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A photonic quantum information interface.

Quantum communication requires the transfer of quantum states, or quantum bits of information (qubits), from one place to another. From a fundamental perspective, this allows the distribution of entanglement and the demonstration of quantum non-locality over significant distances. Within the context of applications, quantum cryptography offers a provably secure way to establish a confidential key between distant partners. Photons represent the natural flying qubit carriers for quantum communication, and the presence of telecommunications optical fibres makes the wavelengths of 1,310 nm and 1,550 nm particularly suitable for distribution over long distances. However, qubits encoded into alkaline atoms that absorb and emit at wavelengths around 800 nm have been considered for the storage and processing of quantum information. Hence, future quantum information networks made of telecommunications channels and alkaline memories will require interfaces that enable qubit transfers between these useful wavelengths, while preserving quantum coherence and entanglement. Here we report a demonstration of qubit transfer between photons of wavelength 1,310 nm and 710 nm. The mechanism is a nonlinear up-conversion process, with a success probability of greater than 5 per cent. In the event of a successful qubit transfer, we observe strong two-photon interference between the 710 nm photon and a third photon at 1,550 nm, initially entangled with the 1,310 nm photon, although they never directly interacted. The corresponding fidelity is higher than 98 per cent.

Journal Article↗

Telemedicine in otolaryngology.

BACKGROUND: Telemedicine (TM) is the use of advanced information and communication technology to provide health care services. TM in general, and specifically in the field of otolaryngology, has become a reality. Because of the improvements in telecommunications and computer technology, TM applications are becoming more common in both hospitals and private practice. These applications are altering the manner in which otolaryngology is practiced both at the primary care and the specialist level. This study reviews and summarizes the use of TM specifically in otolaryngology, and discusses some of its advantages, barriers, and future. MATERIAL AND METHODS: A review of the current literature pertaining to the use of TM applications in otolaryngology-head and neck surgery was performed. RESULTS: TM applications are being developed and used worldwide in the many fields of otolaryngology. As telecommunication and audio-visual technologies advance, these applications become more exacting and cost effective. CONCLUSION: We encourage the otolaryngologist to understand the technical, legal, ethical, and financial impact of TM on managed care in otolaryngology and to make use of the potential opportunities of TM in otolaryngology-head and neck surgery.

Otolaryngology↗

Biofeedback using telemedicine: clinical applications and case illustrations.

Telecommunications technology is dramatically changing our world, allowing healthcare professionals to offer medical healthcare, in the form of consultation, assessment, and treatment, through the use of new communications media. In behavioral medicine, advances in telecommunications have brought about new ways of offering services by expanding healthcare to patients located all over the world and simultaneously reducing costs and improving outcome efficacy. This article describes the use of biofeedback to treat various pain and psychophysiological disorders through telemedicine technology. The authors provide a description of "off-the-shelf," low-cost, and low-bandwidth telemedicine equipment used to deliver clinical biofeedback treatment when the patient and provider are in two different locations. In addition, the authors discuss practical issues of behavioral telehealth.

Adult↗

Directed use of the Cincinnati Prehospital Stroke Scale by laypersons.

BACKGROUND: The Cincinnati Prehospital Stroke Scale (CPSS) is a three-item examination that has been effective in the identification of stroke victims by health care professionals. However, assessment of the patient earlier in the chain of care, specifically by a 9-1-1 telecommunicator, may improve stroke outcomes. OBJECTIVES: To modify the CPSS for over-the-phone administration and to assess whether untrained adults can follow the CPSS instructions, identify deficits in stroke survivors, and return these findings to an investigator. METHODS: One hundred nonpatient visitors to an academic tertiary care emergency department were recruited. Each participant was brought to a room with a stroke survivor possessing unresolved symptoms from a previous stroke. The participant was telephoned by an investigator and led through administering the CPSS to the stroke survivor. The investigator noted whether the participant accurately administered CPSS instructions and whether normal or abnormal findings were returned. RESULTS: Participants correctly administered CPSS directions 98% of the time. For facial weakness, the sensitivity of the participants' assessments was 74% and the specificity was 94%. For arm weakness, the sensitivity was 97% and the specificity was 72%. For speech deficits, the sensitivity was 96% and the specificity was 96%. CONCLUSIONS: Untrained adults can use the CPSS to accurately identify stroke symptoms and can relay these findings to an investigator. Telecommunicator administration of the CPSS may allow for expedited prehospital triage of the stroke patient and delivery of resources in a timely manner and, given the limited time window for efficacious treatment, may lead to improved patient outcome.

Emergency Medical Service Communication Systems↗

Social presence in a home tele-application.

The current paper presents a study on the subjective evaluation of an advanced telecommunication platform aimed at informal home use, called the PhotoShare tele-application. This platform enables users to view photos (e.g., family or holiday snapshots) together, while the presenter and the viewer are at different, remote locations. The platform includes a common viewing space where the photos are displayed and selected, as well as an audio connection and a large-screen video connection for communication between the remote sites. The study investigated the effects of videocommunication on social presence. In addition, the ability to point at a picture with an electronic pointer was evaluated. In the context of presence research, the current study also provided information regarding the validity of the IPO Social Presence Questionnaire (IPO-SPQ), which was specifically designed to investigate social presence with telecommunication applications. The results indicated that adding broadband, life-size video communication significantly increased social presence. In addition, we found a significant effect of sex on social presence: women gave substantially higher social presence ratings than men. The absence of a significant effect of the pointing function indicated that extensive workspace functionality may be of minor importance to the user's feeling of social presence.

Adolescent↗

Licensing telemedicine: the need for a national system.

The expansion of information technology has shattered geographic boundaries, allowing for extraordinarily increased access to health information and expanded opportunities for telemedicine practice across state boundaries. But despite its recent growth, telemedicine technology remains embedded in a state-based licensure system that places severe limits on its expansion. The current system of medical licensure is based primarily on statutes written at the turn of the 20th century. This system is inadequate to address the emerging medical practices and future uses of medical technology in the telecommunications age. To respond to the changes offered by the telecommunications revolution, we need to design a new regulatory structure for the 21st century. The purpose of this article is to propose a policy of national telemedicine licensure. The primary goal here is not to simply develop a policy proposal, but to discuss the rationale for national licensure and place it on the policy agenda. A national licensure system will expand the market for telemedicine, promote both the use and development of new technologies, and simultaneously eliminate many of the legal and regulatory ambiguities that plague and constrain the present system.

Confidentiality↗

Intelligent biomedical clothing for personal health and disease management: state of the art and future vision.

Telemedicine has been introduced to overcome distance in order to get prompt access to medical knowledge and appropriate health care. More recently, work in telemedicine has aimed at developing solutions to support the management of chronic diseases such as diabetes, and lung and heart diseases, as well as to provide support for home care services. Telemedicine is also entering the fields of health promotion/prevention disease, life style management, and well-being. The evolution and broadening of telemedicine gives birth to a nomenclature that includes "e-health," "telehealth," and "telecare." The latest developments in microsystems and nanotechnologies as well as in information processing and communication technologies allow miniaturization and non-invasive smart monitoring of physiological and physical data. Ongoing cutting-edge multidisciplinary research in textile fibers, biomedical sensors, and wireless and mobile telecommunications integrated with telemedicine, aims at developing intelligent biomedical clothing (IBC) that could pave the way to support personalized management of health and diseases at the point of need and at any time. In this study, we aim to describe the current status of multidisciplinary research and development of IBC, based on bibliographic research and reports from seminars, workshops, conferences, and working groups. A further aim is to inform the developers, the decision makers, and users in the health and healthcare sector regarding future solutions to support personalized health care and disease management. Both the textile sector and healthcare sector are looking with great interest at the innovative products and applications that could result from the integration of microsystems, nanotechnologies, biomedical sensors, textiles, and mobile telecommunications. For health monitoring, disease prevention and management, rehabilitation, and sport medicine, IBC may offer, in the mid-term future, a unique, wearable non-obtrusive telemedicine platform for individualized services that is readily accessible and of good quality.

Biomedical Technology↗

The Ottawa telehealth project.

OBJECTIVE: To examine the telehealth system as a means of improving access to cardiac consultations and specialized health services in remote areas of Ontario. METHODS: The University of Ottawa Heart Institute has set up a telehealth test program, Healthcare and Education Access for Remote Residents by Telecommunications (HEARRT), in collaboration with industry and the provincial and federal government, as well as several remote clinical test sites. The program makes off-site cardiology consultations possible. History taking and physical examinations are conducted by video and electronic stethoscope. Laboratory results and echocardiograms are transmitted by document camera and VCR. The technology is being tested in both stable outpatient and emergency situations. Various telecommunications bandwidths and encoding systems are being evaluated, including satellite and terrestrial-based asynchronous transfer-mode circuits. Patient satisfaction and cost-effectiveness are also being assessed. RESULTS: Bandwidths from as low as 384 kbps using H.320 encoders to 40 Mbps using digital transport of NTSC video signals have been evaluated. Although lower bandwidths are sufficient for sending echocardiographic and electrocardiogram data, bandwidths with transport speeds of 4 to 6 Mbps appear necessary to capture the nuances of the cardiac physical examination. A preliminary satisfaction survey of 19 patients noted that all felt that they could communicate effectively with the cardiologist by video, and each had confidence in the advice offered. None reported that he or she would rather have traveled to the doctor in person. Initial and projected examination of the costs suggested that telehealth will effectively reduce overall health care spending while decreasing travel expenses for rural patients. CONCLUSION: Telehealth technology is sufficiently sophisticated to allow off-site cardiology assessments. Preliminary results suggest there is a sound business case for the implementation of telehealth technology to meet the needs of remote residents in northern Ontario. Working closely with government and industry, we will develop a marketing and commercialization plan to support the use of this technology throughout Ontario and expand application to patient education and continuing medical education.

Cardiology↗

Rural telemedicine infrastructure and services in the Department of Cauca, Colombia.

The development of telemedicine programs for the public health network of the Department of Cauca, Colombia, (Department is the major political and territorial division of the country. The Department of Cauca is located on the Pacific coast in the southwest of the country.) would make it possible to satisfy many identified needs such as medical coordination, continuing education, epidemiologic surveillance, patient referral and counterreferral, and an end to the feeling of isolation among professionals who work in rural health centers. Nevertheless, geographic, economic, and social difficulties, and the lack of a telecommunication infrastructure in areas with these characteristics present a challenge of such magnitude that the majority of existing telemedicine projects in Colombia have been centered in urban or other areas which present fewer difficulties. In the municipality of Silvia, the University of Cauca has established a prototype network using the "Hispano-American Health Link" (EHAS in Spanish) program technologies, which uses very high frequency (VHF) and wireless fidelity, (WiFi, a set of standards for wireless local area networks) radio systems for the deployment of low-cost voice and data networks. Over this network information access and exchange services have been developed, in order to meet the needs identified above. The objectives were to obtain information about the development of the project's activities and their possible impact. Project telecommunication network and information services are described, and the results and conclusions of the first evaluation are presented.

Colombia↗

An initial trial of a prototype telepathology system featuring static imaging with discrete control of the remote microscope.

Routine diagnosis of pathology images transmitted over telecommunications lines remains an elusive goal. Part of the resistance stems from the difficulty of enabling image selection by the remote pathologist. To address this problem, a telepathology microscope system (TelePath, TeleMedicine Solutions, Birmingham, Ala) that has features associated with static and dynamic imaging systems was constructed. Features of the system include near real time image transmission, provision of a tiled overview image, free choice of any fields at any desired optical magnification, and automated tracking of the pathologist's image selection. All commands and images are discrete, avoiding many inherent problems of full motion video and continuous remote control. A set of 64 slides was reviewed by 3 pathologists in a simulated frozen section environment. Each pathologist provided diagnoses for all 64 slides, as well as qualitative information about the system. Thirty-one of 192 diagnoses disagreed with the reference diagnosis that had been reached before the trial began. Qf the 31, 13 were deferrals and 12 were diagnoses of cases that had a deferral as the reference diagnosis. In 6 cases, the diagnosis disagreed with the reference diagnosis yielding an overall accuracy of 96.9%. Confidence levels in the diagnoses were high. This trial suggests that this system provides high-quality anatomic pathology services, including intraoperative diagnoses, over telecommunications lines.

Diagnostic Imaging↗

Monitoring and telemedicine support in remote environments and in human space flight.

The common features of remote environments are geographical separation, logistic problems with health care delivery and with patient retrieval, extreme natural conditions, artificial environment, or combination of all. The exposure can have adverse effects on patients' physiology, on care providers' performance and on hardware functionality. The time to definite treatment may vary between hours as in orbital space flight, days for remote exploratory camp, weeks for polar bases and months to years for interplanetary exploration. The generic system architecture, used in any telematic support, consists of data acquisition, data-processing and storage, telecommunications links, decision-making facilities and the means of command execution. At the present level of technology, a simple data transfer and two-way voice communication could be established from any place on the earth, but the current use of mobile communication technologies for telemedicine applications is still low, either for logistic, economic and political reasons, or because of limited knowledge about the available technology and procedures. Criteria for selection of portable telemedicine terminals in remote terrestrial places, characteristics of currently available mobile telecommunication systems, and the concept of integrated monitoring of physiological and environmental parameters are mentioned in the first section of this paper. The second part describes some aspects of emergency medical support in human orbital spaceflight, the limits of telemedicine support in near-Earth space environment and mentions some open issues related to long-term exploratory missions beyond the low Earth orbit.

Humans↗

UMTS signal measurements with digital spectrum analysers.

The launch of the Universal Mobile Telecommunications System (UMTS), the most recent mobile telecommunications standard has imposed the requirement of updating measurement instrumentation and methodologies. In order to define the most reliable measurement procedure, which is aimed at assessing the exposure to electromagnetic fields, modern spectrum analysers' features for correct signal characterisation has been reviewed.

Cell Phone↗

Transcontinental robot-assisted remote telesurgery: feasibility and potential applications.

OBJECTIVE: To show the feasibility of performing surgery across transoceanic distances by using dedicated asynchronous transfer mode (ATM) telecommunication technology. SUMMARY BACKGROUND DATA: Technical limitations and the issue of time delay for transmission of digitized information across existing telecommunication lines had been a source of concern about the feasibility of performing a complete surgical procedure from remote distances. METHODS: To verify the feasibility and safety in humans, the authors attempted remote robot-assisted laparoscopic cholecystectomy on a 68-year-old woman with a history of abdominal pain and cholelithiasis. Surgeons were in New York and the patient in Strasbourg. Connections between the sites were done with a high-speed terrestrial network (ATM service). RESULTS: The operation was carried out successfully in 54 minutes without difficulty or complications. Despite a round-trip distance of more than 14,000 km, the mean time lag for transmission during the procedure was 155 ms. The surgeons perceived the procedure as safe and the overall system as perfectly reliable. The postoperative course was uneventful and the patient returned to normal activities within 2 weeks after surgery. CONCLUSIONS: Remote robot-assisted surgery appears feasible and safe. Teletransmission of active surgical manipulations has the potential to ensure availability of surgical expertise in remote locations for difficult or rare operations, and to improve surgical training worldwide.

Aged↗

Tunable all-optical delays via Brillouin slow light in an optical fiber.

We demonstrate a technique for generating tunable all-optical delays in room temperature single-mode optical fibers at telecommunication wavelengths using the stimulated Brillouin scattering process. This technique makes use of the rapid variation of the refractive index that occurs in the vicinity of the Brillouin gain feature. The wavelength at which the induced delay occurs is broadly tunable by controlling the wavelength of the laser pumping the process, and the magnitude of the delay can be tuned continuously by as much as 25 ns by adjusting the intensity of the pump field. The technique can be applied to pulses as short as 15 ns. This scheme represents an important first step towards implementing slow-light techniques for various applications including buffering in telecommunication systems.

Journal Article↗

OTE-TS--a new value-added telematics service for telemedicine applications.

A new telemedicine service denoted as the Hellenic Telecommunication Organization Telemedicine Service (OTE-TS), which addresses an open multidisciplinary group of medical care providers (users), is presented in this paper. OTE-TS is supported by the Hellenic Telecommunication Organization (OTE) and is the result of the close collaboration of engineers, medical doctors, and market analysts. Its architecture provides the user with an integrated electronic working domain handling diverse types of conversational audiovisual information and medical records. It includes a stack of functions, protocols, and interfaces for data acquisition, processing, and display, and for the composition of dial-up multiparty cooperation schemes (synchronous or asynchronous), suitable for the coordination and management of high-level consult, report, and review activities. The service provider (i.e., the OTE) performs the central administration and maintenance of the service, as well as the management of medical cases and reports that are exchanged among the users. The service has been extensively tested in real-world conditions.

Computer Graphics↗

Multiperiod cellular network design via price-influenced simulated annealing (PISA).

Cellular telecommunications systems tend to be more flexible than traditional ones. As a result, traditional approaches to telecommunications network design are often inappropriate for the design of cellular networks, and approaches that explicitly incorporate the increased flexibility into the design process need to be developed. This paper presents one such multiperiod cellular network design problem and solves it via a hybrid heuristic that incorporates ideas from linear programming (LP) and simulated annealing (SA). Extensive computational results comparing the performance of the heuristic with the lower bound obtained from the LP relaxation are presented. These results indicate that this price-influenced simulated annealing (PISA) procedure is extremely efficient, consistently providing solutions with average gaps of 0.30% or less in fewer than 30 s.

Cell Phone↗

The use of freeze frame (slow scan) video for health professional education.

Continuing education in the professions is receiving increased emphasis and the economic and effective delivery of programmes must be a priority for the future. Freeze frame video, one of the newer telecommunication technologies, is a promising method for delivering continuing medical education (CME) over distance for those who have difficulty in regularly attending educational update programmes, especially for those in rural and isolated areas. The system uses two telephone lines to transmit both voice and a still picture simultaneously to one or several sites. The video portion can be a view of the patient, text, 35-mm slides, microscopic slides, or any other still object. Five years' experience with a slow-scan system as used for education is outlined. Three types of programme formats were all presented with this technology; consultations; discussion/case presentations; and lectures. The best use of the system was for small groups, with discussion of their unique problems. The fully interactive nature of the slow-scan system assisted in the presentations and allowed all sites in multisite conferences to be fully involved. Because most teachers are not familiar with the technology in their everyday life it requires more orientation and experience to accomplish a skilled programme than with other telecommunication systems such as the telephone or television.

Community Health Workers↗

Current status of telepathology.

Telepathology is moving from the experimental stage to become a regular feature of pathology practice. This has been made possible by technical advances in telecommunications and image processing. Since 1990 the University Hospital of Tromsø has provided local hospitals in northern Norway with a remote frozen section service and with access to video conferences for the review of microscopic findings and for the discussion of major diagnostic issues. Several other hospitals in Norway are now participating in this development and practical relations among pathology laboratories for the purpose of consultation and education will be the next step in the procedure. Similar developments in telepathology have taken place in other countries. Standardization of network and telepathology workstations will be needed before extensive international collaboration can be achieved. Progress in high quality video devices, high capacity telecommunication lines and improved image compression techniques will increase the usage of telepathology services and make them cost-effective. Thus, telepathology will contribute to the development of pathology services in the next century.

False Negative Reactions↗