Telemedicine for Developing Countries

May combine two claims.

Mobile telemedicine terminals feature higher portability; mobile phones mainly help in behavioral health interventions and fail in real clinical situations.

“Mobile terminals, conversely, feature a higher portability: typically, mobile phones mainly help in behavioral health interventions, and fail in real clinical situations [58].”

• cites [58] sourceDisputed

  Section 3.1 describes mobile phones as mobile, and section 3.2.2 discusses their use in behavioral health interventions. But section 3.3 gives contrary clinical examples: phone-based reminders improved tuberculosis medication adherence, and mobile technologies supported remote monitoring and treatment. The paper does not say mobile phones fail in clinical situations. (LLM, conf=0.86)

  Checked by a reasoning model — may be wrong.

  Experimental — accuracy not yet measured

May combine two claims.

Studies from 1995-2014 report health expenditure ratio 5.9-7.7 for high income countries and 1.5-2.4 for low income countries.

“Some more studies over the decades from 1995 to 2014 report a ratio between 5.9 and 7.7 for high income countries and a ratio between 1.5 and 2.4 for low income countries [26].”

• cites [26] The World Bank. Health expenditure, public (% of GDP). 2016. Available from: http://data.worldbank.org/indicator/SH.XPD.PUBL.ZS sourceCould not verify

  The indexed copy identifies DOI 10.1596/25062 as the Mexico Public Expenditure Review and discusses public spending on health in Mexico (unlabeled passages; no page numbers available). Searches for the 1995–2014 period, the stated ranges, and high- and low-income country comparisons found no passage reporting the claimed figures. (LLM, conf=0.76)

  Experimental — accuracy not yet measured

May combine two claims.

The infrastructure dimension mainly affects developing countries, while developed countries with good infrastructures are less impaired.

“It can be easily observed that the infrastructure dimension mainly affects developing countries [32,33,34], while developed countries featuring very good infrastructures are less impaired by this dimension.”

• cites [32] sourceSupported
  Experimental — accuracy not yet measured
• cites [33] sourcePartly supported

  The “Technology Infrastructure, Market Determinants, and Operational Issues” section (page unavailable) identifies poor telecommunications infrastructure as a major impediment to Internet applications in developing societies. The paper does not establish the claimed comparison that developed countries are less impaired by infrastructure; its “Socioeconomic and Development Constraints” section notes that technology-access inequalities occur in both industrialized and developing countries. (LLM, conf=0.85)

  Experimental — accuracy not yet measured
• cites [34] sourceSupported
  Experimental — accuracy not yet measured

May combine two claims.

In rural regions of developing countries, communication media mainly include voice via VHF transceiver and text via email, while rural regions of developed countries have more powerful media.

“In rural regions of developing countries, communication media [31] mainly include voice (typically, via a VHF transceiver) and text (typically, via e-mail messages), while rural regions of developed countries feature very different and more powerful communication media.”

• cites [31] sourcePartly supported

  The EHAS system section (p. 3) describes voice communication by VHF transceiver and email at rural health posts in Peru. The Discussion (p. 6) suggests the results apply to areas with similar conditions, but the paper does not establish that these are the main media across rural developing countries or compare them with more powerful media in developed countries. (LLM, conf=0.88)

  Experimental — accuracy not yet measured

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The annual cost of the Brazil project increased to US$2.0 million in the second year, extending to 21 centers and services.

“the annual cost increased to US$2.0 million in the second year, extending the project to 21 centers and services.”

• cites [43] sourcePartly supported

  The Relevant changes section reports that annual cost rose from US$1.2 million in the first year to US$2.0 million when the network expanded to 21 centres and perinatology services in 2014. It does not call 2014 the second year; the same section reports network activity beginning in January 2012, so the claimed timing is not supported. (LLM, conf=0.88)

  Experimental — accuracy not yet measured

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The Nepal project reported that major critical issues include infrastructure problems, lack of human resources, competence, and financing.

“The project reported that major critical issues include infrastructure problems, lack of human resources, competence and financing.”

• cites [57] Bhatta, 2015, J Nepal Health Res Counc sourceSupported

May combine two claims.

In the Amazon region of Peru, the main telemedicine project started in 2001 and aimed to set up an e-mail connection between 39 previously isolated health facilities and the main hospital in Lima.

“The main project started in 2001 and aimed at setting up an e-mail connection between 39 previously isolated health facilities and the main hospital in Lima.”

• cites [31] sourcePartly supported

  The Summary (p. 1) confirms that email facilities were installed in 39 previously isolated health facilities in Peru. The EHAS system section (p. 2) says installation occurred during 2000 and 2001, not that the project started in 2001. It identifies a main server in Lima, not a main hospital there; the provincial hospital was in Yurimaguas. (LLM, conf=0.90)

  Experimental — accuracy not yet measured

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

A project in Nepal by the local government involved about thirty peripheral district hospitals and mainly focused on challenges in telemedicine.

“A pilot project in Nepal [57] by the local government, involving some thirty peripheral district hospitals, mainly focused on the challenges in telemedicine.”

• cites [57] Bhatta, 2015, J Nepal Health Res Counc sourcePartly supported

  The Introduction and Abstract say Nepal’s government implemented the rural-telemedicine program in 30 remote district hospitals. But the program aimed to improve access to specialist care; it was the study that examined opportunities and challenges, not a project mainly focused on challenges. (LLM, conf=0.87)

  Experimental — accuracy not yet measured

Classified as probably not a substantial claim.

Features such as language, culture, local habits, religion, and resource scarcity can strongly affect a telemedicine project when designers are unfamiliar with the remote setting.

“When facing telemedicine projects, and particularly when project designers are not aware about all the characteristics of the remote environment, some features such as language, culture, local habits, religion, and lack of resources may strongly affect the project.”

• cites [33] sourcePartly supported

  The “Bridging the Digital Divide” section identifies language barriers and calls for applications in national languages; the challenges sections describe resource constraints and say organizational culture can impede project results (no page numbers provided). The paper does not identify religion or local habits as barriers, or specifically link these factors to telemedicine designers’ unfamiliarity with a remote setting. (LLM, conf=0.84)

  Experimental — accuracy not yet measured
• cites [39] sourceNot checked — no full text of the source
• cites [57] Bhatta, 2015, J Nepal Health Res CouncNot checked yet

  Not checked in the free run.

• cites [64] Shiferaw F, Zolfo M. The role of information communication technology (ICT) towards universal health coverage: the first steps of a telemedicine project in Ethiopia. Global Health Act 2012; 5 sourcePartly supported

  The Discussion (page unavailable) says eHealth strategies should address cultural and language differences and adapt to the local traditional context; it also describes funding and infrastructure constraints. It does not specifically identify religion as a factor or link these effects to designers being unfamiliar with the remote setting. (LLM, conf=0.84)

  Experimental — accuracy not yet measured
• cites [16] Combi C, Pozzani G, Pozzi G. Design, development, deployment of a telemedicine system in a developing country: Dealing with organizational and social issues. In 2015 International Conference on Healthcare Informatics, ICHI 2015, Dallas, TX, USA, October 21-23, IEEE Computer Society 2015; 545-554. sourceNot checked — no full text of the source

May combine two claims.

In India, telemedicine projects' major difficulties are bureaucracy and protectionist policies, despite services being free and recipients generally satisfied.

“Major difficulties encountered by the projects are bureaucracy and protectionist policies [39], despite the provided services were free and recipients have been generally satisfied with the projects.”

• cites [39] sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

More simple telemedicine systems provide asynchronous connection, mainly based on e-mail messages.

“More simple systems provide users with an asynchronous connection, mainly based on e-mail messages.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

More simple telemedicine systems permit only point-to-point connection, meaning two locations can be involved at a time and no more than two locations can be simultaneously involved.

“More simple systems permit one to have a point-to-point connection, only: this means that two locations can be involved in the telemedicine communication at a time, only, and there is no way of simultaneously involving more locations.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Simple information transmitted in telemedicine can be alphanumerical text.

“Simple information that can be transmitted from the remote hospital to the telemedicine center (and, obviously, vice versa) are alphanumerical (text).”

Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

Web app architecture requires launching applications, generally written in Java, within a Web browser.

“This architecture requires to launch applications, generally written in Java, within a Web browser.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The Burundi project's first experiments focused mainly on teleconsulting for pediatric cardiology.

“First experiments were done mainly focusing on teleconsulting for pediatric cardiology [16].”

• cites [16] Combi C, Pozzani G, Pozzi G. Design, development, deployment of a telemedicine system in a developing country: Dealing with organizational and social issues. In 2015 International Conference on Healthcare Informatics, ICHI 2015, Dallas, TX, USA, October 21-23, IEEE Computer Society 2015; 545-554. sourceNot checked — no full text of the source

May combine two claims.

In that Burundi screening, 25 suspected cases of rheumatic and congenital cardiovascular patients were identified, 50% of them pediatric.

“identifying 25 suspected cases of rheumatic and congenital cardiovascular patients (50% of them were pediatric ones).”

Probably not a substantial claim: may not pass S3 (load-bearing).

More powerful telemedicine systems permit multipoint connection, meaning users can simultaneously involve different centers for remote counseling.

“Conversely, more powerful systems permit one to have a multipoint connection: this means that users can simultaneously involve different centers for remote counseling”

May combine two claims.

The Zambia telemedicine project sets up a teleconsulting system that also enables hospital staff to access historical patient data, mainly lab exams and X-ray images stored remotely.

“The telemedicine project sets up a teleconsulting system, which also enables the staff of the hospital to access historical data of patients, basically consisting of lab exams and X-ray images stored in remote facilities.”

• cites [44] Nexus Mundi Foundation. Chikuni Mission Hospital. 2014. Available from: http://s328691085.onlinehome.us/Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

In the ZCM project, micro and macro images are stored locally at the patient side, and remote consulting is performed by expert physicians from Italian hospitals.

“Micro and macro images are stored locally (patient-side), and remote consulting is performed by expert physicians from Italian hospitals.”

• cites [46] Patologi Oltre Frontiera. Available from: http://www.apof.eu/Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Although the Burundi project focused on cardiovascular diseases, the system was also used to ask for second opinions about cancer, pneumonia, and laryngomalacia.

“Although the project focused on cardiovascular diseases, the proposed system has been used also to ask for a second opinion about cases of cancer, pneumonia, and laryngomalacia.”

Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

Web based architecture requires only a Web browser.

“This architecture basically requires a Web browser, only.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The ZCM project by Patologi Oltre Frontiera aimed at setting up laboratories to perform preventive cancer examinations in developing countries.

“The project from the Italian association Patologi Oltre Frontiera [46] aimed at setting up laboratories to perform preventive examinations to fight cancer in developing countries.”

• cites [46] Patologi Oltre Frontiera. Available from: http://www.apof.eu/Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

May combine two claims.

Some of the Burundi consultations confirmed the suspects and identified patients for surgical intervention.

“Some of the consultations confirmed the suspects and identified patients for surgical intervention.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The Balkans teleconsulting system was developed by the Italian association Cuore un Mondo with partners and is based on open source systems.

“The Italian association Cuore un Mondo, in cooperation with the Ospedale del Cuore, Massa (Italy), the Tuscany Region (Italy), and the CNR of Pisa (Italy) developed a teleconsulting system based on open source systems [45].”

• cites [45] Gori, 2010, Comput CardiolNot matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Education in the Occidental Africa project was extended to allow remote education among African countries (South to South) and from Africa back to Europe (South to North) for African and tropical diseases.

“Education was extended, too, so that remote education could take place also among African countries (South to South) as well as from Africa back to Europe (South to North) for African and tropical diseases.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The ZCM project's major feature is that the server is local (patient-side), and remote experts connect via a web browser.

“Major feature of this project is that the server is local, i.e., patient-side, and remote experts connect via a web-browser.”

• cites [46] Patologi Oltre Frontiera. Available from: http://www.apof.eu/Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

May combine two claims.

In Egypt, major difficulties for telemedicine projects include technical, financial, and human resources aspects.

“Major difficulties encountered by the projects in Egypt include the technical, financial, and human resources aspect [40].”

• cites [40] Hussein, 2012, GMS Medizinische Informatik, Biometrie und EpidemiologieNot matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The Chikuni Mission Hospital serves about 180 small villages in a strictly rural area.

“The hospital serves some 180 small villages, thus covering a strictly rural area.”

• cites [44] Nexus Mundi Foundation. Chikuni Mission Hospital. 2014. Available from: http://s328691085.onlinehome.us/Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Probably not a substantial claim: may not pass S3 (load-bearing).

No more recent telemedicine projects seem to have been started in Pacific Islands and Micronesia.

“No more recent projects seem to have been started in this area.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The Occidental Africa project is based on an open source platform for remote consulting, iPath, developed at the University of Basel.

“The project is based on an open source platform for remote consulting, namely iPath [50], developed at the University of Basel, Switzerland.”

• cites [50] sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S2 (checkable), S4 (based).

Evaluating deployed systems and tools to identify suggestions and recommendations for future telemedicine and telecounseling initiatives is extremely challenging.

“Evaluating the deployed systems and tools, in order to identify some suggestions and recommendations for future similar initiatives in the field of telemedicine and telecounseling, is an extremely challenging task.”

Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing), S4 (based).

Voice must have synchronous transmission, preferably.

“Voice must have a synchronous transmission, preferably.”

Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

Most telemedicine projects are generally based on a remote server (expert-side) rather than a patient-side server.

“Most projects, instead, are generally based on a remote server (expert-side, and not patient-side) which receives connections from patient-side physicians.”

Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

More powerful telemedicine systems provide synchronous connection, including chat and voice.

“On the other side, more powerful systems provide users with a synchronous connection, which includes chat and voice;”

Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

Remote app architecture requires only a dumb terminal locally deployed, which connects to a remote processing system, with all control logics defined and stored remotely.

“This architecture just requires a dumb terminal locally deployed, which connects to a remote processing system.All the control logics are defined and stored within the remote system.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The Burundi telemedicine project, funded by the Veneto Region and University of Verona, aimed to provide local physicians at the Hospital of Ngozi with expert second opinions from colleagues at the University of Verona on interpreting ECG signals, ultrasound, and X-ray images.

“This telemedicine project, funded by the Veneto Region and by the University of Verona, considers requirement collection and analysis, design, implementation, and deployment of a prototype aimed at providing local physicians of the Hospital of Ngozi, Burundi, with expert second opinions from their colleagues in the University of Verona, Italy, on interpreting ECG signals, ultrasound and X-ray imag”

• cites [16] Combi C, Pozzani G, Pozzi G. Design, development, deployment of a telemedicine system in a developing country: Dealing with organizational and social issues. In 2015 International Conference on Healthcare Informatics, ICHI 2015, Dallas, TX, USA, October 21-23, IEEE Computer Society 2015; 545-554. sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The Occidental Africa project started by the University Hospital of Geneva initially involved Mali in 2001 and was later extended to Morocco, Tunisia, Cameroon, Madagascar, Ivory Coast, Niger, Burkina Faso, and Djibouti.

“The project started by the University Hospital of Geneva, Switzerland, initially involved Mali in 2001, and then was extended to include Morocco, Tunisia, Cameroon, Madagascar, Ivory Coast, Niger, Burkina Faso and Djibouti [47,48,49,50].”

• cites [47] Geissbuhler A, Ly O, Lovis C, L‘Haire JF. Telemedicine in Western Africa: lessons learned from a pilot project in Mali, perspectives and recommendations. In AMIA Annual Symposium Proceedings, volume 2003. American Medical Informatics Association, p.249Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

• cites [48] Bagayoko CO, Muller H, Geissbuhler A. Telemedicine network in French-speaking Africa (RAFT). In Medical Imaging and Telemedicine. pp. 108-113Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

• cites [49] sourceNot checked — no full text of the source
• cites [50] sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

The original main goal of the Occidental Africa project was remote education from North to South for physicians in Occidental Africa, receiving education from Geneva.

“The main original goal of the project was remote education (North to South) for physicians in Occidental Africa, receiving education from Geneva, Switzerland.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The Burundi project trained 20 nurses on ECG machine use and 5 physicians on ultrasound system use for echocardiographic examinations.

“the project trained 20 nurses on how to better use the ECG machine, and 5 physicians on how to use the ultrasound system for performing echocardiographic examinations.”

May combine two claims.

To avoid major pitfalls, the Burundi project provided local users with proper skills before deploying the system and performed continuous follow-up of the system and its usage in everyday practice.

“In order to avoid the major pitfalls, the project provided the local users with the proper skills before deploying the system, and then performing a continuous follow up of the system and of its usage in the everyday practice.”

Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

Web based architecture has limitations including limited functionality and limited storage possibilities.

“some limitations apply, such as limited functionality and limited storage possibilities.”

Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

App architecture requires downloading an application and running it directly, typically on recent mobile systems such as smartphones and tablets.

“This architecture requires to download an application and the run it directly, typically on most recent mobile systems such as smartphones and tablets.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The Balkans project's major feature is the deployment of open source systems only.

“Major feature of this project is the deployment of open source systems, only.”

• cites [45] Gori, 2010, Comput CardiolNot matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

In Zambia, the Nexus Mundi Foundation takes care of the Chikuni Mission Hospital, where one physician and some nurses manage a 95-bed hospital.

“The Nexus Mundi Foundation [44] in Zambia takes care of the Chikuni Mission Hospital, where one physician and some nurses manage a 95 bed hospital.”

• cites [44] Nexus Mundi Foundation. Chikuni Mission Hospital. 2014. Available from: http://s328691085.onlinehome.us/Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

Web app architecture overrides most limitations of a pure Web based architecture, but may lack full and deep control over the application.

“Most of the limitations of a pure Web based architecture are overridden by this approach: however, full and deep control over the application may lack.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

More powerful telemedicine systems can transmit voice and sound, static images, and sequences of images and movies.

“More powerful system include voice and sound (e.g., typically sounds from the internal of the body are detected by auscultation), static images, and sequences of images and movies.”

Classified as probably not a substantial claim. May combine two claims.

Hard working conditions (temperature, humidity, dust) may strongly challenge computer systems, and spare parts are hardly delivered to remote locations in developing countries, so a redundant and fault-tolerant architecture can permit safer storage.

“In fact, hard working conditions (temperature, humidity, dust) may strongly challenge the computer systems: moreover, spare parts are hardly delivered to remote locations in developing countries, thus a redundant and fault tolerant architecture can permit a safer storage.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Fixed telemedicine terminals typically provide higher performance, low portability, and require more resources including power consumption.

“Typically, fixed terminals provide users with higher performances (e.g., video resolution of highest frame rates for video rendering), feature low portability (e.g., to move to the place where the patient is for a visual inspection by remote physicians), but require more resources -also in term of power consumption”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The Burundi screening and consultation process involved two physicians in Ngozi and four physicians in Verona.

“This screening and consultation process involved two physicians in Ngozi and four physicians in Verona.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The Occidental Africa project was later enriched to cover remote consulting for pathologists, neurosurgeons, and oncologists.

“The project has then been enriched to cover remote consulting for pathologist, neurosurgeons, and oncologists.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Web based architecture has advantages including ease-of-use, no installation required, and multi-platform execution.

“While major advantages include ease-ofuse, non installation required, and multi-platform execution”

May combine two claims.

Telemedicine experiments in Pacific Islands and Micronesia date back to 1996 and were mainly devoted to remote medical education.

“The experiments of telemedicine date back to 1996, and were mainly devoted to remote medical education.”

• cites [41] Bice SD, Dever G, Mukaida L, Norton SA, Samisone J. Telemedicine and telehealth in the Pacific islands region: A survey of applications, experiments, and issues. In Peacesat. Pacific Telecommunications Council, pp. 574-581Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

• cites [42] sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

More powerful telemedicine systems provide remote computers with redundant storage so that failures such as hard disk failures do not wipe all stored information.

“More powerful telemedicine systems provide the remote computers with redundant storage, so that failures (typically, hard disk failures) do not wipe all the information stored.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

App architecture provides full control of the processing system, including storage, transmission, and vital sign analysis, and may include advanced control logics.

“This architecture is providing full control of the processing system, including storage, transmission and vital sign analysis, and may also include advanced control logics.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The literature considers many other case studies that are poorly described or cover a very narrow geographical area.

“The literature considers many other case studies, which, however, are poorly described or cover a very narrow geographical area.”

Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

Open source tools come for free but in most cases carry very poor assistance and documentation, making their use extremely challenging for relevant projects.

“Open source tools come for free but in most cases carry along a very poor assistance and documentation, making their use extremely challenging for relevant projects.”

Probably not a substantial claim: may not pass S4 (based).

The more resources are needed, the higher the cost of the overall system and the cost of keeping it running, including electric power consumption.

“The more resources are needed, the higher will be the cost of the overall system as well as the cost for keeping it running, also in terms of electric power consumption.”

Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

The number of teleconsultations per month can be extremely low at project onset, requiring a very limited set of resources, and can increase very rapidly after tuning and start-up.

“In fact, the number of teleconsultations per month can be extremely low at the project onset, requiring a very limited set of resources.After tuning the components and staring up the project, the number of participants to the project -according to the spent efforts and to the success of the project itself -can increase very rapidly”

Classified as probably not a substantial claim.

If a project is deployed in a rural location or on a mobile facility, power consumption together with network and telecommunication requirements becomes one of the most relevant issues for the real success of the telemedicine system.

“If the project is to be deployed in a rural location or on a mobile facility (in order to have a wider coverage in terms of assisted population), the power consumption, together with network and telecommunication requirements, becomes one of the most relevant issues in terms of the real success for the telemedicine system.”

Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing), S4 (based). May combine two claims.

More powerful tools are suitable for research-oriented prototypes and systems and may lead to fragile applications; more reliable tools are suitable for systems deployed in everyday practice, focusing on more robust applications.

“More powerful tools are suitable for research-oriented prototypes and systems, and may lead to fragile applications: more reliable tools are suitable for systems deployed in the everyday practice, focusing on more robust applications.”

Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing). May combine two claims.

Tools used in developing telemedicine systems would preferably be powerful, so that few instructions achieve the required goal, and easy to use, so that developers do not need extensive and expensive training courses.

“Tools used in developing telemedicine systems would preferably be powerful, so that few instructions/commands achieve the required goal, and easy to use, so that developers do not need extensive (and expensive) training courses on getting skills on the used technology and tools [36].”

• cites [36] Moodley D, Pillay AW, Seebregts CJ. Position paper: Researching and developing open architectures for national health information systems in developing African countries. In Liu Z, Wassyng A, editors, FHIES, volume 7151 of Lecture Notes in Computer Science. Springer, pp. 129-139 sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

Very simple information management tools may be a very good starting point.

“Very simple information management tools (FileMaker in [62]) may be a very good starting point.”

• cites [62] sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Such considerations are confirmed by the paper's taxonomy and by the survey based on it.

“Such considerations are confirmed by our taxonomy and by the survey based on it.”

• AssumptionRests on an assumption: The taxonomy dimensions used in Tables 1 and 2 are sufficient to categorize the projects and support the discussion's conclusions.

Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing), S4 (based).

Follow-up studies aimed at evaluating the real advantages and usefulness of every project are extremely complex, as too many success factors must be considered and suitably weighted to achieve a success/failure evaluation.

“follow-up studies, aimed at evaluating the real advantages and usefulness of every project, are extremely complex, as too many success factors must be considered and suitably weighted to achieve a Success/Failure evaluation of the project.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Reusability enables developers to deploy new systems by difference with respect to already developed ones, reducing costs and development times.

“Reusability enables the developers to deploy new systems moving by difference with respect to already developed one, thus reducing both costs”

Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

User interface is one of the most important issues for acceptance, and local languages, especially in developing countries, must be suitably adopted because use of the local language may be the only way for proper interaction with local users.

“As for the acceptance, user interface obviously is one of the most important issues: however, local languages -especially in developing countries -must be suitably adopted, as the use of the local language may be the only way for a proper interaction with the local users.”

Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

Very few projects in developed countries feature a follow-up study.

“However, very few projects in developed country feature a follow-up study, too”

Probably not a substantial claim: may not pass S4 (based).

The results of the entire project strongly depend on the acceptance of the application and of the telemedical service.

“The results of the entire project strongly depend on the acceptance of the application and of the telemedical service, too.”

Classified as probably not a substantial claim.

Flexible, adaptable, and reusable tools enable developers to achieve a final system that can be easily adapted and extended to cover wider application scenarios.

“These features of the tools enable the developers to achieve a final system which can be easily adapted and extended to cover wider application scenarios”

Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

Proprietary tools are generally expensive but more documented, constantly updated, and maintained over time.

“On the other side, proprietary tools are generally expensive but more documented, constantly updated and maintained over time.”

Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

Low budgets affect all projects of developing countries, also outside the strict health care sector.

“Low budgets are affecting all the projects of developing countries, also outside the strict health care sector.”

Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

Interoperable tools can be easily interconnected when developing the system.

“Interoperable tools can be easily interconnected each other, when developing the system.”

Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

Interoperability calls for standard mechanisms for sharing and exchanging information among modules, including file formats and remote invocation of procedures and services.

“Interoperability calls for standard mechanisms for sharing and exchanging information among the modules, including file formats and remote invocation of procedures and services.”

Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

Tools must be appropriate to the goals targeted by the project.

“The tools must be appropriate to the goals targeted by the project.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

A new prototype, TeleDICOM, introduces new essential features like multipoint-to-multipoint communication, although a very good bandwidth is required.

“A new prototype, namely TeleDI-COM, introduces new essential features, like multipoint-to-multipoint communication -although a very good bandwidth is required.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Training personnel on how to use the system is another fundamental issue to achieve good technology acceptance, because difficulties at early interaction may discourage further use.

“Furthermore, training of personnel on how to use the system is another fundamental issue to achieve a pretty good technology acceptance: in fact, the difficulties encountered at the very early interaction with the system may discourage further use of the system itself.”

Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

While most EMR systems in developed countries are computer-based, most EMR systems in developing countries are paper-based.

“While most systems for Electronic Medical Record (EMR) in developed countries are computerbased, most EMR of developing countries are paper-based.”

Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

Generally, proprietary tools require more resources than open source ones, but many counterexamples exist.

“Generally, proprietary tools require more resources than open source ones -but many counterexamples exist.”

Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing), S4 (based).

Scalable and extensible tools imply that the resulting system can be easily enriched to cover more cases, wider areas, greater population, more pathologies, and more health care centers.

“Scalable and extensible tools imply that the resulting system can be easily enriched to cover more cases, wider areas, greater population, more pathologies and more health care centers.”

May combine two claims.

All considered projects include remote diagnosis in their goals, and some include further goals.

“All the considered projects include in the goals the”

Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

Performance considerably differs between open source and proprietary tools, especially when project size and workload increase during deployment and resources need to be scaled up.

“Generally speaking, performance considerably differs between open source and proprietary tools, especially when the size and the workload of the project increase during project deployment, and resources need to be scaled up.”

Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing), S4 (based). May combine two claims.

The impact of the telemedicine system on everyday practice is absolutely relevant and must not be neglected.

“The impact of the telemedicine system on everyday practice is absolutely relevant and must not be neglected.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Very few project reports describe the real economic effort spent in deploying the project; such data are generally expressed as percentage of GDP, reported only for a few major projects, and not available at all for mid or small size projects.

“Very few project reports describe the real economic effort spent in deploying the project itself: such data, which are generally expressed as percentage of the GDP, are reported only for a few of the major projects, and are not available at all for mid or small size projects.”

Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

Success rate, even if extracted from project descriptions in the literature and not clearly stated, is not related to the dimension of the project.

“Success rate, even if the information is extracted from the description of the project as presented by the literature and not clearly stated, is not related to the dimension of the project.”

• AssumptionRests on an assumption: The project descriptions in the surveyed literature are accurate and complete enough to support the survey's comparisons and conclusions.
• AssumptionRests on an assumption: A project's success rate can be inferred from its description in the literature even when the description does not clearly state it.

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The location addressed by the project is preferably rural for major projects and urban for minor projects.

“The location addressed by the project is preferably rural for major projects, and urban for minor projects.”

Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

Highly interoperable tools and higher interoperability levels provide higher information sharing, thus easily increasing the functionalities of the telemedicine system and the number of health care centers involved.

“Highly interoperable tools and higher interoperability levels provide higher information sharing, thus easily increasing the functionalities of the telemedicine system and the number of health care centers involved in the project.”

Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

Preferably, the telemedicine system can enable the remote system to locally store information from the other corresponding facility, permitting off-line analysis.

“Preferably, the telemedicine system can also enable the remote system to locally store information from the other corresponding facility/facilities, i.e., the telemedicine center can make local copies of the files from the remote hospital(s) in the developing country, and vice versa.This permits the users to have an off-line analysis, too.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Telemedicine programs in developed countries have been deployed and reported for 10-15 years in several countries.

“In developed countries several programs have been deployed, and they have been promptly reported for 10-15 years (e.g., in the United Kingdom [4,5], in Finland [6], in Europe [7], in Taiwan [8], and world-wide [9]).”

• cites [4] sourceNot checked — no full text of the source
• cites [5] sourceNot checked — no full text of the source
• cites [6] sourceNot checked — no full text of the source
• cites [9] sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

The WHO counted 104 distinct peer-reviewed definitions of telemedicine in 2009.

“the WHO (World Health Organization) in 2009 counted 104 distinct, peer-reviewed definitions of the concept [1].”

• cites [1] World Health Organization. Telemedicine: opportunities and developments in Member States: report on the second global survey on eHealth. Global Observatory for eHealth Series, 2, World Health Organization. 2009Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

May combine two claims.

In Africa, fifty percent of responding nations believed infrastructure to be a barrier to telemedicine in general, and to teleradiology in Sub-Saharan area.

“In Africa alone, fifty percent of the responding nations believed infrastructure to be a barrier to telemedicine in general [1], and in particular to teleradiology in the Sub-Saharan area [35].”

• cites [1] World Health Organization. Telemedicine: opportunities and developments in Member States: report on the second global survey on eHealth. Global Observatory for eHealth Series, 2, World Health Organization. 2009Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

• cites [35] sourceNot checked — no full text of the source

May combine two claims.

Main Indian telemedicine projects are Apollo, Otri, and Asia Heart Foundation; they involved Indian national locations and focused on cardiology, emergency, radiology, ophthalmology, and nephrology.

“The main telemedicine projects are known as Apollo, Otri, and Asia Heart Foundation.All of them mainly involved Indian national locations, and focused on major needs from cardiology, emergency, radiology, ophthalmology, and nephrology departments.”

• cites [39] sourceNot checked — no full text of the source

May combine two claims.

In Indian projects, signals, diagnostic images and videos are transferred among Intel-based workstations, with peaks of 750 sessions per month.

“Signals, diagnostic images and videos are transferred among workstations based on Intel computers: some peaks of 750 sessions per month have been achieved, thus proving a real deployment on the field for the project.”

• cites [39] sourceNot checked — no full text of the source

May combine two claims.

Developing countries are not the only deployment field for telemedicine; it can also be used in resource-limited locations such as airplanes or maritime media, and to reduce NHS costs.

“Developing countries are not an exclusive deployment field for telemedicine projects: they can be fruitfully deployed also in locations where resources are limited or some external constraints apply, such as airplanes or maritime media [21,22,23], as well as to reduce the overwhelming costs of a National Health Service [4].”

• cites [21] sourceNot checked — no full text of the source
• cites [22] sourceNot checked — no full text of the source
• cites [23] sourceNot checked — no full text of the source
• cites [4] sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

According to the World Bank, emerging countries have GDP per capita per year below US$12,475; developing countries below US$4,035.

“According to the World Bank [24], GDP is the proper figure of merit to distinguish emerging countries still have a GDP (or a per capita income) comparably low with respect to developed countries (i.e., a GDP per capita per year smaller than US$ 12,475), however they are rapidly growing up and reducing their gap from developed countries; developing countries, instead, still lack a growth in their G”

• cites [24] The World Bank. The World Bank - Working for a World Free of Poverty [Internet]. 2016. Available from: http://www.worldbank.org/ sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

About 70% of the 40 million people worldwide with HIV/AIDS live in Sub-Saharan Africa.

“some 70% of the 40 million worldwide people suffering from this disease live in the SSA”

• cites [35] sourceNot checked — no full text of the source

May combine two claims.

The Sichuan project saved about US$2.3 million for patients and US$3.7 million for specialists.

“The authors also sum up the net saving of some US$ 2.3 million for patients (diagnosed in the rural hospital, patients did not need to move to the main hospital) and of some US$ 3.7 million for specialists (specialists did not need to move to the rural hospital to complete the diagnosis or to validate the treatment).”

• cites [15] sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

A Western Australian telemedicine program was used mainly for remote education (76%), wound cases (55%), psychiatry cases (54%), and store-and-forward ECG.

“Some more recent programs were devoted to include also medical education, such as in Western Australia [10], where the program has been mainly used for remote education (76% of the considered cases), without neglecting other goals such as wound cases (55%), and psychiatry cases (54%), and store-and-forward ECG (ElectroCardioGraphy) recordings.”

• cites [10] sourceNot checked — no full text of the source

May combine two claims.

The Sichuan telemedicine network from 2002 to 2013 connected 249 spoke hospitals in 112 rural cities with highly specialized urban hospitals, focusing on 40 medical expertise areas.

“One of the most relevant projects covered the Sichuan area (West China) from 2002 to 2013 [15]: the telemedicine network connected some 249 spoke hospitals in 112 rural cities with some highly specialized urban hospitals, focusing on 40 medical expertise areas.”

• cites [15] sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

Tulu et al. [20] in 2007 identifies five major dimensions: application purpose, application area, environmental setting, communication infrastructure, and delivery options.

“One more taxonomy by Tulu et al. [20] in 2007 identifies five major dimensions of classifications: application purpose, application area, environmental setting, communication infrastructure, and delivery options.”

• cites [20] sourceNot checked — no full text of the source

May combine two claims.

In the Sichuan project, 39.8% of original diagnoses and 55% of original treatments were modified after teleconsulting.

“39.8% of the original diagnoses were modified after the teleconsulting; 55% of the original treatments were modified after the teleconsulting.”

• cites [15] sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

A good evaluation of project success is the lifespan of the project.

“A good evaluation of the project and of its success is the lifespan of the project [36].”

• cites [36] Moodley D, Pillay AW, Seebregts CJ. Position paper: Researching and developing open architectures for national health information systems in developing African countries. In Liu Z, Wassyng A, editors, FHIES, volume 7151 of Lecture Notes in Computer Science. Springer, pp. 129-139 sourceNot checked — no full text of the source

May combine two claims.

The physician-to-population ratio in Sub-Saharan Africa ranges from 1:5,000 to 1:30,000, compared with about 1:300 in developed countries.

“The physician-to-population ratio ranges from 1:5,000 to 1:30,000, while in developed countries the typical ratio is 1:300 [35].”

• cites [35] sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

Sub-Saharan Africa has a population of about 725 million.

“With a population of some 725 million inhabitants, the Sub-Saharan Africa (SSA) [35] region”

• cites [35] sourceNot checked — no full text of the source

Classified as probably not a substantial claim. May combine two claims.

The efficacy and cost-effectiveness of telemedicine versus conventional care still need proper evaluation.

“Efficacy and the cost-effectiveness of telemedicine compared with conventional health care still are to be properly evaluated [14]:”

• cites [14] Wootton R. Telemedicine and developing countries-successful implementation will require a shared approach. J Telemed Telecare 2001; 7 sourceNot checked — no full text of the source

May combine two claims.

Current (2014) Chinese technological infrastructure has greatly improved communication quality, and most rural locations are now covered by good communication infrastructure.

“The current (2014) Chinese technological infrastructure has greatly improved the communication quality of the telemedicine projects, and most rural locations are now (2014) covered by a good communication infrastructure.”

• cites [38] sourceNot checked — no full text of the source

May combine two claims.

During the 12-year Sichuan project, 11,987 teleconsultations were performed, mainly for neoplasms, injuries, and cardiovascular diseases.

“During the 12-year period, some 11,987 teleconsultations were performed, mainly devoted to diagnosing neoplasms, injuries, and cardiovascular diseases.”

• cites [15] sourceNot checked — no full text of the source

May combine two claims.

Multipoint-to-multipoint communication is sometimes needed and more powerful than point-to-point, particularly when critical cases require different expert teams.

“in fact, multipoint-tomultipoint communication is sometimes needed, which is much more powerful than a simple point-to-point architecture, particularly when critical cases may require different teams of expert to be involved in the discussion [37].”

• cites [37] sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

In India, life expectancy at birth is 52 years, technological infrastructure reaches over 65% of landmass and 80% of population, and GDP devoted to health-care is estimated 4.9% as of 2005.

“In India the life expectancy at birth is of 52 years, and the technological infrastructure reaches over 65% of the Indian landmass and 80% of its population.The percentage of GDP devoted to health-care is estimated to be 4.9% (as of 2005).”

• cites [39] sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S4 (based). May combine two claims.

Telemedicine applications in developing countries could provide basic health care to wide populations and connect rural areas with specialized hospitals.

“Nevertheless, telemedicine applications in developing countries could be a leverage to provide wide populations with basic health care services and to close the distance between rural areas and specialized hospitals usually located in big cities.”

Classified as probably not a substantial claim. May combine two claims.

Tulu et al. [19] focuses on telemedicine in general, without distinguishing developed or developing countries, and considers only few technical details such as application purpose, hospital size, bandwidth, connection type, and no other dimension.

“This paper by Tulu et al. focuses on telemedicine in general, without distinguishing projects deployed for developed or for developing countries: moreover, only few technical details are considered, such as application purpose, size of the hospital/healthcare center, bandwidth usage, type of connection (synchronous vs. asynchronous), and no other dimension is considered by the taxonomy.”

• cites [19] Tulu B, Chatterjee S, Laxminarayan S. A taxonomy of telemedicine efforts with respect to applications, infrastructure, delivery tools, type of setting and purpose. In 38th Hawaii International Conference on System Sciences (HICSS-38 2005), CD-ROM / Abstracts Proceedings, 3-6 January 2005, Big Island, HI, USA. IEEE Computer Society. sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

Malaria kills more than 1 million children every year in Sub-Saharan Africa.

“malaria (killing more than 1 million children every year)”

• cites [35] sourceNot checked — no full text of the source

May combine two claims.

Average electric power consumption in Sub-Saharan Africa is 124 KWh per capita per year, about one tenth of elsewhere in developing world, barely enough for one 100-W light bulb per person for three hours daily.

“the average electric power consumption in Sub-Saharan Africa is 124 KWh per capita per year, only a tenth of what found elsewhere in the developing world, and barely enough to power one 100-W light bulb per person for three hours a day [29]”

• cites [29] The World Bank. Fact sheet: Infrastructure in sub-Saharan Africa. 2014. Available from: http://go.worldbank.org/SWDECPM5S0Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

May combine two claims.

In China, 20% of resources are available to 900 million rural people, about 70% of Chinese population as of 2007.

“In China [38] 20% of the resources are available to 900 million rural people, which represent some 70% of the entire Chinese population (as of 2007, no further studies available).”

• cites [38] sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Tulu et al. [20] does not distinguish developed vs developing countries and considers no particular technical detail.

“Again, no distinction applies on project targets between developed and developing countries, and no particular technical detail is considered.”

• cites [20] sourceNot checked — no full text of the source

May combine two claims.

Generic infrastructures limiting telemedicine projects include poor electricity, water, telephone services, isolation and lack of CME for health staff, and poor supervision.

“poor-quality water supplies; poor-quality telephone services; isolation and lack of continuing medical education (CME) for health care staff; and poor supervision of health care staff [30].”

• cites [30] sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

China's overall health systems performance is ranked 144 as of 2007.

“Despite its rapidly growing economy, the overall health systems performance of China is ranked 144, as of 2007 [38].”

• cites [38] sourceNot checked — no full text of the source

May combine two claims.

Major organizational issues in developing countries include lack of medical supplies, especially drugs, poor referral system, and lack of transportation.

“major issues concern the lack of medical supplies, especially drugs, poor referral system (and usually no feedback to the person originating the referral), and lack of transportation [30].”

• cites [30] sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

In Pacific Islands and Micronesia, 45% of the population is under 15.

“estimating that 45% of the population is under 15.”

• cites [41] Bice SD, Dever G, Mukaida L, Norton SA, Samisone J. Telemedicine and telehealth in the Pacific islands region: A survey of applications, experiments, and issues. In Peacesat. Pacific Telecommunications Council, pp. 574-581Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

• cites [42] sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Pacific Islands and Micronesia have a total population of about 160,000 spread over 97 islands, with some 2,000 uninhabited islands.

“the total population of some 160,000 inhabitants is spread over 97 islands, villages are densely populated, while some 2,000 islands are not inhabited.”

• cites [41] Bice SD, Dever G, Mukaida L, Norton SA, Samisone J. Telemedicine and telehealth in the Pacific islands region: A survey of applications, experiments, and issues. In Peacesat. Pacific Telecommunications Council, pp. 574-581Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

• cites [42] sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

In this way, design experts derive choices that determine the main functionality of the project as well as its success.

“In this way, design experts derive the choices which will then determine the main functionality of the project -as well as its success.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

One possible interpretation is that major projects, requiring major economic efforts, can be deployed by countries whose economy is not extremely poor; such countries may have already prioritized telemedicine in urban locations and then focused on rural locations.

“One possible interpretation is that major projects, which require major economic efforts, can be deployed by countries whose economy is not extremely poor: such countries may have already given higher priority to telemedicine projects in urban locations, and -as a second intervention -have then focused on rural locations”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Telemedicine projects are usually funded for three years, after which the deployed service is evaluated for continuation or discontinuation.

“Typically, projects are funded for a period of three years, and then the deployed telemedicine service needs to be evaluated and, eventually, to be continued or discontinued [59].”

• cites [59] sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Consequently, bigger projects come with bigger budgets and may focus on rural locations where higher power consumption and greater bandwidth availability result in a bigger economic effort.

“Consequently, as stated above, bigger projects come with bigger budgets and may focus on rural locations where higher power consumption and greater bandwidth availability result in a bigger economic effort.”

May combine two claims.

Email communication is inexpensive, requires simple hardware and software, and can transmit information in store-and-forward mode.

“E-mail communication is cheap, hardware and software requirements are simple, and the information transmission could be in store and forward mode [35].”

• cites [35] sourceNot checked — no full text of the source

May combine two claims.

Minor projects come from poorer countries with very restricted economies, whose governments are now committed to providing urban locations with health-service coverage, and extending to rural locations is probably a second-level priority.

“On the other side, minor projects come from poorer countries with a very restricted economy, and whose governments are now committed to providing urban locations with an health-service coverage: extending the project to rural locations is probably set as second-level priority for that country.”