Use and Adap a ion o Open Sou ce
So wa e o Capaci y Building o
S eng hen Heal h Resea ch in Low- and
Middle-Income Coun ies
S e an HOCHWARTERa,1, Salla ATKINSa,b, Vinod K. DIWANa and Nabil ZARYc,d
a Depa men o Public Heal h Sciences, Global Heal h (IHCAR), Ka olinska Ins i u e ,
S ockholm, Sweden
b School o Heal h Sciences, Uni e si y o Tampe e, Finland
c Depa men o Lea ning, In o ma ics, Managemen and E hics, Ka olinska Ins i u e ,
S ockholm, Sweden
d Lee Kong Chian School o Medicine, Nanyang Technological Uni e si y, Singapo e,
Singapo e
Abs ac . Heal h esea ch capaci y s eng hening is o impo ance o each heal h
goals. The ARCADE p ojec s' aim was o s eng hen heal h esea ch ac oss A ica
and Asia using inno a i e educa ional echnologies. In he ou yea s o he EU
unded p ojec s, challenges also o echnical na u e we e iden i ied. This a icle
epo s on a s udy conduc ed wi hin he ARCADE p ojec s. The s udy ocused on
add essing challenges o ideo con e encing in esou ce cons ained se ings and
was conduc ed using ac ion esea ch. As a esul , a plugin o he open sou ce ideo
con e encing sys em minisip was implemen ed and e alua ed. The s udy showed
ha bo h he audio and ideo s eams could be imp o ed by he in oduced plugin,
which add essed one echnical challenge.
Keywo ds. Capaci y building, open sou ce so wa e, ICT4D, blended lea ning
1. In oduc ion
E o s o s eng hen heal h esea ch capaci y in low- and middle-income coun ies a e
needed[1]. The ARCADE HSSR and RSDH (A ican/Asian Resea ch Capaci y
De elopmen o Heal h Sys ems and Se ices Resea ch/Social De e minan s o Heal h)
p ojec s we e wo Eu opean Union- unded p ojec s implemen ed om 2011 o 2015 and
coo dina ed by he Di ision o Global Heal h a Ka olinska Ins i u e in S ockholm. The
p ojec s aimed o s eng hen heal h esea ch ac oss A ica and Asia by using inno a ional
educa ional echnologies[2]. The ARCADE p ojec s can be di ided in o he ollowing
ou in e linked componen s[3]. The i s componen o he ARCADE p ojec s was he
de elopmen and deli e y o online cou ses on global heal h opics.
E-lea ning can be di ided in o synch onous and asynch onous educa ion o e-
lea ning. The la e one, asynch onous educa ion, p o ides educa ion om he eache o
1 Co esponding au ho , E-mail: s e an@hochwa e .o g.
In o ma ics o Heal h: Connec ed Ci izen-Led Wellness and Popula ion Heal h
R. Randell e al. (Eds.)
© 2017 Eu opean Fede a ion o Medical In o ma ics (EFMI) and IOS P ess.
This a icle is published online wi h Open Access by IOS P ess and dis ibu ed unde he e ms
o he C ea i e Commons A ibu ion Non-Comme cial License 4.0 (CC BY-NC 4.0).
doi:10.3233/978-1-61499-753-5-338
338
he s uden e en i bo h a e no online a he same ime. Thus, in simple e ms
asynch onous educa ion uses echnologies and ools like e-mail, panels o e-lea ning
pla o ms like Moodle. The s eng hs o asynch onous educa ion lies wi hin i s lexibili y
on bo h ime and place and i s low equi emen s on he bandwid h, which is an impo an
poin o esou ce cons ained se ings[4]. On he o he hand, asynch onous e-lea ning
has also weaknesses, such as no possibili y o immedia e eedback, discussions on
boa ds will las much longe on complex opics compa ed o ace- o- ace discussions and
he lack o social in e ac ion which may esul in s uden s no eeling connec ed o each
o he . Mo eo e , his me hod equi es a se e e discipline om he s uden s as hey need
o manage hei ime o lea ning on hei own[5]. To o e come he disad an ages o e-
lea ning and o ake in o accoun bandwid h challenges, he ARCADE p ojec s used
mos ly blended lea ning which is a combina ion o synch onous ( ace- o- ace online o
in pe son) and asynch onous (e-lea ning) me hods.
The ARCADE p ojec used di e en open sou ce so wa e o p epa e, o ganise and
deli e e-lea ning cou ses. Almos 55 cou ses we e de eloped and deli e ed o o e 920
pos g adua e s uden s in A ica, Asia and Eu ope using e-lea ning p inciples and
speci ically blended lea ning[6]. The open sou ce e-lea ning pla o m Moodle was he
main en y poin o he s uden s. Synch onous dis ance educa ion was deli e ed wi h
he help o minisip 2, which is an open sou ce Session Ini ia ion P o ocol (SIP)
implemen a ion de eloped by ARCADE’s p ojec pa ne Royal Ins i u e o Technology
S ockholm[7]. Howe e , as his pa ne ship weakened o e ime, al e na i es o minisip
we e e alua ed and used. Con en managemen was implemen ed wi h he help o
Al esco Communi y Edi ion, an En e p ise Con en Managemen pla o m.
Dissemina ion and publica ion o esea ch indings we e p esen ed online a he sel -
hos ed p ojec ’s web si e (www.a cade-p ojec .o g) which is powe ed by Wo dp ess.
Fä nman e . al. in es iga ed he challenges which he ARCADE p ojec eam came
ac oss du ing he ou yea s o p ojec un ime by in e iewing 16 pa icipan s om 12
pa ne ins i u ions. The main challenges o e-lea ning included p oblems in echnology,
a ailabili y o skilled echnical s a ac oss implemen a ion si es and a ac ing s uden s’
in e es in cou ses. The epo also poin s ou he high demand on bandwid h and so wa e
de iciencies in esou ce es ained se ings[3]. This is speci ically ue o synch onous
dis ance educa ion. The limi a ion o he bandwid h, poo image and ideo quali y as
well as connec i i y issues a e challenges when ideo elecon e encing sys ems a e
used[8]. In his a icle we will demons a e how open sou ce so wa e can be used o
o e come bandwid h limi a ions.
2. Me hods
The aim o his s udy was o e alua e how Open Sou ce So wa e (OSS) can be used and
op imised o dis ance educa ion, pa icula ly in he a ea o heal h esea ch/educa ion in
a global se ing. As he s udy ook place wi hin he ARCADE p ojec which used he
minisip so wa e, he unde lying s udy ques ion can be s a ed as ollowed.
x How can OSS such as minisip imp o e he deli e y o synch onous heal h
educa ion in esou ce- es ic ed en i onmen s?
2 h ps://gi hub.com/csd/minisip
S. Hochwa e e al. / Use and Adap a ion o Open Sou ce So wa e o Capaci y Building 339
The design o he s udy was de ined by an ac ion esea ch amewo k[9]. Bo h
quali a i e and quan i a i e da a we e used, hence we ollowed a mixed esea ch
app oach. This s udy can be di ided in he di e en phases o ac ion esea ch.
1. Obse e: A ques ionnai e was conduc ed wi h he aim o explo e he ARCADE
RSDH’s eaching ac i i ies and i s p io i ies o he sys em and quan i a i e da a
was collec ed a S . John’s Resea ch Ins i u e in India.
2. Re lec : The da a om he ques ionnai e and measu emen we e analyzed and
possible imp o emen s we e iden i ied.
3. Ac : Based on he e lec ions, an imp o emen was chosen o implemen a ion.
4. E alua e: The implemen ed imp o emen was es ed and e alua ed a Wuhan’s
Tongji Medical College.
The ques ionnai e consis ed o one mul iple choice ques ion and h ee ee- ex
ques ions and was answe ed by ARCADE pa ne s om Sweden (Ka olinska Ins i u e )
and India (S . John’s Resea ch Ins i u e). A quan i a i e measu emen o he Minisip
pe o mance using Wi esha k was done a S . John’s Resea ch Ins i u e in Bangalo e.
The Minisip pe o mance o he ARCADE RSDH p ojec was e alua ed and
imp o emen s we e sugges ed, implemen ed and es ed. The s udy ook place a
ARCADE pa ne s in Sweden (Ka olinska Ins i u e ), India (S . John’s Resea ch Ins i u e
Bangalo e) and China (Wuhan’s Tongji Medical College). Du ing he s udy, he ocus
o he e ms "adap abili y" and "pe o mance" we e na owed down based on he
ou come o he ques ionnai e.
Da a we e analysed using he s a is ical en i onmen o R. The R package RQDA
was used o o ganise and analyse quali a i e da a. Cap u ed a ic om minisip was
eco ded and il e ed by using Wi esha k. Wi esha k o e s de ailed analyse unc ion o
SIP calls and Real-Time T anspo P o ocol (RTP) s eams, including package loss and
ji e .
3. Resul s
In he i s s ep (Obse e), he backg ound, aims and equi emen o he unde lying
p ojec was in es iga ed by a ques ionnai e. A quan i a i e analysis o minisip a S .
John’s Resea ch Ins i u e in Bangalo e showed ha one challenge was he a he high
Packe Delay Va ia ion (PDV) o so-called "ji e ". Based on he ques ionnai e in he i s
s ep and he measu emen ou come (Re lec ), we decided o implemen a plugin o
minisip wi h he aim o minimise he PDV. Minisip o e s an in e ace o inse an
ex ension a di e en s ages o he a ic low. The implemen ed ex ensions we e
inse ed a e he RTP pipeline a he p ojec pa ne a Wuhan’s Tongji Medical College,
China (Ac ).
Two di e en algo i hms we e implemen ed o imp o e he a ic low. As he
audio packe s all had he same size, a simple leaky bucke algo i hm was su icien .
Howe e , he ideo packe s we e o di e en size and he e o e he by e-based oken
bucke algo i hm was chosen[10].
S. Hochwa e e al. / Use and Adap a ion o Open Sou ce So wa e o Capaci y Building340
Figu e 1. Measu emen om he leaky bucke plugin o audio s eam (Wuhan, China)
The inal phase o he ac ion esea ch was o e alua e he ou come o he
implemen a ion. Figu e 1 shows he ou pu o he leaky bucke ex ension o incoming
audio. The i s diag am isualises he incoming packe s, each do ep esen s one
incoming packe (each 125 By es) be o e he ex ension is shaping he a ic. The second
diag am shows he manipula ed a ic, again one do ep esen s one packe . Finally, he
hi d diag am ep esen s he cu en con en o he bucke wi h a maximum capaci y o
15 packe s.
Figu e 2 illus a es he e ec o he oken bucke algo i hm. The diag am "incoming
a ic" isualises he incoming ideo packe s o e ime and he diag am "shaped a ic"
shows he esul ed a ic a e he oken bucke ex ension. One do ep esen s one packe
and he e ical axes shows he packe size. Two impo an pa ame e s o he ex ension
a e also isualised: The packe queue shows he numbe o by es (no packe s) wai ing
o ansmission and he las diag am ep esen s he oken a ailable o a ic. One oken
is equal o one By e in he used con igu a ion.
As shown in Figu e 1 and Figu e 2, he PDV was success ully minimised o bo h
audio and ideo s eams.
4. Discussion
The s udy demons a ed wi h a speci ic example, how open sou ce so wa e can be
adap ed o capaci y building in low and middle income coun ies based on a scien i ic
backg ound. Howe e , o add ess he challenges which he ARCADE p ojec eam
encoun e ed du ing hei ou yea p ojec un ime, di e en s a egies should be used.
Fo example, in es men in IT in as uc u e and educa ing echnical s a would be wo
possible s a egies.
Du ing his s udy we also aced a ypical isk when using open sou ce so wa e ha
is no backed by a s ong communi y. The main de elope o minisip s opped his
con ibu ion and since hen minisip is no u he de eloped. The ini ial s eng h, namely
he close pa ne ship wi h he de elope and he eby he possibili y o ecei e an adap ed
so wa e solu ion o ou se ings, u ned ou o be also a high isk ac o .
S. Hochwa e e al. / Use and Adap a ion o Open Sou ce So wa e o Capaci y Building 341
Figu e 2. Measu emen s om he leaky bucke plugin o he ideo (H.264) s eam (Wuhan, China)
Ne e heless, we belie e ha he use o open sou ce so wa e has high po en ial and
s ong ad an ages, especially in esou ce es ained se ings. Wi hin a limi ed ime- ame,
he p ojec eam success ully in oduced an imp o emen o a speci ic p oblem based
on measu emen s and in e iews. This was made possible h ough an open sou ce
so wa e ha had a clean codebase and ex ensi e documen a ion. The e o e ex e nal
de elope s and con ibu o s we e enabled o in oduce changes and imp o emen s. As
pa o a u u e s udy, he plugins could also be in eg a ed and es ed in o he SIP
implemen a ions. Finally, he implemen ed plugins could be u he imp o ed by
au oma ically de ec ing he algo i hms’ pa ame e s.
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