A generalized equation for the calculation of receptor noise limited colour distances in n-chromatic visual systems.

Researchers must assess similarities and differences in colour from an animal's eye view when investigating hypotheses in ecology, evolution and behaviour. Nervous systems generate colour perceptions by comparing the responses of different spectral classes of photoreceptor through colour opponent mechanisms, and the performance of these mechanisms is limited by photoreceptor noise. Accordingly, the receptor noise limited (RNL) colour distance model of Vorobyev and Osorio (Vorobyev & Osorio 1998 Proc. R. Soc. Lond. B265, 351-358 (doi:10.1098/rspb.1998.0302)) generates predictions about the discriminability of colours that agree with behavioural data, and consequently it has found wide application in studies of animal colour vision. Vorobyev and Osorio (1998) provide equations to calculate RNL colour distances for animals with di-, tri- and tetrachromatic vision, which is adequate for many species. However, researchers may sometimes wish to compute RNL colour distances for potentially more complex colour visual systems. Thus, we derive a simple, single formula for the computation of RNL distance between two measurements of colour, equivalent to the published di-, tri- and tetrachromatic equations of Vorobyev and Osorio (1998), and valid for colour visual systems with any number of types of noisy photoreceptors. This formula will allow the easy application of this important colour visual model across the fields of ecology, evolution and behaviour.

Anthropometric characteristics and obesity among adolescents in the United Arab Emirates.

Anthropometric measurements and the prevalence of overweight and obesity were studied in 661 adolescents aged 12-17 years from Dubai, United Arab Emirates. Mean values for height and weight increased steadily with age in both sexes. Mean values for waist circumference ranged from 70.8-76.6 cm in males and 64.0-68.8 cm in females. Hip circumference varied from 84.8-91.2 cm in males and 84.9-91.2 cm in females. Body mass index was generally higher in males than in females (range 21.9-23.6 kg/m2 and 19.8-24.1 kg/m2 respectively). The overall prevalence of overweight and obesity was 19.3% and 21.6% in males and 12.3% and 19.5% in females. This study confirms the high incidence of overweight and obesity in Dubai adolescents.

Anthropometric characteristics and obesity among adolescents in the United Arab Emirates

Anthropometric measurements and the prevalence of overweight and obesity were studied in 661 adolescents aged 12-17 years from Dubai, United Arab Emirates. Mean values for height and weight increased steadily with age in both sexes. Mean values for waist circumference ranged from 70.8-76.6 cm in males and 64.0-68.8 cm in females. Hip circumference varied from 84.8-91.2 cm in males and 84.9-91.2 cm in females. Body mass index was generally higher in males than in females [range 21.9-23.6 kg/m[2] and 19.8-24.1 kg/rn[2] respectively]. The overall prevalence of overweight and obesity was 19.3% and 21.6% in males and 12.3% and 19.5% in females. This study confirms the high incidence of overweight and obesity in Dubai adolescents

TELEMAM: a cluster randomised trial to assess the use of telemedicine in multi-disciplinary breast cancer decision making.

AIM: The TELEMAM trial aimed to assess the clinical effectiveness and costs of telemedicine in conducting breast cancer multi-disciplinary meetings (MDTs). METHODS: Over 12 months 473 MDT patient discussions in two district general hospitals (DGHs) were cluster randomised (2:1) to the intervention of telemedicine linkage to breast specialists in a cancer centre or to the control group of 'in-person' meetings. Primary endpoints were clinical effectiveness and costs. Economic analysis was based on a cost-minimisation approach. RESULTS: Levels of agreement of MDT members on a scale from 1 to 5 were high and similar in both the telemedicine and standard meetings for decision sharing (4.04 versus 4.17), consensus (4.06 versus 4.20) and confidence in the decision (4.16 versus 4.07). The threshold at which the telemedicine meetings became cheaper than standard MDTs was approximately 40 meetings per year. CONCLUSION: Telemedicine delivered breast cancer multi-disciplinary meetings have similar clinical effectiveness to standard 'in-person' meetings.

A comprehensive approach for evaluating telemedicine-delivered multidisciplinary breast cancer meetings in southern Scotland.

Multidisciplinary team (MDT) meetings for decisions on cancer management are a cornerstone of UK cancer policy. We have proposed a comprehensive methodology to assess the clinical and economic effectiveness of telemedicine in this setting, which is being tested in a randomized breast cancer trial. Pre- and post-telemedicine assessment includes attitudes to and expectations of telemedicine, based on semistructured interviews. The communication content of videotapes of the MDT meeting is being scored using Borgatta's revised Interaction Process Analysis System. The technical performance of the telemedicine equipment is reported on a standardized pro forma. A short questionnaire captures key elements of professional satisfaction for each patient discussion (consensus on future management, confidence in and sharing of decision), added value of linkage, group atmosphere, overall conduct of the meeting and compliance with SIGN guidelines. A cost-minimization analysis will be used for economic assessment.

Experience-based guidelines for the implementation of telemedicine services.

Many telemedicine projects fail to survive beyond the funded research phase. A review of seven Scottish telemedicine services was conducted to identify successes and failures. Qualitative interviews were conducted with key individuals in each project. All projects were partly successful. The main reasons associated with partial failure were: the service was not needs-driven; there was no commitment to provide the service; there was no suitable exit strategy after research funding expired; there was poor communication; there was a lack of training; there were technical problems; work practices were not updated; the protocols for use were poor or non-existent. Based on this, guidelines that might improve the chances of success in future projects were drawn up.

Attitudes of breast cancer professionals to conventional and telemedicine-delivered multidisciplinary breast meetings.

We surveyed the attitudes of breast cancer professionals to standard face-to-face and future telemedicine-delivered breast multidisciplinary team (MDT) meetings. Interviews, which included the Group Behaviour Inventory, were conducted face-to-face (n = 19) or by telephone (n = 26). The mean total score on the Group Behaviour Inventory was 96 (SD 19) for 33 respondents, which indicated satisfaction with standard MDT meetings, irrespective of role and base hospital. Positive attitudes to videoconferencing were more common among participants with previous experience of telemedicine (Spearman's rank correlation 0.26, P = 0.91). Common themes emerging from the interviews about telemedicine-delivered MDTs included group leadership, meeting efficiency, group interaction, group atmosphere and technical quality of communication. Most participants were satisfied with standard breast MDTs. Nurses and allied health professionals were least supportive of telemedicine.

Evaluation of an accident and emergency teleconsultation service for north-east Scotland.

We evaluated an accident and emergency teleconsultation service provided to 14 community hospitals in north-east Scotland. Each community hospital was equipped with a videoconferencing system and a document camera to allow transmission of radiographs. The network used 384 kbit/s ISDN connections. A total of 1392 teleconsultations were recorded during a 12-month study period. Seventy-seven per cent of patients (n = 1072) were managed locally and 23% (n = 320) were transferred to Aberdeen. The majority (95%) of teleconsultations were conducted on weekdays, and 90% of these occurred between the hours of 09:00 and 16:00. The mean delay in contacting a doctor was 9 min and the mean consultation time was 10 min. The majority of patients were suffering from fractures or suspected fractures of the limbs. Radiograph transmission was used in 75% of all teleconsultations. A high degree of satisfaction was recorded by all users of the service.

The importance of setting and evaluating standards of telemedicine training.

The importance of appropriate training in the use of videoconferencing equipment for clinical purposes is often underestimated when telemedicine projects are established. We developed a user training programme which was delivered via videoconferencing to a group of 130 nurses. Training was delivered on a one-to-one basis. A questionnaire was developed to evaluate user satisfaction and the effectiveness of training. One hundred and two fully completed questionnaires were returned (a 79% response rate). High levels of satisfaction were obtained but the level of user competence reached 100% only when training was supported by a training manual and at least weekly practice. Before establishing a telemedicine service, the following steps appear to be important: identify the required training competencies; deliver a 'hands on' training programme based on the required training competencies; back up the training programme with an instruction booklet; ensure that trainees have at least weekly practice; measure the level of user competence.

Study of mortality risk factors for children under age 5 in Abu Dhabi.

We investigated the association of biological, sociocultural and economic risk factors with child mortality in Abu Dhabi from 1 January-31 December 1997. With McNemar chi-squared test, most selected biological risk factors were statistically associated with child mortality, although maternal age older than 40 years and history of fetal death were not positively correlated with neonate, infant or age under 5 mortality. Among sociocultural and economic risk factors, maternal lack of formal education and low monthly income were significantly associated with child death. Consanguinity was significantly associated with under 5 and infant but not neonatal mortality. Gestation <37 weeks was highly associated with mortality among all ages. Strengthening health care programmes and emphasizing the need to identify high risk groups should be priorities.

Study of mortality risk factors for children under age 5 in Abu Dhabi

We investigated the association of biological, sociocultural and economic risk factors with child mortality in Abu Dhabi from 1 January-31 December 1997. With McNemar chi-squared test, most selected biological risk factors were statistically associated with child mortality, although maternal age older than 40 years and history of fetal death were not positively correlated with neonate, infant or age under 5 mortality. Among sociocultural and economic risk factors, maternal lack of formal education and low monthly income were significantly associated with child death. Consanguinity was significantly associated with under 5 and infant but not neonatal mortality. Gestation <37 weeks was highly associated with mortality among all ages. Strengthening health care programmes and emphasizing the need to identify high risk groups should be priorities

Evaluation of a pilot telemedicine network for accident and emergency work.

A pilot accident and emergency teleconsulting service was established in Scotland. It was based at the accident and emergency department of the main hospital in Aberdeen. There were three peripheral sites in rural Grampian (Peterhead, Turriff and Huntly) and one in the Shetland Isles. The videoconferencing equipment used was connected by ISDN at 384 kbit/s. During the 15 months of the study, 1998 videoconference calls were made, of which 402 (20%) calls were made to the accident and emergency department for clinical consultations. The majority of the clinical calls (95%) were made between 09:00 and 17:00, and more than 90% were completed within 20 min. During the majority of calls (87%) one or more X-ray images were transmitted. The majority of patients (89%) received treatment without transportation to the main centre in Aberdeen. The present study demonstrated that accident and emergency teleconsultations can be technically reliable, effective in reducing the number of patient transfers and acceptable to the referring clinicians. As a result, approximately 1.5 million has been made available by the government to develop a national system for Scotland.

The development of a pilot telemedicine network in Scotland: lessons learned.

A pilot telemedicine network was established in 11 sites using funding provided by the Department of Trade and Industry in the UK. The main purpose of the project was to develop and evaluate clinical and educational links between central and peripheral sites in Scotland. The results were very encouraging, and clinical services were established in accident and emergency medicine, tele-ultrasound and clinical psychology. An undergraduate medical teaching service was also successfully established. All of these services are to be continued after the completion of the project. Many lessons were learned during the establishment of this network which will be useful in future projects. These included the importance of training for telemedicine users, the importance of identifying a telemedicine champion, the pitfall of health economics and the fact that services must be needs driven.

Implementation and evaluation of telemedicine for remote health-care--the European Northern Periphery Programme Project.

We evaluated the provision of telemedicine services based on information technology in four northern European countries. Improved communication and access to specialist care was reported, as well as cost reductions in certain areas.

Asthma diagnosis and management in adults: is the risk of underdiagnosis and undertreatment related to patients' education levels?

To determine the relationship between patient education and the risk of underdiagnosis and undertreatment of asthma, a cross-sectional study of 500 (250 males and 250 females) adult attendees between 16 and 44 years of age was undertaken at five primary health care (PHC) centers in Al-Ain, United Arab Emirates. We used an Arabic translation of the European Community Respiratory Health Survey Screening Questionnaire. Asthmatics with higher levels of education had a significantly higher risk of underdiagnosis and undertreatment than asthmatics with less education. Doctors at PHC centers railed to diagnose 34.6% of the asthmatics with lower levels of education and 77.6% of the patients with higher levels of education. Eighty-five percent of the asthmatics with lower levels of education and 46.6% of the asthmatics with higher levels of education recognized that they had asthma. Thirty-eight percent of the asthmatics with lower levels of education and 83% of the asthmatics with higher levels of education were undertreated. It was found that 19% of the asthmatics with lower levels of education and 3% of the asthmatics with higher level of education were on prophylactic medication for asthma. We concluded that education level was related to underdiagnosis and undertreatment of asthma among adults between 16 and 44 years of age. People with higher levels of education have a higher risk of underdiagnosis and undertreatment than do those with lower levels of education. The factors that might be associated with these findings need to be explored in further studies.

Asthma and respiratory symptoms among school children in United Arab Emirates.

OBJECTIVES: To determine the prevalence of asthma, wheezing, hay fever, and eczema among primary school children aged 6-13 years in United Arab Emirates (UAE). DESIGN: A cross-sectional study on school children was performed using the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaires. SETTING: Government primary school children in seven Emirates, in UAE. SUBJECTS: Subjects were selected by a multi-stage stratified sampling design. 4200 children targeted for this study, but only 3200 children aged 6-13 years were agreed to participate and responded to the study. The overall response rate was 69.8%. RESULTS: The prevalence of physician diagnosed asthma was 13%, in addition, the wheeze by history was 15.6%. Furthermore, the prevalence of nocturnal cough was 21%. On the other hand, the prevalence of eczema was 11% and hay fever was 14.9%. Parental asthma but not parental atopy was associated with an increased risk of asthma and wheezing in children. CONCLUSIONS: The prevalence of asthma and wheezing in UAE is consistent with that in neighbouring Gulf countries.

The diagnostic acceptability of low-bandwidth transmission for tele-ultrasound.

Ultrasound recordings were made of 100 consecutive patients attending for obstetric examination in Peterhead and 100 patients attending for non-obstetric examination in Aberdeen. Two identical video-conferencing machines were used to transmit and receive the original ultrasound images at data rates of 384 kbit/s and 128 kbit/s, thus producing a total of three tapes for each case. Four experienced observers, who were blinded to the transmission bandwidth, each viewed 300 examinations and decided whether the images were acceptable or not for diagnosis. Almost 100% of the obstetric ultrasound images on the original recordings were considered diagnostically acceptable, compared with 93% of the 384 kbit/s transmissions and 44% of the 128 kbit/s transmissions. Similarly, 99% of the non-obstetric ultrasound images were considered acceptable, compared with 87% of the 384 kbit/s transmissions and 21% of the 128 kbit/s transmissions. For the obstetric ultrasound images the intra-observer diagnostic agreement was 93% (kappa = 0.89) between the original and the 384 kbit/s transmissions, and 78% (kappa = 0.63) between the original and the 128 kbit/s transmissions. For the non-obstetric ultrasound images the respective intra-observer diagnostic agreements were 77% (kappa = 0.62) and 78% (kappa = 0.63). The quality of dynamic ultrasound images transmitted at 384 kbit/s was diagnostically acceptable, but was unsatisfactory at 128 kbit/s.

Fabrication of long-period optical fiber gratings by use of ion implantation.

We report the fabrication of long-period optical fiber gratings by use of a refractive-index increase induced by ion implantation. Helium ions were implanted in an optical fiber core through a metal mask that had a 170-microm -pitch grating with spacing of 60 microm . We obtained a wavelength-dependent effective transmission loss by use of the grating.

Low-bandwidth tele-ultrasound.

We examined the acceptability and diagnostic accuracy of dynamic ultrasound images transmitted at 128 kbit/s and 384 kbit/s. The gold standard was the direct recording of 200 ultrasound examinations on video-tape. The taped images were later transmitted at both 128 kbit/s and 384 kbit/s and recorded, resulting in three tapes for each case. Four observers viewed each tape individually. Ninety per cent of images transmitted at 384 kbit/s were rated as diagnostically acceptable compared with 32% of images transmitted at 128 kbit/s. Diagnostic agreement between tapes transmitted at 384 kbit/s and the gold standard was 85%, compared with 78% for 128 kbit/s transmissions. Observers were not satisfied with low-bandwidth transmission of ultrasound images despite adequate diagnostic accuracy. Dynamic ultrasound images transmitted at 384 kbit/s were viewed as both diagnostically acceptable and accurate.

Efficacy of a single dose of oral antibiotic given within two hours of birth in preventing watery mouth disease and illthrift in colostrum-deficient lambs.

An antibiotic with a product licence limited to the treatment and control of infectious bacterial enteritis associated with Escherichia coli in piglets was tested for its ability to control watery mouth disease in neonatal lambs. Three groups of lambs were kept in conditions commonly encountered in intensive lambing systems, where high levels of environmental bacterial contamination may be expected. They were allocated at birth to: a control group (group 1) consisting of 18 colostrum-deprived lambs; group 2, consisting of 17 lambs given one feed of colostrum when they were two hours old; and group 3, consisting of 18 colostrum-deprived lambs given spectinomycin orally when they were two hours old. Nine group 1 lambs became diseased and were killed for humane reasons. Blood biochemical changes included hyperglycaemia followed by hypoglycaemia, lactacidaemia, hypoproteinaemia and metabolic acidosis, and postmortem examination of the diseased lambs showed signs consistent with endotoxaemia and a clinical diagnosis of watery mouth disease. Coliforms were isolated from the blood of all group 1 lambs and from half the lambs in groups 2 and 3, but endotoxaemia and watery mouth disease occurred only in group 1 lambs. The results for groups 2 and 3 showed that neither colostrum nor antibiotic at the rates and frequency used prevented bacteraemia, although consecutive samples were positive only on three occasions. Group 3 lambs consistently grew more rapidly than the surviving group 1 lambs and as rapidly as group 2 lambs. There was no evidence that male lambs were more prone to watery mouth disease than female lambs. The results indicated that the antibiotic spectinomycin did not induce endotoxaemia during low-grade bacteraemia and that a single oral dose given within two hours of birth protected colostrum-deprived lambs delivered into a contaminated indoor environment against watery mouth disease.