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This study presents financial network indicators that can be applied to inspect the financial contagion on real economy, as well as the spatial spillover and industry aggregation effects. We propose to design both a directed and undirected networks of financial sectors of top 20 countries in GDP based on symbolized transfer entropy and Pearson correlation coefficients. We examine the effect and usefulness of the network indicators by newly using them instead of the original Dow Jones financial sector as explanatory variables to construct the higher-order information spatial econometric models. The results demonstrate that the estimated accuracies obtained from both the two networks are improved significantly compared with the spatial econometric model using the original data. It indicates that the network indictors are more effective to capture the dynamic information of financial systems. And meanwhile, the accuracy based on the directed network is a little higher than the undirected network, which indicates the symbolized transfer entropy, i.e. the directed and weighted network, is more suitable and effective to reflect relationships in the financial field. In addition, the results also show that under the global financial crisis, the co-movement between financial sectors of a country/region and the global financial sector as well as between financial sectors and real economy sectors is increased. However, some sectors in particular Utilities and Healthcare are impacted slightly. This study tries to use the financial network indicators in modeling to study contagion channels on the real economy and the industry aggregation effects and suggest how network indicators can be practically used in financial fields., Competing Interests: The authors have declared that no competing interests exist.

The rapid growth of the mobile telecommunication sectors of many emerging countries creates a number of problems such as network congestion and poor service delivery for network operators. This results primarily from the lack of a reliable and cost-effective power solution within such regions. This study presents a comprehensive review of the underlying principles of the renewable energy technology (RET) with the objective of ensuring a reliable and cost-effective energy solution for a sustainable development in the emerging world. The grid-connected hybrid renewable energy system incorporating a power conversion and battery storage unit has been proposed based on the availability, dynamism, and technoeconomic viability of energy resources within the region. The proposed system's performance validation applied a simulation model developed in MATLAB, using a practical load data for different locations with varying climatic conditions in Nigeria. Results indicate that, apart from being environmentally friendly, the increase in the overall energy throughput of about 4 kWh/$ of the proposed system would not only improve the quality of mobile services, by making the operations of GSM base stations more reliable and cost effective, but also better the living standards of the host communities.

In this document, the Commission adopts further measures to improve the structure, efficiency, and quality of the video relay service (VRS) program, reducing the inefficiencies in the program, as well as reducing the risk of waste, fraud, and abuse, and ensuring that the program makes full use of advances in commercially-available technology. These measures involve a fundamental restructuring of the program to support innovation and competition, drive down ratepayer and provider costs, eliminate incentives for waste that have burdened the Telecommunications Relay Services (TRS) Fund in the past, and further protect consumers. The Commission adopts several measures in order to: ensure that VRS users can easily select their provider of choice by promoting the development of interoperability and portability standards; enable consumers to use off-the-shelf devices and deploying a VRS application to work with these devices; create a centralized TRS User Registration Database to ensure VRS user eligibility; encourage competition and innovation in VRS call handling services; spur research and development on VRS services by entering into a Memorandum of Understanding with the National Science Foundation; and pilot a National Outreach Program to educate the general public about relay services. In this document, the Commission also adopts new VRS compensation rates that move these rates toward actual costs over the next four years which will better approximate the actual, reasonable costs of providing VRS, and will reduce the costs of operating the program. The Commission takes these steps to ensure the integrity of the TRS Fund while providing stability and certainty to providers.

In this document, the Federal Communications Commission reforms its universal service support program for health care, transitioning its existing Internet Access and Rural Health Care Pilot programs into a new, efficient Healthcare Connect Fund. This Fund will expand health care provider access to broadband, especially in rural areas, and encourage the creation of state and regional broadband health care networks. Access to broadband for medical providers saves lives while lowering health care costs and improving patient experiences.

Communication and health monitoring technology and devices will enhance the potential for improved home health care services over the next decade. The technology exists to improve patients' access to specialized care, to monitor in-home risks for patients who have dementia or limitations in activities of daily living, and to minimize annoyances such as delays and long waiting times. Certain barriers must be addressed, however, such as third-party reimbursement restrictions, regulatory issues, and technologic limitations. Innovative clinicians will find ways to use these technologies to improve care while lowering costs and increasing value.

We propose a novel fiber design optimized for short-reach interconnects in consumer applications. A detailed analysis of the optical and mechanical properties of this fiber design is presented. Results are presented demonstrating (i) low bend loss and enhanced mechanical reliability in bends as small as 3 mm diameter; (ii) high power budget margin to enable relaxed mechanical tolerances on transmitter, receiver, and expanded-beam connectors for low-cost connectivity; and (iii) high bandwidth capability and system testing results at 10 Gb/s.

Steps to implementing an outsourced telecom or wireless expense management (TEM or WEM) solutions should include: Review of the organization's prior experience with these solutions. Promotion of the approach across the organization. Assignment of an internal owner of the TEM or WEM functions. The decision as to which activities to outsource. Due diligence in sourcing the TEM or WEM solution.

Background: Smoking is harmful to health. On average, lifelong smokers lose 10 years of life, and about half of all lifelong smokers have their lives shortened by smoking. Stopping smoking reverses or prevents many of these harms. However, cessation services in the NHS achieve variable success rates with smokers who want to quit. Approaches to behaviour change can be supplemented with electronic aids, and this may significantly increase quit rates and prevent a proportion of cases that relapse., Objective: The primary research question we sought to answer was: What is the effectiveness and cost-effectiveness of internet, pc and other electronic aids to help people stop smoking? We addressed the following three questions: (1) What is the effectiveness of internet sites, computer programs, mobile telephone text messages and other electronic aids for smoking cessation and/or reducing relapse? (2) What is the cost-effectiveness of incorporating internet sites, computer programs, mobile telephone text messages and other electronic aids into current nhs smoking cessation programmes? and (3) What are the current gaps in research into the effectiveness of internet sites, computer programs, mobile telephone text messages and other electronic aids to help people stop smoking?, Data Sources: For the effectiveness review, relevant primary studies were sought from The Cochrane Library [Cochrane Central Register of Controlled Trials (CENTRAL)] 2009, Issue 4, and MEDLINE (Ovid), EMBASE (Ovid), PsycINFO (Ovid), Health Management Information Consortium (HMIC) (Ovid) and Cumulative Index to Nursing and Allied Health Literature (CINAHL) (EBSCOhost) from 1980 to December 2009. In addition, NHS Economic Evaluation Database (NHS EED) and Database of Abstracts of Reviews of Effects (DARE) were searched for information on cost-effectiveness and modelling for the same period. Reference lists of included studies and of relevant systematic reviews were examined to identify further potentially relevant studies. Research registries of ongoing studies including National Institute for Health Research (NIHR) Clinical Research Network Portfolio Database, Current Controlled Trials and ClinicalTrials.gov were also searched, and further information was sought from contacts with experts., Review Methods: Randomised controlled trials (RCTs) and quasi-RCTs evaluating smoking cessation programmes that utilise computer, internet, mobile telephone or other electronic aids in adult smokers were included in the effectiveness review. Relevant studies of other design were included in the cost-effectiveness review and supplementary review. Pair-wise meta-analyses using both random- and fixed-effects models were carried out. Bayesian mixed-treatment comparisons (MTCs) were also performed. A de novo decision-analytical model was constructed for estimating the cost-effectiveness of interventions. Expected value of perfect information (EVPI) was calculated. Narrative synthesis of key themes and issues that may influence the acceptability and usability of electronic aids was provided in the supplementary review., Results: This effectiveness review included 60 RCTs/quasi-RCTs reported in 77 publications. Pooled estimate for prolonged abstinence [relative risk (RR) = 1.32, 95% confidence interval (CI) 1.21 to 1.45] and point prevalence abstinence (RR = 1.14, 95% CI 1.07 to 1.22) suggested that computer and other electronic aids increase the likelihood of cessation compared with no intervention or generic self-help materials. There was no significant difference in effect sizes between aid to cessation studies (which provide support to smokers who are ready to quit) and cessation induction studies (which attempt to encourage a cessation attempt in smokers who are not yet ready to quit). Results from MTC also showed small but significant intervention effect (time to relapse, mean hazard ratio 0.87, 95% credible interval 0.83 to 0.92). Cost-threshold analyses indicated some form of electronic intervention is likely to be cost-effective when added to non-electronic behavioural support, but there is substantial uncertainty with regard to what the most effective (thus most cost-effective) type of electronic intervention is, which warrants further research. EVPI calculations suggested the upper limit for the benefit of this research is around £ 2000-3000 per person., Limitations: The review focuses on smoking cessation programmes in the adult population, but does not cover smoking cessation in adolescents. Most available evidence relates to interventions with a single tailored component, while evidence for different modes of delivery (e.g. e-mail, text messaging) is limited. Therefore, the findings of lack of sufficient evidence for proving or refuting effectiveness should not be regarded as evidence of ineffectiveness. We have examined only a small number of factors that could potentially influence the effectiveness of the interventions. A comprehensive evaluation of potential effect modifiers at study level in a systematic review of complex interventions remains challenging. Information presented in published papers is often insufficient to allow accurate coding of each intervention or comparator. A limitation of the cost-effectiveness analysis, shared with several previous cost-effectiveness analyses of smoking cessation interventions, is that intervention benefit is restricted to the first quit attempt. Exploring the impact of interventions on subsequent attempts requires more detailed information on patient event histories than is available from current evidence., Conclusions: Our effectiveness review concluded that computer and other electronic aids increase the likelihood of cessation compared with no intervention or generic self-help materials, but the effect is small. The effectiveness does not appear to vary with respect to mode of delivery and concurrent non-electronic co-interventions. Our cost-effectiveness review suggests that making some form of electronic support available to smokers actively seeking to quit is highly likely to be cost-effective. This is true whether the electronic intervention is delivered alongside brief advice or more intensive counselling. The key source of uncertainty is that around the comparative effectiveness of different types of electronic interventions. Our review suggests that further research is needed on the relative benefits of different forms of delivery for electronic aids, the content of delivery, and the acceptability of these technologies for smoking cessation with subpopulations of smokers, particularly disadvantaged groups. More evidence is also required on the relationship between involving users in the design of interventions and the impact this has on effectiveness, and finally on how electronic aids developed and tested in research settings are applied in routine practice and in the community.

Electronic consultation (e-consultation) is an emerging tool that primary care clinicians can use to communicate with specialists about patients asynchronously--that is, at different times that are convenient for each physician. To conduct an e-consultation, clinicians use either a Web-based program or a shared electronic medical record. Early adopters of e-consultation describe positive experiences for patients, clinicians, and health systems, including improved continuity of care, access to specialists, convenience, and information transfer. E-consultation presents opportunities to improve health care quality and reduce specialty care costs, but dissemination will be limited unless incentives are created and clinicians are encouraged to use e-consultation through financial reimbursement.

Hotlines and warmlines have been successfully used in the developed world to provide clinical advice; however, reports on their replicability in resource-limited settings are limited. A warmline was established in Rakai, Uganda, to support an antiretroviral therapy program. Over a 17-month period, a database was kept of who called, why they called, and the result of the call. A program evaluation was also administered to clinical staff. A total of 1303 calls (3.5 calls per weekday) were logged. The warmline was used mostly by field staff and peripherally based peer health workers. Calls addressed important clinical issues, including the need for urgent care, medication side effects, and follow-up needs. Most clinical staff felt that the warmline made their jobs easier and improved the health of patients. An HIV/AIDS warmline leveraged the skills of a limited workforce to provide increased access to HIV/AIDS care, advice, and education.

Background: Non-attendance is common in primary care and previous studies have reported that reminders were useful in reducing broken appointments., Objective: To determine the effectiveness of a text messaging reminder in improving attendance in primary care., Design: Multicentre three-arm randomized controlled trial., Setting: Seven primary care clinics in Malaysia. Participants. Patients (or their caregivers) who required follow-up at the clinics between 48 hours and 3 months from the recruitment date. Interventions. Two intervention arms consisted of text messaging and mobile phone reminders 24-48 hours prior to scheduled appointments. Control group did not receive any intervention. Outcome measures. Attendance rates and costs of interventions., Results: A total of 993 participants were eligible for analysis. Attendance rates of control, text messaging and mobile phone reminder groups were 48.1, 59.0 and 59.6%, respectively. The attendance rate of the text messaging reminder group was significantly higher compared with that of the control group (odds ratio 1.59, 95% confidence interval 1.17 to 2.17, P = 0.005). There was no statistically significant difference in attendance rates between text messaging and mobile phone reminder groups. The cost of text messaging reminder (RM 0.45 per attendance) was lower than mobile phone reminder (RM 0.82 per attendance)., Conclusions: Text messaging reminder system was effective in improving attendance rate in primary care. It was more cost-effective compared with the mobile phone reminder.

The use of telepsychiatry technology and services has gained attention among legal and clinical practitioners. In the current article, telepsychiatry is defined, and an innovative model of telepsychiatry care delivery that is in use in a child and adolescent forensic evaluation clinic is examined. Critical factors specific to forensics services are examined, as are those specific to telepsychiatry, including transmission mode, privacy and confidentiality, expense, quality of care, face-to-face versus video transmission, user satisfaction, and liability concerns in the use of telepsychiatry.

Objectives: To test the hypotheses that virtual outreach would reduce offers of hospital follow-up appointments and reduce numbers of medical interventions and investigations, reduce numbers of contacts with the health care system, have a positive impact on patient satisfaction and enablement, and lead to improvements in patient health status. To perform an economic evaluation of virtual outreach., Design: A randomised controlled trial comparing joint teleconsultations between GPs, specialists and patients with standard outpatient referral. It was accompanied by an economic evaluation., Setting: The trial was centred on the Royal Free Hampstead NHS Trust, London, and the Royal Shrewsbury Hospital Trust in Shropshire. The project teams recruited and trained a total of 134 GPs from 29 practices and 20 consultant specialists., Participants: In total, 3170 patients were referred, of whom 2094 consented to participate in the study and were eligible for inclusion. In all, 1051 patients were randomised to the virtual outreach group and 1043 to standard outpatient appointments. The patients were followed 6 months after their index consultation., Interventions: Patients randomised to virtual outreach underwent a joint teleconsultation, in which they attended the general practice surgery where they and their GP consulted with a hospital specialist via a videolink between the hospital and the practice., Main Outcome Measures: Outcome measures included offers of follow-up outpatient appointments, numbers of tests, investigations, procedures, treatments and contacts with primary and secondary care, patient satisfaction (Ware Specific Visit Questionnaire), enablement (Patient Enablement Instrument) and quality of life (Short Form-12 and Child Health Questionnaire). An economic evaluation of the costs and consequences of the intervention was undertaken. Sensitivity analysis was used to test the robustness of the results., Results: Patients in the virtual outreach group were more likely to be offered a follow-up appointment. Significant differences in effects were observed between the two sites and across different specialities. Virtual outreach increased the offers of follow-up appointments more in Shrewsbury than in London, and more in ENT and orthopaedics than in the other specialities. Fewer tests and investigations were ordered in the virtual outreach group, by an average of 0.79 per patient. In the 6-month period following the index consultation, there were no significant differences overall in number of contacts with general practice, outpatient visits, accident and emergency contacts, inpatient stays, day surgery and inpatient procedures or prescriptions between the randomised groups. Tests of interaction indicated that virtual outreach decreased the number of tests and investigations, particularly in patients referred to gastroenterology, and increased the number of outpatient visits, particularly in those referred to orthopaedics. Patient satisfaction was greater after a virtual outreach consultation than after a standard outpatient consultation, with no heterogeneity between specialities or sites. However, patient enablement after the index consultation, and the physical and psychological scores of the Short Form-12 for adults and the scores on the Child Health Questionnaire for children under 16, did not differ between the randomised groups at 6 months' follow-up. NHS costs over 6 months were greater for the virtual outreach consultations than for conventional outpatients, pound 724 and pound 625 per patient, respectively. The index consultation accounted for this excess. Cost and time savings to patients were found. Estimated productivity losses were also less in the virtual outreach group., Conclusions: Virtual outreach consultations result in significantly higher levels of patient satisfaction than standard outpatient appointments and lead to substantial reductions in numbers of tests and investigations, but they are variably associated with increased rates of offer of follow-up according to speciality and site. Changes in costs and technological advances may improve the relative position of virtual consultations in future. The extent to which virtual outreach is implemented will probably be dependent on factors such as patient demand, costs, and the attitudes of staff working in general practice and hospital settings. Further research could involve long-term follow-up of patients in the virtual outreach trial to determine downstream outcomes and costs; further study into the effectiveness and costs of virtual outreach used for follow-up appointments, rather than first-time referrals; and whether the costs of virtual outreach could be substantially reduced without adversely affecting the quality of the consultation if nurses or other members of the primary care team were to undertake the hosting of the joint teleconsultations in place of the GP. Qualitative work into the attitudes of the patients, GPs and hospital specialists would also be valuable.

In this document, the Commission modifies its rules to improve the effectiveness of the rural health care support mechanism, which provides discounts to rural health care providers to access modern telecommunications for medical and health maintenance purposes. Because participation in the rural health care support mechanism has not met the Commission's initial projections, the Commission amends its rules to improve the program, increase participation by rural health care providers, and ensure that the benefits of the program continue to be distributed in a fair and equitable manner. In addition, the Commission denies Mobile Satellite Ventures Subsidiary's petition for reconsideration of the 1997 Universal Service Order.

Objective: To predict the true cost of developing and maintaining an electronic immunization registry, and to set the framework for developing future cost-effective and cost-benefit analysis., Data Sources/study Setting: Primary data collected at three immunization registries located in California, accounting for 90 percent of all immunization records in registries in the state during the study period., Study Design: A parametric cost analysis compared registry development and maintenance expenditures to registry performance requirements., Data Collection/extraction Methods: Data were collected at each registry through interviews, reviews of expenditure records, technical accomplishments development schedules, and immunization coverage rates., Principal Findings: The cost of building immunization registries is predictable and independent of the hardware/software combination employed. The effort requires four man-years of technical effort or approximately $250,000 in 1998 dollars. Costs for maintaining a registry were approximately $5,100 per end user per three-year period., Conclusions: There is a predictable cost structure for both developing and maintaining immunization registries. The cost structure can be used as a framework for examining the cost-effectiveness and cost-benefits of registries. The greatest factor effecting improvement in coverage rates was ongoing, user-based administrative investment.

We analyze the productivity of information technology in emergency response systems. "Enhanced 911" (E911) is information technology that links caller identification to a location database and so speeds up emergency response. We assess the impact of E911 on health outcomes using Pennsylvania ambulance and hospital records between 1994 and 1996, a period of substantial adoption. We find that as a result of E911 adoption, patient health measured at the time of ambulance arrival improves, suggesting that E911 speeds up emergency response. Further analysis using hospital discharge data shows that E911 reduces mortality and hospital costs.

This paper considers the potential role of videoconferencing technology for postgraduate dental and medical education. Drawing on work from the University of Bristol Dental School, it presents an analysis of the potential cost savings achievable by using videoconferencing compared to traditional face-to-face teaching across a range of scenarios. A summary of the feedback from trainees is also provided.

A new image transmission and teleconference system using international digital telephone services was established between Japan and Malaysia. This new system consists of an ordinary personal computer, image scanner, and terminal adapter for digital telephone lines. The quality of images transferred using this system was high enough for diagnosis and discussion except for images such as radiographs requiring huge data transfer. Transmission of one image took approximately 20 seconds. The cost performance was almost equal to the conventional mailing system. The most remarkable advantage of this new system is the high quality of transferred images, the cost and time performance, and security of the medical information. New communication systems using international digital networks including the internet may allow re-distribution of medical resources between advanced countries and developing countries in neurosurgery.

On November 24, 1998, the Federal-State Joint Board adopted a Second Recommended Decision regarding universal service. In this decision, the Joint Board made numerous recommendations on universal service issues. The Joint Board recommends a federal high cost support mechanism for non-rural carriers that enables rates to remain affordable; that the Commission replace the 25/75 jurisdictional division of responsibility for high cost support; that the Commission compute federal high cost support for non-rural carriers through a two-step process; and that the mechanisms outlined be reviewed no later than three years from July 1, 1999. The Commission seeks comment on the Second Recommended Decision.

Background: Rural physicians need access to digital health sciences libraries (DHSLs) that is easy and reasonably rapid. The goal of this project was to study rural hospitals' access to a DHSL on the Internet, by comparing differing access speeds with differing costs and their acceptability for retrieving text, image, and video information in a DHSL., Methods: DHSL system response time was measured at three different times during the day over three different types of network connections (T1, Frame Relay, Modem). Text, image, and video information was retrieved. Costs were determined for installation and operation of the different types of network connections., Results: System response times were consistent at the three different testing times for each media type retrieved by each of the three network connection types. System response times for text retrieval met literature standards for all connections. Image retrieval met literature standards for T1 and Frame relay connections. No connection met literature standards for video retrieval., Conclusions: High speed access to DHSLs is preferable; Frame relay connections provide substantively similar service as T1 connections at less cost. However, access via modem to a DHSL can provide access to the majority of information--text--in a DHSL with an acceptable system response time.

This Order changes the funding year for the schools and libraries universal service support mechanism from a calendar year cycle to a fiscal year cycle. This Order also adjusts the amount of money available for schools and libraries, and rural health care providers for the period from January 1, 1998 through June 30, 1999. In addition, this Order establishes rules of priority when a filing window is in effect.

In this document, the Commission seeks comment on the Report and Proposed Plan of Reorganization (Plan) filed on July 1, 1998 by the Universal Service Administrative Company (USAC), the Schools and Libraries Corporation (SLC), and the Rural Health Care Corporation (RHCC). The Plan proposes a revised adminstrative structure of the federal universal service support mechanisms. RHCC filed a Separate Statement of the Rural Health Care Corporation and Request for Three Changes in the Plan, dissenting from certain provisions of the proposed Plan. In this document, the Commission also seeks comment on other issues regarding the administration of the federal universal service support mechanisms, including processes for Commission review of actions by USAC, SLC, and RHCC.

HMT's February Focus Survey deviates from the customary format to present the first segment of a multipart survey that was conducted by William Halverson, principal of Network Associates and a technical director for Pacific Bell's Healthcare Marketing Group. This first survey segment is designed to educate wide area network users about the multiple services that are offered within the U.S. market. General service availability and prices, as well as service descriptions and required equipment are covered in this segment of the survey. The remainder of Halverson's work will be published in the June issue of Health management Technology, and will detail service availability and prices for individual companies.

There is an increasing number of efforts to install wide area health care networks. Some of these networks are being built to support several applications over a wide user base consisting primarily of medical practices, hospitals, pharmacies, medical laboratories, payors, and suppliers. Although on-line, multi-media telecommunication is desirable for some purposes such as cardiac monitoring, store-and-forward messaging is adequate for many common, high-volume applications. Laboratory test results and payment claims, for example, can be distributed using electronic messaging networks. Several network prototypes have been constructed to determine the technical problems and to assess the effectiveness of electronic messaging in wide area health care networks. Our project, Health Link, developed prototype software that was able to use the public switched telephone network to exchange messages automatically, reliably and securely. The network could be configured to accommodate the many different traffic patterns and cost constraints of its users. Discrete event simulations were performed on several network models. Canonical star and mesh networks, that were composed of nodes operating at steady state under equal loads, were modeled. Both topologies were found to support the throughput of a generic wide area health care network. The mean message delivery time of the mesh network was found to be less than that of the star network. Further simulations were conducted for a realistic large-scale health care network consisting of 1,553 doctors, 26 hospitals, four medical labs, one provincial lab and one insurer. Two network topologies were investigated: one using predominantly peer-to-peer communication, the other using client-server communication.(ABSTRACT TRUNCATED AT 250 WORDS)

This Order suspends enforcement of hearing aid compatibility for telephones required by section 68.112(b) (1), (3), and (5) of the Federal Communications Commission rules to be hearing aid compatible by May 1, 1993 for establishments with twenty or more employees and by May 1, 1994 for establishments with fewer than twenty employees. This action responds to an Emergency Request for Stay of section 68.112(b) filed by the Tele-Communications Association and is taken to give the Commission adequate time to evaluate serious issues raised in the Emergency Request involving costs of compliance and the feasibility of compliance with 47 CFR 68.112(b).

Competition among hospital satellite networks could heat up this year as a new player enters the game and others add programming and make other changes to improve their product. Networks hope the savings their educational programs can offer, as well as lower costs for satellite receiving equipment, will have more hospitals tuning in and more revenues rolling in.