Mobile, cloud, and big data computing: Contributions, challenges, and new directions in telecardiology

International Journal of Environmental Research and Public Health

Volumn 10, Issue 11, 2013, Pages 6131-6153

  Hsieh, Jui Chien ^a   Li, Ai Hsien ^b   Yang, Chung Chi ^c  

^a YUAN ZE UNIVERSITY   (Taiwan)

^b FAR EASTERN MEMORIAL HOSPITAL   (Taiwan)

^c TAOYUAN ARMED FORCES GENERAL HOSPITAL   (Taiwan)

Author keywords

Big data; Cloud computing; Echocardiography; Electrocardiograph; Medical images; Mobile computing; Telecardiology

Indexed keywords

CARDIOLOGY; DATA PROCESSING; INFORMATION TECHNOLOGY; REAL TIME;

CLOUD COMPUTING; COMPUTER NETWORK; COMPUTER SECURITY; CONFIDENTIALITY; CORONARY CARE UNIT; DIGITAL IMAGING; DIGITAL IMAGING AND COMMUNICATIONS IN MEDICINE; ECHOCARDIOGRAPHY; ELECTROCARDIOGRAPHY; ELECTROCARDIOGRAPHY MONITORING; HEART ATRIUM FIBRILLATION; HOME MONITORING; HUMAN; INFORMATION PROCESSING; INFORMATION RETRIEVAL; INFORMATION STORAGE; INTENSIVE CARE; MOBILE COMPUTING; MOBILE PHONE; PICTURE ARCHIVING AND COMMUNICATION SYSTEM; PRIVACY; REAL TIME ECHOGRAPHY; REVIEW; ST SEGMENT ELEVATION MYOCARDIAL INFARCTION; TELECARDIOLOGY; TELECONSULTATION; TELEDIAGNOSIS; TELEMONITORING; WIRELESS COMMUNICATION;

CARDIOLOGY; ECHOCARDIOGRAPHY; ELECTROCARDIOGRAPHY; HUMANS; IMAGE INTERPRETATION, COMPUTER-ASSISTED; INFORMATION STORAGE AND RETRIEVAL; REMOTE CONSULTATION;

EID: 84887684572     PISSN: 16617827     EISSN: 16604601     Source Type: Journal    
DOI: 10.3390/ijerph10116131     Document Type: Review

References (94)

1. Sable, C. Telecardiology: Potential impact on acute care. Crit. Care Med. 2001, 29, doi:10.1542/peds.109.1.e3.
2. Nikus, K.; Virtanen, V.; Sclarovsky, S.; Eskola, M. The Role of Standard 12-lead ECG in a Telecardiology Consultation Service. In Telemedicine Techniques and Applications; Graschew, G, Rakowsky, S., Eds.; InTech: Rijeka, Croatia, 2011; doi:10.5772/17347.
3. Evangelista, A.; Flachskampf, F.; Lancellotti, P.; Badano, L.; Aguilar, R.; Monaghan, M.; Zamorano, J.; Nihoyannopoulos, P. European Association of Echocardiography recommendations for standardization of performance, digital storage and reporting of echocardiographic studies. Eur. J. Echocardiogr. 2008, 9, 438-448.
4. Birati, E.; Roth, A. Telecardiology. Israel Med. Assoc. J. 2011, 13, 498-503.
5. Sørensen, J.T.; Clemmensen, P.; Sejersten, M. Telecardiology: Past, present and future. Revista Española de Cardiología (English Edition) 2013, 66, 212-218.
6. Backman, W.; Bendel, D.; Rakhit, R. The telecardiology revolution: Improving the management of cardiac disease in primary care. JRSM 2010, 103, 442-446.
7. Atar, S. Telecardiology-Close to the heart, but still out of reach. Israel Med. Assoc. J. 2011, 13, 496-497.
8. Hsieh, J. C.; Hsu, M.W. A cloud computing based 12-lead ECG telemedicine service. BMC Med. Inform. Decis. Making 2012, 12, doi: 10.1186/1472-6947-12-77.
9. Orlov, O.I.; Drozdov, D.V.; Doarn, C.R.; Merrell, R.C. Wireless ECG monitoring by telephone. Telemed. J. e-Health 2001, 7, 33-38.
10. Giannakakis, G.; Buliev, I. ECG signal recording, processing and transmission using a mobile phone. Proceedings of the 1st International Conference on PErvasive Technologies Related to Assistive Environments, Athens, Greece, 15-19 July 2008; ACM Digital Library: New York, NY, USA., 2008; doi:10.1145/1389586.1389680.
11. Lee, H.J.; Lee, S.H.; Ha, K.-S.; Jang, H.C.; Chung, W.-Y.; Kim, J.Y.; Chang, Y.-S.; Yoo, D.H. Ubiquitous healthcare service using Zigbee and mobile phone for elderly patients. Int. J. Med. Inform. 2009, 78, 193-198.
12. Yousef, J.; Lars, A. Validation of a real-time wireless telemedicine system, using bluetooth protocol and a mobile phone, for remote monitoring patient in medical practice. Eur. J. Med. Res. 2005, 10, 254-262.
13. Chu, Y.; Ganz, A. A mobile teletrauma system using 3G networks. Inform. Technol. Biomed Technol 2004, 8, 456-462.
14. Brunetti, N.D.; Amodio, G.; de Gennaro, L.; Dellegrottaglie, G.; Pellegrino, P.L.; di Biase, M.; Antonelli, G. Telecardiology applied to a region-wide public emergency health-care service. J. Thromb. Thrombolysis 2009, 28, 23-30.
15. Scalvini, S.; Piepoli, M.; Zanelli, E.; Volterrani, M.; Giordano, A.; Glisenti, F. Incidence of atrial fibrillation in an Italian population followed by their GPs through a telecardiology service. Int. J. Cardiol. 2005, 98, 215-220.
16. Klingenheben, T.; Israel, C.W. Use of telemedicine in the diagnosis of paroxysmal atrial fibrillation and to monitor the effect of antiarrhythmic drug therapy. Herzschrittmachertherapie and Elektrophysiologie 2006, 17, 225-228.
17. Board, Q.D.H.I. Tele-cardiology for Patients with Chronic Heart Failure: The "SHL" experience in Israel and Germany. Stud. Health Technol. Inform. 2005, 114, 235-237.
18. Atoui, H.; Télisson, D.; Fyan, J.; Rubel, P. Ambient intelligence and pervasive architecture designed within the EPI-MEDICS personal ECG monitor. Int. J. Healthcare Inform. Syst. Inform. 2008, 3, 68-80.
19. Hsieh, J.C.; Yu, K.C.; Yang, C.C. The realization of ubiquitous 12-lead ECG diagnosis in emergency telemedicine. Telemed. e-Health 2009, 15, 898-906.
20. Brunetti, N.D.; de Gennaro, L.; Dellegrottaglie, G.; Procacci, V.; di Biase, M. Fast and furious: Telecardiology in acute myocardial infarction triage in the emergency room setting. Eur. Res. Telemed. 2013, 2, 75-78.
21. Nallamothu, B.K.; Bates, E.R.; Herrin, J.; Wang, Y.; Bradley, E.H.; Krumholz, H.M. Times to treatment in transfer patients undergoing primary percutaneous coronary intervention in the United States national registry of myocardial infarction (NRMI)-3/4 Analysis. Circulation 2005, 111, 761-767.
22. Smith, S.C.; Feldman, T.E.; Hirshfeld, J.W.; Jacobs, A.K.; Kern, M.J.; King, S.B.; Morrison, D.A.; O'Neill, W.W.; Schaff, H.V.; Whitlow, P.L.; et al. ACC/AHA/SCAI 2005 Guideline update for percutaneous coronary intervention. A report of the American college of cardiology/American heart association task force on practice guidelines. J. Am. Coll. Cardiol. 2006, 47, doi: 10.1016/j.jacc.2011.08.007.
23. Hsieh, J.C.; Lo, H.C. The clinical application of a PACS-dependent 12-lead ECG and image information system in E-medicine and telemedicine. J. Digital Imaging 2010, 23, 501-513.
24. Mildenberger, P.; Eichelberg, M.; Martin, E. Introduction to the DICOM standard. Eur. Radiol. 2002, 12, 920-927.
25. Huang, H.K. PACS and imaging informatics: Basic principles and applications; Wiley: Hoboken, NJ, USA, 2009.
26. Costa, C.; Oliveira, J.L. Telecardiology through ubiquitous Internet services. Int. J. Med. Inform. 2012, 81, 612-621.
27. Marcin, J.P.; Marcin, M.; Sadorra, C.; Dharmar, M. The Role of telemedicine in treating the critically ill. ICU Director 2012, 3, 70-74.
28. Lilly, C.M.; Cody, S.; Zhao, H.; Landry, K.; Baker, S.P.; McIlwaine, J.; Chandler, M.W.; Irwin, R.S. Hospital mortality, length of stay, and preventable complications among critically ill patients before and after tele-ICU reengineering of critical care processes. JAMA 2011, 305, doi:10.1001/jama.2011.697.
29. Goran, S.F. A second set of eyes: An introduction to tele-ICU. Crit. Care Nurse 2010, 30, 46-55.
30. Nikus, K.; Lähteenmäki, J.; Lehto, P.; Eskola, M. The role of continuous monitoring in a 24/7 telecardiology consultation service-A feasibility study. J. of Electrocardiol. 2009, 42, 473-480.
31. Zhang, P.; Kumabe, A.; Kogure, Y.; Akutagawa, M.; Kinouchi, Y.; Zhang, Q. New functions developed for ICU/CCU remote monitoring system using a 3G mobile phone and evaluations of the system. Proceedings of the Conference of Medicine and Biological Society, Vancouver, Canada, 21-24 August 2008; doi:10.1109/IEMBS.2008.4650421.
32. Ting, H.H.; Krumholz, H.M.; Bradley, E.H.; Cone, D.C.; Curtis, J.P.; Drew, B.J.; Field, J.M.; French, W.J.; Gibler, W.B.; Goff, D.C. Implementation and integration of prehospital ECGs into systems of care for acute coronary syndrome. A scientific statement from the American Heart Association Interdisciplinary Council on quality of care and outcomes research, emergency cardiovascular care committee, council on cardiovascular nursing, and council on clinical cardiology. Circulation 2008, 118, 1066-1079.
33. Grim, P.; Feldman, T.; Martin, M.; Donovan, R.; Nevins, V.; Childers, R.W. Cellular telephone transmission of 12-lead electrocardiograms from ambulance to hospital. Amer. J. Cardiol. 1987, 60, 715-720.
34. Pavlopoulos, S.; Kyriacou, E.; Berler, A.; Dembeyiotis, S.; Koutsouris, D. A novel emergency telemedicine system based on wireless communication technology-ambulance. IEEE Trans. Inf. Technol. Biomed. 1998, 2, 261-267.
35. Clark, E.N.; Sejersten, M.; Clemmensen, P.; Macfarlane, P.W. Automated electrocardiogram interpretation programs versus cardiologists' triage decision making based on teletransmitted data in patients with suspected acute coronary syndrome. Amer. J. Cardiol. 2010, 106, 1696-1702.
36. Sejersten, M.; Sillesen, M.; Hansen, P.R.; Nielsen, S.L.; Nielsen, H.; Trautner, S.; Hampton, D.; Wagner, G.S.; Clemmensen, P. Effect on treatment delay of prehospital teletransmission of 12-lead electrocardiogram to a cardiologist for immediate triage and direct referral of patients with ST-segment elevation acute myocardial infarction to primary percutaneous coronary intervention. Amer. J. Cardiol. 2008, 101, 941-946.
37. Väisänen, O.; Mäkijärvi, M.; Silfvast, T. Prehospital ECG transmission: Comparison of advanced mobile phone and facsimile devices in an urban Emergency Medical Service System. Resuscitation 2003, 57, 179-185.
38. Hsieh, J.C.; Lin, B.X.; Wu, F.R.; Chang, P.C.; Tsuei, Y.W.; Yang, C.C. Ambulance 12-lead electrocardiography transmission via cell phone technology to cardiologists. Telemedicine and E-Health 2010, 16, 910-915.
39. Meadows-Pitt, M.; Fields, W. The impact of prehospital 12-lead electrocardiograms on door-to-balloon time in patients with ST-elevation myocardial infarction. J. Emerg. Nurs. 2013, In Press.
40. Martinoni, A.; de Servi, S.; Boschetti, E.; Zanini, R.; Palmerini, T.; Politi, A.; Musumeci, G.; Belli, G.; de Paolis, M.; Ettori, F. Importance and limits of pre-hospital electrocardiogram in patients with ST elevation myocardial infarction undergoing percutaneous coronary angioplasty. Eur. J. Cardiovasc. Prev. Rehabil. 2011, 18, 526-532.
41. Maharaj, R.C.; Geduld, H.; Wallis, L.A. Door-to-needle time for administration of fibrinolytics in acute myocardial infarction in Cape Town. S. Afr. Med. J. 2012, 102, 241-244.
42. Sable, C. Digital echocardiography and telemedicine applications in pediatric cardiology. Pediatr. Cardiol. 2002, 23, 358-369.
43. Giansanti, D.; Morelli, S. Digital tele-echocardiography: A look inside. Annali dell'Istituto superiore di sanità 2009, 45, 357-362.
44. Pian, L.; Gillman, L.M.; McBeth, P.B.; Xiao, Z.; Ball, C.G.; Blaivas, M.; Hamilton, D.R.; Kirkpatrick, A.W. Potential use of remote telesonography as a transformational technology in underresourced and/or remote settings. Emerg. Med. Int. 2013, 1-9.
45. Finley, J.P.; Sharratt, G.P.; Nanton, M.A.; Chen, R.P.; Bryan, P.; Wolstenholme, J.; MacDonald, C. Paediatric echocardiography by telemedicine-nine years' experience. J. Telemed. Telecare 1996, 3, 200-204.
46. Trippi, J.A.; Kopp, G.; Lee, K.S.; Morrison, H.; Risk, G.; Jones, J.H.; Cordell, W.H.; Chrapla, M.; Nelson, D. The feasibility of dobutamine stress echocardiography in the emergency department with telemedicine interpretation. J. Am. Soc. Echocardiogr. 1996, 9, 113-118.
47. Widmer, S.; Ghisla, R.; Ramelli, G.P.; Taminelli, F.; Widmer, B.; Caoduro, L.; Gallino, A. Tele-echocardiography in paediatrics. Eur. J. Pediatr. 2003, 162, 271-275.
48. Grant, B.; Morgan, G.J.; McCrossan, B.A.; Crealey, G.E.; Sands, A.J.; Craig, B.; Casey, F.A. Remote diagnosis of congenital heart disease: the impact of telemedicine. Arch. Dis. Child. 2010, 95, 276-280.
49. Dowie, R.; Mistry, H.; Young, T.A.; Franklin, R.C.; Gardiner, H.M. Cost implications of introducing a telecardiology service to support fetal ultrasound screening. J. Telemed. Telecare 2008, 14, 421-426.
50. McCrossan, B.A.; Sands, A.J.; Kileen, T.; Doherty, N.N.; Casey, F.A. A fetal telecardiology service: Patient preference and socioeconomic factors. Prenatal Diag. 2012, 32, 883-887.
51. Huang, T.; Moon-Grady, A.J.; Traugott, C.; Marcin, J. The availability of telecardiology consultations and transfer patterns from a remote neonatal intensive care unit. J. Telemed. Telecare 2008, 14, 244-248.
52. Andersen, G.N.; Haugen, B.O.; Graven, T.; Salvesen, Ø.; Mjølstad, O.C.; Dalen, H. Feasibility and reliability of point-of-care pocket-sized echocardiography. Eur. J. Echocardiogr. 2011, 12, 665-670.
53. Panoulas, V.F.; Daigeler, A.-L.; Malaweera, A.S.; Lota, A.S.; Baskaran, D.; Rahman, S.; Nihoyannopoulos, P. Pocket-size hand-held cardiac ultrasound as an adjunct to clinical examination in the hands of medical students and junior doctors. Eur. Heart J. Cardiovasc. Imaging 2013, 14, 323-330.
54. Choi, B.G.; Mukherjee, M.; Dala, P.; Young, H.A.; Tracy, C.M.; Katz, R.J.; Lewis, J.F., Interpretation of remotely downloaded pocket-size cardiac ultrasound images on a web-enabled smartphone: Validation against workstation evaluation. J. Am. Soc. Echocardiogr. 2011, 24, 1325-1330.
55. Prinz, C.; Dohrmann, J.; Buuren, F.V.; Bitter, T.; Bogunovic, N.; Horstkotte, D.; Faber, L. Diagnostic performance of handheld echocardiography for the assessment of basic cardiac morphology and function: A validation study in routine cardiac patients. Echocardiography 2012, 29, 887-894.
56. Karson, T.H.; Zepp, R.C.; Chandra, S.; Morchead, A.; Thomas, J.D. Digital storage of echocardiograms offers superior image quality to analog storage, even with 20: 1 digital compression: results of the Digital Echo Record Access Study. J. Am. Soc. Echocardiogr. 1996, 9, 769-778.
57. Langer, S.G. Challenges for data storage in medical imaging research. J. Digital Imaging 2011, 24, 203-207.
58. Teng, C.C.; Mitchell, J.; Walker, C.; Swan, A.; Davila, C.; Howard, D.; Needham, T. A medical image archive solution in the cloud. Softw. Eng. Serv. Sci. 2010, 431-434.
59. Agrawal, D.; Das, S.; Abbadi, A. In Big data and cloud computing: current state and future opportunities. Proceedings of the 14th International Conference on Extending Database Technology, Uppsala, Sweden, 22-24 March 2011; ACM Digital Library: New York, NY, USA, 2011; doi:10.1145/1951365.1951432.
60. Mell, P.; Grance, T. Final Version of NIST Cloud Computing Definition Published. Available online: http://csrc.nist.gov/publications/nistpubs/800-145/SP800-145.pdf (accessed on 8, November 2013).
61. Chia, C.C.; Syed, Z. Computationally generated cardiac biomarkers: Heart rate patterns to predict death following coronary attacks. Proceedings of the 11th SIAM International Conference on Data Mining (SDM11), Mesa, AZ, USA, 28-30 April 2011; pp. 735-746.
62. Keyes, R.W.; Romano, C.; Arnold, D.; Luan, S. Radiation Therapy Calculations Using an On-demand Virtual Cluster via Cloud Computing. Available online: http://arxiv.org/pdf/ 1009.5282v1.pdf (accessed on 8 November 2013).
63. Raju, P.K.; Prasad, S. Telemedicine and cardiology-Decade of our experience. J. Indian Coll. Cardiol. 2012, 2, 4-16.
64. Philbin, J.; Prior, F.; Nagy, P. Will the next generation of PACS be sitting on a cloud? J. Digital Imaging 2011, 24, 179-183.
65. Silva, L.A.B.; Costa, C.; Oliveira, J.L. A PACS archive architecture supported on cloud services. Int. J. Comput. Assist. Radiol. Surg. 2012, 7, 349-358.
66. Ratib, O.; Rosset, A.; Heuberger, J. Open source software and social networks: Disruptive alternatives for medical imaging. Eur. J. Radiol. 2011, 78, 259-265.
67. Kagadis, G.C.; Alexakos, C.; Langer, S.G.; French, T. Using an open-source PACS virtual machine for a digital angiography unit: Methods and initial impressions. J. Digital Imaging 2012, 25, 81-90.
68. Rostrom, T.; Teng, C.C. Secure communications for PACS in a cloud environment. Eng. Med. Biol. Soc. 2011, 8219-8222.
69. Norcen, R.; Podesser, M.; Pommer, A.; Schmidt, H.-P.; Uhl, A. Confidential storage and transmission of medical image data. Comp. Biol. Med. 2003, 33, 277-292.
70. Pearson, S.; Shen, Y.; Mowbray, M. A privacy manager for cloud computing. Cloud Comput. Lect. Note. Comput. Sci. 2009, 5931, 90-106.
71. Mowbray, M.; Pearson, S.; Shen, Y. Enhancing privacy in cloud computing via policy-based obfuscation. J. Supercomp. 2012, 61, 267-291.
72. Satyanarayanan, M.; Bahl, P.; Caceres, R.; Davies, N. The case for vm-based cloudlets in mobile computing. Pervasive Comput. IEEE 2009, 8, 14-23.
73. Rikitake, K.; Araki, Y.; Kawahara, Y.; Minami, M.; Morikawa, H. NGN/IMS-based Ubiquitous Health Monitoring System. Proceedings of 6th IEEE Consumer Communications and Networking Conference, Las Vegas, NV, USA., 10-13 January 2011; pp. 1-2.
74. Krendzel, A.; Lopatin, S.; Mangues-Bafalluy, J. Implementation of NGN/IMS Technologies into Legacy Network Infrastructures. Proceedings of World Telecommunication Congress, Vienna, Austria, 13-14 September 2010; pp. 1-6.
75. Skodras, A.; Christopoulos, C.; Ebrahimi, T. The JPEG 2000 still image compression standard. IEEE Signal Process. Mag. 2001, 18, 36-58.
76. Wiegand, T.; Sullivan, G.J.; Bjontegaard, G.; Luthra, A. Overview of the H264/AVC video coding standard. Circ. Syst. Video T. 2003, 13, 560-576.
77. Kim, D.K.; Kim, E.Y.; Yang, K.H.; Lee, C.K.; Yoo, S.K. A mobile tele-radiology imaging system with JPEG2000 for an emergency care. J. Digital Imaging 2011, 24, 709-718.
78. Pedersen, P.C.; Dickson, B.W.; Chakareski, J. Telemedicine applications of mobile ultrasound. Proceedings of IEEE International Workshop on Multimedia Signal Process, Rio de Janeiro, Brazil, 5-7 October 2009; pp. 1-6.
79. Satyanarayanan, M. Pervasive computing: Vision and challenges. IEEE Personal Commun. 2001, 8, 10-17.
80. Kumar, K.; Lu, Y.-H. Cloud computing for mobile users: Can offloading computation save energy? Computer 2010, 43, 51-56.
81. Trigo, J.D.; Alesanco, A.; Martinez, I.; Garcia, J. A review on digital ECG formats and the relationships between them. Inform. Technol. Biomed. 2012, 16, 432-444.
82. Sakkalis, V.; Chiarugi, F.; Kostomanolakis, S.; Chronaki, C.; Tsiknakis, M.; Orphanoudakis, S. A gateway between the SCP-ECG and the DICOM supplement 30 waveform standard. Comput. Cardiol. 2003, 30, 25-28.
83. van Ettinger, M.; Lipton, J.; de Wijs, M.; van der Putten, N.; Nelwan, S. An open source ECG toolkit with DICOM. Comput. Cardiology 2008, 35, 441-444.
84. Chronaki, C.; Chiarugi, F.; Lees, P.; Bruun-Rasmussen, M.; Conforti, F.; Ruiz Fernandez, R.; Zywietz, C. Open ECG: A European project to promote the SCP-ECG standard, a further step towards interoperability in electrocardiography. Comput. Cardiology 2002, 29, 285-288.
85. Lubbers, P.; Albers, B.; Salim, F. Overview of HTML5. In Pro HTML5 Programming; Apress: New York, NY, USA, 2011.
86. Holzinger, A.; Treitler, P.; Slany, W. Making apps useable on multiple different mobile platforms: On interoperability for business application development on smartphones. Lect. Note. Computer Sci. 2012, 7465, 176-189.
87. DICOM Part 16: Content Mapping Resource, NEMA, Rosslyn, Virginia 22209, USA, 2011. Available online: http://medical.nema.org/Dicom/2011/11_16pu.pdf (accessed on 17 August 2013).
88. DICOM Supplement 23: Structured Reporting SOP Classes, NEMA, Rosslyn, Virginia 22209, USA, 2011. Available online: http://medical.nema.org/Dicom/supps/sup23_lb.pdf (accessed on 17 August 2013).
89. Hussein, R.; Engelmann, U.; Schroeter, A.; Meinzer, H.P. DICOM structured reporting Part 1. Overview and characteristics1. Radiographics. 2004, 24, 891-896.
90. Hussein, R.; Engelmann, U.; Schroeter, A.; Meinzer, H.P. DICOM structured reporting Part 2. Problems and challenges in implementation for PACS workstations1. Radiographics. 2004, 24, 897-909.
91. Howe, D.; Costanzo, M.; Fey, P.; Gojobori, T.; Hannick, L.; Hide, W.; Hill, D.P.; Kania, R.; Schaeffer, M.; St Pierre, S. Big data: The future of biocuration. Nature 2008, 455, 47-50.
92. Bidgood, W.D., Jr. Clinical importance of the DICOM structured reporting standard. Int. J. Cardiac Imaging 1998, 14, 307-315.
93. Homorodean, C.; Olinic, M.; Olinic, D. Development of a methodology for structured reporting of information in echocardiography. Med. Ultrason. 2012, 14, 29-33.
94. Swinfen Charitable Trust. Available online: http://www.swinfencharitabletrust.org (accessed on 28 October 2013).