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Background: Indonesia as an archipelagic country, makes the efforts to fulfill the needs of medical specialists in remote areas are not easy tasks. This study aimed to explore the availability and the needs fulfillment efforts of medical specialist in remote areas; and to know whether the availability of medical specialists have met the hospital needs, and how the authorities efforts to fulfill them, also the factors that affect the effort. Methods: This qualitative research was conducted with case study approach in Haji Abdoel Madjid Batoe District Hospital (RSUD HAMBA) Batanghari Jambi and Malingping District Hospital (RSUD Malingping) in Lebak Banten. In-depth interviews were conducted with various stakeholders. Results: The availability of medical specialist in both hospitals in number and type are inadequate. This fact indicates low retention and motivation of medical specialists to work in remote area. The major factor in both hospitals is inadequate salaries, difficult access, lack of medical equipment, also the difficulty to develop a career. However, these factors in both area ultimately boil down to the lack of government policies that support medical specialist fulfillment. Conclusion: The important factors that affect the lackness of effort in fulfilling medical specialists’ placement in remote areas are inadequate of infrastructures, competence and career development contraints, and the coordination between national and regional policies. The commitment of central and regional government to improve the infrastructures, competence and career developments, and regulations with respect to medical specialists in remote areas.

In order to meet the power prerequisites of their citizens, many countries are heavily dependent on the utilization of fossil fuels for power generation. This has reduced the natural reserve of fossil fuels and caused a large percentage of greenhouse gas emissions (GHGs). It is imperative to harness energy from renewable energy resources (RERs) as a measure to supplement the authors’ daily energy needs from the conventional units. The proposed microgrid system deals with the incorporation of the wind turbine generator (WTG), diesel generator, hydro turbine, photovoltaic and battery storage system for optimisation of net present cost (NPC), annualised cost of the system (ACS), GHG, fuel cost, operating costs and cost of energy (COE) by using hybrid optimisation model for electric renewables using HOMER software. The system is designed with the energy demand of 618 kWh/day at a peak load of 72.5 kW. The values of NPC, COE, ACS and fuel consumption obtained in the optimised configuration are $942,654/yr, $ 127,415, $0.327/kWh and 51,236 L/yr. The simulation results obtained from the optimised scenario reveal that the utilisation of RERs has been found to be a cost effective means to supply remote areas.

Telehealth is an alternative method of delivering health care to people required to travel long distances for routine health care. The aim of this systematic review was to examine whether patients and their caregivers living in rural and remote areas are satisfied with telehealth videoconferencing as a mode of service delivery in managing their health. A protocol was registered with PROSPERO international prospective register of systematic reviews (#CRD42017083597) and conducted in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. A systematic search of Ovid Medline, Embase, CINAHL, ProQuest Health Research Premium Collection, Joanna Briggs Institute and the Cochrane Library was conducted. Studies of people living in rural and remote areas who attended outpatient appointments for a health condition via videoconference were included if the studies measured patient and/or caregivers’ satisfaction with telehealth. Data on satisfaction was extracted and descriptively synthesised. Methodological quality of the included studies was assessed using a modified version of the McMaster Critical Review Forms for Quantitative or Qualitative Studies. Thirty-six studies of varying study design and quality met the inclusion criteria. The outcomes of satisfaction with telehealth were categorised into system experience, information sharing, consumer focus and overall satisfaction. There were high levels of satisfaction across all these dimensions. Despite these positive findings, the current evidence base lacks clarity in terms of how satisfaction is defined and measured. People living in rural and remote areas are generally satisfied with telehealth as a mode of service delivery as it may improve access to health care and avoid the inconvenience of travel. [ABSTRACT FROM AUTHOR]

As a new strategy to power forest wireless sensors in remote areas, an environmental microenergy collection device has been improved, and field experiments were carried out under natural conditions for the first time. The thermoelectric power generation devices used a gravity-assisted heat pipe to transmit heat from shallow soil to ground level, and a thermoelectric generator (TEG) was employed to generate electric power from the temperature difference between soil and air. Over the 6-month experimental period at two natural sites, approximately 128.74 J of energy could be harvested in a single day, and 5 209.92 J of energy could be harvested in a generation cycle. The results showed the feasibility of using this green energy to power wireless sensors in remote forests or other environments, This work is relevant to the current acute energy shortages and environmental pollution problems. [ABSTRACT FROM AUTHOR]

Background: There are few quantitative studies on palliative care provision to Indigenous Australians, a population known to experience distinctive barriers to quality healthcare and to have poorer health outcomes than other Australians. Objectives: To investigate equity of specialist palliative care service provision through characterising and comparing Indigenous and non-Indigenous patients at entry to care. Methods: Using data (01/01/2010–30/06/2015) from all services participating in the multi-jurisdictional Palliative Care Outcomes Collaboration, Indigenous and non-Indigenous patients entering palliative care were compared on proportions vis-à-vis those expected from national statutory datasets, demographic characteristics, and entry-to-care status across fourteen ‘problem’ domains (e.g., pain, functional impairment) after matching by age, sex, and specific diagnosis. Results: Of 140,267 patients, 1,465 (1.0%, much lower than expected from statutory data) were Indigenous, 133,987 (95.5%) non-Indigenous, and 4,905 (3.5%) had a missing identifier. The proportion of patients with a missing identifier diminished markedly over the study period, without a corresponding increase in the proportion identified as Indigenous. Indigenous compared with non-Indigenous patients were younger (mean 62.8 versus 73.0 years, p<0.001), a higher proportion were female (51.5% versus 46.3%; p<0.001) or resided outside major cities (44.2% versus 21.5%, p<0.001). Across all domains, Indigenous compared with matched non-Indigenous patients had lower or equal risk of status requiring prompt intervention. Conclusions: Indigenous patients (especially those residing outside major cities) are substantially under-represented in care by services participating in the nationwide specialist palliative care Collaboration, likely reflecting widespread access barriers. However, the similarity of status indicators among Indigenous and non-Indigenous patients at entry to care suggests that Indigenous patients who are able to access these services do not disproportionately experience clinically important impediments to care initiation. [ABSTRACT FROM AUTHOR]

Self-regulation and executive functioning impairments are common in children with fetal alcohol spectrum disorder. Given the high rates of fetal alcohol spectrum disorder identified amongst children living in the remote Fitzroy Valley region of Western Australia, the Alert ProgramVR was identified as a culturally safe intervention for use in local primary schools. Researchers collaborated with Aboriginal Elders, community members, and staff from a Fitzroy Valley primary school to trial the Alert ProgramVR. Teachers were trained to deliver eight Alert ProgramVR lessons to children in class. Self-regulation and executive functioning were measured using teacher and parent/caregiver questionnaires three times. Data were analyzed using repeated-measures ANOVA. Teacher-led delivery of the Alert ProgramVR was feasible in a region with high fetal alcohol spectrum disorder rates. As measured by teacher and parent/caregiver ratings, this curriculum may improve the self-regulation and executive functioning of children for some outcomes and provide sustained effects for some children. This community partnered pilot research, evaluated a school-based program to reduce the behavioral impact of fetal alcohol spectrum disorder, and informed design of a larger trial across eight Aboriginal community schools. [ABSTRACT FROM AUTHOR]

With the development of photovoltaic power generation technology, a large number of micro-power grid with distributed generation system have appeared in remote areas. It has the longer transmission line between the traditional power grid and the inverter of the distributed generation system. This caused the equivalent network impedance would be increased and would weak the power-grid characteristics. When the photovoltaic inverter is connected to a weaker power grid, the bandwidth of the control system of the inverter will be reduced. Using the traditional PR control to solve the problem is not ideal. This paper proposes fuzzy quasi-PRD control to improve the current quality. The inverter with the LCL filter has the peak of the resonance oscillation, it will affect the stability of the system. The paper adopts the adjustable virtual damping to suppress resonance. At last, the idea is verified by MATLAB/Simulink. The results show that the fuzzy quasi-PRD control method has better control performance, and dynamic tracking characteristics. [ABSTRACT FROM AUTHOR]

Background: The benefits of clinical supervision are more pronounced for health professionals in rural and remote areas. Most clinical supervision studies to date have occurred in metropolitan centres and have used the survey methodology to capture participant experiences. There is a lack of qualitative research that captures participants’ lived experiences with clinical supervision at the frontline. Methods: Participants were recruited from rural and remote sites of two Australian states using a purposive maximum variation sampling strategy. Data were collected through individual, semi-structured interviews with participants. Data were analysed using content analysis and themes were developed. Sixteen participants from six professions completed the interviews. Results: Eight themes were developed including the content of supervision, context of supervision, value of supervision, increased need for professional support and unique characteristics of rural and remote clinical supervision. Conclusions: This study has highlighted the value of clinical supervision for the rural and remote health professional workforce. Furthermore, it has shed light on the unique characteristics of clinical supervision in this population. This information can be used by organisations and health professionals to ensure clinical supervision partnerships are effective thereby enhancing rural and remote workforce recruitment and retention. [ABSTRACT FROM AUTHOR]

Objective: To explore migrant physicians’ conceptions about working in rural and remote areas in Sweden to understand what influences their motivation to work in these areas. Method and material: The study employed a qualitative approach with semi-structured interviews with 24 migrant physicians. Transcripts were thematically analysed. Results: Conceptions were identified about foremost work content and tasks, and about living in rural and remote areas. Work content and tasks related to the health care systems, type of health care facility, duties, specialty, resources, patient population, colleagues, and professional development. Conceptions about living concerned geographical characteristics, people living in rural and remote areas, opportunities for travelling, family, leisure activities, social life, and language skills. Conceptions seemed to be influenced by individual, professional and societal aspects from both previous countries and Sweden. Conceptions and biographical aspects both appeared to affect motivation. Discussion: Motivation regarding working in rural and remote areas appeared to be influenced by conceptions of these areas. A specific type of place could be understood as being able to provide (or not) the external conditions needed for fulfilling needs and reaching goals, whether professional or personal, and as a tool for reaching or facilitating the achievement of these. Conceptions of an area can hence affect motivation and choices for where to work and live. However, biographical aspects also impact motivation. Our results indicate that positive rural experience in the recipient country might be a predictor for motivation. Conclusion: Professional and personal life and are intertwined. Conceptions about an area influence willingness to work there. Willingness is also affected by, and intertwined with, other aspects such as previous experiences, age, marital status and family circumstances. [ABSTRACT FROM AUTHOR]

Purpose: The study purpose was to investigate the acceptability and utility of, and preference for, wearable activity trackers (WATs) amongst cancer survivors living in regional and remote areas of Western Australia. Methods: Twenty participants were recruited (Mean age = 63 years, SD = 13) to test two to three trackers from five available models (Fitbit Alta, Garmin Vivofit 2, Garmin Vivosmart, Polar loop 2 and Polar A300). Participants wore each device for two weeks, followed by a one-week washout period between devices. Interviews were conducted with participants to explore user perceptions and experiences. Interview transcripts were analysed using thematic analysis. Results: Four main themes emerged: (i) Consciousness raising; (ii) Prompts and Feedback; (iii) Accuracy and registry of activities; and, (iv) WAT preferences and features. Conclusions: WATs were acceptable and useful to cancer survivors. WATs increased self-awareness of physical activity, provided real time feedback in relation to step goals, and reinforced progress and efforts towards goals. The aesthetics of the WATs were deemed crucial in determining preference and likelihood of use. Implications for cancer survivors: Future interventions may do well to have two different WATs available for participants to choose from, according to activity preferences, aesthetic preferences, and display size. [ABSTRACT FROM AUTHOR]

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Highlights • New approaches for the management of municipal waste is a must in modern cities. • Environmental benefits should also be considered in waste collection activities. • OPEX associated with underground systems is much more advantageous for the final user. • Vacuum waste collection systems achieves reductions in CO2 emissions above 90% Abstract Waste collection is the activity of transporting solid waste from the point of production to the point of treatment or disposal. Today, the most common way of waste collection is by road from each individual’s house or collecting point. Whilst other services and utilities such as sewage, water, drainage and even modern day telecommunications have wisely been designed to be out of sight in the underground infrastructure, solid waste collection has commonly remained unchanged since the 19th century. Furthermore, traditional municipal waste handling in historical city centres is often made difficult by: old infrastructures; narrow, crooked streets that are not suitable for large waste collection vehicles; little space for rubbish bins, making at source separation difficult, and; high volumes of tourists that make traditional bins less accessible by waste operatives, which often conflicts with the objectives of keeping areas associated with tourism clean and hygienic. In these circumstances, underground vacuum waste collection arise as a revolutionary solution, even in remote areas. This waste management model lets integrate waste collection into the infrastructure of a building, a residential development a district or even entire towns, by transporting waste using vacuum technology through an underground network of pipes. The result, among other positive elements, is an average reduction in CO 2 emissions above 90% compared with traditional collection models by truck. [ABSTRACT FROM AUTHOR]

Abstract: Numerical studies have revealed the possibility of improving the energy supply of low-power energy consumers located in remote areas using local environmentally friendly renewable energy resources of small streams, wind surface layers of the atmosphere, and solar radiation. [ABSTRACT FROM AUTHOR]

Global navigation satellite systems (GNSS) can attain centimeter level positioning accuracy, which is conventionally provided by real-time precise point positioning (PPP) and real-time kinematic (RTK) techniques. Corrections from the data center or the reference stations are required in these techniques to reduce various GNSS errors. The time-relative positioning approach differs from the traditional PPP and RTK in the sense that it does not require external real-time corrections. It computes the differences in positions of a single receiver at different epochs using phase observations. As the code observations are not used in this approach, its performance is not affected by the noise and multipath of code observations. High reliability is another advantage of time-relative precise positioning because the ambiguity resolution is not needed in this approach. Since the data link is not required in the method, this approach has been widely used in remote areas where wireless data link is not available. The main limitation of time-relative positioning is that its accuracy degrades over time between epochs because of the temporal variation of various errors. The application of the approach is usually limited to be within a time interval of less than 20 min. The purpose of this study was to increase the time interval of time-relative positioning and to extend the use of this method to applications with a longer time requirement, especially in remote areas without wireless communication. In this paper, the main error sources of the time-relative method are first analyzed in detail, and then the approach to improve the accumulated time relative positioning method is proposed. The performance of the proposed method is assessed using both static and dynamic observations with a duration as long as several hours. The experiments presented in this paper show that, among the four scenarios tested (i.e., GPS, GPS/Galileo, GPS/Galileo/BeiDou, and GPS/Galileo/BeiDou/GLONASS), GPS/Galileo/BeiDou performed best and GPS/Galileo/BeiDou/GLONASS performed worst. The maximum positioning errors were mostly within 0.5 m in the horizontal direction, even after three hours with GPS/Galileo/BeiDou. It is expected that the method could be used for positioning and navigation for as long as several hours with decimeter level horizontal accuracy in remote areas without wireless communication.

Our understanding about viruses carried by wild animals is still scarce. The viral diversity of wildlife may be best described with discovery-driven approaches to the study of viral diversity that broaden research efforts towards non-canonical hosts and remote geographic regions. Birds have been key organisms in the transmission of viruses causing important diseases, and wild birds are threatened by viral spillovers associated with human activities. However, our knowledge of the avian virome may be biased towards poultry and highly pathogenic diseases. We describe and compare the fecal virome of two passerine-dominated bird assemblages sampled in a remote Neotropical rainforest in French Guiana (Nouragues Natural Reserve) and a Mediterranean forest in central Spain (La Herrería). We used metagenomic data to quantify the degree of functional and genetic novelty of viruses recovered by examining if the similarity of the contigs we obtained to reference sequences differed between both locations. In general, contigs from Nouragues were significantly less similar to viruses in databases than contigs from La Herrería using Blastn but not for Blastx, suggesting that pristine regions harbor a yet unknown viral diversity with genetically more singular viruses than more studied areas. Additionally, we describe putative novel viruses of the families Picornaviridae, Reoviridae and Hepeviridae. These results highlight the importance of wild animals and remote regions as sources of novel viruses that substantially broaden the current knowledge of the global diversity of viruses.

In 2018 the number of people without access to electricity dropped to less than 1 billion. However, the difficulty of serving these people became higher, as the locations are in the most remote areas of the world. Brazil, for example, needs to bring electricity to around 1 million people who, in the vast majority, live within the Amazon region. In this way, hybrid energy systems (HESs) count as an attractive alternative for power generation, especially in remote areas. Therefore, this article analyzes a case study of a hybrid photovoltaic-diesel system installed in the Tapajós-Arapiuns Extractive Reserve in the Brazilian Amazon region. The studied plant is composed of a photovoltaic (PV) system, a lead-acid electrochemical battery bank, a diesel generator, and electro-electronic loads with highly variable demand throughout the year. The HOMER PRO software is used as the simulation tool. The results show that the load following dispatch strategy is the best option, with 85.6% of the load demand being supplied by PV energy and only 14.4% by the diesel generator set. As a result, the system is technically feasible to be replicated as a reliable energy source in other areas of the reserve to supply schools, public health places, and other community services.

The current energy inefficiencies in relocatable temporary camps of the Armed Force troops create logistic challenges associated with fuel supply. The energy needs of these camps are primarily satisfied by diesel engine generators, which imply that a significant amount of fuel needs to be continuously provided to these camps, often built in remote areas. This paper presents an alternative solution, named Smart Hybrid Energy System (SHES), aiming towards significantly reducing the amount of fuel needed and minimizing transportation logistics while meeting camp energy demands. The SHES combines the existing diesel generators with solar power generation, energy storage, and waste heat recovery technologies, all connected to a microgrid, ensuring uninterrupted electricity and hot water supplies. All components are controlled by an energy management system that prioritizes output and switches between different power generators, ensuring operation at optimum efficiencies. The SHES components have been selected to be easily transportable in standard shipping 20 ft containers. The modularity of the solution, scalable from the base camp for 150 people, is designed according to available on-site renewable sources, allowing for energy optimization of different camp sizes in different climates.

As satellite communications provide ubiquitous coverage, they play a key role in providing Internet connectivity in remote or marginalized areas, so as to enable the vision of a truly global connectivity of the Internet of Things (IoT). However, these areas often lack reliable electricity supply. Thus, this paper proposes a satellite internet access point powered by solar energy, so that a stable Internet connection can be provided. The access point provides Wi-Fi coverage so that sensors, IoT, and devices can connect to the access point using the Wi-Fi, a common wireless technology. Our design took some cost-saving measures to make it affordable and selected the components that require minimal maintenance operations. The satellite access point costs about USD $500, and can provide four days of Internet connectivity without solar energy.

With the development of photovoltaic power generation technology, a large number of micro-power grid with distributed generation system have appeared in remote areas. It has the longer transmission line between the traditional power grid and the inverter of the distributed generation system. This caused the equivalent network impedance would be increased and would weak the power-grid characteristics. When the photovoltaic inverter is connected to a weaker power grid, the bandwidth of the control system of the inverter will be reduced. Using the traditional PR control to solve the problem is not ideal. This paper proposes fuzzy quasi-PRD control to improve the current quality. The inverter with the LCL filter has the peak of the resonance oscillation, it will affect the stability of the system. The paper adopts the adjustable virtual damping to suppress resonance. At last, the idea is verified by MATLAB/Simulink. The results show that the fuzzy quasi-PRD control method has better control performance, and dynamic tracking characteristics.

This paper is based on the experience of introducing wireless sensor networks (WSNs) into the building industry in Denmark and in a rural area of Greenland. There are very real advantages in the application of the technology and its consequences for the life cycle operation of the building sector. Sensor networks can be seen as an important part of the Internet of Things and may even constitute an Internet of Sensors, since the communication layers can differ from the Internet standards. The current paper describes the case for application, followed by a discussion of the observed adaptive advantages and consequences of the technology. Essentially, WSNs constitute a highly sophisticated technology that is more robust in a rural context due to its extremely simple installation procedures (plug and play) allowing the use of local less-skilled labour, and the possibility of reconfiguring and repurposing its use remotely.