicine, and current federal policy. Methods: Review of practice models and published literature on primary studies of the efficacy of neurology telemedicine. Results: Teleneurology is of greatest benefit to populations with restricted access to general and subspecialty neurologic care in rural areas, those with limited mobility, and those deployed by the military. Through the use of real-time audio-visual interaction, imaging, and store-and-forward systems, a greater proportion of neurologists are able to meet the demand for specialty care in underserved communities, decrease the response time for acute stroke assessment, and expand the collaboration between primary care physicians, neurologists, and other disciplines. The American Stroke Association has developed a defined policy on teleneurology, and the American Academy of Neurology and federal health care policy are beginning to follow suit. Conclusions: Teleneurology is an effective tool for the rapid evaluation of patients in remote locations requiring neurologic care. These underserved locations include geographically isolated rural areas as well as urban cores with insufficient available neurology specialists. With this technology, neurologists will be better able to meet the burgeoning demand for access to neurologic care in an era of declining availability. An increase in physician awareness and support at the federal and state level is necessary to facilitate expansion of telemedicine into further areas of neurology. PMID:23400317

Real-time ISEE data system

NASA Technical Reports Server (NTRS)

Tsurutani, B. T.; Baker, D. N.

1979-01-01

A real-time ISEE data system directed toward predicting geomagnetic substorms and storms is discussed. Such a system may allow up to 60+ minutes advance warning of magnetospheric substorms and up to 30 minute warnings of geomagnetic storms (and other disturbances) induced by high-speed streams and solar flares. The proposed system utilizes existing capabilities of several agencies (NASA, NOAA, USAF), and thereby minimizes costs. This same concept may be applicable to data from other spacecraft, and other NASA centers; thus, each individual experimenter can receive quick-look data in real time at his or her base institution.

Telemedicine security: a systematic review.

PubMed

Garg, Vaibhav; Brewer, Jeffrey

2011-05-01

Telemedicine is a technology-based alternative to traditional health care delivery. However, poor security measures in telemedicine services can have an adverse impact on the quality of care provided, regardless of the chronic condition being studied. We undertook a systematic review of 58 journal articles pertaining to telemedicine security. These articles were selected based on a keyword search on 14 relevant journals. The articles were coded to evaluate the methodology and to identify the key areas of research in security that are being reviewed. Seventy-six percent of the articles defined the security problem they were addressing, and only 47% formulated a research question pertaining to security. Sixty-one percent proposed a solution, and 20% of these tested the security solutions that they proposed. Prior research indicates inadequate reporting of methodology in telemedicine research. We found that to be true for security research as well. We also identified other issues such as using outdated security standards. © 2011 Diabetes Technology Society.

Telemedicine Security: A Systematic Review

PubMed Central

Garg, Vaibhav; Brewer, Jeffrey

2011-01-01

Telemedicine is a technology-based alternative to traditional health care delivery. However, poor security measures in telemedicine services can have an adverse impact on the quality of care provided, regardless of the chronic condition being studied. We undertook a systematic review of 58 journal articles pertaining to telemedicine security. These articles were selected based on a keyword search on 14 relevant journals. The articles were coded to evaluate the methodology and to identify the key areas of research in security that are being reviewed. Seventy-six percent of the articles defined the security problem they were addressing, and only 47% formulated a research question pertaining to security. Sixty-one percent proposed a solution, and 20% of these tested the security solutions that they proposed. Prior research indicates inadequate reporting of methodology in telemedicine research. We found that to be true for security research as well. We also identified other issues such as using outdated security standards. PMID:21722592

In vivo Real-Time Mass Spectrometry for Guided Surgery Application

NASA Astrophysics Data System (ADS)

Fatou, Benoit; Saudemont, Philippe; Leblanc, Eric; Vinatier, Denis; Mesdag, Violette; Wisztorski, Maxence; Focsa, Cristian; Salzet, Michel; Ziskind, Michael; Fournier, Isabelle

2016-05-01

Here we describe a new instrument (SpiderMass) designed for in vivo and real-time analysis. In this instrument ion production is performed remotely from the MS instrument and the generated ions are transported in real-time to the MS analyzer. Ion production is promoted by Resonant Infrared Laser Ablation (RIR-LA) based on the highly effective excitation of O-H bonds in water molecules naturally present in most biological samples. The retrieved molecular patterns are specific to the cell phenotypes and benign versus cancer regions of patient biopsies can be easily differentiated. We also demonstrate by analysis of human skin that SpiderMass can be used under in vivo conditions with minimal damage and pain. Furthermore SpiderMass can also be used for real-time drug metabolism and pharmacokinetic (DMPK) analysis or food safety topics. SpiderMass is thus the first MS based system designed for in vivo real-time analysis under minimally invasive conditions.

Adoption of intensive care unit telemedicine in the United States

PubMed Central

Kahn, Jeremy M.; Cicero, Brandon D.; Wallace, David J.; Iwashyna, Theodore J.

2013-01-01

Objective Intensive care unit (ICU) telemedicine is a novel approach for providing critical care services from a distance. We sought to study the extent of use and patterns of adoption of this technology in United States ICUs. Design Retrospective study combining a systematic listing of ICU telemedicine installations with hospital characteristic data from the Centers for Medicare and Medicaid Services. We examined adoption over time and compared hospital characteristics between facilities that have adopted ICU telemedicine and those that have not. Setting United States hospitals from 2003 to 2010. Measurements and main results The number of hospitals using ICU telemedicine increased from 16 (0.4% of total) to 213 (4.6% of total) between 2003 and 2010. The number of ICU beds covered by telemedicine increased from 598 (0.9% of total) to 5,799 (7.9% of total). The average annual rate of ICU bed coverage growth was 101% per year in the first four study years but slowed to 8.1% per year over the last four study years (p<0.001 for difference in linear trend). Compared to non-adopting hospitals, hospitals adopting ICU telemedicine were more likely to be large (percentage with >400 beds: 11.1% vs. 3.7%, p<0.001), teaching (percentage with resident coverage: 31.4% vs. 21.9%, p=0.003) and urban (percentage located in metropolitan statistical areas with over one million residents: 45.3% vs. 30.1%, p<0.001). Conclusions ICU telemedicine adoption was initially rapid but recently slowed. Efforts are needed to uncover the barriers to future growth, particularly regarding the optimal strategy for using this technology most effectively and efficiently. PMID:24145839

Real-time quasi-3D tomographic reconstruction

NASA Astrophysics Data System (ADS)

Buurlage, Jan-Willem; Kohr, Holger; Palenstijn, Willem Jan; Joost Batenburg, K.

2018-06-01

Developments in acquisition technology and a growing need for time-resolved experiments pose great computational challenges in tomography. In addition, access to reconstructions in real time is a highly demanded feature but has so far been out of reach. We show that by exploiting the mathematical properties of filtered backprojection-type methods, having access to real-time reconstructions of arbitrarily oriented slices becomes feasible. Furthermore, we present , software for visualization and on-demand reconstruction of slices. A user of can interactively shift and rotate slices in a GUI, while the software updates the slice in real time. For certain use cases, the possibility to study arbitrarily oriented slices in real time directly from the measured data provides sufficient visual and quantitative insight. Two such applications are discussed in this article.

Evaluation of Telemedicine Satisfaction Among Naval Radiologists

DTIC Science & Technology

2003-01-16

study, radiologists in the present study used telemedicine more for patient education (28% of radiologists vs. 11.5% of ENT personnel), provider...personnel were also consistently more likely than all the radiology staff to use telemedicine for patient education . The radiologists were less...Radiologists N = 20 ENT Personnel N = 15 Telemedicine Technology Diagnosis Confirmation % Patient Education % Diagnosis Confirmation % Patient

Real-time Feynman path integral with Picard–Lefschetz theory and its applications to quantum tunneling

DOE Office of Scientific and Technical Information (OSTI.GOV)

Tanizaki, Yuya, E-mail: yuya.tanizaki@riken.jp; Theoretical Research Division, Nishina Center, RIKEN, Wako 351-0198; Koike, Takayuki, E-mail: tkoike@ms.u-tokyo.ac.jp

Picard–Lefschetz theory is applied to path integrals of quantum mechanics, in order to compute real-time dynamics directly. After discussing basic properties of real-time path integrals on Lefschetz thimbles, we demonstrate its computational method in a concrete way by solving three simple examples of quantum mechanics. It is applied to quantum mechanics of a double-well potential, and quantum tunneling is discussed. We identify all of the complex saddle points of the classical action, and their properties are discussed in detail. However a big theoretical difficulty turns out to appear in rewriting the original path integral into a sum of path integralsmore » on Lefschetz thimbles. We discuss generality of that problem and mention its importance. Real-time tunneling processes are shown to be described by those complex saddle points, and thus semi-classical description of real-time quantum tunneling becomes possible on solid ground if we could solve that problem. - Highlights: • Real-time path integral is studied based on Picard–Lefschetz theory. • Lucid demonstration is given through simple examples of quantum mechanics. • This technique is applied to quantum mechanics of the double-well potential. • Difficulty for practical applications is revealed, and we discuss its generality. • Quantum tunneling is shown to be closely related to complex classical solutions.« less

Is there a contradiction between telemedicine and business?

PubMed

Lievens, Frank; Jordanova, Malina

2004-01-01

Is there a contradiction between telemedicine and business? The driving forces in the telemedicine market are: competition within the health-care industry, newly developed cheap information technology (especially the Internet) and 21st-century health-care consumers, with their expectations of free choice and a high level of health-care. The market has four segments (citizens, patients, professionals and employees) and the boundaries between these segments are blurred. The telemedicine market is obviously growing, but it is still unstructured, fractured and disorganized. The telemedicine market needs a meeting place where the status of telemedicine and telecare can be reviewed. This would be a place in which to explore new ways to improve the efficiency of health-care services and a forum in which to draw a roadmap for future developments. One such place is the International Trade Event and Conference for eHealth, Telemedicine and Health ICT, Med-e-Tel. At the 2004 event, there were 32 exhibitors from 23 countries and over 400 industry and medical participants. A survey of participants showed that the event was judged to be a success. There is no conflict between telemedicine and business. On the contrary, telemedicine is a promising area of business development.

Telemedicine in the Solomon Islands: 2006 to 2009.

PubMed

Martiniuk, Alexandra; Negin, Joel; Hersch, Fred; Dalipanda, Tenneth; Jagilli, Rooney; Houasia, Patrick; Gorringe, Lilijana; Christie, Annie

2011-01-01

Telemedicine has been used in the Solomon Islands since 2000. We used quantitative and qualitative methods to examine telemedicine use in the Solomon Islands from January 2006 to June 2009. During the study period 66 telemedicine cases were submitted to the store and forward telemedicine system being used there. These included orthopaedic, oncology, cardiothoracic, infectious, congenital, gastroenterology and dermatology cases. Most cases (52%) were submitted by doctors at the National Referral Hospital (NRH) in Honiara. The majority of responses came from the NRH (27%). A final, firm recommendation regarding patient diagnosis and/or care was given for 46% of the cases. Interviews were conducted with 23 stakeholders in the Solomon Islands and in Australia to better understand the current and future use of telemedicine. The interviews identified the fragility of the Solomon Islands infrastructure, including the lack of training, as the largest barrier to the future use of telemedicine. The best use of telemedicine appears to be case sharing within the Solomon Islands, with connections to clinicians in other countries as a secondary benefit when particular expertise is required.

Algorithm for real-time detection of signal patterns using phase synchrony: an application to an electrode array

NASA Astrophysics Data System (ADS)

Sadeghi, Saman; MacKay, William A.; van Dam, R. Michael; Thompson, Michael

2011-02-01

Real-time analysis of multi-channel spatio-temporal sensor data presents a considerable technical challenge for a number of applications. For example, in brain-computer interfaces, signal patterns originating on a time-dependent basis from an array of electrodes on the scalp (i.e. electroencephalography) must be analyzed in real time to recognize mental states and translate these to commands which control operations in a machine. In this paper we describe a new technique for recognition of spatio-temporal patterns based on performing online discrimination of time-resolved events through the use of correlation of phase dynamics between various channels in a multi-channel system. The algorithm extracts unique sensor signature patterns associated with each event during a training period and ranks importance of sensor pairs in order to distinguish between time-resolved stimuli to which the system may be exposed during real-time operation. We apply the algorithm to electroencephalographic signals obtained from subjects tested in the neurophysiology laboratories at the University of Toronto. The extension of this algorithm for rapid detection of patterns in other sensing applications, including chemical identification via chemical or bio-chemical sensor arrays, is also discussed.

Head movement compensation in real-time magnetoencephalographic recordings.

PubMed

Little, Graham; Boe, Shaun; Bardouille, Timothy

2014-01-01

Neurofeedback- and brain-computer interface (BCI)-based interventions can be implemented using real-time analysis of magnetoencephalographic (MEG) recordings. Head movement during MEG recordings, however, can lead to inaccurate estimates of brain activity, reducing the efficacy of the intervention. Most real-time applications in MEG have utilized analyses that do not correct for head movement. Effective means of correcting for head movement are needed to optimize the use of MEG in such applications. Here we provide preliminary validation of a novel analysis technique, real-time source estimation (rtSE), that measures head movement and generates corrected current source time course estimates in real-time. rtSE was applied while recording a calibrated phantom to determine phantom position localization accuracy and source amplitude estimation accuracy under stationary and moving conditions. Results were compared to off-line analysis methods to assess validity of the rtSE technique. The rtSE method allowed for accurate estimation of current source activity at the source-level in real-time, and accounted for movement of the source due to changes in phantom position. The rtSE technique requires modifications and specialized analysis of the following MEG work flow steps.•Data acquisition•Head position estimation•Source localization•Real-time source estimation This work explains the technical details and validates each of these steps.

Telemedicine and neurosciences.

PubMed

Ganapathy, K

2005-11-01

It is well known that in most countries there is a perennial shortage of specialists in neurosciences. The available neurologists and neurosurgeons are clustered in the metropolitan, urban areas. Those living in suburban and rural areas may have limited or no access to neurological care. Concurrently, there has been an unprecedented growth in information and communication technology (ICT). In this article, the author will demonstrate how the practice of neurosciences will change, with increasing use of telemedicine and ICT. In addition to presenting the author's personal experience, the literature on telemedicine in neurosciences is reviewed.

Making real-time reactive systems reliable

NASA Technical Reports Server (NTRS)

Marzullo, Keith; Wood, Mark

1990-01-01

A reactive system is characterized by a control program that interacts with an environment (or controlled program). The control program monitors the environment and reacts to significant events by sending commands to the environment. This structure is quite general. Not only are most embedded real time systems reactive systems, but so are monitoring and debugging systems and distributed application management systems. Since reactive systems are usually long running and may control physical equipment, fault tolerance is vital. The research tries to understand the principal issues of fault tolerance in real time reactive systems and to build tools that allow a programmer to design reliable, real time reactive systems. In order to make real time reactive systems reliable, several issues must be addressed: (1) How can a control program be built to tolerate failures of sensors and actuators. To achieve this, a methodology was developed for transforming a control program that references physical value into one that tolerates sensors that can fail and can return inaccurate values; (2) How can the real time reactive system be built to tolerate failures of the control program. Towards this goal, whether the techniques presented can be extended to real time reactive systems is investigated; and (3) How can the environment be specified in a way that is useful for writing a control program. Towards this goal, whether a system with real time constraints can be expressed as an equivalent system without such constraints is also investigated.

ANMCO/SIT Consensus Document: telemedicine for cardiovascular emergency networks

PubMed Central

Gulizia, Michele Massimo; Gabrielli, Domenico; Sicuro, Marco; De Gennaro, Luisa; Giammaria, Massimo; Grieco, Niccolò Brenno; Grosseto, Daniele; Mantovan, Roberto; Mazzanti, Marco; Menotti, Alberto; Brunetti, Natale Daniele; Severi, Silva; Russo, Giancarmine; Gensini, Gian Franco

2017-01-01

Abstract Telemedicine has deeply innovated the field of emergency cardiology, particularly the treatment of acute myocardial infarction. The ability to record an ECG in the early prehospital phase, thus avoiding any delay in diagnosing myocardial infarction with direct transfer to the cath-lab for primary angioplasty, has proven to significantly reduce treatment times and mortality. This consensus document aims to analyse the available evidence and organizational models based on a support by telemedicine, focusing on technical requirements, education, and legal aspects. PMID:28751844

Friction coefficient of skin in real-time.

PubMed

Sivamani, Raja K; Goodman, Jack; Gitis, Norm V; Maibach, Howard I

2003-08-01

Friction studies are useful in quantitatively investigating the skin surface. Previous studies utilized different apparatuses and materials for these investigations but there was no real-time test parameter control or monitoring. Our studies incorporated the commercially available UMT Series Micro-Tribometer, a tribology instrument that permits real-time monitoring and calculation of the important parameters in friction studies, increasing the accuracy over previous tribology and friction measurement devices used on skin. Our friction tests were performed on four healthy volunteers and on abdominal skin samples. A stainless steel ball was pressed on to the skin with at a pre-set load and then moved across the skin at a constant velocity of 5 mm/min. The UMT continuously monitored the friction force of the skin and the normal force of the ball to calculate the friction coefficient in real-time. Tests investigated the applicability of Amonton's law, the impact of increased and decreased hydration, and the effect of the application of moisturizers. The friction coefficient depends on the normal load applied, and Amonton's law does not provide an accurate description for the skin surface. Application of water to the skin increased the friction coefficient and application of isopropyl alcohol decreased it. Fast acting moisturizers immediately increased the friction coefficient, but did not have the prolonged effect of the slow, long lasting moisturizers. The UMT is capable of making real-time measurements on the skin and can be used as an effective tool to study friction properties. Results from the UMT measurements agree closely with theory regarding the skin surface.

TES: A modular systems approach to expert system development for real time space applications

NASA Technical Reports Server (NTRS)

England, Brenda; Cacace, Ralph

1987-01-01

A major goal of the space station era is to reduce reliance on support from ground based experts. The TIMES Expert System (TES) is an application that monitors and evaluates real time data to perform fault detection and fault isolation as it would otherwise be carried out by a knowledgeable designer. The development process and primary features of the TES, the modular system and the lessons learned are discussed.