Suitability of Some Climatic Parameters for Grapevine Cultivation in South Africa, with Focus on Key Physiological Processes

To optimise the functioning of the grapevine in a specific environment and to improve grape and wine quality,suitability of climatic parameters for key grapevine physiological processes needs to be assessed at fine scales. Thispaper presents methodology using hourly weather data in three wine producing regions of South Africa (CoastalRegion – Stellenbosch district; Breede River Valley – Robertson district; Central Orange River Region – Upingtondistrict) during the pre- (November to December) and post-véraison (January to February) periods. Durationsinside and outside an optimum climatic range and of extreme climatic conditions were calculated over a 5-yearperiod (1999/2000 to 2003/2004) to quantify a climatic profile related to grapevine physiological requirements.Climatic requirements for optimum photosynthetic activity were defined as follows: temperature 25°C to 30°C,windspeed <4 m/s, relative humidity 60% to 70%. Unsuitable climatic periods for vine performance werecalculated as <20°C and >35°C, >4m/s, <50% and >80%. A coefficient was assigned to each climatic parameteraccording to an assumed importance level for physiological processes. Optimum temperature requirements forother physiological parameters were also investigated. A diurnal minimum/maximum temperature range of25°C to 30°C was used for sugar content and organic acid levels and a maximum night/day temperature rangeof 15°C/25°C for colour and flavour. Light intensity was accepted as being sufficient. Stations were classifiedaccording to their potential for meeting the climatic requirements of each physiological parameter. Markedvariation in climatic profiles and available time for optimal physiological functioning occurred between regions.All factors considered, the climatic profile of the Coastal Region (Stellenbosch district) seemed to best satisfy theclimatic requirements of the physiological parameters studied

Relationship between the quality of service provided through store-and-forward telemedicine consultations and the difficulty of the cases – implications for long-term quality assurance

Published version. Also available at http://dx.doi.org/10.3389/fpubh.2015.00217We examined the difficulty of telemedicine cases and the quality of the resultant consultation in a mature store-and-forward telemedicine network. A random sample of 10 telemedicine cases was selected from those occurring over a 3-month period (5% of the workload) and they were scored by three experienced observers. Inter-observer agreement on the difficulty scores was poor (Fleiss’s kappa = 0.18) and it was also poor on the consultation quality scores (Fleiss’s kappa = 0.11). Differences between observers were minimized by consensus scoring, and the cases were re-assessed jointly by two observers. Based on the consensus scores, there was a weak negative relation between output quality and case difficulty, i.e., the more difficult cases tended to result in lower quality consultations. However, the effect was non-significant (P = 0.59) and a larger study might be helpful. In the meantime, routine monitoring of telemedicine service quality will continue in the interests of quality assurance. As yet, there is no evidence on which to base a correction for case difficulty

Topography interactions with the Atlantic Ocean and its impact on Vitis vinifera L. 'Tannat'

Climate is one of the main factors conditioning the chemical composition of grapes and wine. At a vineyard scale, during the growing season, topography can explain spatial temperature variability. Furthermore, each topographical factor (altitude, slope, exposure) may have a different impact on grapevine production, even in low altitude terrains. This work aims to evaluate the mesoclimate of Uruguay's Atlantic region and determine the topography and ocean's effect on temperature and, thus on the response of the 'Tannat' grapevine. Data from 19 temperature sensors, installed in a coastal vineyard under contrasted topography conditions, were used over three growing seasons in order to study the relationships between bioclimatic indicators of different sites and the plant response of nine 'Tannat' plots under similar agronomical management and soil type. Mesoclimate, especially due to altitude and exposition to the ocean winds, mostly explained 'Tannat' variability. Significant differences in extreme temperatures (minimum and maximum) were observed: The plots at higher altitudes (118-140 m a.s.l.) exposed to oceanic winds had a lower daytime temperature than the plot sheltered at lower altitude (70-94 m a.s.l.). The average difference was 0.9 °C during the hottest summer, reaching 1,7 °C between the most contrasted sites. In particular, the local sea breeze circulation during heat waves of the ripening period, prevent extreme high temperatures in sites facing the ocean. Temperature drop of 4.3°C in upwind sites was noticed, against 0.9°C in sheltered plots. The plots at lower altitude presented a nighttime temperature lower than plots at higher altitude (up to 1.0°C lower, on average, during ripening), thus resulting in greater diurnal thermal amplitude (1.5 °C greater). A direct association between altitude, mesoscale temperature and 'Tannat' grape metabolites was observed for three consecutive years: plots at higher altitude recorded significative greater malic acid (+1.7 g L-1), while plots at lower altitude recorded greater anthocyanin potential (ApH1) (+1920 mg L-1). Other variables such as soluble solids, total titratable acidity, pH and polyphenols were differentiated at least over one growing season. No significant differences in agronomic response parameters such as yield, pruning weight and Ravaz Index were observed. Topographic differences less than 70 m a.s.l. but enhanced by the Atlantic Ocean influence, made it possible to differentiate plots with equal vine responses. Seasonal and spatial climatic characterization of the region at fine scale along with grapevine response will allow to optimize agronomic decisions especially in search of fresh terroirs where the vines can adapt to climate change

Experience with quality assurance in two store-and-forward telemedicine networks

Published version. Also available at http://dx.doi.org/10.3389/fpubh.2015.00261Despite the increasing use of telemedicine around the world, little has been done to incorporate quality assurance (QA) into these operations. The purpose of the present study was to examine the feasibility of QA in store-and-forward teleconsulting using a previously published framework. During a 2-year study period, we examined the feasibility of using QA tools in two mature telemedicine networks [Médecins Sans Frontières (MSF) and New Zealand Teledermatology (NZT)]. The tools included performance reporting to assess trends, automated follow-up of patients to obtain outcomes data, automated surveying of referrers to obtain user feedback, and retrospective assessment of randomly selected cases to assess quality. In addition, the senior case coordinators in each network were responsible for identifying potential adverse events from email reports received from users. During the study period, there were 149 responses to the patient follow-up questions relating to the 1241 MSF cases (i.e., 12% of cases), and there were 271 responses to the follow-up questions relating to the 639 NZT cases (i.e., 42% of cases). The collection of user feedback reports was combined with the collection of patient follow-up data, thus producing the same response rates. The outcomes data suggested that the telemedicine advice proved useful for the referring doctor in the majority of cases and was likely to benefit the patient. The user feedback was overwhelmingly positive, over 90% of referrers in the two networks finding the advice received to be of educational benefit. The feedback also suggested that the teleconsultation had provided cost savings in about 20% of cases, either to the patient/family, or to the hospital/clinic treating the patient. Various problems were detected by regular monitoring, and certain adverse events were identified from email reports by the users. A single aberrant quality reading was detected by using a process control chart. The present study demonstrates that a QA program is feasible in store-and-forward telemedicine, and shows that it was useful in two different networks, because certain problems were detected (and then solved) that would not have been identified until much later. It seems likely that QA could be used much more widely in telemedicine generally to benefit patient care

The The use of GFV and GSR temperature-based models in emerging wine regions to help decision-making regarding choices in grape varieties and wine styles. Application to Brittany (France)

Viticulture and wine production are facing climate change. While it can be a challenge in some regions, it is an opportunity for others. The aim of this study is to develop a methodology to assess climatic characteristics and potential for viticulture of new areas, through spatial analyses of data from temperature-based grapevine models (the Grapevine Flowering Veraison model -GFV and the Grapevine Sugar Ripeness model -GSR) during current and future periods. A deadline for veraison was set on the 1st of September for dry wine and on the 15th of September for sparkling wine. Different sugar levels were targeted for the production of different wine styles (170 g·L-1 for sparkling wine, 190 g·L-1 and 200 g·L-1 dry white and red wines, respectively) on the 15th of October. The methodology was applied over the region of Brittany (France) to assess the potential to produce different wine styles from 6 grapevine varieties (‘Sauvignon blanc’, ‘Chardonnay’, ‘Chenin’, ‘Pinot noir’, ‘Cabernet franc’ and ‘Cabernet-Sauvignon’). Observed data from the Météo-France weather stations network and an 8-km gridded climate model data from the 2014 EUROCORDEX simulation set (CNRM-CM5/RCA4 climate model) were used over the past (1950-2020) and future periods (2031-2060 and 2071-2100) under two GHG emission scenarios (RCP 4.5 and 8.5). Climatic conditions of this region seem to be increasingly suitable in the future depending on climate scenario, time period projections and targeted types of wine. The methodology can be applied to any emerging winegrowing region with the ability to adjust variety choices, time lines and sugar levels thresholds as desired to meet the needs of a specific region

Teledermatology in low-resource settings: the MSF experience with a multilingual tele-experise platform

Introduction: In 2010, Médecins Sans Frontières (MSF) launched a tele-expertise system to improve the access to specialized clinical support for its field health workers. Among medical specialties, dermatology is the second most commonly requested type of tele-expertise. The aim of the present study was to review all MSF teledermatology cases in the first 4 years of operation. Our hypothesis was that the review would enable the identification of key areas for improvement in the current MSF teledermatology system. Methods: We carried out a retrospective analysis of all dermatology cases referred by MSF field doctors through the MSF platform from April 2010 until February 2014. We conducted a quantitative and qualitative analysis based on a survey sent to all referrers and specialists involved in these cases. Results: A total of 65 clinical cases were recorded by the system and 26 experts were involved in case management. The median delay in providing the first specialist response was 10.2 h (IQR 3.7–21.1). The median delay in allocating a new case was 0.96 h (IQR 0.26–3.05). The three main countries of case origin were South Sudan (29%), Ethiopia (12%), and Democratic Republic of Congo (10%). The most common topics treated were infectious diseases (46%), inflammatory diseases (25%), and genetic diseases (14%). One-third of users completed the survey. The two main issues raised by specialists and/or referrers were the lack of feedback about patient follow-up and the insufficient quality of clinical details and information supplied by referrers. Discussion: The system clearly delivered a useful service to referrers because the workload rose steadily during the 4-year study period. Nonetheless, user surveys and retrospective analysis suggest that the MSF teledermatology system can be improved by providing guidance on best practice, using pre-filled referral forms, following-up the cases after teleconsultation, and establishing standards for clinical photography

The development of a multilingual tool for facilitating the primary-specialty care interface in low resource settings: the MSF tele-expertise system

In 2009, Médecins Sans Frontières (MSF) started a pilot trial of store-and-forward telemedicine to support field workers. One network was operated in French and one in English; a third, Spanish network was brought into operation in 2012. The three telemedicine pilots were then combined to form a single multilingual tele-expertise system, tailored to support MSF field staff. We conducted a retrospective analysis of all telemedicine cases referred from April 2010 to March 2014. We also carried out a survey of all users in December 2013. A total of 1039 referrals were received from 41 countries, of which 89% were in English, 10% in French, and 1% in Spanish. The cases covered a very wide range of medical and surgical specialties. The median delay in providing the first specialist response to the referrer was 5.3 h (interquartile range 1.8, 16.4). The survey was sent to 294 referrers and 254 specialists. Of these, 224 were considered as active users (41%). Out of the 548 users, 163 (30%) answered the survey. The majority of referrers (79%) reported that the advice received via the system improved their management of the patient. The main concerns raised by referrers and specialists were the lack of support or promotion of system at headquarters' level and the lack of feedback about patient follow-up. Because of the size of the MSF organization, it is clear that there is potential for further organizational adoption

Identifying Elderly Patients at Risk of Falling using Time-Domain and Cyclostationarity Related Features

Falls are a prevalent and severe health problem in the elderly community, leading to unfortunate and devastating consequences. Some falls can be prevented through interventions, proper management, and extra care. Therefore, studying and identifying elderly people with risk of falls is essential to minimize the falling risk and to minimize the severity of injuries that can occur from these falls. Besides, identifying at-risk patients can profoundly affect public health in a positive way. In this paper, we use classification techniques to identify at-risk patients using pressure signals of the innersoles of 520 elderly people. These people reported whether they had experienced previous falls or not. Two different types of feature sets were used as inputs to the classification models and were compared: The first feature set includes time-domain, physiological, and cyclostationary features, whereas the second includes a subset of those features chosen by Relief-F as the most important features. Our study showed that the use of features from different walking conditions and using Relief-F as a feature selection method significantly improved the model prediction accuracy, i.e. by 5.24% from the best previously existing model. The results also point out that the mean and standard deviation of the stride time, gender, the degree of cyclostationarity were the most important features to include in classification models for the identification of elderly people at risk of falling

Teleradiology usage and user satisfaction with the telemedicine system operated by Médecins Sans Frontières

Médecins Sans Frontières (MSF) began a pilot trial of store-and-forward telemedicine in 2010, initially operating separate networks in English, French, and Spanish; these were merged into a single, multilingual platform in 2013. We reviewed the pattern of teleradiology usage on the MSF telemedicine platform in the 4-year period from April 2010. In total, 564 teleradiology cases were submitted from 22 different countries. A total of 1114 files were uploaded with the 564 cases, the majority being of type JPEG (n = 1081, 97%). The median file size was 938 kb (interquartile range, IQR 163-1659). A panel of 14 radiologists was available to report cases, but most (90%) were reported by only 4 radiologists. The median radiologist response time was 6.1 h (IQR 3.0-20). A user satisfaction survey was sent to 29 users in the last 6 months of the study. There was a 28% response rate. Most respondents found the radiologist's advice helpful and all of them stated that the advice assisted in clarification of a diagnosis. Although some MSF sites made substantial use of the system for teleradiology, there is considerable potential for expansion. More promotion of telemedicine may be needed at different levels of the organization to increase engagement of staff