Adaptation of video for Tele Echography
Alejandro Tovar de Dueñas
A solution to provide tele-diagnosis to be used for people in remote areas, be them rural areas, a ship in the middle of the sea, etc. A solution that makes video imags from any echography device to be reachable real-time anywhere desired.
The requirements are very high: quality has to be good enough to enable a correct diagnosis, but the constrains are also many, amongst many the quality of the connectivity. Special installations are avoided, so once the video is captured, it is streamed through the net by a streaming server, and any client can access the signal without the need of any kind of software installation, just a web browser.
A key issue is how to capture the maximum frame rate possible with a midrange PC for the possible VGA modes.
Alejandra Pimentel: Are there any network requirements? A: Any network that supports IP protocols and 300Kbps of bandwidth.
Mazhar Ali: What about security in the transmission of sensitive data? A: Access to the video, though free, can be made private by creating accounts both on the streaming server and the client side.
Ugo Vallauri: Could the video be saved instead of streamed, and sent asynchronously afterwards by e-mail or any other way? A: It could be very easy to do to even establish a procedure where the patient is told to follow some simple instructions and send the video their physician.
Development of a real-time digital wireless tele-stethoscope for isolated rural areas in the developing world
Why real time telemedicine instead of store-and-forward:
- More knowledge about patient’s status.
- Local health personnel less qualified.
- BUT: Higher costs for telecommunication infrastructures.
So, the goal of this project is to lower the costs of infrastructures while being able to provide real time telemedicine. But this is no easy problem to solve: the quality needed to send good information valid for diagnosis is very high. This puts a lot of stress both in the sound card and the bandwidth (or pay highest costs or have landlines). Thus, both hardware and software had to be developed to create a capturing device, to digitize and amplify the signal, to send the signal and to retrieve/represent it.
Further research implies substituting the PC with a smartphone, make all the operations through a website, design a stethoscope-oriented software CODEC, thinking in how to apply it in disaster situations, or automatic support and diagnosis.
Christopher Foch: has there been any research on how the patients feel for not having their physician face-to-face with them? What about physicians, being “substituted” by a device? A: in general, even if people prefer face-to-face interaction, the departure point is no diagnosis at all, so it is not about substitution, but about provision. Besides, some physicians have stated that, technically, they’d rather have this digital stethoscope, as it allows amplification, which sometimes is very beneficial.
Biniam Goshu Meknonnen: What if the network fails? A: The device won’t work because it was designed for a real-time interaction, but it could certainly be modified to work in a store-and-forward mode.
Soraya Hidalgo: what’s the cost of it all? A: It adds 120€ to the total cost of a new stethoscope (circa +20%) and, of course, a PC connected to the Internet is needed.
Fifth Annual ICT4D Postgraduate Symposium (2010)
Notes from the first II Conferencia Internacional Brecha Digital e Inclusión Social (II International Conference on the Digital Divide and Social Inclusion held at the Universidad Carlos III de Madrid will be hosting at their campus in Leganés (Spain) on October 28th to 30th, 2009.
Parallel session: Trends and advances before the digital divide: assessment systems and good practices
Moderator: Concepción Colomer Revuelta, Subdirector at the Oficina de Planificación Sanitaria and Director del Observatorio de Salud de la Mujer del Ministerio de Sanidad y Política Social
Digital and informational divides in a context of digital, cultural, cognitive and generational convergence
Marcelo D’Agostino, Consultant in Knowledge Management, Organización Panamericana de la Salud
Marcelo D’Agostino believes that the digital digital will shrink, necessarily, as
the Internet won’t make steps backwards [he seems to forget that the digital divide is actually widening, especially if we take into account the quality of access, namely, broadband access, and what you can or cannot do with that different quality of access].
Advise to bridge the digital divide:
- Don’t be intimidated by technical jargon
- Don’t be afraid of technology
- Nobody is an expert in everything
- Trust first your capacity and then apply technologies
- Be careful where you look for information
Benefits of ICTs for Public Health: a better link between patients and professionals; better and life-long training.
Open access to health and medical information: a challenge before the digital divide
Helena Martín Rodero, Head of the Sección Bibliotecas Biosanitarias de la Universidad de Salamanca
open-access more harm than good in developing world (published in Nature, comment by Peter Suber) stating the rich world patronising the poor world, in the sense that rich ones might be more interested in poor ones reading rather than publishing.
We are witnessing a crisis in the system of scientific diffusion, that has lead to the creation of the Open Access movement and several international declarations to foster scientific publishing in open access journals (gold access) or scientific self-archiving in open access repositories (green access).
Open access is compatible with peer-review, professional quality, prestige, preservation, intellectual property, profit, priced add-ons and print (originally in Open access to the scientific journal literature, by Peter Suber.
Access to knowledge will necessarily help to bridge the digital divide, and open access publications and repositories is a way to enable a better access to knowledge.
Web 2.0 and Medicine
Dídac Margaix Arnal, Librarian at the Universidad Politécnica de Valencia
New generations (digital natives) have been born with new technologies and these are no strange to them. Have different skills towards technology and information, which they manage in different ways.
We might be in an age similar to the Renaissance, where technology feeds cultural and social change, and culture and society feed technological change.
Three kinds of Web 2.0 sites
- The web as the platform: use the web instead of the desktop (e.g. Zoho)
- Remix the web: use the web to mix different content (e.g. Google Maps)
- The social web: it is users what counts, not visits. Users add value to the site (e.g. YouTube)
Medicine 2.0: use of a set of web tools by health professionals applying the principles of open source, open access, etc. It is different from e-Medicine, that is applying ICTs in health issues. There has been an inflexion point that has put humans into technology, from just ICTs to the dimension of community. It is a matter not of technology but of participation.
- “Suppormediation”: support and mediation by non-professionals (in Spanish: Apomediación)
There increasingly are websites that provide health information on the Internet. We should prescribe more information than pills (or, at least, as much information as pills).
Summing up: new agents, new tools, collaboration, personalization, training.
Internet and Health
David Novillo Ortiz, Agencia de Calidad del Sistema Nacional de Salud. Ministerio de Sanidad y Política social
Related to health, increasingly people get their information from the Internet and less from TV, and more from blogs. In general, e-mail, search engines and social networking sites have entered with strength into the information landscape.
Search for health information in the Internet has gone from 19% in 2003 to 54% in 2008 (Spain, % of total Internet users). There is a gender gap where women score 10 points higher than men, probably due to their role as the person at home that cares for the family members.
In April 2007, the same search terms in 4 different search engines produced only 0.6% of overlap (only 0.6% of all results were the same in the 4 search engines). We should be careful about that, as the information that search engines produce is, by any means, the same one ever.
Indeed, we trust more the people we know that the ones we don’t, that’s why Google Social Search might be adding a lot of value as it will bring personal context to people’s searches.
On the other hand, we can access certified/verified health websites whose information is backed by the reputation of the institutions that publish those websites. E.g. excelenciaclinica.net, a metasearch engine that crawls the best health websites in Spanish.
II International Conference on the Digital Divide and Social Inclusion (2009)
Notes from the Fourth IPID ICT4D Postgraduate Symposium 2009, held in the Royal Holloway University of London, Egham, United Kingdom, on September 11-12th, 2009. More notes on this event: ict4d_symposium_2009.
Extrending WiMAX coverage for providing Quality of Service in wide rural areas of developing countries
Carlos Rey Moreno
EHAS Foundation promotes the use of wireless technologies for e-Health in Latin America.
Health Care Centres are the reference point of many Health Care Posts, but the later are very far from the former. So, how to coordinate action?
Characteristics of the target areas:
- Isolated or hard to reach
- Low income
- Lack of constnat power supply
- Trnsmission of voice is paramount
Solutions based on:
- Wireless communications, as it is hard to wire the area
- License-free frequencies
- Low power consumption
- Low cost of operation
Cellular technologies (e.g. 3G) can only be applied in urban areas due to coverage. Satellite is expensive. Thus why WiFi or WiMAX.
Though WiFi is quite low cost and easy to apply, the usage of voice does require higher quality technologies, hence the usage of WiMAX: allows for long distance links, grants quality of service, etc. The problem being that there are few experiences with WiMAX in developing countries. On the other hand, WiMAX is more expensive and difficult to implement than WiFi. So, how to improve quality while making the whole system sustainable?
The proposal is to build a hybrid architecture that takes the best of WiFi and WiMAX: 802.11e EDCA in the access tier, and 802.19-2009 in the backhaul tier. Another optino being the usage of WiMAX Relay Mode (IEEE 802.16j), which is compatible with fixed WiMAX devices.
There are parallel projects that focus in transferring not only the technology but in training the end-user in their management and, actually, its improvement. A network management system is also being developed so that the project improves in self-management, autonomy and sustainability. This knowledge transfer — besides technology transfer — is made in partnerships with local institutions like governments and the local health care system.
There’s also an ongoing work with simulations that enable testing before final implementation.
Factors influencing the adoption of mobile phones among the farmer in Bangladesh: theories and practices
What is adoption? It is not diffusion, but the decision of a group or individual to make full use of an innovation. It is about the users deciding about how and when they will use a specific technology.
Research objectives: understand relevant theories and models of the technology adoption process, develop hypothetical model and test it, identify the adoption factors relating to other technology and mobiles inparticilar, and explain the factors pertinent to rural Bangladesh.
Relevant theories of technological adoption
- Diffusion of Innovation, Rogers (1995)
- Theory of Reasoned Action, Schiffman & Kanuk (2004)
- Theory of Planned Behaviour
- Technology acceptance model, Davis et al. (1989)
Factors of adoption of technology: age, gender, culture, income & household, occupation, education, agroecological…
Own model, specific for mobile phone adoption:
- facilitating conditions
- awareness, social influences
- demographic factors
- individual factors
- perceived ease of use
- tech-service attrributes
- perceived usefulness
- behavioural intentions
- actual use
The use of mobile phones in education: Evidence from two pilot projects in Bangladesh
Ahmed T. Rashid & Mizan Rahman
The second millennium development goal as a background: the importance of education in development. ICTs a key solution?
Why mobile phones? m-Learning attractive because mobile phones:
- Most ubiquitous
- Specially good “leapfrogger”
- Not juzt voice but data transfer
Theories of mobile learning:
- The role of mobile in improving access to education, the basis of distance education. Rural and remote areas where communication is barrier; mobility/portability breaks barriers of time and space; reduction of substitution cost (e.g. less travel); flexibility.
- The role of mobiles in promoting new learning, how mobile phones can transform education. Learner centred, because it is participatory, customizable; learning with understanding, accessing specific information; situated and constant learning that occurs outside classroom.
Investigate how mobile phones alone (no blended learning, though lab controlled) could be used to introduce interactivity, and copare it to face to face and sitance education with SMS enabled questions. Test outcomes similar, though some evidence of enthusiasm among.
Determine whether mobile phone supported distance education could serve as effective modality for teacher training. Findings indicate that there is very little evidence between study and control groups. Lack of English competency and technological problems being the main problems found. interaction between trainers and trainees which possibly facilitated new learning.
Conclusions are not conclusive. Mixed outcomes in terms of both facilitating access and promoting new learning, though there are signs that it could be possible.
Fourth Annual ICT4D Postgraduate Symposium (2009)
Notes from the PhD Dissertation defence by Francisco Lupiáñez entitled Internet, Salud y Sociedad: Análisis de los usos de Internet relacionados con la Salud en Catalunya (Internet, Health and Society: Analyses of the uses of the Internet related to Health in Catalonia), directed by Manuel Castells.
The research (partly) belongs to E-Health and Society: An Empirical Study of Catalonia, at its turn belonging to the Project Internet Catalonia (PIC).
Historically, the concepts of health, healthiness, public health, etc. lack of consensus. The scientific revolution brings a new approach to these concepts, secularizing the way it is dealt with drawing the biomedical model. But social sciences imply a disruption in the building of consensus and a separation from the usual biomedical model, relating it with society, the relationships of power, human structures, etc. Castells goes one step further stating that the informational paradigm, within the Information Society, brings in yet another change: how (specially) the Internet newly interrelates the different authors around the concept of Health.
The thesis wants to identify and characterize these authors and how and why they use the Internet to get informed and interact amongst them.
- The Internet is a space for information
- Decision taking determines the uses of the Internet for Health related issues
- A new profile arises between the health professionals: the networked health professional
Data come from surveys answered by patients, physicians, nurses and chemists.
(Complex) Information is simplified by factor analysis and cluster analysis.
Binomial logit regressions are used to find the determinants of Internet use for health related issues.
patients tend to browse the Internet to get information about their diseases or other health related issues, somewhat limited by the lack of personal infrastructures (hardware, connectivity, skills, etc.). This means that patients are empowered by the Internet to decide about their health based on better grounds. Those are the connected citizens. At the other end, we have the disconnected citizens, mainly due to their socio-economic background: income, education… The relationship (not the causality) between connected citizens, better health and higher socio-economic status is evident.
The Health digital divide excludes 40% of the total population.
Interaction does not happen: Internet is out of the equation in the physician-patient relationship.
Three types of Internet use: focus towards research, health information dissemination and institutional information.
The network physician: uses the Internet to get information and communicate with their peers, disseminate their research and spread information about their institutions. These are just 5% of the total physicians.
Networked physicians believe that the Internet is good for their patients, but only half of them encourage their patients in browsing the Internet.
Orientation towards research and intensive search and use of international information mostly determines a physician being or not being a networked physician.
The networked nurse follows a similar path than the networked physician: focus on research and lowest proportion in relation to the whole population of nurses (4.5%). As the physicians, networked nurses also believe that the Internet is good and empowers their patients.
Just like the prior professional profiles, the networked chemist is research and international information focused, and they also believe that the information in the Internet is good for their patients and has a positive impact on them being autonomous.
- Internet is a space for information, not interaction.
- The e-patient is determined by access to information and intensive use of the Internet to get information about health.
- The health e-professional is determined by orientation towards research and access to international information.
Future lines of research
- What are the determinants of innovation processes in the health system, including its impact on productivity.
- What are the determinants of the state of health in the framework of the Information Society
- What are the public policies to improve the health system in the framework of the Information Society,
- How the biomedical paradigm evolves within the framework of the Information Society
There is a lack of available data about the impact of the use of the Internet on the health of the patients. It is, undoubtedly, a future line of research.
The e-patient paradox: the networked patients are the ones — because they are healthier — that benefit less from e-Health.
The public health system tends to use the Internet to inform, while the private health system has a more intensive use of information technologies for management issues (e.g. e-invoicing), though not necessarily related with physician-patient — or interaction — focused applications.
While physicians see the Internet as a gate to access better information, they are also threatened by a potential use of authority in front of their patients. Thus why they are intensive Internet users, but only for information related issues, not for interaction with their patients. On the other hand, chemists have to ensure their customers’ loyalty, so they have more incentives to share information and open new channels of interaction with them, which might explain why they are more eager to encourage their customers/patients to enter the Internet.
It is very likely that both the methodology and the findings of this research can be applied into other economies that are in their transition towards the Information Society, provided their health and social systems are similar.
It seems there is a new health paradigm: the technoscientific health paradigm, where technology plays an important part along with health infrastructures (e.g. hospitals), culture, etc.
Internet does not replace — in the eyes of the patient — the professional: it’s complementary. Actually, patients are fully aware on who’s behind the information on the Internet, and asks for a professional backup of this information to consider it quality information. But the professionals don’t usually feel alike. A further research, indeed, should analyse the actual relationships of power between patients and professionals, and how these relationships change or can change due to the Internet and the information that it makes broadly available.
A technological layer, in combination with an evolving social layer, has enabled Health “getting out of the closet” and being present in all aspects of life, way beyond the walls of the hospital. This is new, and this issue should be addressed seriously in further research about society in general and Health especially.
It’s very difficult to define “quality” in the Internet, specially when speaking about websites about Health. Maybe, the focus should be not quality of the information, but the skills of the one that searches and accesses this information. Indeed, the concept of quality is closely related with the authors that issue and access the information, thus why the stress in capacity building, digital skills and, in general, digital literacy.
Internet is becoming not an exogenous, dependent variable of the Health system, but an endogenous, independent one that should be included in the equation of Health studies.
The e-patient, unlike the networked professionals, cluster around patient associations, engaging into interaction amongst them and not restricting themselves only to access to and use of information.
There are dire problems in most researchers about Internet uses: how to define the population, how to define the actual use, how to define authorship, how to define jurisdiction, etc. These problems make it difficult to state with statistical significance some findings that might be perfectly valid for the sample.
For a complete listing of references for the PhD Dissertation, please see The definitive references’ collection of my thesis.
NOTE: summa cum laude. Congats!!
Thesis defense: The Internet, Health and Network Society, by Francisco Lupiáñez-Villanueva.
Notes from the IPID ICT4D PG symposium 2008, Mekrijärvi Research Station, Joensuu University, Finland. 8 and 9 September, 2008.
What is IT Governance? Business support, IT risks, performance, delivery time, service cost, service quality, etc. Basically, business people have to be aligned with IT people.
A holistic approach covering the following areas of improvement:
- Effective coordination mechanisms
- Reasonable IT investment
Research question: how could IT Governance in the public sector in a developing country be streamlined in order to improve public services delivery? A framework for effective governance:
- ITG Context
- ITG Mechanisms
- ITG Key Decisions
- ITG Maturity
- ITG Problems & Consequences
Participatory action research approach to help health care workers to improve their work. “My Wellbeing” is an e-health tool (actually in conceptualization phase) for families and individuals to monitor their own health.
Challenges: how to know the user needs? how to know the best way to fit them?
Some approaches to conceptualize this “my wellbeing”
- Health services development
- Information needs assessment, information behaviour, information seeking behaviour, information practices
- Personal information management
Ugandan framework for ICT and Education
- ICt acquisition liberalization (1996)
- Rolling out a National Data Backbone
- Growth of the ICT Sector
- Integration of ICT into the curriculum of primary and secondary education
- Integration of ICT in teaching and research in Higher Education
- SchoolNet Uganda, Uganda Connect, Research Network of Uganda
BUT the reality is that there are ICT acceptance issues and limited utilization of ICTs for education: e-mail, LMS to upload notes, and powerpoint presentations to teach. Maybe due to limited access, maybe due to a lack of awareness in the educational framework.
Instead, there is a growing informal e-learning in Uganda: Internet, chats, e-content, mailing lists and chats… This informal e-learning should be exploited.
[this reminds me of Ivan Illich, Sugata Mitra and others about deschooling society and being confident about the ability of children to self-teach themselves when an appropriate framework is provided.]
- Need for active policies to spread ICTs in rural areas and the benefits of investing in agriculture.
- How does access to mobile technology influence the rural residents bargaining power in the market place?
- How do mobile technologies fulfil social functions in the marketing process? How are issues discussed including and beyond “pure” price negotiations?
Based on action research.
Third Annual ICT4D Postgraduate Symposium (2008)
Notes from the 4th Internet, Law and Politics Congress.
Government on the Web
A shift of paradigm in Government
Dunleavy, Margetts (2006) Digital Era Governance: the dominant paradigm of public governance reform (new public management) is dead. The digital-era governance is nigh… or just happening.
What happened during the New Public Management?
- Disaggregation, into tiny decentralized government and quasi-government agencies
- Competition within the daily tasks of government, its relationships with suppliers, outsourcing, financing, etc.
- Incentivization: via privatization, performance related pay, charging, etc.
What are we likely to see during the Digital-era governance?
- Reintegration, going the way back of atomization that the New Public Management achieved adn that showed not being always efficient
- Needs-based Holism, focusing on the client and client structures, including co-creation and co-production. This can lead to government doing less and citizens doing more.
- Digitalization, of documents, of deliveries, of processes, of communications, etc.
But things are happening slowly: e-government lags behind e-commerce, web-based provision still weak, low interaction at the G2B and G2C levels.
Government on the Web
While most government sites are roughly steady in the amount of visitors they have, Directgov, the global, cross-level, cross-government, portal for e-Government in the UK has a huge increase, which brings interesting reflections both about the successful strategies and also the related threats. Directgov, for instance, as an impressive amount of inbound links, even if outbound links are not much higher than other Government sites. Reasons are many, but an accuracy to define a profile and links from other countries and initiatives are two of the most important. On the other hand, Directgov is one of the smallest (in number of pages and documents) sites of all, being the tax agency and the education department on the other end. A correct strategy would be for these heavy sites to bring their content — or links — to Directgov, acting the latter as a hub and the former ones as the store.
Generally, the cross-government site got and retained more users looking for specific content (15 questions on a survey) than search engines.
- Sites are well rated and quality has improved, but the design and heavy-text makes can make them being near obsolete in the short run
- Despite the amount of money spent, more should be put in improving the existing information
- Centralization strategy seems to be working
Digital Era Governance
- Risk: adding up to the creation of a super-state that the New Public Management began
- Risk: setting up a chaotic, poorly designed, digital strategy that is built on the run
- Use of pervasive information
- De-coupling information analysis from control
- Customer orientation and segmentation
- Isocratic government: help citizens do it themselves
- Co-production: the government sets the frame, the citizen fills it
- Co-creation: government provides capacity or facility, citizens design own projects using it
- Peer production: government benefits from social production
- The change of the public management regime increases the autonomy of the citizen and the level of social problem-solving.
- If the government does not provide the information and services, people would find it anyway
- Rich information and content
- Highly specific “deep” search
- Giving information back to the users about their own use of the service
- Creating part-finished products
- Co-production leading to co-creation
- Customer segmentation
- Broadening the amount of stakeholders implied
- Para-organizations can blossom, where users are into front office
- Performance data freely available
- Managers can be customer oriented
- Direct voice for patients
- Co-production, co-creation
- Patient input replaces controls
Risks of remaining in e-Government 1.0
- Ignore young people
- Text-only communications is under-investment
- People go where they want to go
- Loss of visibility, loss of nodality for not being there
Me: Does Web 2.0 poses a threat to representative democracy? Why should I be engaged if it is really comfortable, efficient, to be represented? HM: Engagement has now less costs, and the impact of being engaged is now higher, so the net balance of engagement is much higher, as costs are lower and benefits are higher.
Eduard Aibar: What happens if all skills and human capital is placed at the private sector? where is the limit of outsourcing public services? HM: Is is a threat to the enforcement of the social contract. The Government has a need for public-private partnerships, but should leverage the learnings in its own benefit and also be aware of imbalances.
Eben Moglen: what happens with data security, citizen privacy, spending on privative software, etc.? What happens with the politics of public services? Maybe Google will always be superior to any e-strategy from the UK Government. HM: Incompetence adds to politics in this case, and sometimes personal agendas — Eben Moglen absolutely disagrees.
Mònica Vilasau: is the citizen more concerned about security or privacy when he addresses a government website than when he uses e-commerce? HM: Normally yet, people are more concerned of giving their data away to governments than to private services, maybe because they’re unaware of the benefits of the public service and the government (cleverly, responsibly) using their data.
Michael Jensen: Implications of the process of co-production and co-creation. HM: The citizenry are creating with their searches, with their comments… they are whatever they do. So the Government should not permit himself being set aside from this conversation.
Me: what’s the risk of mashups and websites run by para-governmental organizations? who’s liable for the quality of the information? who’s to assess its accuracy? HM: Of course there’s a risk, but if the Government is publishing the right, correct, needed, information for the citizen, good practices will be more than the bad ones. And these sites put pressure on the Government to issue its official and original information to the wide public in an easy, quick and accessible way. On the other hand, we should distinguish about websites with low level of identification with high level ones, where more “important” transactions take place.
Rosa Borge: What makes Directgov so different? How can these metrics be developed?. HM: Metrics were gathered by coding brand new free software for the research project. The big difference of Directgov it is that it was brand new in many ways, especially the concept. But its main problem is that it is really centralized, and that central office could not now everything about the UK Government. This is being corrected, and is shifting towards a more Web 2.0 approach.
David Osimo: Quite often we see “cool but useless” sites from governments, that are reluctant to give away their information or “power”. What to do about this? HM: There’s a need for a cultural change inside institutions, where they realize that they have to innovate in this area, and begin to listen, and aim towards (an unwanted) change.
4th Internet, Law and Politics Congress (2008)