Twenty years of telemedicine in chronic disease management – an evidence synthesis

A literature review was conducted to obtain a high-level view of the value of telemedicine in the management of five common chronic diseases (asthma, COPD, diabetes, heart failure, hypertension). A total of 141 randomised controlled trials (RCTs) was identified, in which 148 telemedicine interventions of various kinds had been tested in a total of 37,695 patients. The value of each intervention was categorised in terms of the outcomes specified by the investigators in that trial, i.e. no attempt was made to extract a common outcome from all studies, as would be required for a conventional meta-analysis. Summarizing the value of these interventions shows, first, that most studies have reported positive effects (n = 108), and almost none have reported negative effects (n = 2). This suggests publication bias. Second, there were no significant differences between the chronic diseases, i.e. telemedicine seems equally effective (or ineffective) in the diseases studied. Third, most studies have been relatively short-term (median duration 6 months). It seems unlikely that in a chronic disease, any intervention can have much effect unless applied for a long period. Finally, there have been very few studies of cost-effectiveness. Thus the evidence base for the value of telemedicine in managing chronic diseases is on the whole weak and contradictory

Effect of nut-in-shell storage conditions on volatile profile in macadamia nuts

In order to study the effect of storage conditions on the volatile profile of macadamia nuts, both temperature and the presence of oxygen were controlled. Nuts-in-shell of variety 246 were stored at -18, 10 and 15°C. At each temperature, samples were stored in net bags and vacuum packed in EVOH (ethylene vinyl alcohol) for a period of 2 months. Prior to testing, samples were cracked and roasted. Analytical tests included peroxide value, p-anisidine and TBA (thiobarbituric acid number). Volatile compounds were isolated using Head-Space-Solid-Phase-Micro Extraction (DVB/PDMS/CAR). Volatiles were analysed by chromatography/mass spectrometry (GC/MS). The results show that at –18°C peroxide, p-Anisidine and TBA values were lower compared to the other 2 storage temperatures. This indicates that lipid degradation was lowest at this temperature. The main compounds found in volatile components of both fresh and roasted macadamia nut were hydrocarbons, aldehydes, and ketones. Several compounds deriving from lipid degradation and Maillard reaction were detected such as hexanal, thiazole. This indicates that changes in volatiles of macadamia nuts result from compounds present in macadamia nuts which were the precursors of volatile compounds produced during roasting. Storage materials which were net bag and EVOH showed no significant effect on volatile produced during 2 months storage trial. Volatiles generated depend mainly on processing steps such as roasting. The lipid degradation was minimised at low temperature. Therefore storage conditions for nut-in-shell influence the final macadamia kernel quality, especially shelf-life, as peroxide value and other lipid degradation product were used as criteria of shelf-life changes while volatile produced by Maillard reaction indicated roasting quality. Keywords: Macadamia, Volatiles, Storage conditions, Head-Space-Micro Extraction, Lipid change

Development of the big eight accounting firms in the United States, 1900-1990

This paper examines the growth and changing role of the accounting profession in the United States from 1900 to 1990 with special emphasis on Big Eight accounting firms. Major political, economic, and social events of the period and their influence on the accounting profession are analyzed. Each decade is examined in turn, and the historical consequences of the decade on Big Eight accounting firms in total and individually are presented

Matching biological motion at extreme distances

The goal of the current paper was to determine the maximum distance at which an actor could be placed so that an observer would still be able to interpret their behavior. Although we know a great deal about the limits of action perception, particularly through studies of biological motion processing, this question of distance has not been previously documented. We began by reviewing the sizes of point-light figures used in 100 previous studies of biological motion. We found that with an average figure height of 6.68 visual angle, actors were effectively 15 m from the observer, assuming average physical height of 1.75 m. No previous studies had explicitly examined extreme distances. Here, we introduce a new matching task in which we systematically varied the apparent distance of point-light figures relative to a fixed viewing position by manipulating size. Our results suggest that a variety of human actions could potentially be interpreted up to 1000 m away, a distance at which a human figure would subtend only 0.18 visual angle in height. Dynamic figures could be interpreted at further distances than static figures (Experiment 1), and upright figures were similarly processed more efficiently than inverted figures (Experiment 2). We discuss these findings in the context of the processing mechanisms thought to underlie action perception and suggest that the ability to match actions at extreme distance is another example of the robust nature of biological motion processing.peer-reviewe

On the uniqueness of (p,h)(p,h)-gonal automorphisms of Riemann surfaces

Let $X$ be a compact Riemann surface of genus $g\geq 2$. A cyclic subgroup of prime order $p$ of $Aut(X)$ is called properly $(p,h)$-gonal if it has a fixed point and the quotient surface has genus $h$. We show that if $p>6h+6$, then a properly $(p,h)$-gonal subgroup of $Aut(X)$ is unique. We also discuss some related results.Comment: final version, 9 pages, minor improvements, added 2 reference

A web-based telemedicine system for low-resource settings 13 years on: insights from referrers and specialists

Background: One way to tackle health inequalities in resource-poor settings is to establish links between doctors and health professionals there and specialists elsewhere using web-based telemedicine. One such system run by the Swinfen Charitable Trust has been in existence for 13 years which is an unusually long time for such systems. Objective: We wanted to gain some insights into whether and how this system might be improved. Methods: We carried out a survey by questionnaire of referrers and specialists over a six months period. Results: During the study period, a total of 111 cases were referred from 35 different practitioners, of whom 24% were not doctors. Survey replies were received concerning 67 cases, a response rate of 61 per cent. Eighty-seven per cent of the responding referrers found the telemedicine advice useful, and 78% were able to follow the advice provided. As a result of the advice received, the diagnosis was changed in 22% of all cases and confirmed in a further 18 per cent. Patient management was changed in 33 per cent. There was no substantial difference between doctors and non-doctors. During the study period, the 111 cases were responded to by 148 specialists, from whom 108 replies to the questionnaire were received, a response rate of 73 per cent. About half of the specialists (47%) felt that their advice had improved the management of the patients. There were 62 cases where it was possible to match up the opinions of the referrer and the consultants about the value of a specific teleconsultation. In 34 cases (55%) the referrers and specialists agreed about the value. However, in 28 cases (45%) they did not: specialists markedly underestimated the value of a consultation compared to referrers. Both referrers and specialist were extremely positive about the system which appears to be working well. Minor changes such as a clearer referral template and an improved web interface for specialists may improve it

Feasibility and acceptability of a remotely delivered transdiagnostic CBT treatment for postnatal anxiety and related disorders: A pilot case series

Women in the postnatal period are at a high risk of developing clinically significant symptoms of anxiety. Cognitive behavioural therapy is effective in the treatment of postnatal anxiety; however, there are many barriers to accessing this treatment. This study examined the feasibility and acceptability of transdiagnostic cognitive behavioural therapy delivered remotely via Internet videoconferencing. Three women (Mage = 28.33 years; SD = 4.04) with a postnatal anxiety-related disorder were treated using the videoconference-delivered cognitive behavioural therapy. The treatment was delivered once per week over a 5-week period. All participants met criteria for clinically significant change in anxiety symptoms at post-treatment, and one participant met criteria for clinically significant change in depressive symptoms, which was maintained at 3-month follow-up. The intervention was also found to be acceptable by participants. The results provide preliminary feasibility evidence of the clinical utility and acceptability of remotely delivered transdiagnostic cognitive behavioural therapy as an intervention for postnatal anxiety disorders

A critical study of Kleist's tales

This thesis is divided into five sections. In the introduction the development of the short story before Kleist is outlined and two chief forms are distinguished, one emphasising incident, the other character. The diverse sources of jileist's tales are considered in the second chapter. in Michael Kohlhaas a chronicle is developed into a tale with the fundamental theme of a search for justice. Die Marquise von 0.... presents the theme of a moral story, transformed by the author's individual treatment of the chief characters. Die Yerlobung in St.Domingo was suggested by contemporary events, and the theme of Das Bettelweib von Locarno was familiar in Kleist's day. Der Findling was influenced by Moliere's Le Tartuffe, and Der Zweikampf by episodes from Froissart and Cervantes. it "Das Erdbeben in chili and Die Heilige Cacilie are examples of original invention.in the third chapter the nature of the themes is discussed, and an attempt is made to interpret their tragic content. Tragic conflict in the individual is found to consist either in confusion of feeling or in disharmony with his surroundings. A fundamental problem of justice is shown to underlie three of the tales : Michael Kohlhaas, Das Erdbeben in Chili, and Der zweikampf. The fourth chapter deals with methods of artistic expression. The underlying idea is shown to be reflected in the external action. Characteristics of Kleist's narrative style are discussed with reference to epic and dramatic methods and economy in diction. In conclusion an attempt is made to estimate Kleist's achievement, particularly his fusion, by portrayal of a close relationship between character and circumstance, of the two former types of tale, illustrations from subsequent writers are given, which reveal how the form thus created persists with modifications in German literature, and show the influence of Kleist upon the themes of German Novelien.<p