Indigenous telemedicine

We are describing a simple and innovative way of documenting tachycardia. This patient came with video recording of neck pulsation done with the help of mobile phone camera. No other documentation of this tachycardia was available as patient was living in a remote area away from even basic health facilities.     

Clinical effects of an optimised care program with telehealth in heart failure patients in a community hospital in the Netherlands

Background

Our hypothesis was that telehealth in combination with an optimised care program coordinated amongst care professionals in primary, secondary and tertiary care can achieve beneficial outcomes in heart failure. The objective was to evaluate the clinical effects of introduction of telehealth in an optimised care program in a community hospital in the north of the Netherlands.

Methods

We compared the number of unplanned admissions for heart failure in the year before and after adding telehealth to the optimised care program. Furthermore, blood pressure and N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels were evaluated at baseline and 3, 6 and 12 months after telehealth. Quality of life and knowledge about the disease were regularly evaluated via surveys on the telehealth system.

Findings

The number of unplanned admissions for heart failure decreased from on average 1.29 to 0.31 admissions per year after telehealth introduction. Blood pressure decreased independent of medication and NT-proBNP levels improved as well. Quality of life increased during the telehealth intervention and disease knowledge remained high throughout the follow-up period. Unplanned admissions that remained after telehealth introduction could be accurately predicted at baseline by a multivariate regression model.     

Development of an Intelligent Mobile Health Monitoring System for the Health Surveillance System in Indonesia

Mobile phone applications have been widely used in various fields, including health care. Generally, this technology is used to overcome problems in health care by utilising mobile phone features for facilitating basic needs in health services. This study proposes an intelligent mobile health monitoring system that can be used in rural and remote areas where health services are still lacking. The system was made based on client/server architecture. Nine symptoms of typhoid, cough and diarrhoea from 30 patients were gathered from a hospital. Based on this data, a machine learning model using Support Vector Machine (SVM) was performed to distinguish these diseases. To find the best model parameters of the SVM, three different kernels (linear, polynomial, and Radial Basis Function (RBF)) were analysed. The result showed that RBF with degree 2 provided the best result in this particular application. The system was designed to receive input from patients about symptoms of the disease they have. The mobile phone application sends the data of the symptoms using Short Message Service (SMS) to the server. Furthermore, a machine algorithm module in the server identifies to which disease it belongs to based on the machine learning model created before. The prediction result is accessible to the doctor and the nearest Community Health Center (CHC). Based on the result, the doctor proposes a treatment plan for the patient to be recorded and sent to the patient by CHC. The proposed mobile health monitoring system has run properly and is ready to be evaluated in a real situation.     

基于Agent模型的生态公平指数构建与模拟

伴随着社会经济的发展,社会公平逐渐成为热点话题。社会公平问题不但体现在社会现象上,还对生态系统起着重要的影响。通过构建资本交换自主体模型,模拟社会财富分配动态过程,可观测资本交换熵指数变化情况,从而解释熵增原理。除此以外,不同系统的最终状态能达到的最大熵指数不同,用熵增原理与本文构建的最大熵指数模型可以对系统的生态公平进行纵向或横向评价。构建的资本交换熵模型也可以证明最大熵原理,同时,财富集中的现象将会使生态环境的选择权完全交予富人群体,影响可持续发展。     

Página web DiabeTIC: estudio piloto de la satisfacción e impacto sobre el control metabólico

ObjectivesTo evaluate satisfaction and short-term impact on metabolic control of diabetes monitoring through the DiabeTIC website.Patients and methodsA prospective, uncontrolled intervention study was conducted in 32 patients aged 29.7 ± 9.7 years (65% female) incorporated to the telemedicine platform DiabeTIC between March and September 2012. All patients completed a satisfaction questionnaire in the first month, and impact on metabolic control was evaluated at three and six months.ResultsIn the satisfaction survey conducted in the first month of follow-up, the following mean scores (0-10) were obtained: overall impression with the platform: 8.6 ± 1.8; ease of use: 8.1 ± 1.5; intuitive navigation: 6.7 ± 3.0; value of measurements: 9.1 ± 1.1; importance of the platform in diabetes management: 9.5 ± 0.9; sense of security: 9.5 ± 0.8; value of the library: 9.4 ± 1.1; value of messages: 9.1 ± 1.4, and recommendation to use the platform: 9.4 ± 0.9. Glycosilated hemoglobin concentrations significantly improved at six months as compared to study start (7.0 ± 0.8 versus 8.1 ± 1.9; p = 0.007). Nine patients were discharged from DiabeTIC before completing six months of follow-up.ConclusionsPatients with diabetes monitored through the DiabeTIC website report a high degree of satisfaction, showing improved metabolic control at short-term follow-up.     

Porte sonde motorisé pour une télé-échographie abdominale en temps différé : étude de faisabilité

PurposeDesign a system of delayed telesonography between expert center and isolated site where there is no sonographer.Materials and methodsA motorized probe holder printing a movement of TILT (± 40°) to any 2D echograph probe available in an isolated site, allows a non-sonographer to capture the patients’ whole organ images. This volume of images is sent to the expert center via internet. The video sequence is decomposed into images in the JPEG format by the software VirtualDub. A post-processing software (ECHO-CNES) allows the expert to find the incidences necessary for the diagnosis. This system has been tested on 50 patients at the CHU Trousseau (Tours, France).ResultsOrgans investigated were liver, portal vein, gall-bladder, kidneys (right and left) and spleen. The acquisition time of the volumes of images was 4 min maximum and allowed to reconstruct images necessary for the diagnosis in 80% of the cases. Scanning duration lasted 4 s on average; processing duration of the volume of images lasted approximately 15 min.ConclusionThis system is in validation in real situation in Togo with the aim of its generalization for medical care according to the obtained results.     

How Might the European Union Engage Constructively with China in the South China Sea?

The decision of the International Court of Justice in the Australia/Japan Whaling Case marks an advance in the law of the sea and the obligation on states to cooperate in common ocean resource regimes. The Court found substantially for Australia, prohibiting Japan's long-running program to capture large cetaceans in the Southern Ocean around Antarctica for scientific research. The Court's discussion of the criteria for states to design and implement scientific research whaling programs is assessed, as is the obligation for cooperation in such research and ocean research generally. The result for whaling and for the future work of the International Whaling Commission is considered.     

Should Persons Detained During Public Health Crises Receive Compensation?

One of the ways in which public health officials control outbreaks of epidemic disease is by attempting to control the situations in which the infectious agent can spread. This may include isolation of infected persons, quarantine of persons who may be infected and detention of persons who are present in or have entered premises where infected persons are being treated. Most who have analysed such measures think that the restrictions in liberty they entail and the detriments in welfare they impose can be justified and this paper proceeds from the assumption that detention measures are justifiable in some circumstances. Such measures are often implemented without any compensation being given to the persons who are detained. This raises the question: What do we owe to those whose liberty is justifiably restricted (e.g. through isolation, quarantine or detention) as a public health measure during a public health emergency? More specifically, do we owe them compensation for any losses they experience? The paper falls in four main sections. The first section provides examples of the current regulatory state of affairs from the US, Canada and WHO. The second section lays out the liberal, welfarist and pragmatic arguments for providing compensation. The third section discusses the arguments against compensation and the fourth and final section provides the conclusion. It is argued that the arguments for providing compensation clearly outweigh the counterarguments and that the default public policy therefore should be that compensation is provided.     

The two faces of revenge: moral responsibility and the culture of honor

Retributive emotions and behavior are thought to be adaptive for their role in improving social coordination. However, since retaliation is generally not in the short-term interests of the individual, rational self-interest erodes the motivational link between retributive emotions and the accompanying adaptive behavior. I argue that two different sets of norms have emerged to reinforce this link: (1) norms about honor and (2) norms about moral responsibility and desert. I observe that the primary difference between these types of retribution motivators lies in where the normative focus is placed after an offense. In the first form of retribution, the normative focus is on the offended party. In the second, it is on the offender. Next, I show how each class of norms is well tailored to the particular features of the environment in which these forms of retributive behavior emerge. Finally, I consider some philosophical implications of these observations. I suggest that my account, if correct, would pose tough challenges for contemporary philosophical theories of moral responsibility and punishment.

Generating power: gender,ethnicity and empowerment in India's Narmada Valley

Current analyses of issues relating to ethnicity and empowerment are silent about the significance of the environment in shaping and being shaped by human relations. For its part, environmental policy research, with few exceptions, has also ignored the dynamics of identity construction and cultural values that inform human relationships with the environment and thus affect environmental sustainability. I address this gap in the scholarship through an analysis of the Sardar Sarovar Project [SSP] in India. I explore the interweaving of the constructions of gender, ethnicity and empowerment and their implications for a new politics of the environment - the politics of environmental justice. I argue that discourses of modernization underpin the arguments of all those who discuss the SSP, whether in favour or against.     

Documento de posicionamiento sobre la eficiencia de las tecnologías aplicadas al manejo de la diabetes

Di@bet.es study results are impressive, showing that diabetes affects 13.8% of the Spanish population. Not only the statistical facts are alarming, but the increasing incidence of this disease is a major problem, as pandemic proportions of type 2 diabetes are expected. Thus, the study of diabetes represents a challenge not only for health services, but also for the Ministries of Health and Finance. Technology has become an essential tool in the quality care of patients with diabetes, as it helps in the healthcare processes to obtain an optimum metabolic balance and prevent possible complications. Insulin pumps, continuous glucose monitoring and self-monitoring blood glucose have all proved their efficiency, and telemedicine it is making good progress. The indirect costs of diabetes in Spain are much higher than the direct ones, showing the importance of inverting the paradox. The optimization of resources depends not only on the ability of the physicians, but also the administration, to implant and sustain technological innovations in our system, and with that make it effective in terms of benefits. Cost-effectiveness and cost-utility analysis are needed to prioritize and allow health management services to make the correct choices for approaching this prevalent chronic disease.     

主要利益相关方在履行《名古屋议定书》中的关系与义务

生物遗传资源及其相关传统知识的获取与惠益分享(Access and Benefit Sharing,ABS)涉及三个主要利益相关方,即提供方、使用方和监管方.在我国履行《名古屋议定书》的过程中,需深刻理解《名古屋议定书》中对于提供方、使用方和监管方的相关规定,分析三方关系内涵及各自义务,对有效履行《名古屋议定书》具有重...