Use and Adaptation of Open Source Software for Capacity Building to Strengthen Health Research in Low- and Middle-Income Countries

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. Re e ences [1] McKee, M., S uckle , D., & Basu, S. (2012). Whe e he e is no heal h esea ch: wha can be done o ill he global gaps in heal h esea ch? PLoS Med, 9(4), e1001209. [2] P o si , M., Rosales-Klin z, S., Bwanga, F., Zwa ens ein, M., & A kins, S. (2016). Blended lea ning ac oss uni e si ies in a Sou h–No h–Sou h collabo a ion: a case s udy. Heal h Resea ch Policy and Sys ems, 14(1), 67. [3] Fä nman, R., Diwan, V., Zwa ens ein, M., & A kins, S. (2016). Successes and challenges o no h–sou h pa ne ships–key lessons om he A ican/Asian Regional Capaci y De elopmen p ojec s Global Heal h Ac ion, 9. [4] B anon RF, Essex C. 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