An investigation into the use of 3G mobile communications to provide telehealth services in rural KwaZulu-Natal

This article has been made available through the Brunel Open Access Publishing Fund.Abstract Background: We investigated the use of third-generation (3G) mobile communications to provide telehealth services in remote health clinics in rural KwaZulu-Natal, South Africa. Materials and Methods: We specified a minimal set of services as our use case that would be representative of typical activity and to provide a baseline for analysis of network performance. Services included database access to manage chronic disease, local support and management of patients (to reduce unnecessary travel to the hospital), emergency care (up to 8 h for an ambulance to arrive), e-mail, access to up-to-date information (Web), and teleclinics. We made site measurements at a representative set of health clinics to determine the type of coverage (general packet radio service [GPRS]/3G), its capabilities to support videoconferencing (H323 and Skype™ [Microsoft, Redmond, WA]) and audio (Skype), and throughput for transmission control protocol (TCP) to gain a measure of application performance. Results: We found that none of the remote health clinics had 3G service. The GPRS service provided typical upload speed of 44 kilobits per second (Kbps) and download speed of 64 Kbps. This was not sufficient to support any form of videoconferencing. We also observed that GPRS had significant round trip time (RTT), in some cases in excess of 750 ms, and this led to slow start-up for TCP applications. Conclusions: We found audio was always so broken as to be unusable and further observed that many applications such as Web access would fail under conditions of very high RTT. We found some health clinics were so remote that they had no mobile service. 3G, where available, had measured upload speed of 331 Kbps and download speed of 446 Kbps and supported videoconferencing and audio at all sites, but we frequently experienced 3G changing to GPRS. We conclude that mobile communications currently provide insufficient coverage and capability to provide reliable clinical services and would advocate dedicated wireless services where reliable communication is essential and use of store and forward for mobile applications.The Royal Society, United Kingdom

Late Payment of Insurance Money

__Abstract__ The question of damages for failure to pay sums due came before the House of Lords in 2007 in the Sempra case. Although not the main ground of the decision, the House stated that a claimant would succeed, if the claimant satisfied the usual tests of 'remoteness' of loss. The article shows how difficult and thus expensive it is to reach what to most is an obvious result, underlining the importance of particular judges, and that counsel need to 'know' the judges before whom they argue a case. People might well conclude that the Sempra ruling covers failure by insurers to pay insurance money on time. The article explains why it does not, with reference to leading cases, including those supporting a bizarre rule of English insurance contract law concerning the nature of insurance cover. The article then considers the likely response to the issue in other countries of common law, and how it might be seen in Europe. The article concludes that English law needs reform - not new precedent, but new legislation, and the chance that through current work at the Law Commission, this will occur

Oceanic cephalopod distribution and species diversity in the eastern north Atlantic.

This work provides a baseline against which we might measure future changes to oceanic midwater cephalopod stability in the eastern North Atlantic It records a considerable sampling effort from 1959 to 1986 aimed at oceanic midwater cephalopods made by the author and colleagues in the eastern North Atlantic between approximately 10ºN to 70ºN and 0ºto 30ºW. From these samples the latitudinal distribution, the biodiversity and, to some extent, the relative rarity of the species present in the area is shown. Over 700 collections were made with a range of nets from small plankton nets to large commercial trawls of many designs. As an independent measure of the efficiency of our sampling, the species represented by lower beaks from the stomach contents of 241 sperm whales (Physeter catodon) caught or stranded at five different localities in the area are listed and discussed. In total, over 40,000 cephalopods of 82 oceanic midwater species and 16 shelf and slope species were identified and are included here. The number of midwater species caught by nets increases regularly from 11ºN to 32ºN and decreases from 32ºN to 60ºN. A sharp increase at 32ºN of about 10 species above the curve produced by the catches at other stations is very probably due to the use of lights on the nets at this position. This suggests that further use of lights at all stations might elevate the curve at each position commensurate with the numbers of species found by conventional nets. The number of midwater cephalopods caught by nets in each of the 32 families show that Cranchiidae are by far the most numerous (and speciose) followed by Pyroteuthidae and Enoploteuthidae at half the number. 18 families numbered less than 100 individuals. Families eaten by sperm whales showed that Histioteuthidae was by far the most numerous (22787) with Cranchiidae (3285), Octopoteuthidae (1710) and Cycloteuthidae (1360) following in importance. Architeuthidae was not caught by nets but was present in the whale diet (221). The scarcity and expense of net collections suggests that estimates of cephalopod distribution and relative numbers should rely more on analysis of the diet of predators than on net catches. The value of monitoring cephalopods in the deep ocean is discussed

Effect of culture on acceptance of telemedicine in Middle Eastern countries: Case study of Jordan and Syria

© Mary Ann Liebert, INC.We investigated issues that affect the use and adoption of telemedicine in Middle Eastern countries, taking the Hashemite Kingdom of Jordan and the Syrian Arab Republic as case studies. Our study is based on interviews with key stakeholders (including doctors, technicians, engineers, and decision makers) and questionnaires administered to key stakeholders (including patients), ensuring opinion was gained from people from a full range of backgrounds and roles in the healthcare system. We found doctor and patient resistance was a major issue preventing the adoption of telemedicine in both countries, followed by poor infrastructure, lack of funding, and lack of information technology training. Our research identifies that culture is a greater issue than technical matters for the adoption of telemedicine in Middle Eastern countries. Based on our preliminary results we developed a guideline framework for each country that might be applied to telemedicine projects at the pre-implementation phase. The proposed guideline framework was validated through a return visit to the stakeholders and seeking further opinion

Political skill and role overload as antecedents of innovative work behavior in the public sector

We draw upon the theory of Conservation of Resources (COR) in positing political skill and role overload as influencing perceptions of either resource loss or conservation not previously studied in innovative work behavior. Based on a survey of 249 junior doctors in the United Kingdom, we found that role overload not only had direct positive effects on innovative work behavior but also negatively affects innovative work behavior, mediated through its effects on perceived organizational support. Political skill was positively associated with innovative work behavior, mediated through role-breadth self-efficacy. Our findings support a growing body of literature suggesting that engaging in innovative work behavior is a problem-focused coping strategy to deal with job demands and stressors. Current theorizing that job demands can have positive effects on innovative work behavior needs to be reconsidered given alternative negative effects suggested by COR

Exploring a new security framework for remote patient monitoring devices

Security has been an issue of contention in healthcare. The lack of familiarity and poor implementation of security in healthcare leave the patients’ data vulnerable to attackers. The main issue is assessing how we can provide security in an RPM infrastructure. The findings in literature show there is little empirical evidence on proper implementation of security. Therefore, there is an urgent need in addressing cybersecurity issues in medical devices. Through the review of relevant literature in remote patient monitoring and use of a Microsoft threat modelling tool, we identify and explore current vulnerabilities and threats in IEEE 11073 standard devices to propose a new security framework for remote patient monitoring devices. Additionally, current RPM devices have a limitation on the number of people who can share a single device, therefore, we propose the use of NFC for identification in Remote Patient Monitoring (RPM) devices for multi-user environments where we have multiple people sharing a single device to reduce errors associated with incorrect user identification. We finally show how several techniques have been used to build the proposed framewor

Accessible Home Environments for People with Functional Limitations: A Systematic Review

The aim of this review is to evaluate the health and social effects of accessible home environments for people with functional limitations, in order to provide evidence to promote well-informed decision making for policy guideline development and choices about public health interventions. MEDLINE and nine other electronic databases were searched between December 2014 and January 2015, for articles published since 2004. All study types were included in this review. Two reviewers independently screened 12,544 record titles or titles and abstracts based on our pre-defined eligibility criteria. We identified 94 articles as potentially eligible; and assessed their full text. Included studies were critically appraised using the Mixed Method Appraisal Tool, version 2011. Fourteen studies were included in the review. We did not identify any meta-analysis or systematic review directly relevant to the question for this systematic review. A narrative approach was used to synthesise the findings of the included studies due to methodological and statistical heterogeneity. Results suggest that certain interventions to enhance the accessibility of homes can have positive health and social effects. Home environments that lack accessibility modifications appropriate to the needs of their users are likely to result in people with physical impairments becoming disabled at home

The common law of contract in 1993: will there be a general doctrine of good faith?

Cover title.Includes bibliographical references.published_or_final_versio