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 ADVANCES IN
TELEMEDICINE:
TECHNOLOGIES,
ENABLING FACTORS
AND SCENARIOS
Edited by Georgi Graschew
and Theo A. Roelofs
Advances in Telemedicine: Technologies, Enabling Factors and Scenarios
Edited by Georgi Graschew and Theo A. Roelofs

Published by InTech
Janeza Trdine 9, 51000 Rijeka, Croatia

Copyright © 2011 InTech

All chapters are Open Access articles distributed under the Creative Commons
Non Commercial Share Alike Attribution 3.0 license, which permits to copy,
distribute, transmit, and adapt the work in any medium, so long as the original
work is properly cited. After this work has been published by InTech, authors
have the right to republish it, in whole or part, in any publication of which they
are the author, and to make other personal use of the work. Any republication,
referencing or personal use of the work must explicitly identify the original source.

Statements and opinions expressed in the chapters are these of the individual contributors
and not necessarily those of the editors or publisher. No responsibility is accepted
for the accuracy of information contained in the published articles. The publisher
assumes no responsibility for any damage or injury to persons or property arising out
of the use of any materials, instructions, methods or ideas contained in the book.

Publishing Process Manager Katarina Lovrecic

Technical Editor Teodora Smiljanic
Cover Designer Martina Sirotic
Image Copyright Lasse Kristensen, 2010. Used under license from Shutterstock.com

First published March, 2011

Printed in India

A free online edition of this book is available at www.intechopen.com

Additional hard copies can be obtained from [email protected]

Advances in Telemedicine: Technologies, Enabling Factors and Scenarios,

Edited by Georgi Graschew and Theo A. Roelofs
p. cm.
ISBN 978-953-307-159-6
free online editions of InTech
Books and Journals can be found at
www.intechopen.com
Contents

Preface IX

Part 1 Fundamental Technologies 1

Chapter 1 Cross Layer Design of Wireless LAN for Telemedicine

Application Considering QoS Provision 3
Eko Supriyanto, Emansa Hasri Putra, Jafri bin Din,
Haikal Satria and Hamid Azwar

Chapter 2 Novel Wireless Communication Protocol

for e-Health Applications 27
A. Zvikhachevskaya and L. Mihaylova

Chapter 3 Safety and Electromagnetic Compatibility

in Wireless Telemedicine Applications 63
Victoria Ramos and José Luís Monteagudo

Part 2 Applied Technologies 85

Chapter 4 High-Quality Telemedicine Using

Digital Video Transport System
over Global Research and Education Network 87
Shuji Shimizu, Koji Okamura, Naoki Nakashima,
Yasuichi Kitamura, Nobuhiro Torata, Yasuaki Antoku,
Takanori Yamashita, Toshitaka Yamanokuchi,
Shinya Kuwahara and Masao Tanaka

Chapter 5 Lossless Compression Techniques

for Medical Images In Telemedicine 111
J.Janet, Divya Mohandass and S.Meenalosini

Chapter 6 Video-Telemedicine with Reliable Color

Based on Multispectral Technology 131
Masahiro Yamaguchi, Yuri Murakami,
Yasuhiro Komiya, Yoshifumi Kanno,
Junko Kishimoto, Ryo Iwama, Hiroyuki Hashizume,
Michiko Aihara and Masaki Furukawa
VI Contents

Chapter 7 Sharp Wave Based HHT Time-frequency

Features with Transmission Error 149
Chin-Feng Lin, Bing-Han Yang, Tsung-Ii Peng,
Shun-Hsyung Chang, Yu-Yi Chien, and Jung-Hua Wang

Chapter 8 Teleconsultation Enhanced via Session Retrieval Capabilities:

Smart Playback Functions and Recovery Mechanism 165
Pau-Choo Chung and Cheng-Hsiung Wang

Chapter 9 Statistics in Telemedicine 191

Anastasia N. Kastania and Sophia Kossida

Chapter 10 Video Communication in Telemedicine 211

Dejan Dinevski, Robi Kelc and Bogdan Dugonik

Chapter 11 Telemedicine & Broadband 233

Annarita Tedesco, Donatella Di Lieto, Leopoldo Angrisani,
Marta Campanile, Marianna De Falco and Andrea Di Lieto

Part 3 Enabling Factors 259

Chapter 12 Quality Control in Telemedicine - “CE” Label 261

O. Ferrer-Roca

Chapter 13 Innovative Healthcare Delivery:

the Quest for Effective Telemedicine-based Services 271
Laura Bartoli, Emanuele Lettieri and Cristina Masella

Part 4 Scenarios 295

Chapter 14 Real-time Interactive Telemedicine for Ubiquitous Healthcare:

Networks, Services and Scenarios 297
Georgi Graschew, Theo A. Roelofs
Stefan Rakowsky and Peter M. Schlag

Chapter 15 Could There Be a Role for Home Telemedicine

in the U.S. Medicare Program? 319
Lorenzo Moreno, Arnold Chen, Rachel Shapiro and Stacy Dale

Chapter 16 Development of a Portable Vital Sensing

System for Home Telemedicine 345
F. Ichihashi and Y. Sankai

Chapter 17 Implementing the Chronic Disease Self

Management Model in Vulnerable Patient Populations:
Bridging the Chasm through Telemedicine 357
Cardozo Lavoisier J, Steinberg Joel, Cardozo Shaun,
Vikas Veeranna, Deol Bibban and Lepczyk Marybeth
 Contents VII

Chapter 18 The Spanish Ministry of Defence (MOD)

Telemedicine System 379
Alberto Hernandez Abadia de Barbara

Chapter 19 A Telemedicine System for Hostile Environments 397

Ebrahim Nageba, Jocelyne Fayn and Paul Rubel
Preface

Innovative developments in information and communication technologies (ICT) irre-

vocably change our lives and enable new possibilities for society. One of the fields that
strongly profits from this trend is Telemedicine, which can be defined as novel ICT-
enabled medical services that help to overcome classical barriers in space and time.
Through Telemedicine patients can access medical expertise that may not be available
at the patient’s site. The use of specifically designed communication networks with
sophisticated quality-of-service for Telemedicine (distributed medical intelligence)
contributes not only to the continuous improvement of patient care, but also to reduc-
ing the regional disparity in access to high-level healthcare. Telemedicine services can
range from simply sending a fax message to a colleague to the use of broadband net-
works with multimodal video- and data streaming for obtaining second opinions as
well as medical telepresence. Depending on the specific medical service requirements,
a range of classes-of-services is used, each requiring its own technological quality-of-
service.

Originally started as interdisciplinary efforts of engineers and medical experts, Telemed-

icine is more and more evolving into a multidisciplinary approach. Consequently, com-
piling a book on recent “Advances in Telemedicine” will have to cover a correspond-
ingly wide range of topics. In addition, if each topic shall be treated in sufficient depth
to allow the reader to get a comprehensive understanding of both the developmental
state-of-the-art as well as the broad spectrum of issues relevant to Telemedicine, one
might easily end up with a huge tome, too big to be practical in handling. Therefore,
this book “Advances in Telemedicine” has been split into two volumes, each covering
specific themes: Volume 1: Technologies, Enabling Factors and Scenarios; Volume 2:
Applications in Various Medical Disciplines and Geographical Regions. The Chapters
of each volume are clustered into four thematic sections.

The current Volume 1 “Advances in Telemedicine: Technologies, Enabling Factors and

Scenarios” contains 19 Chapters clustered into the following thematic sections:

• Fundamental Technologies (Chapters 1-3),

• Applied Technologies (Chapters 4-11),
• Enabling Factors (Chapters 12-13),
• Scenarios (Chapters 14-19).

The section on Fundamental Technologies starts off with a thorough study on a novel

cross-layer design of wireless-LAN (1) that combines the SVC extension of the H.264
X Preface

video coding standard with the recent IEEE 802.11e WLAN standard. This new ap-
proach allows for the transmission of video streams over WLAN with an assigned
guaranteed bandwidth (QoS) as required for telemedicine video applications in suf-
ficiently high quality. The next study reports on the development of a wireless cross-
standard communication protocol (2) that supports the creation of network-of-net-
works for e-Health applications from existing commercial (WiFi, WiMAX) and military
(HIDL, Link 11) communication systems. This new protocol has been implemented
in a demonstrator network that allows for the operation and investigation of various
real-life healthcare scenarios. The section is closed up by extensive considerations on
safety and electromagnetic compatibility (3) in wireless WiFi-, DECT- or GSM-based
telemedicine applications. The electromagnetic environment of typical urban homes
is characterised and an assessment for the potential safe use of home telemonitoring
systems is presented. The need for adequate and harmonised legislation and regula-
tion is also addressed.

The next section on Applied Technologies begins with an exploration of combining

digital video transport systems with global research and education networks (4) for
high quality video streaming in telemedicine. This new combination can help to over-
come many of the bottlenecks in telemedicine implementation in daily routine, such as:
insufficient image quality, too-high cost for set-up and operation, too difficult to use by
medical experts. Next, a new algorithm for lossless compression of medical images
(5) of various kinds using Huffman-based contourlet transform coding is presented. It
is demonstrated that this new algorithm achieves higher compression ratios and yet
superior image quality for different classes of medical images as compared to existing
methods in the literature. The next chapter addresses the critical question as to the reli-
ability of colour representation in transmission and display of medical videos and still
images by presenting a novel sophisticated multispectral colour reproduction system
(6). Experimental evaluation of this new system used in video-based telemedicine ap-
plications for dermatology, surgery and general teleconsultation demonstrates that the
reproduced colour is perceived as almost identical to the original, enabling improved
remote diagnosis. The following chapter describes the application of Hilbert Huang
transformation-based time-frequency analysis approach for studying normal and
sharp waves in electroencephalograms contaminated by transmission errors (7). Es-
pecially when applied as a tool to diagnose, differentiate and classify various stages of
epilepsy this novel analysis approach yields more accurate results. The section contin-
ues with a presentation of three-level indexing hierarchy (TIH)-based smart playback
and recovery functions to enrich teleconsultation systems with retrieval capabili-
ties (8). Thanks to the smart combination of cross-linked referencing and prioritised
recovery the system allows a range of smart playback functions (e.g. replaying all the
segments of a session controlled by a particular physician, or replaying all the session
segments for which a particular medical image is discussed). The next chapter exten-
sively treats a wide range of different aspects of the application of statistics in telemed-
icine (9). It treats diverse aspects of qualitative and quantitative statistical methods
in telemedicine such as for research and evaluation, for testing web-based platforms
with different numbers of users, for new biomarker detection, or for electronic medical
records and bio-banks. This work uncovers corresponding opportunities and challeng-
es and provides the reader with useful guidelines. The subsequent chapter provides
a survey on the technological and perceptive aspects of video communication (10)
as used in various classes of services in telemedicine. It describes video applications
 Preface XI

ranging from simple videoconferencing up to medical telepresence and stereoscopic

(3D) video communication. Technological solutions for applications in surgery, der-
matology, ophthalmology and emergency medicine are presented. The section ends
with a comprehensive overview of benefits and technological solutions for broadband
applications in telemedicine (11). Besides descriptions of suitable technologies this
survey also addresses the potential benefits from the different perspectives of the vari-
ous stakeholders. This chapter closes with an address of important challenges that are
currently still unresolved, like privacy policies, security standards, interoperability
guidelines, patients’ acceptance and proof of cost effectiveness.

The section on Enabling Factors starts with a chapter on Quality Control in Tele-
medicine (12). Describing the transposition of a corresponding Directive by the Euro-
pean Union into Spanish national legislation, the paper explains in detail how quality
control in distant medical service provision has recently been legally regulated (by a
CE-label instrument similar to the one for equipment) and points out the consequences
for medical doctors and healthcare providers. It calls for and contributes to appropriate
measures for corresponding training and licensing of health workers. The next chapter
focuses on those complex heterogeneous factors (“work system”) other than technol-
ogy that are crucial for sustainable implementation of Effective Telemedicine-based
Services (13). Using an established approach from research on Socio Technical Systems
as lens of analysis, three main levers emerge: formalisation of a clear and agreed busi-
ness model between hospital unit and local health agency, involvement of a call center
for service provision, empowerment of nurses. The resulting managerial implications
are discussed.

The last section on telemedicine Scenarios begins with a contribution on Real-time

Interactive Telemedicine for Ubiquitous Healthcare (14). It describes specifically de-
signed modules that allow for various real-time interactive scenarios: telesonography,
telesurgery, telemicrobiology, distributed collaborative work, telementoring, etc. Both
networks and services have been optimised and deployed for different real-life situa-
tions and shall ultimately be integrated into a Virtual Hospital. The next chapter ad-
dresses the question as to a Possible Role for Home Telemedicine in the U.S. Medicare
Program (15). An independent evaluation of the congressionally mandated IDEATel
demonstration is presented, which includes intervention effects both on intermediate
clinical outcomes and on use and costs of Medicare services, besides the cost of the
demonstration itself. The evaluation results suggest that although the applied technol-
ogy did not lead to a reduced use of Medicare services (and corresponding costs) and
was very expensive in itself, home telemedicine might become important in the future,
if legislative and market trends align to yield positive synergies. The next contribution
describes a Portable Vital Sensing System for Home Telemedicine (16). Integration of
physiological sensing circuits, digital signal processors and wireless communication
devices into a small smart unit allows for noninvasive monitoring of blood pressure,
electrocardiograph and pulse wave and body temperature. Collection and processing
of these data on a home medical server applying a virtual physiological model allows
for health monitoring in support of the prevention of lifestyle diseases. The follow-
ing chapter treats the role of Telemedicine for Implementation of Self Management
Models for Chronic Diseases in Vulnerable Patient Populations (17). It is described
how telemedicine services, if tailored to the individual patients’ needs, can lead to
the empowerment of elderly, rural or underprivileged minority patient populations.
XII Peface

It can promote patient-centered healthcare systems by linking acute, transitional and

chronic care needs, thus creating a care continuum. Also, continuous medical edu-
cation of both patients and service providers becomes imperative. In the next chap-
ter the Telemedicine System of the Spanish Ministry of Defense (18) is described,
with emphasis on its role in tactical and strategical medical evacuation scenarios in the
context of international (NATO-coordinated) interventions abroad. The standard sys-
tem components have been selected to support both store-and-forward and real-time
telemedical scenarios. Emphasis has been put on system standardisation according to
ISO/IEEE 11073. Work in progress includes a Tele-Assistant system (for diagnostic and
surgical procedures), a mobile ICU ambulance with integrated telemedicine capabili-
ties for on-the-move scenarios, as well as a robotic tele-ultrasound examination unit.
The last chapter of this book gives a presentation on a novel Telemedicine system for
hostile environments (19) that is ontology-based and accounts for the lack of sensors
or pre-defined data exchange protocols, conditions typical for these kind of settings. It
implements a knowledge framework based on interrelated ontologies, a rule base and
an inference engine. The implemented knowledge base is generic, scalable and open to
support different telemedicine applications and services in patient-oriented scenarios.

This book has been conceived to provide valuable reference and learning material to
other researchers, scientists and postgraduate students in the field. The references at
the end of each chapter serve as valuable entry points to further reading on the various
topics discussed and should provide guidance to those interested in moving forward
in the field of Telemedicine.

We sincerely acknowledge all contributing authors for their time and effort in prepar-
ing the various chapters; without their dedication this book would not have been possi-
ble. Also we would like to thank Katarina Lovrecic from InTech Open Access Publisher
for her excellent technical support during the realisation process of this book.

Georgi Graschew and Theo A. Roelofs

Surgical Research Unit OP 2000
Max-Delbrück-Center for Molecular Medicine
and Experimental and Clinical Research Center
Charité – University Medicine Berlin
Campus Berlin-Buch
Lindenberger Weg 80, D-13125 Berlin,
Germany

Email: [email protected] and [email protected]

 Part 1

Fundamental Technologies
 1

Cross Layer Design of Wireless LAN

for Telemedicine Application
Considering QoS Provision
Eko Supriyanto1, Emansa Hasri Putra2, Jafri bin Din3,
Haikal Satria4 and Hamid Azwar5
1Faculty of Biomedical Engineering and Health Science, Universiti Teknologi Malaysia,
2,5Telecommunication Department, Politeknik Caltex Riau,
3,4Faculty of Electrical Engineering, Universiti Teknologi Malaysia,
1,3,4Malaysia,
2,5Indonesia

1. Introduction
Wireless Local Area Network (WLAN) have been widely utilized at this moment to support
video-related applications such as video streaming, multimedia messaging, teleconference,
voice over IP, and video telemedicine. This is due to WLAN constitutes a ubiquitous
wireless standard solution and its implementation is not complex in terms of WLAN devices
configuration and deployment. In addition, WLAN has superior characteristics compared
with other wireless standard, including mobility fashions, high data rate, and low cost
infrastructure.
The video-related application transmission such as telemedicine video will experience
challenges including low throughput, delays, jitter and packet lost during its transmission
over wireless network. This is due to wireless network or WLAN has specific characteristics
which can influence the transmission consisting of time-varying channel, transmission error,
and fluctuating bit rate characterized by factors such as noise, interference, and multiple
fading. Thus, a video coding system for the transmission is necessary to adapt to the WLAN
characteristics.
Recently, The Scalable Video Coding (SVC) standard as an extension of H.264/AVC have
enabled a video bit stream to adapt to time-varying channel, transmission error, and
fluctuating bit rate (Schierl et al. 2007). SVC also provides a scalability of receiver side
receptions since receivers have possibly heterogeneous capabilities in terms of display
resolution and processing power. In addition, SVC can support lower throughput and
improve better coding efficiency compared with prior video coding techniques such as
H.262/MPEG-2, H.263, MPEG-4, and H.264/AVC.
Currently, a new IEEE standard called The IEEE 802.11e is available to support Quality of
Service (QoS) in WLAN. Specifically, this standard introduces a new MAC layer
coordination function called Hybrid Coordination Function (HCF). Although IEEE 802.11e
is more reliable than the previous standard, it still refers to OSI protocol stack in which
every layer does not cooperate with each other. While wireless environments have specific
4 Advances in Telemedicine: Technologies, Enabling Factors and Scenarios

characteristics which may influence and degrade the quality level of the telemedicine
application, namely time-varying bandwidth, delay, jitter and loss (Kim et al. 2006).
There are previous works which concern with cross layer techniques in wireless network. In
(Choi et al., 2006), the focus was on cross layer optimization between application, data link,
and physical layers to obtain the end to end quality of wireless streaming video application.
A cross layer scheduling algorithm was utilized in (Kim, 2006) for throughput improvement
in WLAN considering scheduling method and physical layer information. The authors
utilized a H.264/AVC video coding in application layer over IEEE 802.11e EDCA wireless
networks (Ksentini et al., 2006). MPEG-4 FGS video coding and FEC were utilized in
application layer to deliver video application over IEEE 802.11a WLAN in (Schaar et al.,
2003). In (Schaar et al., 2006), the authors utilized a MCTF video coding in application layer
over IEEE 802.11 a/e HCCA wireless networks.
In this paper, a new approach in transmitting telemedicine video application over wireless
LAN is performed to assign guaranteed bandwidth (QoS) for connection request of
telemedicine video application. This approach utilizes a cross layer design technique based
on H.264/SVC and IEEE 802.11e wireless network to optimize the existing wireless LAN
protocol stack. From our results, an appropriate bandwidth could be achieved based on
Quality of Service (QoS) provision for telemedicine video application during its
transmission over wireless LAN.
The rest of this paper is organized as follows. The overview of telemedicine system
including Telemedicine, H.264/SVC, and IEEE 802.11e Wireless Network is explained in
Section II. Section III explains our proposed cross layer design of wireless LAN for video
telemedicine transmission. The prototype and simulation model is described in Section IV.
Results and Analysis is explained in Section V. Then, we conclude this paper in Section VI.

2. Telemedicine system
2.1 Telemedicine
Telemedicine constitutes healthcare services implemented through network infrastructures
such as LAN, WLAN, ATM, MPLS, 3G, and others, to provide health care service quality
especially in rural, urban, isolated areas, or mobile areas (Ng et al., 2006). Furthermore,
telemedicine involves interactions between medical specialists at one station and patients at
other stations and utilizes healthcare application which can be divided into video images,
images, clinical equipments, and radiographic images.
The authors in (Pavlopoulos et al., 1998) have presented an example of telemedicine
advantage through implementation on ambulatory patient care at remote area. Another
application has been done in (Sudhamony et al., 2008) for cancer care in rural area. High
technology telemedicine application in surgery has already been developed in (Xiaohui et
al., 2007).
Currently, the telemedicine utilizes available wired and wireless infrastructures.
Telemedicine infrastructures with wired network have been proposed using Integrated
Service Digital Network (ISDN) (Al-Taei, 2005), Asynchronous Transfer Modes (ATM)
(Cabral and Kim, 1996), Very Small Aperture Terminal (VSAT) (Pandian et al., 2007) and
Asymmetric Digital Subscriber Line (ADSL) (Ling et al., 2005). Telemedicine has also been
implemented in wireless network using Wireless LAN (WLAN) (Kugean et al., 2002),
Worldwide Interoperability for Microwave Access (WIMAX) (Chorbev et al., 2008), Code
Division Multiple Access (CDMA) 1X-EVDO (Yoo et al., 2005), and General Packet Radio
Switch (GPRS) (Gibson et al., 2003).
Cross Layer Design of Wireless LAN for Telemedicine Application Considering QoS Provision 5

Every infrastructure has its own obstacle, in particularly when implemented in a remote
area. For example, Asynchronous Transfer Mode (ATM) and Multi Protocol Label Switching
(MPLS) have mobility and scalability limitations, although both networks provide high
Quality of Service (QoS) and have stability on delivering data (Nanda and Fernandes, 2007).
The fragility of 3G UMTS network for telemedicine has been explored in (Tan et al., 2006),
where the implementation costs are high and does not provide QoS.
There is a necessity of specific rule to define Quality of Services (QoS) provision of
telemedicine application. In addition, parameterized QoS is a clear QoS bound expressed in
terms of quantitative values such as data rate, delay bounds, jitter, and packet loss (Ni and
Turletti, 2004). Thus, we refer to (Supriyanto et al., 2009) to obtain the parameterized QoS or
QoS provision for telemedicine application. The desired output data rate for telemedicine
system in seven medical devices can be seen in Table 1.

Devices Data Rates

Good Excellent
ECG 2 kbps 12 kbps
Doppler Instrument 40 kbps 160 kbps
Blood Pressure Monitor 1 kbps 1 kbps
Ultrasound Machine 100 kbps 400 kbps
Camera 100 kbps 2,000 kbps
Stethoscope 40 kbps 160 kbps
Microphone 40 kbps 160 kbps
Total 323 kbps 2,893 kbps
Table 1. Desired output data rate (Supriyanto et al., 2009)
Table 2 shows QoS bounds required for telemedicine application, namely throughput,
delay, jitter and packet loss.

Parameter Definition Requirement

throughput packet arrival rate min 323 kbps
delay the time taken by a packet to reach its destination max 100 ms
jitter time of arrival deviation between packets max 50 ms
packet loss percentage of non-received data packets max 5 %
Table 2. QoS bounds for telemedicine application (Supriyanto et al., 2009)

2.2 H.264/SVC Standard

Recently, a video coding technique in wireless network has transformed into a way to
optimize the video quality over a fluctuating bit rate instead of at a fixed bit rate. This due to
wireless network or WLAN has specific characteristics which can influence video
transmission consisting of time-varying channel, transmission error, and fluctuating bit rate
characterized by factors such as noise, interference, and multiple fading. Thus, the video
coding technique should adapt to fluctuating bit rate in wireless network and then
reconstructing a video signal with the optimized quality at that bit rate.
Figure 1 shows a characteristic of video coding techniques consisting of non-scalable and
scalable video coding. The horizontal axis means the channel bit rate, while the vertical axis
6 Advances in Telemedicine: Technologies, Enabling Factors and Scenarios

means the received video quality. The distortion-rate curve constitutes an indicator of
acceptable video quality for any coding techniques at fluctuating bit rate. If a video coding
curve follows the movement of the distortion-rate curve, an optimal video quality will be
acquired. The three staircase curves mean the performance of the non-scalable coding
technique. On fluctuating bit rate conditions such as low, medium, or high bit rate, the non-
scalable coding techniques try to follow the movement of the distortion-rate curve indicated
by the upper corner of the staircase curve very close to the distortion-rate curve. The three
staircase curves have different optimal video quality at each since every staircase curve can
only achieve the distortion-rate curve either in low, medium or high bit rate. While a
scalable video coding can follow the movement of the distortion-rate curve in which the
scalable video coding has two layers, namely base layer and enhancement layer. Thus, the
scalable video coding has the optimal video quality at each condition, either in low,
medium, or high bit rate.

Fig. 1. A characteristic of video coding techniques consisting of non-scalable and scalable

video coding (Li, 2001)
In the scalable coding technique, a video sequence is encoded into a base layer and an
enhancement layer. The enhancement layer bit stream is similar to the base layer bit stream
in which it is either completely received or it does not enhance the video quality at all. The
base-layer bit rate constitutes the first stair while the enhancement layer bit rate constitutes
the second stair as shown in Figure 1 (Li, 2001).
A Scalable Video Coding (SVC) standard constitutes an extension of H.264/AVC widely
utilized for video transmission such as multimedia messaging, video telephony, video
conference, Mobile TV, and other mobile networks at this time. The SVC provides
scalability capability to improve features of prior video coding systems such as
H.262/MPEG-2, H.263, MPEG-4, and H.264/AVC. In addition, The SVC has an adaptation
capability to time-varying bandwidth conditions in wireless network, and heterogeneous
receiver requirements. The time-varying bandwidth will lead to throughput variations,
varying delays or transmission errors. Then, the heterogeneous receiver conditions will
influence acceptable video bit stream in receiver sides limited by display resolution and
processing power.
Cross Layer Design of Wireless LAN for Telemedicine Application Considering QoS Provision 7

The common forms of scalability consist of temporal, spatial, and quality scalability. The
spatial scalability constitutes a video coding technique in which picture size (spatial
resolution) of video source is reduced. The temporal scalability means some parts of video
bit stream reduced in term of frame rate (temporal resolution). Then, quality scalability
constitutes a video coding technique in which the spatio-temporal resolution of video source
is still the same as the complete bit stream, but fidelity is lower. The quality scalability is
also commonly known as SNR scalability. Figure 2 shows a basic concept of SVC in which it
combines temporal, spatial, and quality scalability.

Fig. 2. SVC encoder structure (Schwarz et al., 2007)

The SVC encoder structure is arranged in dependency layers in which every dependency
layers has a definite spatial resolution. The dependency layers utilize motion-compensated
and intra prediction as in H.264/AVC single-layer coding and include one or more quality
layers. Then, each dependency layer corresponds to a video source for a time instant with a
definite spatial resolution and a definite fidelity. For more complete overview of SVC
concept is referred to (Schwarz et al., 2007).

2.3 IEEE 802.11e Wireless Network

There are two different kinds of wireless network configuration. The first one is an
infrastructure network, in which every communication between wireless stations is through
an access point (AP). The second one is an ad hoc network, where communications between
wireless stations are directly to each other, without a connection to an access point (AP). A
group of stations arranged by an access point (AP) is called a basic service set (BSS), while
for an ad hoc network is called independent BSS (IBSS). An area included by the BSS is
referred as the basic service area (BSA), such as a cell in a cellular mobile network.
The IEEE 802.11 WLAN standard includes both datalink and physical layers of the open
system interconnection (OSI) network reference model. The datalink layer intends to
arrange access control functions to the wireless medium such as access coordination,
addressing or frame check sequence generation. Basically, there are two medium access
coordination functions, namely the basic Distributed Coordination Function (DCF) and the
optional Point Coordination Function (PCF).
8 Advances in Telemedicine: Technologies, Enabling Factors and Scenarios

Recently, IEEE 802.11e standard proposed a new MAC layer coordination function in the
datalink layer to provide QoS support, namely HCF (Hybrid Coordination Function). HCF
consists of two channel access method, namely The Enhanced Distributed Channel Access
(EDCA) and The HCF Controlled Channel Access (HCCA). Access Points (APs) and
wireless stations which have supported The IEEE 802.11e standard are called QoS-enhanced
AP (QAP) and QoS-enhanced station (QSTA) respectively (Ni and Turletti, 2004).

2.3.1 The Enhanced Distributed Channel Access (EDCA)

The EDCA consists of four access categories and starts from the highest priority until the
lowest priority for supporting traffics of voice (AC_VO), video (AC_VI), best effort (AC_BE),
and background (AC_BK) respectively, as illustrated in Figure 3. Table 3 shows relations
between user priorities and access categories starting from the lowest until the highest
priority.

Fig. 3. The IEEE 802.11e EDCA model (Kim et al., 2006)

User 802.1D Access

Priority Designation
Priority Designation Category
Lowest 1 BK AC_BK Background
2 - AC_BK Background
0 BE AC_BE Best Effort
3 EE AC_BE Video
4 CL AC_VI Video
5 VI AC_VI Video
6 VO AC_VO Voice
Highest 7 NC AC_VO Voice
Table 3. Relations between user priorities and access categories (Kim et al., 2006)
The IEEE 802.11 standard specifies four types of Interframe Spaces (IFS) utilized to define
different priorities, namely Short Interframe Spaces (SIFS), Point Coordination IFS (PIFS),
Cross Layer Design of Wireless LAN for Telemedicine Application Considering QoS Provision 9

Distributed IFS (DIFS), and Arbitrary IFS (AIFS). SIFS is the smallest IFS utilized to transmit
frames such as ACK, RTS, and CTS. PIFS is the second smallest IFS utilized by Hybrid
Coordinator (HC) to acquire the medium before any other stations. DIFS is the IFS for
stations to wait after sensing an idle medium. The last, AIFS is the IFS utilized by different
Access Categories (ACs) in The Enhanced Distributed Channel Access (EDCA) to wait after
sensing an idle medium.
Every access categories in the EDCA contains their own Arbitrary Interframe Space (AIFS),
Minimum Contention Windows (CWmin), Maximum Contention Windows (CWmax), and
Transmission Opportunity (TXOP) in which the highest priority is assigned by the smallest
values of AIFS, CWmin, CWmax, and the largest value of TXOP to acquire the first probability
in term of channel access functions, and the lowest priority is vice versa, as illustrated in
Figure 4 (Kim et al., 2006).

Fig. 4. Different IFS values in IEEE 802.11e EDCA (Kim et al., 2006)

2.3.2 The HCF Controlled Channel Access (HCCA)

The Hybrid Coordination Function (HCF) includes an optional contention-free period
(CFP) and a mandatory contention period (CP) and contains a centralized coordinator
called Hybrid Coordinator (HC). HC can perform a poll-and-response mechanism and
start HCCA during CFP and CP. After optional CFP with a PCF mechanism, EDCA and
HCCA mechanisms will alternate during mandatory CP. Although HCCA is better to
support QoS than EDCA, the latter is still mandatory in IEEE 802.11e standard. Figure 5
shows Target Beacon Transmission Time (TBTT) interval of IEEE 802.11e HCF frame (Ni
and Turletti, 2004).
When a QSTA desires to deliver data, the QSTA has to determine a Traffic Stream (TS)
distinguished by a Traffic Specification (TSPEC). The TSPEC which is arranged between
the QSTA and the QAP constitutes the QoS parameter requirement of a traffic stream
consisting of Mean Data Rate, Delay Bound, Nominal Service Data Unit (SDU) Size,
Maximum SDU Size, and Maximum Service Interval (MSI). The QSTA can deliver up to
eight traffic streams and its transmission time is bounded by Transmission Opportunity
(TXOP) (Cicconetti, 2005).
10 Advances in Telemedicine: Technologies, Enabling Factors and Scenarios

Fig. 5. The Target Beacon Transmission Time (TBTT) interval of IEEE 802.11e HCF frame
(Cicconetti, 2005)

3. The proposed cross layer design

Cross layer design (CLD) is a new paradigm to optimize the existing OSI architecture. Every
layer of OSI protocol stacks has tasks and services independently to each other as well as
there are no direct communications between adjacent layers. It enables to provide
dependencies and communications between layers to select the optimal solution. This
optimization is provided to adapt to wireless environments and support QoS for
telemedicine video application (Chen et al., 2008).
The Cross layer design can be split into three main ideas consisting of:
1. Parameter abstraction: Required information is collected from application, datalink, and
physical layer through a process of parameter abstraction. The process of parameter
abstraction selects specific parameters of the existing protocol layers into parameters
which are possible for the cross-layer optimizer, so-called cross-layer parameters.
2. Cross-layer optimization: Parameters obtained through the parameter abstraction then are
optimized to find a particular objective.
3. Decision distribution: The results of cross-layer optimization are distributed back into the
related layers.
As illustrated in Figure 6, our proposed cross layer design consists of one expert station
connected to an access point of WLAN IEEE 802.11g, and some patient stations will access
the expert station in other side. A medical specialist in expert station side may conduct
telemedicine application which involves data, video, and voice to examine patients in
patient station through WLAN infrastructure.
To assign guaranteed bandwidth for connection requests of telemedicine application from a
patient station to an expert station and vice versa, we perform cross layer design of the
existing WLAN protocol stacks. We consider three OSI layers, namely application, datalink,
and physical. We gather important information of them through a process of parameter
abstraction. Then, the information is optimized to fulfil QoS provisions of telemedicine
application. The results of optimizer are implemented back into application, datalink, and
physical layers.
Cross Layer Design of Wireless LAN for Telemedicine Application Considering QoS Provision 11

Fig. 6. Proposed Cross Layer Design of Wireless LAN for Telemedicine Video Transmission
We utilize H.264/SVC as a video coding technique in application layer due to this standard
has an ability to support current technologies such as digital television, animated graphics,
and multimedia application. In addition, its implementation utilizes relatively low bit rate in
wireless network so it could be accessed easily by heterogeneous mobile users.
In datalink layer, we utilize a new MAC layer coordination function in datalink layer of OSI
layers to provide QoS support, namely HCF (Hybrid Coordination Function). The HCF
consists of two channel access method, namely The Enhanced Distributed Channel Access
(EDCA) and HCF Controlled Channel Access (HCCA).
In physical layer, we utilize IEEE 802.11g standard which is currently available in many
wireless LAN devices. This standard operates in 2.4 GHz radio band and supports a variety
of modulations and data rates so that it can operate with its predecessor such as 802.11a and
802.11b (Labiod et al., 2007).

4. Prototype and simulation model

We have performed two NS2 simulation models to examine our proposed cross layer design
of wireless LAN, namely called EDCA and HCCA simulation respectively. As explained in
Section III, we utilize HCF consisting of EDCA and HCCA in datalink layer. Thus, we
divide our NS2 simulation models into EDCA and HCCA simulation respectively based on
the channel access method, namely EDCA and HCCA in the datalink layer. After NS2
simulations, we perform experiments of IEEE 802.11e EDCA prototype to identify and to
investigate the proposed cross layer design in real wireless LAN environment. In this
prototype, only EDCA scheme is utilized in the datalink layer to arrange access control
functions to the wireless medium.

4.1 EDCA Simulation Model

This simulation was conducted in NS2 simulation (Ke, 2006) consisting of three steps. First
step, we utilize a “Sony Demo” SVC video (Auwera and Reisslein, 2009) delivered over the
proposed cross layer design. Furthermore, the “Sony Demo” video encoded with single
layer H.264/AVC, temporal scalability, and spatial scalability (Auwera et al., 2008)
respectively is delivered over the proposed cross layer design. In addition, we also utilize a
“Jurassic Park 1” MPEG4 video (Trace, 1993) delivered over the proposed cross layer design.
12 Advances in Telemedicine: Technologies, Enabling Factors and Scenarios

Parameter Value
Application Layer
Video coding H.264/SVC
Datalink Layer
Slot time 20 µs
SIFS 10 µs
Data rate 54 Mbps
Basic rate 6 Mbps
Parameter for queue 0
AIFS 2
CWMin 7
CWMax 15
TXOP 3.008 ms
Parameter for queue 1
AIFS 2
CWMin 15
CWMax 31
TXOP 6.016 ms
Parameter for queue 2
AIFS 3
CWMin 31
CWMax 1023
TXOP 0
Parameter for queue 3
AIFS 7
CWMin 31
CWMax 1023
TXOP 0
Physical Layer
Frequency 2.472 GHz
Preamble length 96 bits
PLCP header length 24 bits
PLCP data rate 6 Mbps
Table 4. Simulation parameters for the proposed cross layer design (the second step)
Then, the SVC video is compared with others. In this step we only utilize one QSTA and one
QAP.
In the second step, there are four kinds of traffic flows between QSTA and QAP delivered over
the proposed cross layer design. First flow is VoIP traffic at 64 Kbps data rate over UDP
protocol and constitutes the highest priority. Second flow is video traffic in which we utilize a
“Sony Demo” SVC video over UDP protocol and constitutes the second highest priority. Third
flow is CBR traffic at 125 Kbps data rate over UDP protocol and constitutes the third highest
priority. Forth flow is FTP traffic at 512 Kbps data rate over TCP protocol and constitutes the
Cross Layer Design of Wireless LAN for Telemedicine Application Considering QoS Provision 13

lowest priority. The simulation parameters utilized in this step are shown in Table 4. In this
step, we utilize five QSTAs and one QAP to increase traffic in the wireless LAN.
Third step, four traffic flows are delivered over the original IEEE 802.11b wireless LAN. First
flow is VoIP traffic at 64 Kbps data rate over UDP protocol. Second flow is video traffic in
which we utilize a “Sony Demo” SVC video over UDP protocol. Third flow is CBR traffic at
125 Kbps data rate over UDP protocol. Forth flow is FTP traffic at 512 Kbps data rate over
TCP protocol. In this step, we also utilize five QSTAs and one QAP to increase traffic in the
wireless LAN.

4.2 HCCA simulation model

In this HCCA simulation, we utilized one QAP and one QSTA in our proposed cross layer
design. There is a bi-directional video flow between QAP and QSTA in which we utilize a
“Sony Demo” SVC video over UDP protocol. Furthermore, we also generate other bi-
directional flows consisting of VoIP, CBR, and FTP as the same way as in the EDCA
simulation model to increase traffic in the network. The simulation is conducted in NS2
simulation (Cicconetti et al., 2005).
The SVC video traffic flow constitutes the highest priority for HCCA scheduler in the
datalink layer. When the QSTA desires to deliver the SVC video, the QSTA has to determine
a Traffic Stream (TS) characterized by a Traffic Specification (TSPEC). The TSPEC arranged
between the QSTA and the QAP constitutes the QoS parameter requirement of a traffic
stream consisting of Mean Data Rate, Delay Bound, Nominal Service Data Unit (SDU) Size,
Maximum SDU Size, and Maximum Service Interval (MSI). Table 5 shows Traffic
Specification (TSPEC) for the SVC video traffic flow.

Parameter Value
Application Layer
Video coding H.264/SVC
Datalink Layer
Service Interval (SI) 20 ms
Mean Data rate 10 Mbps
Nominal SDU size 1500 byte
Maximum SDU size 2132 byte
SIFS 10 µs
PIFS 30 µs
CWMin 31
CWMax 1023
TXOP 8.16 ms
Physical Layer
Frequency 2.472 GHz
Preamble length 96 bits
PLCP header length 24 bits
PLCP data rate 1 Mbps
Table 5. Simulation parameters for the proposed cross layer design (HCCA simulation
model)
14 Advances in Telemedicine: Technologies, Enabling Factors and Scenarios

4.3 IEEE 802.11e EDCA prototype

IEEE 802.11e EDCA prototype consists of a wireless Access Point (AP) and a wireless station
(STA). A wireless Access Point (AP) constitutes a personal computer (PC) equipped with a
wireless TP-LINK TL-WN551G card, and Debian 4 Linux OS, and configured as wireless
Access Point (AP) through Madwifi software (Madwifi, 2009) in the PC. A wireless station is
also a PC equipped with a wireless TP-LINK TL-WN551G card, and Debian 4 Linux OS, and
configured as wireless station (STA) through Madwifi software in the PC. As shown in
Figure 7, then the wireless Access Point (AP) is connected to the wireless station utilizing 2.4
GHz frequency with 54 Mbps data rate. The wireless station also functions as a wireless
monitor to capture and analyze packets delivered over wireless LAN utilizing Wireshark
software (Wireshark, 2009). Table 6 shows specifications of the IEEE 802.11e EDCA
prototype.

Wireless Station (Sta)

Wireless Access Point (AP)

2.412 GHz, 54 Mbps, 8 meters

Fig. 7. The IEEE 802.11e EDCA Prototype consists of Wireless AP and wireless station
Table 7 shows Madwifi WMM/WME parameter [36] utilized in wireless AP and wireless
station in which we can observe that video and voice traffic flows have smaller CWmin,
CWmax, and AIFS values and higher TXOP values. Thus, the video and voice traffics will
have greater probability of gaining access to the wireless medium.
To perform live video streaming application during experiments, we assign the wireless AP
as a streaming server utilizing VLC software (VLC, 2009). The VLC software is also installed
in the wireless station to display the live video streaming application. Then, the Foreman
QCIF video is delivered over wireless LAN and the wireless station will display the
Foreman QCIF video streaming utilizing the VLC media player.
All experiments performed consist of two steps. First step, we activate the WMM/WME
(WiFi multimedia / WiFi multimedia extension) feature of Madwifi driver on the IEEE
802.11e EDCA prototype. Furthermore, this experiment is begun with FTP and Ping
application running firstly, namely from t = 0 s to t = 4.3 s. Beginning at t = 4.3 s, the
Foreman QCIF video streaming flow is begun and begins competing for channel access with
the previous applications. Finally, at t = 16.46 s, the live video streaming finishes and the
other applications also follow to finish after that.
Cross Layer Design of Wireless LAN for Telemedicine Application Considering QoS Provision 15

Specification Description
Wireless Access Point
Personal Computer (PC) Dell PC with Intel Pentium IV 2.4 GHz
Operating System (OS) Debian 4 Linux OS
Wireless Ethernet TP-LINK TL-WN551G
Wireless device driver Madwifi
Applications VLC server, Proftp server, ping
Frequency 2.412 GHz
Data rate 54 Mbps
Wireless Station
Personal Computer (PC) Dell PC with Intel Pentium IV 2.4 GHz
Operating System (OS) Debian 4 Linux OS
Wireless Ethernet TP-LINK TL-WN551G
Wireless device driver Madwifi
Applications VLC client, Firefox browser, Wireshark
Frequency 2.412 GHz
Data rate 54 Mbps
Table 6. Specifications of the IEEE 802.11e EDCA Prototype

Madwifi WMM/WME Access Class

Parameter AC_BE AC_BK AC_VI AC_VO
CWMin 4 4 3 2
CWMax 10 10 4 3
AIFS 2 7 2 2
TXOP 2048 0 3008 1504
Table 7. Madwifi WMM/WME parameter utilized in wireless AP and wireless station
(Yoon, 2006)
In the first step, we perform FTP application utilizing Proftp software in which a DVD video
is downloaded by the wireless station through the FTP application. We also generate
background traffic utilizing ping application with 512 MB size to increase traffic load over
the wireless LAN. In addition, packet analyzer software called Wireshark is operated to
capture packets delivered over wireless LAN during this experiment.
Second step, we do not activate the WMM/WME (WiFi multimedia / WiFi multimedia
extension) feature of Madwifi driver. We repeat procedures as the same way as the first
step. Furthermore, this second step is begun with FTP and Ping application running firstly,
namely from t = 0 s to t = 4.3 s. Beginning at t = 8.91 s to 20.6 s, the QCIF video streaming
flow is begun and begins competing for channel access with the previous applications.
Finally, at t = 20.6 s, the live video streaming finishes and the other applications also follow
to finish after that.
In the second step, we also perform FTP application and generate background traffic
utilizing ping application to increase traffic load over the wireless LAN. In addition, packet
analyzer software called Wireshark is also operated to capture packets delivered over
wireless LAN during this experiment.
16 Advances in Telemedicine: Technologies, Enabling Factors and Scenarios

5. Results and analysis

We analyze results of two NS2 simulation models, namely EDCA and HCCA Simulation,
and experiments of IEEE 802.11e EDCA prototype respectively. Then, we investigate
whether results of the NS2 simulation and the IEEE 802.11e EDCA prototype fulfill the QoS
provision to support telemedicine application.

5.1 EDCA simulation analysis

Figure 8 shows the throughput values of five different video flows over The IEEE 802.11e
EDCA wireless network. We can observe that “Sony Demo” SVC video has the lowest
throughput compared with the others. This indicates that the H.264/SVC has a capability to
reduce the required bit rate for the same perceptual video quality since the others require
higher throughput. This also means that the H.264/SVC can improve better coding
efficiency.

Fig. 8. The throughput values of five different video flows over The IEEE 802.11e EDCA
wireless network
Figure 9 shows the throughput values of four flows with different priorities over the
proposed cross layer design. We can observe that the voice and video flows acquire the
assigned throughput, namely 64.13 Kbps and 309.59 Kbps respectively. In the Figure 9, the
high priority streams look stable during their transmission over wireless LAN. This can
happen due to EDCA scheme associates voice and video packets with access category 1
(AC1) and access category 2 (AC2) respectively so it give more channel access opportunities.
In the EDCA scheme, the AC1 and AC2 have higher priority and the AC1 and AC2 are
assigned with smaller CWmin, CWmax, and AIFS and longer TXOP to influence the
successful transmission probability.
Cross Layer Design of Wireless LAN for Telemedicine Application Considering QoS Provision 17

Fig. 9. The throughput values of four flows with different priorities over the proposed cross
layer design.

Fig. 10. The throughput values of four flows over the conventional IEEE 802.11b wireless
network
18 Advances in Telemedicine: Technologies, Enabling Factors and Scenarios

Figure 10 shows the throughput values of four flows in which there are not priorities over
the conventional IEEE 802.11b wireless network. We can observe that the VoIP flow has the
same throughput as the FTP flow. It indicates that the delay-constrained VoIP flow
competes with the non-delay-constrained FTP flow to acquire the available bandwidth. This
is can happen due to there are not priorities in the wireless medium, so every traffic flow
will contends each other to access to the wireless medium.
Table 8 shows the average throughput values of four flows for every video coding technique
over the proposed cross layer design. We can observe that VoIP, CBR, and FTP flows are
similar in term of average throughput for five video coding techniques. Furthermore, the
H.264/SVC video has the lowest throughput compared with the other video coding
techniques.
Table 9 shows the average throughput, delay and packet loss values of video flow for every
video coding technique over the proposed cross layer design. We observe that the proposed
cross layer design delivers 99.68 percent of video packets within average delay of 10.66 ms.
Furthermore, the proposed cross layer design has the lowest packet loss value than the
previous solutions such as Static Mapping and Adaptive Cross Layer Mapping (Lin et al.,
2009). Thus, this proves that the proposed cross layer design fits to be utilized very
acceptably in telemedicine application.

Average Throughput (Bytes per second)

VoIP Video CBR FTP
H.264/SVC 8,016.03 38,698.35 15,645.05 13.33
H.264/AVC 8,016.03 164,313.91 15,625.02 13.33
Temporal Scalability 8,016.03 185,328.26 15,625.02 13.33
Spatial Scalability 8,016.10 200,065.69 15,625.16 13.33
MPEG4 8,016.03 91,404.70 15,645.05 13.33

Table 8. The average throughput values of four flows for every video coding technique

Average Throughput (Kbps) Delay (ms) Packet Loss (%)

H.264/SVC 309.59 10.66 0.32
H.264/AVC 1,314.51 11.30 52.17
Temporal Scalability 1,482.63 11.32 54.34
Spatial Scalability 1,600.53 11.42 52.46
MPEG4 731.24 10.27 0.38

Table 9. The average throughput, delay and packet loss values of video flow for every video
coding technique
Cross Layer Design of Wireless LAN for Telemedicine Application Considering QoS Provision 19

Fig. 11. The throughput values of SVC video flow over HCCA downlink, HCCA uplink, and
EDCA

Fig. 12. The delay values of SVC video flow over HCCA downlink, HCCA uplink, and
EDCA
20 Advances in Telemedicine: Technologies, Enabling Factors and Scenarios

5.2 HCCA simulation analysis

Throughput curve on Figure 11 shows that both downlink HCCA and uplink HCCA
schemes succeed to acquire the required throughput for SVC video flow. In addition, SVC
video flows over both HCCA downlink and HCCA uplink are more stable than SVC video
flow over EDCA. This is mainly due to HCCA scheduler assigns a fixed TXOP for every
SVC video traffic flow based on the required mean data rate during service interval (SI). It
indicates that the reference scheduler of HCCA has a capability to support the SVC video
flow with the QoS guarantee through a negotiation process of parameterized guarantee,
namely Traffic Specification (TSPEC).
Figure 12 shows the delay values of SVC video flow over HCCA downlink, HCCA uplink,
and EDCA. We observe that HCCA delivers 96.25 percent of the SVC video packets within
average delay of 18.58 ms from the QAP to the QSTA (downlink). In addition, HCCA
delivers 99.99 percent of the SVC video packets within average delay of 907.94 ms from the
QSTA to the QAP (uplink). The both average delays are still in QoS provision as shown in
Table 2.
Table 10 shows the throughput, delay and packet loss values of SVC video flow over HCCA
downlink, HCCA uplink, and EDCA link. We can observe that throughputs of SVC/HCCA
downlink, SVC/HCCA uplink, and SVC/EDCA fits to the QoS provision in Table 2. This
also applies to delay and packet loss values which are suitable with the QoS provision.
Furthermore, the delay values of SVC video flow over HCCA downlink, and EDCA link are
lower than the delay values of the FHCF scheme (Ansel et al., 2006) and the SFS scheme
(Bourawy, 2008). Moreover, the packet loss values of SVC video flow over HCCA downlink,
HCCA uplink, and EDCA link are lower than the packet loss value of the SFS scheme. Thus,
our proposed cross layer design fits to deliver very acceptably telemedicine application
which contains delay sensitive data such as video and voice data.

Throughput (Kbps) Delay (ms) Packet Loss (%)

SVC/HCCA Downlink 1,539.76 18.58 3.75

SVC/HCCA Uplink 1,669.8 907.94 0.01

SVC/EDCA 309.59 10.66 0.32

Table 10. The throughput, delay and packet loss values of video flow over HCCA downlink,
HCCA uplink, and EDCA link

5.3 IEEE 802.11e EDCA prototype analysis

Figure 13 shows throughput values of video streaming flow when the IEEE 802.11e EDCA
prototype utilizes EDCA scheme in the datalink layer. From t = 4.3 s to t = 5.37 s, the
throughput increase quickly, and after that decrease towards the average point at 292.27
Kbps. We can observe that the bit rate requirement does not vary widely over time for the
video flow. Although the video flow constitutes Variable Bit Rate (VBR) flow, the video flow
is more similar to Constant Bit Rate (CBR) flow. This is mainly due to the fact that the IEEE
802.11e EDCA prototype gives more channel access opportunities (transmission) to video
Cross Layer Design of Wireless LAN for Telemedicine Application Considering QoS Provision 21

Fig. 13. EDCA throughput plot

Fig. 14. Non-EDCA throughput plot

22 Advances in Telemedicine: Technologies, Enabling Factors and Scenarios

500
450
400
350
Delay (ms)

300
250 Video Flow
200
150
100
50
0
4.30
4.58
5.06
5.89
6.66
7.61
8.43
9.28
10.10
11.41
12.37
13.23
14.12
15.08
15.96
Time (second)

Fig. 15. EDCA delay plot

1000
950
900
850
800
750
700
650
Delay (ms)

600
550
500 Video Flow
450
400
350
300
250
200
150
100
50
0
8.91
9.2
9.63
10.4
11.2
12
12.9
13.7
14.6
15.4
16.4
17.3
18.2
20.1
20.9

Time (second)

Fig. 16. Non-EDCA delay plot

Cross Layer Design of Wireless LAN for Telemedicine Application Considering QoS Provision 23

flow in which video packets are assigned with smaller CWmin, CWmax, and AIFS values
and higher TXOP values.
Figure 14 shows throughput value of video streaming flow over the original IEEE 802.11g
wireless LAN in which we do not activate the EDCA scheme in the datalink layer. From t =
20.02 s to t = 20.25 s, the throughput decrease deeply below 100 Kbps, while the average
throughput value is 292.02 Kbps. We can observe that the bit rate requirement vary widely
over time for the video flow. At this duration, we can see that the video streaming
experiences delay for the moment. This is can happen due to there are not priorities in the
wireless medium, thus video traffic flow will contends with other flows to access the
wireless medium.
Figures 15 shows delay experienced by video flow over our IEEE 802.11e EDCA prototype
in which the average delay value is 36.09 ms. The IEEE 802.11e EDCA prototype reduces the
delay to the minimum level, indicating that video packets are transmitted almost
immediately. At t = 10.85 s, the delay increase greatly towards 431.99 ms, while the
maximum delay value allowed is 100 ms. Then, the packet loss value experienced by video
flow is 4.71 % and this is still in QoS provision.
Figures 16 shows delay values for video flow over the original IEEE 802.11g wireless LAN in
which the average delay value is 37.17 ms. Due to video traffic has the same priority as other
applications, it results in greatly increased video packet delays. This is mainly due to all
packets competing with each other without restraint to acquire the shared channel medium.
At t = 20.02 s, the delay increase greatly towards 942.7 ms and this is greater than the delay
in our IEEE 802.11e EDCA prototype. Then, the packet loss value experienced by video flow
is 7.48 % and this is out of QoS provision.

6. Conclusion
In this paper, we have implemented a proposed cross layer design of wireless LAN to deliver
four traffic flows of telemedicine application with different priorities and to assign
telemedicine video with QoS guarantee simulated in NS2 environment and implemented in
IEEE 802.11e EDCA prototype. The NS2 simulation models are divided into EDCA and HCCA
simulation respectively based on the channel access method, namely EDCA and HCCA in the
datalink layer. Results of NS2 simulations and experiments of the IEEE 802.11e EDCA
prototype prove that the cross layer design of wireless LAN is able to support telemedicine
application acceptably during its transmission over wireless LAN based on Quality of Service
(QoS) provision. Thus, the new design has a potential to be utilized in telemedicine system.

7. Acknowledgement
This work is fully support by Ministry of Science, Technology and Innovation (MOSTI)
Malaysia under grant of Science Fund Vot No. 79196. The authors would like to thank to
Research Management Centre (RMC) Universiti Teknologi Malaysia (UTM) for their support.

8. References
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and Applications, IEEE, Amman, Jordan.
24 Advances in Telemedicine: Technologies, Enabling Factors and Scenarios

Ansel, P.; Ni, Q.; and Turletti, T. (2006). “ FHCF: A Simple and Efficient Scheduling Scheme
for IEEE 802.11e Wireless LAN”, Mobile Networks and Applications, 11, 391-403,
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Auwera, G.; and Reisslein, M. (2009). “Implications of Smoothing on Statistical Multiplexing
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 2

Novel Wireless Communication Protocol for

e-Health Applications
A. Zvikhachevskaya and L. Mihaylova
School of Computing and Communications, InfoLab21
Lancaster University
UK

1. Introduction
Evolution from wired to wireless communication systems has brought great advantages to
healthcare services. Mobility support function for e-Health applications gives practitioners,
medical centres, and hospitals new tools for managing patients’ care, electronic records, and
medical billing to ultimately enable patients to have a higher control of their own well
being. E-Health and health care services are information based, hence better utilisation of
information has the potential to make services more integrated, can enhance patient safety
and accountability. These will have a positive impact and will increase patient’s acceptance
of the services. In order to make e-Health applications more integrated and acceptable for
the users it is needed to improve their efficiency. All the above motivated us to research
within area of wireless standards and their interconnectivity in order to provide efficient,
reliable, and robust service and eliminate connectivity boundaries for e-Health applications.
In this chapter, focus is on the development and investigation of novel technologies which
would allow efficient and reliable healthcare by utilising the latest wireless technologies.
More specifically, research methodology and ideas, which consider the use of wireless
broadband systems, commercial (such as WiFi, WiMAX) and military (such as HIDL, Link
11), in real-life healthcare scenarios are proposed and studied.

2. E-Health and Emergency Services applications interconnection

The healthcare industry includes many services, emergency services are among them.
During emergency situations communication channels may suffer congestion, errors, call
dropping and data loss. In contrary to commercial mobile networks the mobile network
technologies for the emergency e-Health services have to be able to provide better
connectivity due to sensitivity of the medical applications to data loss, corruption or delay
and are expected to provide vital aid for patients.
The most common characteristic of emergency situation is mobility of involved elements
(people, devices, etc) and requirements for real-time applications running over the e-Health
network have to have stringent requirements in terms of delay, bandwidth, packet loss, jitter
and other QoS parameters (Istepanian, et.al., 2009).
ESs must use the most reliable personal safety applications and communication channels. If
military services are involved in the emergency case then they will use the military data-links
28 Advances in Telemedicine: Technologies, Enabling Factors and Scenarios

(www.synthesis.co.uk, 2006) (such as Link11, Link16 and HIDL). Link 11 (www.lm-isgs.co.uk,

2010) is a broadcast digital communications system that was designed for use over UHF or HF
frequencies to exchange tactical information between units such as ships, helicopters and
submarines. Link 16 (www.lm-isgs.co.uk, 2010) is a tactical data-link that provides a bigger
data-rate capability than Link 11 and a more sophisticated network management system. It
was designed to meet the different communications needs and a role of units within the
emergency places e.g. aircraft, ships, control centres, command posts, and reconnaissance
vehicles. While technically Link 16 is the messaging standard that flows over the network, for
the purposes of this research it is referred to Link 16 as the data-link system as a whole (Tarter,
et.al., 2008). HIDL (www.ultra-cis.com, 2010) is a command and control data-link designed for
communicating with unmanned aerial vehicles and distributing situational awareness
information to active and passive participants on the ground.
Interoperability between these forces is very difficult, resulting in less than optimal
efficiency and effectiveness. As was shown in some well known cases (such as the 9/11
events), this lack of interoperability was the direct cause of significant loss of lives of first
responders and of civilians on site.

3. System boundaries and equipment

As we are defining A New Protocol as being a method of transferring digital data from one
network to another it is very hard to draw simple system boundaries. There are two main
pieces: ‘cross-over’ nodes and terminal equipment.
The ‘cross-over’ nodes can be easily represented as ‘black boxes’ into which the terminal
interfaces from multiple data-links are connected. They read the information coming out of
one terminal and repackage it into a format that another terminal understands and passes it
onto that other terminal. It is possible to think of this device as an operator who reads a message
coming in on one radio and typing it into the terminal for transmission on another radio.
The terminal equipment can take many forms, but in essence this is the equipment that
users/applications interact with that generate or receive Protocol traffic on. For units
operating on a WiMAX network this will be a computer connected via an Ethernet cable to a
WiMAX modem. For Link 16 it could take the format of a box/application placed between a
computer and the Link 16 terminal that converts the user data generated into Link 16
compatible messages that are sent into the terminal.
Essentially they are theoretical ‘bolt on’ pieces of equipment that interface with the existing
equipment and create this ‘network-of-networks’. It should be noted that this research does
not address how these ‘black boxes’ might be designed, manufactured or installed.

4. Data link introduction

4.1 Introduction and types of data
In order for information to be effectively communicated between two users, they must
‘speak the same language'. In computing these formats are for the most part already pre-
defined; video as MPEG-2/H.264/MPEG-4 (Marpe, et.al., 2006; Chiariglione, 2000), audio as
MP3/WMV/AAC (Chandraiah&Domer, 2005; www.microsoft.com, 2010; www.arm.com,
2003), text as ASCII/RTF/WORD (www.asciitable.com, 2010; www.microsoft.com, 1999),
etc. Computer networking has also defined protocols for transferring these formats, the ones
typically used are the Internet Protocol suite e.g. Internet Protocol version 4 and 6 (IPv4,
IPv6), TCP, UDP, RTP.
Novel Wireless Communication Protocol for e-Health Applications 29

IPv4 is the most common network layer protocol and uses a 20 byte header for all its
packets. While this works for networks such as Ethernet which can communicate packets up
to 1500 bytes long, it will not work for networks such as Link 11 which is only capable of
sending 6 byte packets. The computers/people generating the information do not know or
think about the transmission method or protocol that is used to exchange the information
only that they are able to reproduce the source data at the destination. There may be some
requirements on the data such as priority, latency or data-rate, but as long as the
communications medium is able to support this it does not matter how the information is
transported. For the purposes of e-Health service all user data could be arranged into the
three categories: Real time traffic, Priority and Best Effort.
While there may be more subcategories that these types of traffic can be divided into for the
purposes of this research only these should be addressed. Real time traffic (such as audio or
video) has low latency and minimum data rate requirements. If the latency increases or the
data rate decreases too much then the information becomes unusable. Priority traffic (such
as situational awareness updates) is typically of fixed size and has low latency, high
guarantee requirements. Finally best effort traffic (such as email or file transfer) does not
have any specific quality of service requirements. Therefore for each data link not only
description of how to transfer digital user data is important but also how to try and provide
quality of service requirements.
This subsection briefly outlines the characteristics of each data-link and its operation,
including the message formats. In the next subsections an explanation is given on why and
how to transport digital user data over the various data links. After explaining how each
data link works and how to implement a network management system capable of
supporting e-Health ‘network-of-networks’ the translation of information between each
network will be provided and ensure compatibility on such matters as addressing and
quality of service by creating an overarching network management system (NMS) separate
from the individual NMSs on each network .

4.1.1 Internet protocol version 4

IPv4 is presented here before the data links as it is the worldwide standard for packetising
digital user data and the message format for exchanging information not only on the
Internet but also on WiFi, WiMAX, and HIDL. This means that it is the defacto message
format that most PCs, routers and common terminal equipment, that will be connecting to
‘network-of-networks’, will be applied. Therefore this research is using it as the message
format against which all of the others employ will have to be compatible with, i.e. a packet
being generated in another network will have to be able to be readdressed as an IPv4 packet
and vice-versa (Almguist, 1992).
IPv4 is a network layer protocol, which means it provides a mechanism for source to
destination packet delivery. This includes addressing, routing, quality of service and error
control. An IPv4 packet consists of a common 20 byte header and a data portion. The header
includes information such as a source and destination address, a checksum and details of
the underlying packet, packet length, if it has been fragmented, what type of traffic it is etc.
IPv4 is being slowly phased out over the Internet in favour of IPv6. IPv6 amongst many
other features has a larger address space, more features for prioritization and gives a
simplified interface for processing by routers. These features are aimed primarily at large
networks, which handle large amounts of traffic at high data rates, these difficulties will not
be encountered in this research and thus only IPv4 will be used. This is deemed sufficient as
it is possible to translate between IPv6 and IPv4 using well known techniques.
30 Advances in Telemedicine: Technologies, Enabling Factors and Scenarios

Note that an IP network does not guarantee that packets received at a destination will be
received in the same sequence they were sent. It is the responsibility of the transport layer
(for those transport layers that do guarantee data order such as TCP) or the application layer
(if it is using a datagram protocol such as UDP) to handle mis-ordered packets.
Addressing
The pivotal role of IPv4 is that it provides a standard method of addressing which is used
throughout the Internet. In fact, without it, the Internet would probably not exist as we
know it today. IPv4 addressing is very similar to postal addressing; everyone has a house
number, a street, a city and a country. The only difference in IP is that the information is
ordered differently, an IPv4 address consists of 4 bytes which are typically written as
AAA.BBB.CCC.DDD with the A’s in essence denotes the country, B the city, C the street and
D the house number. This subdivision of the address into 4 ‘octets’ allows the Internet to be
broken down into lots of networks of networks to facilitate with routing. Simplistically: two
computers with the same A, B and C numbers will be on the same small local network, two
computers with the same A and B but different C numbers will be in the same larger wide
area network but different local networks, and finally two computers with just the same A
numbers will probably be in the same country but on physically separated networks.
Routers within this ‘network-of-networks’ can use subnet masks therefore to decide if they
need to route a packet internal or external to the network. These subnet masks determine
this via checking the source and destination addresses against the mask and if they are
different then the packet is for a destination external to the network and if they are the same
then it is for somewhere internal to the network. For example a typical IPv4 source address
might be 192.168.20.5 and a destination address 192.15.34.140, if the router operates a subnet
mask of 255.255.0.0 then the router will compare the first and second octets and if they are
the same then route the packet within the network, but if they are different (as in this case)
the packet is routed to the external gateway and to the correct network. The octets matching
the subnet mask are referred to as the Network ID and the rest of the octets are the Host ID,
in the example above the source address has a network ID of 192.168 and a host ID of 20.5.
We will return to this notion of IP addresses and subnet masks later, as a mechanism for
subdividing the ‘network-of-networks’ and thus addressing packets between different data
link networks.
Header
The IPv4 header is outlined below in the table 4.1 below.

Table 1. IPv4 Header

Novel Wireless Communication Protocol for e-Health Applications 31

A quick explanation of each field is given below:

Version: This is a fixed value denoting IPv4;
Header Length: This will always be 20 for headers with no optional additions;
Type of Service: This is used to denote any quality of service requirements;
Total Length: This gives the total length of the packet – header + user data;
Identification: This gives a unique identification field and is used in fragmentation;
Flags: These denote settings for fragmentation;
Fragment Offset: Used to reconstruct a fragmented packet;
Time to Live: Gives the number of hops the packet can take from source to destination
before it is dropped by the network;
Protocol: Tells the receiver the format of the user data portion is e.g.
TCP/UDP/SCTP/OSPF;
Header Checksum: A checksum making sure the header is correct – note it does not protect
the user data portion in any way;
Source Address: The IPv4 address of the sending computer;
Destination Address: The IPv4 address of the destination computer;
Options: This field is very rarely used, but some protocols use it to provide more
information.
If a piece of information regarding the packet can be inferred without the need of the header
then that information is redundant. Thus as we will see later, if we make some assumptions
regarding the traffic going over the network then we limit the amount of header information
we need to translate between networks.

4.1.2 Description of the military data-links

High Integrity Data Link (HIDL) Description
In Figure 1 the typical topology of the HIDL Supported Network is presented, which
includes two HIDL Communities. Each of them has a timing master, Unmanned Aerial
Vehicle (UAV) and a Relay terminal. Overview of the HIDL standard and characteristics of
the named objects is given below in subsections below.

Fig. 1. Architecture of the HILD Supported Network (Tarter, et.al., 2008)

32 Advances in Telemedicine: Technologies, Enabling Factors and Scenarios

HIDL Overview
HIDL was designed to provide a near real time, high integrity data communications link
between multiple nodes within an Unmanned Aerial Vehicle community. It sends command
and control information from a ground station to multiple UAVs in the air. It also allows the
UAVs to send information from the air to other UAVs or ground receivers.
This network can have a maximum of 5 active transmitters in the network at any one time.
This effectively means 1 timing master (base station) and 4 network entrants (client units).
However as explained later there can be multiple receive only passive terminals that are
capable of one way communication.
Time Architecture
HIDL uses a time division mechanism to packetize the data to be transmitted, i.e. a packet of
information is transmitted at a known rate (the period of the time division). The HIDL time
structure divides the time domain into contiguous periods of 10ms - termed Timeslots. A
group of 100 contiguous timeslots is termed an epoch, which is equivalent to a period of one
second. These epochs are repeated every second, and therefore the timeslot allocation is
repeated every second. It is essentially a broadcast architecture and therefore each receiver
is capable of receiving every packet transmitted in an epoch as long as it is in range, and
therefore while there is only ever one transmitter per timeslot there maybe multiple
receivers.
As a result of this scheme multiple QoS schemes cannot be assigned to a timeslot as there is
no data packet processing performed within the system, instead only bandwidth (timeslot
allocation) is the only variable. Therefore voice, text and video packets are treated
identically within the HIDL network; it is up to the operator to provide the required levels
of network resources to meet the demands of the application. This is in contrast to Link 16
which can provide contention access as well as the dedicated access scheme which is used in
HIDL. Ultimately this will mean that while real-time, priority and best effort traffic will be
transported with the same level of QoS the anticipated amount of each type of traffic will be
used to calculate the timeslot allocation.

Fig. 2. The HIDL Time Architecture (Tarter, et.al., 2008)

Novel Wireless Communication Protocol for e-Health Applications 33

Each timeslot in a HIDL network is assigned a ‘circuit’. HIDL supports up to 15 of these

‘circuits’. A ‘circuit’ describes the source terminal, the destination terminal(s), whether the
message is to be relayed, and what the destination multicast address of the data packet in
the circuit should be. As this is a broadcast radio system the list of destination terminals is
really only used to filter the results (if a node is not listed as a receiver then it will not try to
capture the transmission) there is no reason why they all couldn’t receive the broadcast,
however each circuit then need to be defined as broadcast and leave the filtering of the
received packet to a higher level protocol outside of the terminal.
There are five timeslots per epoch in which no User data is allowed to be transmitted,
leaving 95 timeslots per second for user data. These five timeslots are used by the control
station for network management. In each user timeslot a maximum of 422 bytes of user data
is allowed to be transmitted, which when Ethernet, IPv4 and UDP headers are added any
Ethernet packet of up to 468 bytes can be transmitted. Of course any sized packet below this
size maybe transmitted in a time slot, but only at a rate of one packet per timeslot. This gives
a theoretical throughput of 355.7Kbps.
To communicate or receive data, each node must synchronise itself in time with a timing
master (typically the ground station). This enables each transmitting node to operate within
a synchronised global time structure and thus allow each receiving node within range to
receive each packet transmitted collision free from the next packet.
Packet Format
Every packet must conform to UDP-IPv4 over Ethernet and be less than 468 bytes in total.
HIDL is a very simple radio network that operates by distributing UDP/IP packets over the
air. Each packet being sent must conform to UDP-IPv4 over Ethernet and be less than 468
bytes in total (the maximum transmission unit of the radio). If the packet to be transmitted is
in a different format or too large (e.g. a TCP packet of 1000 bytes), then it must be
fragmented and wrapped in a UDP frame and unwrapped and recreated at the other end.

Fig. 3. The HIDL Packet Format

A HIDL terminal accepts user data packets over its Ethernet interface. The terminal
recognises the associated circuit for the data via the destination IP address and puts it in the
correct buffer. When a timeslot comes around that is allocated to that circuit the user data
packet is read from the buffer and sent over the air. The receivers capture the packet and
each one outputs it over its Ethernet interface. All circuits use multicast IP addresses for
their destination address, this is to overcome the limitation that the transmitter does not
know the MAC address of the receiver(s) and to reduce the overhead from the network
headers, maximising user data throughput As a result any packet destined for a unicast
address must be wrapped in a HIDL UDP/IP multicast packet for transmission over the
HIDL network. In order to send packets to different addresses the user could send the
correct packet wrapped in a multicast frame and have a receiving unit do the packet
34 Advances in Telemedicine: Technologies, Enabling Factors and Scenarios

decomposition. Otherwise it could use a Network Address Translation (NAT) router that
will convert the traffic to a unicast address via a Port number. While performing NAT over
HIDL and ‘network-of-networks’ is possible, explanation of its functionality is outside the
scope of this research.
Relay
HIDL provides the ability for one terminal within the network to act as a relay for other
terminals too far away from the source terminal to hear its communication. As all terminals
are part of the same network it is up to the network manager to ensure that there are
sufficient resources (timeslots) for the relay terminal to pass on any messages destined for
terminals out of range of the transmitter. However if there are not enough timeslots
available to the relay to pass on the packets within an epoch some packets will get dropped.
The relay unit also provides time synchronization for the nodes out of range of the ground
control station, thereby ensuring that all nodes throughout the extended network are
operating on the same global time structure.
Receive only units
HIDL allows for portable units to be used in receive only mode, which means that they are
capable of receiving all of the messages communicated throughout the network but unable
to respond. In an operational environment it is envisaged that there will be multiple ground
units with these receive only terminals. This therefore means that when these ground
terminals are networked to other networks as part of a larger system there will be more
ways of communicating in one direction than the other.
HIDL Network Management System
Each network entrant must first communicate with the timing master in order to fully
synchronise itself prior to any node-to-node communication. This process provides a
registration mechanism that the network manager can use to ascertain which terminals are
actively participating. The five network management timeslots already provide each client
with a list of those active client nodes within the network and what their addresses are. This
enables all active and passive nodes in the network to continuously have an up to date list of
all active participants in the network (obviously the passive nodes are not able to declare
their existence).
Resource allocation (time slots) are managed and allocated by the timing master (control
station) and are fixed for the duration, unless the timing master issues a new timeslot
assignment. This means that any node requiring more bandwidth will have to send a
request to the network manager at the base station who will modify the timeslot allocation
scheme and issue a new one.
There is no defined protocol inherent within HIDL to accomplish a change in timeslot
structure, this must be done by sending over the air data messages to the controlling
computer at the timing master who will then provide the timing master HIDL unit with a
new timeslot allocation and instruct it to distribute it to all the nodes who will then adopt it.
As these messages go over the data interface they must be compatible with the formats of
messages being used for ‘network-of-networks’ traffic over HIDL and be identifiable to the
timing master control computer that it is a resource request message. It is the
recommendation of this research project to not use a separate or unique message structure
for identifying these packets, but instead use a pre-existing mechanism such as UDP port
numbers for identification. As long as the length of the packet is less than the maximum
Novel Wireless Communication Protocol for e-Health Applications 35

value that can be transmitted in one timeslot it does not matter how big the packet is, as
only one packet can be transmitted in any one timeslot regardless of size.
It is also proposed that all circuits denoted for use by ‘network-of-networks’ compatible
terminals be set to the broadcast mode, meaning that all packets transmitted by a ‘network-
of-networks’ HIDL terminal will be received by all of the other ‘network-of-networks’ HIDL
terminals, it will be up to each destination computer/router to decide whether or not to
forward or drop the packet. There are two possible methods of implementing ‘network-of-
networks’ over HIDL with regards to resource allocation. The first involves allocating only
one circuit to each HIDL terminal for ‘network-of-networks’ traffic. The second involves
allocating ‘cross-over’ nodes two circuits; the first is used to carry traffic internal to the
network and the second for traffic destined for outside the network (effectively ‘cross-over’
to ‘cross-over’ communication). The second method will provide the network manager
computer with more information that it can use to allocate the timeslots and balance the
amount of network-to-network traffic against internal traffic. Discovery of the most effective
method and resource allocation algorithm will be investigated in simulation.
HIDL Node Attrition Strategy
The HIDL network is very similar in format to a WiFi network: it requires a central base
station to provide timing and network management but individual client units can talk to
each other. All HIDL radio equipment is identical whether the node is to be a timing master,
an active node, a relay or a passive node; therefore any node can be chosen to perform the
timing master’s role. It is advisable to choose a node within range of all other terminals, so
as to allow synchronisation. If a node is too far away but covered by a relay node then the
relay node must be in the range of the timing master. As any node can take on this role of
timing master it is proposed to use the same recovery process as was outlined above in this
section. Although the given scheme, will provide the ability for timing master to take over it
should be noted that HIDL was designed to be a UAV Command and Control data link. As
such nodes could lose contact with the timing master as a result of their location rather than
the loss of the timing master. If a node falls out of link there are mechanisms such as a ‘re-
acquisition strategy’ that are performed to account for this.
Therefore it is not advised that another UAV automatically assume that the timing master
has been lost and adopt its functionality, instead like WiMAX (where the role of the base
station is restricted to a few units) the adoption of the timing master role should only be
performed by a ground unit who should be more capable of making this assessment.
Link 16 Description
Link 16 Overview
Link 16 is one of the military’s Tactical Data Links, which is to say it is primarily used to
communicate tactical information between units or platforms in the battle space. This
research is not aiming to investigate the benefits to be obtained from changing the
equipment, but rather the benefits that could be obtained by modifying the operational use
of the Link 16 standard.
Packet Format
Link 16 messages can be transmitted using either Double Pulse (DP) or Single Pulse (SP)
encoding. Double pulse operation sends the same symbol packet using two pulses rather
than the one used for single pulse operation. This means single pulse packets can send more
36 Advances in Telemedicine: Technologies, Enabling Factors and Scenarios

data per timeslot than double pulse packets but the probability of reception is reduced.
There are 4 different formats a Link 16 message can take Standard, Packed-2 SP, Packed-2
DP and Packed- 4 SP. A standard message can send 225bits/timeslot, both Packed-2 formats
can send 450bits/timeslot and the Packed-4 can send 900 bits/timeslot. As there are 128
timeslots per second this gives us a data rate of 28.8, 57.6 and 115.2Kbps respectively. These
numbers also depend on whether or not Error Detection Coding (EDC) is used, however
this research will not be investigating their use, instead we will only use formats that do use
EDC.
Each transmission in a timeslot is preceded by a Link 16 header which tells the receiver how
to decode the data portion by identifying the packet format (Packed-2, Packed-4 etc), the
message format (free text or fixed format), encoding (i.e. Reed Solomon) the transmitting
terminal and if the message has been relayed.
There are two message formats used in Link 16: Free Text and Fixed Format. Free text
messages within Link 16 do not need to follow any defined message structure; this is how
voice, ASCII text and video are passed over JTIDS. Fixed format messages though need to
follow the Link 16 message structure (J-Series Messages).
Access Methodologies
Link 16 operates a Time Division Multiple Access scheme (TDMA), which means that all
units operating within a Link 16 network are synchronised in time and transmit and receive
at predefined times.
It uses 12.8 minute epoch which is divided into 98,304 timeslots. However, this is a little
unwieldy so it is broken down into 64 frames, each 12 seconds long. Each frame contains
1536 timeslots and these are used when allocating timeslots to terminals. All the timeslots in
the scheme are allocated by the network manager to individual units for transmission. As all
nodes know the timeslot allocation the receivers know when they should listen to receive
data from any given transmitter. By increasing or decreasing a unit’s timeslot allocation you
are effectively changing the maximum transmission bandwidth/data-rate of the unit.
Currently timeslots are first labelled according to their Network Participation Group (a
mechanism for receivers to use to determine in which timeslots they need to listen) then
allocated to units. This mechanism allows us to easily define a new Network Participation
Group (NPG) for ‘network-of-networks’ network data, which will allow ‘network-of-
networks’ to use existing hardware and maintain operational compatibility with existing
systems. Those terminals not equipped to take part in the data network will not listen and
will not take part in the networked data NPG and therefore will not receive any ‘network-
of-networks’ packets and be unable to decode them. Again at the receiver, messages are
output with a header defining in which NPG the packet was received in thereby allowing
terminals to clearly identify ‘network-of-networks’ traffic from other traffic being received
from the network. Users interact with Link 16 terminals by sending messages to the terminal
with a header defining in which NPG the message is to be transmitted. The terminal is then
left to broadcast the message in the appropriate timeslot. An interesting result of using
NPGs is that the sender does not necessarily have to know who the receivers are or the route
to the destination, and as it is a broadcast system, the sender can take for granted that the
same timeslot allocation table has been distributed and therefore that all receivers it wants
to talk to are listening in for its transmissions.
Currently Link 16 systems distribute Precise Participant Location and Identification (PPLI)
messages to organise sender, receiver and route information (at least once every 12 seconds).
Another Random Scribd Document
with Unrelated Content
Lyveth ayens the byleyve,
And no lawe kepeth;
And hath no lykynge to lerne,
Ne of houre Lord hure,
Bote harlotrie other horedom,
Other elles of som wynnyng.
Wan men carpen of Crist
Other of clennesse of soule,
He wext wroth, and wol not huyre
Bote wordes of murthe,
Penaunce and povre men,
The passion of seyntes,
He hateth to huyre therof
And alle that therof carpen.
Thuse beth the braunches, be war,
That bryngeth man to wanhope.
Ye lordes and ladyes,
And legates of holy churche,
That feden fool sages,
Flaterers and lyers,
And han lykynge to lythen hem,
In hope to do yow lawe—
Væ! vobis qui ridetis, etc.
And geveth suche mede an mete,
And povre men refusen;
In youre deth deynge,
Ich drede me sore
Lest tho maner men
To moche sorwe yow brynge.
Consensientes et agentes pari pæna punientur.
Patriarkes and prophetes,
Prechours of Godes wordes,
Saven thorgh here sermons
Mannes soule fro helle:
Ryght so flaterers and foles
Aren the fendes procuratores,
Entysen men thorgh here tales
To synne and to harlotrie.
Clerkus that knowen this,
Sholde kennen lordes
What David seide of suche men,
As the Sauter telleth:
Non habitabit in medio domus meæ qui
facit superbiam, qui loquitur
iniquum.
Sholde non harlot have audience
In halle ne in chaumbre,
Ther that wys men were.
Whitnesse of Godes wordes;
Nother a mys-prout man
Among lordes alouwed.
Clerkus and knyghtes
Wolcometh kynges mynstrales,
For love of here lordes
Lithen hem at festes:
Muche more, me thenketh,
Riche men auhte
Have beggers byfore hem,
Wiche beth Godes mynstreles,
As he seith hymself,
Seynt Johan berith whittnesse:
Qui vos spernit, me etiam spernit.
Therfor ich rede yow, riche,
Reveles when ye maken,
For to solace youre soules,
Suche mynstrales to have,
The povre for a foul sage
Syttynge at thy table,
Whith a lered man to lere the
What oure Lord suffrede,
For to savy thy saule
Fram Satan thyn enemye,
 And fitayle the withoute flateryng
Of Good Friday the feste:
And a blynde man for a bordiour,
Other a bed-reden womman
To crye a largesse byfor oure Lord,
Youre good loos to shewe.
Thuse thre manere mynstrales
Maken a man to lauhe;
In hus deth deyng
Thei don hym gret comfort,
That by hus lyfe loveth hem,
And loveth hem to huyre.
Thuse solaceth the soule,
Til hymself be falle
In a wele good hope, for he wroghte so,
Among worthy seyntes,
Ther flaterers and foles
Whith here foule wordes
Leden tho that lithen hem
To Luciferes feste,
With Turpiloquio, a lay of sorwe,
And Lucifers fitele,
To perpetual peyne
Other purgatorye as wykke,
For he litheth and loveth
That Godes lawe despiteth.
Qui histrionibus dat, dæmonibus sacrificat.

3466. qui manet, &c. Epist. Joan. iv, 16.

3477. Epist. Paul, ad Ephes. iv, 8.

3484. Isai. ix, 2.

3496. Matt. ix, 13.

3502. John i, 14.

3520. Psalm xxxv, 8.

3545. Signes of Synay, | and shelles of Galice ... keyes of Rome. It is

perhaps hardly necessary to remark that the articles mentioned here
were borne by the pilgrim to indicate the particular holy sites which
he had visited. The reader will readily call to mind the lines of a
modern poet:—
 The summon'd Palmer came in place,
His sable cowl o'erhung his face;
In his black mantle was he clad,
With Peter's keys in cloth of red
On his broad shoulders wrought;
The scallop shell his cap did deck;
The crucifix around his neck
Was from Loretto brought.

3622. Seint Thomas shryne. St. Thomas of Canterbury. It may not

perhaps be generally known that an interesting description of this
shrine, when in its glory, is given by Erasmus, Colloq. Peregrinatio
Religionis ergo.

3713. eten apples un-rosted. One of the many specimens of the

burlesque manner in which scripture was frequently quoted in these
times. A very singular passage (but in a tract professedly burlesque)
occurs in the Reliquiæ Antiquæ, vol. i, p. 83:—"Peter askud Adam a
full greyt dowtfull question, and seyd, 'Adam, Adam, why ete thu the
appull unpard?' 'For sothe,' quod he, 'for y had no wardyns fryde.'"

3826. leven, should be lenen.

3890. Luke xiv, 10.

3944, 3948. Psalm lxviii, 29.

3997. the rode of Lukes. The second Trin. Col. MS. has be the rode
of Chestre. There was a famous cross at Lucca, but whether a part
of the real cross, I have not ascertained. Calvin, in his most able and
entertaining Admonitio de Reliquiis, declines undertaking a list of all
the places where pieces of the real cross were shown. "Denique si
congesta in acervum essent omnia quæ reperiri possent, integrum
navis onus efficerent: cum tamen evangelium testificetur ab unico
homine ferri potuisse. Quantæ igitur audaciæ fuit, ligneis frustis sic
totum implere orbem, quibus ferendis ne trecenti quidem homines
sufficiant?" Calvini, Opusc. p. 277. There was also at Lucca one of
the impressions of our Saviour's face on the handkerchief of
Veronica. The peculiar oath of William Rufus was by the holy face at
Lucca.

4027. with hey trolly lolly. MS. Trin. Col. 2.

4154. In the second Trin. Col. MS. the passage stands as follows:—

Ne hadde Peris but a pese lof,

Thei preyede hym beleve,
And with a bene batte
He hadde betwene,
And hitte hunger therwith
Amydde hise lippes,
And blodde in it the bodyward
A bolle ful of growel,
Ne hadde the fisician ferst
Defendite him watir,
To abate the barly bred,
And the benis y-grounde,
Thei hadde be ded be this day,
And dolven al warm.
Faitours for fer, etc.

4194. Thei corven here coppes, | and courtepies made. Whitaker,

who translates it, "They carved wooden cups, and made themselves
short cloaks." It ought to be, "They cut their copes to make
courtpies (a kind of short cloaks) of them."

4242. Paul Epist. ad Galat. vi, 2.

4251. Scimus enim qui dixit, mihi vindicta, et ego retribuam. Paul. ad
Heb. x, 30; conf. Paul. ad Rom. xii, 19.

4256. Luke xvi, 9.

4272. Propter frigus piger arare noluit. Prov. xx, 4.

4306. Labores manuum tuarum quia manducabis, beatus es et bene

tibi erit. Psal. cxxvii, 2.

4336. His mawe is alongid. MS. Trin. Coll. 2.

4336. Whitaker's text inserts here the following passage, which is

curious as containing the same word, latchdrawers, that occurs in
Edward's statute, quoted before in the note to l. 88:—

Thenk that Dives for hus delicat lyf

To the devel wente,
And Lazar the lene beggere
That longed after cromes,
And yut had he hem nat,
For ich Hunger culde hym,
And suthe ich sauh hym sute,
As he a syre were,
At alle manere ese
In Abrahame lappe.
An yf you be of power,
Peers, ich the rede,
Alle that greden at thy gate
For Godes love after fede,
Parte wit hem of thy payn,
Of potage and of souel,
Lene hem som of thy loof,
Thauh thu the lesse chewe.
And thauh lyers and latchedrawers,
And lolleres knocke,
Let hem abyde tyl the bord be drawe,
Ac bere hem none cromes,
Tyl al thyn nedy neihebores
Have none y-maked.
4339. Phisik ... hise furred hodes ... his cloke of Calabre. Whitaker
cites, in illustration of the dress of the physician, the costume still
worn by the Doctors of Medicine in the universities. Chaucer gives
the following description of the dress of the "Doctour of Phisike":—

In sangwin and in pers he clad was al,

Lyned with taffata, and with sendal.
(Cant. T. Prolog. 441.)

Calabre appears to have been a kind of fur: a document in Rymer,

quoted by Ducange, speaks of an indumentum foderatum cum
Calabre.

4390. ripe chiries manye. This passage, joined with the mention of
cherry-time in l. 2794, shows that cherries were a common fruit in
the fourteenth century. "Mr. Gough, in his British Topography, says
that cherries were first brought in by the Romans, but were
afterwards lost and brought in again in the time of Henry VIII, by
Richard Harris, the king's fruiterer; but this is certainly a mistake.
When in the New Forest in Hampshire in the summer of 1808, I saw
a great many cherry-trees, apparently, of much more considerable
age than the time of Henry VIII. The very old trees were universally
of the kind called merries." H. E.

4431. Cato, Distich. i, 21:—

Infantem nudum quum te natura crearit,

Paupertatis onus patienter ferre memento.

4453. so seide Saturne. See the Introduction, p. xii.

4490. Whitaker's text reads after this line:—

Leel and ful of love,

And no lord dreden,
Merciable to meek,
And mylde to the goode,
 And bytynge on badde men
Bote yf thei wolde amende,
And dredeth nat for no deth
To distruye by here powere
Lecherie among lordes,
And hure luther custymes,
And sithen lyve as thei lereth men,
Oure lorde Treuthe hem graunteth,
To be peeres to Apostles, &c.

4525. sette scolers to scole. It was common in the scholastic ages

for scholars to wander about gathering money to support them at
the universities. In a poem in MS. Lansdowne, No. 762, the
husbandman, complaining of the many burdens he supports in taxes
to the court, payments to the church, and charitable contributions of
different kinds, enumerates among the latter the alms to scholars:—

Than cometh clerkys of Oxford, and mak their mone,

To her scole-hire they most have money.

4547. Psa. xiv, 5. Qui pecuniam suam non dedit ad usuram, et

munera super innocentem non accepit.

4571. Psa. xiv, 1.

4593. Matt. vii, 12. Luke vi, 31.

4618. the clerc of stories. Called, elsewhere, maister of stories.

These names were given popularly to Peter Comestor, author of the
famous Historia Scolastica, a paraphrase of the Bible history, with
abundance of legendary matter added to it. The title given him by
the author of Piers Ploughman is not uncommon in English treatises
of the fourteenth and fifteenth centuries. Lydgate, Minor Poems, p.
102 (Ed. Halliwell), speaks of Comestor thus:—

Maister of storyes, this doctour ful notable,

Holding a chalice here in a sonne cliere.
4619. Catons techyng. "Cui des videto," is the twenty-third of the
"Distichorum Lemmata" of Dionysius Cato.

4621. Instead of ll. 4621-4658, the following long and curious

passage is substituted in the text adopted by Mr. Whitaker:—

Wot no man, as ich wene,

Who is worthy to have.
The most needy aren oure neighebores,
And we nyme good hede;
As prisoners in puttes,
And poore folke in cotes
Charged with children
And chef lordes rente,
That thei spynnynge may spare,
Spynen hit in hous hyre,
Bothe in mylk and in mele.
To maken with papelotes
To aglotye with here gurles
That greden after fode.
Al so hemselve
Suffren muche hunger,
And wo in winter tyme;
With wakyng a-nyghtes
To ryse to the ruel,
To rocke the cradel,
Bothe to karde and to kembe,
To clouten and to wasche,
To rubbe and to rely,
Russhes to pilie,
That reuthe is to rede
Othere in ryme shewe
The wo that theese women
That wonyeth in cotes,
And of meny other men
That muche wo suffren,
Bothe a-fyngrede and a-furst,
To turne the fayre outwarde;
And beth abasshed for to begge,
And wolle nat be y-knowe
What hem needeth att here neihebores
At non and at even.
This Wit wot witerly,
As the world techeth,
What other byhoveth
That hath meny children.
And hath no catel bote hus crafte
To clothy hem and to fede,
And fele to fonge therto,
And fewe pans taketh.
Ther is payn and peny ale,
As for a pytaunce y-take;
Cold flesch and cold fyssh,
For veneson y-bake.
Frydays and fastyng-dayes
Ferthyng worth of muscles
Were a feste for suche a folke,
Other so fele cockes.
Theese were almes to helpe
That han suche charges,
And to comforte suche cotyers,
And crokede men and blynde.
Ac beggers with bagges, the wiche
Brewhouses ben here churches,
Bote thei be blynde other broke,
Other elles syke,
Thauh he falle for defaute,
That faiteth for hus lyflode,
Reicheth nevere, ye ryche,
Thauh suche lorelles sterven;
For all that han here hele
And here eyen syghte,
And lymes to laborye with,
And lolleres lyf usen,
Lyven ayens Godes lawe,
And love of holy churche.
And yut arn ther other beggers,
In hele, as it semeth;
Ac hem wanteth here witt,
Men and women bothe,
The wiche aren lunatik lollers
And leperes aboute,
And mad, as the mone sitt,
More other lasse:
Thei caren for no cold,
Ne counteth of no hete,
And are mevenge after the mone,
Moneyles thei walke,
With a good wil wit-lees,
Meny wyde contreys,
Ryght as Peter dude and Paul,
Save that thei preche nat,
Ne myracles maken;
Ac meny tymes hem happeth
To prophetien of the puple,
Pleyninge, as hit were,
And to oure sight, as hit semeth,
Suththe God hath the myghte
To yeven eche a whit wit,
Welthe, and his hele,
And suffreth suche so gon,
Hit semeth to myn inwitt,
Hit arn as hus aposteles suche puple,
Other as his prevye disciples;
For he sente hem forth selverles,
In a somer garnement,
Withoute bred and bagge,
As the Bok telleth.
Quando misi vos sine pane et pera.
Bar fot and bred-les,
Beggeth thei of no man;
And thauh he mete with the meyere
In mydest the strete,
He reverenceth hym ryght nouht
No rather than another.
Neminem salutaveris per viam,
Suche manere of men,
Matheu ous techeth,
We sholde have hem to house,
And help hem when thei come.
Et egenos vagosque induc in domum tuam.
For hit aren murye mouthede men,
Mynstrales of hevene
And Godes boyes bordiours,
As the Bok telleth.
Si quis videtur sapiens, fiet stultus ut
sit sapiens.
And alle manere mynstrales,
Men wot wel the sothe,
To underfonge hem faire
Byfalle for the ryche;
For the lordes love and ladies
That thei with lengen,
Men suffren al that suche seyn,
And in solas taken;
And yut more to suche men
Doth, er thei passe,
Gyven hem gyftes and gold,
For grete lordes sake.
Ryght so, ye riche,
Rather ye sholde, for sothe,
Wolcomen and worsshepen
And with youre goode helpen
Godes mynstrales, and hus messagers,
And hus murye burdiers,
The wiche are lunatik lollares
And leperes aboute.
For under Godes secré seel
Here synnes ben y-keverede.
For thei bereth no bagges,
Ne non botels under clokes,
The wiche is lollaren lyf
And lewede eremytes,
That loken ful louheliche
To lacchen mennes almesse,
In hope to suten at even
By the hote coles,
Unlouke hus legges abrod,
Other lygge at hus ese,
Reste hym and roste hym,
And his ryg turne,
Drynke drue and deepe,
And drawe hym thanne to bedde,
And when hym lyketh and lust
Hus leve ys is to aryse;
When he rysen, rometh out,
And ryght wel aspieth
War he may rathest have a repast,
Other a rounde of bacon,
Sulver other fode-mete
And some tyme bothe,
A loof other alf a loof,
Other a lompe of chese,
And carieth it hom to hus cote,
And cast hym to lyve
In ydelnesse and in ese,
And by others travayle.
And wat frek of thys tolde
Fisketh thus aboute
With a bagge at hus bak,
 Abegeneldes wyse,
And can som manere craft,
In cas he wolde hit use.
Thorgh wiche craft he couthe come
To bred and to ale,
And ovar more to an hater
To helye with hus bones,
And lyveth like a lollere,
Godes lawe him dampneth.
Lolleres lyvinge in sleuthe,
And overe lond stryken,
Beeth nat in thys bulle, quath Peers,
Til thei ben amended.
Nother beggars that beggen,
Bote yf thei have neede.
The Bok blameth alle beggerye,
And banneth in this manere: etc.

4645. Luke xix, 23.

4659. Ps. xxxvi, 25. Junior fui, etenim senui: et non vidi justum
derelictum, nec semen ejus quærens panem.

4695. Here again, after many verbal variations from our text,
Whitaker's text adds the following long passage, which is very
curious, and well worthy to be preserved. Whitaker calls it "one of
the finest passages in the whole poem."

Ac eremites that enhabiten hem

By the heye weyes,
And in borwes among brewesters,
And beggen in churches
Al that holy eremytes
Hateden and despisede,
As rychesses and reverences
And ryche mennes almesse.
These lolleres, latche-draweres,
Lewede eremytes,
Coveyten the contrarie,
As cotyers thei lybben,
For hit beth bote boyes,
Lolleres atten ale,
Of linguage of lettrure
Ne lyf-holy as eremytes
That wonnede wyle in wodes
With beres and lyones.
Some had lyflode of here lynage,
And of no lyf elles;
And some lyvede by here lettrure
And labour of here hondes;
Some had foreynes to frendes,
That hem fode sente;
And bryddes brouhten to some bred,
Werby thei lyveden.
Alle thuse holy eremytes
Were of hye kynne,
Forsoke londe and lordshep
And lykynges of the body;
Ac thuse eremytes, that edefyen
Thus by the hye weyes,
Wylen were workmen,
Webbes and taillours,
And carters knaves
And clerkus without grace,
Heelden hungry hous,
And had much defaute,
Long labour and lyte wynnynge,
And atte laste aspiden
That faitours in frere clothynge
Had fatte chekus;
For-thi lefte thei here laboure,
Theese lewede knaves,
And clothed hem in copes,
Clerkus as hit were.
Other on of som ordre,
Othere elles prophite,
Ayens the lawe he lyveth,
Yf Latyn be trywe:
Non licet nobis legem voluntate, sed voluntatem
conjungere legi.
Now kyndeliche, by Crist!
Beth suche callyd lolleres,
As by Englisch of oure eldres,
Of olde menne techynge,
He that lolleth his lame,
Other his leg out of the joynte,
Other meymed in som membre,
For to meschief hit souneth;
And ryght so sothlyche
Suche manere eremytes
Lollen ayen the bylyeve
And lawe of holy churche.
For holy churche hoteth
Alle manere puple
Under obedience to bee,
And buxum to the lawe,
Furst religious of religion
Here ruele to holde,
And under obedience to be
By dayes and by nyghtes,
Lewede men to laborie,
Lordes to honte
In frythes and in forestes
For fox and other bestes
That in wilde wodes ben,
And in wast places,
As wolves that wyrhyeth men,
Wommen, and children,
And upon Sonedayes to cesse,
Godes service to huyre,
Bothe matyns and messe,
And after mete in churches
To huyre here eve song
Every man ouhte.
Thus it bylongeth for lorde,
For lered and lewede,
Eche halyday to huyre
Hollyche the service,
Vigiles and fastyng dayes
Forthere to knowe,
And fulfille tho fastynges
Bote infirmité hit made,
Poverte othere penaunces,
As pilgrymages and travayles.
Under this obedience
Arn we echone.
Who so brekyeth this, be wel war,
Bot yf he repente,
Amenden hym and mercy aske,
And meekliche hym shryve,
Ich drede me, and he deye,
Hit worth for dedlich synne
Acounted byfore Crist,
Bote Conscience excuse hym.
Loke now were theese lolleres
And lewede eremytes,
Yf thei breke thys obedience
That ben so fro churche,
Wher see we hem on Sonedays
The servise to huyre?
As matyns by the morwe
Tyl masse bygynne,
Other Sonedays at eve songe,
See we wol fewe;
Othere labory for our lyflode
As the lawe wolde
Ac at mydday meel tyme
Ich mete with hem ofte,
Conynge in a cope
As he a clerke were,
A bachelor other a beaupere
Best hym bysemeth,
And for the cloth that kevereth hem
Cald his here a frere,
Whassheth and wypeth,
And with the furste suteth.
Ac while he wrought in thys worlde,
And wan hus mete with Treuthe,
He sat atte syd benche
And secounde table,
Com no wyn in hus wombe
Thorw the weke longe,
Nother blankett in hus bed,
Ne white bred byfore hym.
The cause of al thys caitifté
Cometh of meny bisshepes,
That suffren suche sottes
And othere synnes regne.
Certes ho so thurste hit segge,
Symon quasi dormit.
Vigilate were fairour,
For thow hast gret charge:
For meny waker wolves
Ben broke into foldes.
Thyne berkeres ben al blynde,
That bryngeth forth thy lambren;
Disperguntur oves, thi dogge
Dar nat beerke.
The tarre is untydy
That to thyne sheep bylongeth;
Hure salve ys of supersedeas
In someneres boxes,
Thyne sheep are ner al shabbyd,
The wolf sheteth woolle.
Sub molli pastore lupus lanam cacat, et
grex incustoditus dilaceratur eo.
Hoow hurde wher is thyn hounde,
And thyn hardy herte,
For to wyne the wolf
That thy woolle fouleth.
Ich leyve for thy lacchesse
Thow leest meny wederes,
And ful meny fayre flus
Falsliche wasshe.
When thy lord loketh to have
Alowance for hus bestes,
And of the monye thow haddist thermyd,
Hus meable to save,
And the woolle worth weye,
Woo ys the thenne!
Redde rationem villicationis tuæ,
Other arerage, ffalle.
Then hyre hurde, as ich hope,
Hath nouht to quyty thy dette,
Ther as mede ne mercy
May nat a myte avayle,
Bote have this for that,
Tho that thow toke
Mercy for mede,
And my lawe breke;
Loke now for thi lacchesse
Whether lawe wol the graunt
Purgatorie for thy paye,
Other perpetuel helle.
For shal no pardone praye for yowe ther,
Nother princes letteres.
4708. Matth. xxv, 46. Et ibunt hi in supplicium æternum; justi autem
in vitam æternam.

4721. Psal. xxii, 4.

4739. Psal. xli, 4.

4745. Luke xii, 22. Conf. Matth. vi, 25.

4764. "Dixit insipiens in corde suo, non est Deus," is the

commencement of Psalms xiii. and lii.

4769. Prov. xxii, 10. Ejice derisorem, et exibit cum eo jurgium,

cessabuntque causæ et contumeliæ.

4771. Perkyn, the diminutive of Peter, or Piers. Formerly the

diminutives of people's names were constantly used as marks of
familiarity or endearment, as Hawkyn or Halkyn for Henry, Tymkyn
for Tim or Timothy, Dawkyn for David, Tomkyn for Thomas, &c.

4796. Cato, Distich. ii, 31.

Somnia ne cures, nam mens humana quod optans,

Dum vigilat, sperat, per somnum cernit id ipsum.

4847. Matth. xvi, 19.

4941. Prov. xxiv, 16. Septies enim cadet justus, et resurget; impii
autem corruent in malum.

4963. To falle and to stonde. I by no means agree with Price's

interpretation of this phrase, or in his preference of the reading to
falle if he stonde. (Note on Warton ii, 67.) The motion of the boat
causes the firm man alternately to fall and stand; be he ever so
stable, he stumbles now and then, but his strength is shown in his
being able to recover himself. Such are the moral slips which even
the just man cannot avoid. But if the man in the boat be too weak to
arise again and place himself at the helm, his boat and himself will
be lost for want of strength and guidance. So it is with the wicked
man. The completion of the phrase quoted from Proverbs, as given
in the preceding note, shows the justice of this explanation.

5014. if I may lyve and loke. Price (in Warton) first pointed out the
identity between this expression and the one so common in Homer:
it is "one of those primitive figures which are common to the poetry
of every country."

Οὔτις, ἐμεῦ ζῶντος καὶ ἐπὶ χθονὶ δερκομένοιο,

Σὸι κοίλῃς παρὰ νηυσί βαρείας χεῖρας ἐποίσει.
Il. i, 88.

Whitaker's interpretation is nonsense, "If I have space to live and

look in the book." Other instances of this phrase occur in ll. 12132,
13268, and 13303 of Piers Ploughman.

5082. 2 Corinth. xi, 19.

5157. of four kynnes thynges. The medieval notion of the manner in

which the elements were mixed together in the formation of the
human body, here alluded to, appears to partake more of Western
legend than of Eastern tradition. In the English verses on Popular
Science (given in my "Popular Treatises of Science written during the
Middle Ages," p. 138), we have the following curious account of the
four things forming the body, and the influence of each:—

Man hath of urthe al his bodi, of water he haveth

wete,
Of eyr he haveth wynd, of fur he haveth hete.
Ech quic thing of alle this foure, of some hath more
other lasse;
Ho so haveth of urthe most, he is slou as an asse;
Of vad colour, of hard hide, boustes forme, and ded
strong,
 Of moche thoght, of lute speche, of stille grounynge,
and wraththe long,
A slough wrecche and ferblet, fast and loth to geve his
god,
Sone old, and noght wilful, stable and stedefast of
mode.

And so on with the other elements. This doctrine of the composition

of man from the four elements became a very popular one in the
sixteenth century, when the poets frequently allude to it, as may be
seen in the examples given by Nares (v. Elements). In the Mirror for
Magistrates (King Forrex, page 76), it is said:—

If we behold the substance of a man,

How he is made of elements by kind,
Of earth, of water, aire, and fire, than
We would full often call unto our mind,
That all our earthly joys we leave behind.

Massinger (Renegado iii, 2) says:—

——I've heard
Schoolmen affirm, man's body is compos'd
Of the four elements.

In Shakespeare (Twel. N. ii, 3), Sir Toby Belch inquires, "Does not
our life consist of the four elements?" and Brutus is commended for
possessing these elements properly blended, in which the perfection
of a man's nature was supposed to consist:—

His life was gentle; and the elements

So mix'd in him, that Nature might stand up
And say to all the world, This was a man.
Jul. Cæs. v, 5.

On the other hand, the ill mixing of these elements was supposed to
be accompanied with a corresponding derangement of the
intellectual faculties. Thus, in one of the plays of Beaumont and
Fletcher, a madman is addressed:—

I prithee, thou four elements ill brew'd

Torment none but thyself: Away, I say,
Thou beast of passion.
B. and Fl. Nice Valour, act i, p. 312.

The more mythic form of this legend gives eight things to the
formation of the body, instead of four. Our earliest notice of this
legend in England occurs in the prose Anglo-Saxon Dialogue
between Saturn and Solomon (Thorpe's Analecta, p. 95):—"Saga me
þæt andworc þe Adám wæs of-ge-worht se ærusta man? Ic þe
secge of viii punda ge-wihte. Saga me hwæt hatton þage? Ic þe
secge þæt æroste wæs fóldan pund, of ðam him wæs flesc ge-
worht; oðer wæs fyres pund, þanon him wæs þæt blód reád and
hát; þridde wæs windes pund, þanon him wæs seo æðung ge-seald;
feorðe wæs wolcnes pund, þanon him wæs his módes
unstaðelfæstnes ge-seald; fifte wæs gyfe pund, þanon him wæs ge-
seald se fat and geðang; syxste wæs blostnena pund, þanon him
wæs eagena myssenlicnys ge-seald; seofoðe wæs deawes pund,
þanon him becom swat; eahtothe wæs sealtes pund, þanon him
wæron þa tearas sealte."—Tell me the matter of which Adam the
first man was made? I tell thee, of eight pound-weights. Tell me
their names? I tell thee, the first was a pound of earth, of which his
flesh was made; the second was a pound of fire, from which his
blood was red and hot; the third was a pound of wind, of which
breath was given him; the fourth was a pound of cloud, whereof was
given him his instability of mood; the fifth was a pound of ...,
whereof was given him fat and sinew; the sixth was a pound of
flowers, whereof was given him diversity of eyes; the seventh was a
pound of dew, whereof he had sweat; the eighth was a pound of
salt, whereof he had salt tears. This legend was still prevalent in
England as late as the fifteenth century, when we find it among the
curious collection of questions (closely resembling those of Saturn
and Solomon just quoted) entitled "Questions bitwene the Maister of
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