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A new task for the information literacy training by the university libraries: electronic media and computer networking.

Education and training of traditional information literacy, for librarians as well as for teachers and students, is no more adequate for current demands, even if well established and not over-sophisticated. The present electronic era in the information media and technology has not been fully adopted by all its users, although all of them acknowledge its high efficiency for learning, teaching, and research. Since the year 1993/94 the members of the Institute of Scientific Information (ISI) qualified in librarianship and medicine, prepared a course for pregraduate medical students (group A) and another one for postgraduates in biomedicine (group B). Since the year 1995/96 a course has been established for bachelor studies (C). Special courses or demonstrations corresponding to the demands of those users have been organized for teachers (group D) and for members of the ISI (group E). Group A (30 students/yr, a 4 hours course in "Medical Informatics") received theoretical and practical training in principles of bibliography oriented to searching in basic biomedical databases. Group B (60-80 st/yr, 24-28 hrs/yr in "The Craft of Science") was trained in principles of scientific communication and research data presentation incl. intensive workshops with databases. Group C (50 st/yr, 30 hrs/yr in "Scientific Information") received similar training as group B but with a more practical accentation. Group D (4 persons/yr, 20 hrs/yr) and E (15 p/yr, 30 hrs/yr) proposed their topics themselves. Besides, all the groups received intense training in Internet access. The lasting feed-back contact with the majority of participants of the above courses, mainly with researchers and postgraduate students, have confirmed the advantageousness of these ISI activities.

Computer Communication Networks

An empirical analysis of likelihood-weighting simulation on a large, multiply connected medical belief network.

We are developing a probabilistic reformulation of the Quick Medical Reference (QMR) system. Our current probabilistic model of the QMR knowledge base of internal medicine consists of a two-level, multiply connected, belief network. Because of the size and connectivity of this belief network, most exact algorithms for calculating the posterior marginal probabilities of diseases are not applicable. In this paper, we analyze the convergence properties of an approximation algorithm, called likelihood-weighting simulation, on the QMR-DT belief network. Specifically, on two difficult diagnostic cases, we examine the effects of Markov blanket scoring, importance sampling, and self-importance sampling, demonstrating that the Markov blanket scoring and self-importance sampling significantly improve the convergence of the simulation on our model.

Algorithms

Surfing the Internet.

More physicians are surfing the Internet than ever before, thanks to the recent launch of MSMSNET, the Michigan State Medical Society's new online service for physician members. If words like World Wide Web, E-mail, and Hypertext links send you into a state of confusion, then read on. This month's cover story discusses MSMS's launch into the information superhighway and training programs MSMS has in store for physician members. Also included is an examination of the Internet--past, present and future--by the president of Voyager Information Networks, Inc., a Michigan corporation specializing in Internet services for Michigan trade groups and other organizations, including MSMS. This cover story marks the beginning of a series of articles on the Internet which will appear in future issues of Michigan Medicine. Hop on board and enjoy the ride!

Computer Communication Networks

Ka-boom! When disaster strikes.

When Hurricane Opal slammed Florida's gulf coast last October, Baptist Healthcare in Pensacola was in danger of a direct hit, putting the hospital's mainframe, minicomputers and telecommunications network--not to mention its patients--in peril. But Baptist had planned for just such a danger and, in the end, no harm was done. How would your hospital have fared? Here's what you can do now to make sure your hospital will keep running after disaster strikes.

Computer Communication Networks

[Software support for automatic (computerized) work stations for dentists].

The authors describe the software for a basic computer unified system of working places for dentists specializing in oral, dental surgery and orthodontics with diaries and special entries for each section. The computer system head physician--registration office--primary examination room--rooms of dental treatment, physiotherapy, and x-ray examination--is intended for use as part of local computer network of dental clinics in the MS DOS and Windows systems. Application of the system improves the labor efficiency by up to 35% and the financial efficacy by almost 30%. It also warrants legal protection of both physicians and patients.

Computer Communication Networks

Operational departmentwide picture archiving communication system analysis using discrete event-driven block-oriented network simulation.

The accurate prediction of image throughput is a critical issue in planning for and acquisition of any successful picture archiving and communication system (PACS). Simulation plays an important role in this effort. The PACS image management chain is decomposed into eight subsystems. These subsystems include network transfers over three different networks and five software programs and/or queueing structures. This decomposition is used to create a simulation model that was effectuated using commercially available block-oriented network simulation software. From the PACS database, the traffic generation patterns of the imaging modality devices are used to drive the simulation. The simulation models the image file flow through the PACS for a 24-hour period. The behavior of the simulated traffic generators agreed well with the values derived from the PACS database. The mean delay for the simulated PACS is found to be 225 +/- 59 seconds. The delay time was found to vary during the simulated 24-hour cycle in a consistent manner with observations. This simulation provides estimates on what a radiological department can expect from a PACS in terms of throughput, utilization, and delay. The block-oriented network simulator (BONeS, Comdisco Systems Inc, Foster City, CA) simulation model of the modeled PACS is highly accurate. The models for the imaging modality traffic sources are validated with a high degree of accuracy. The simulation model allows for the study of what happens to the delay time under various loads. In this simulation, the reformatting process was determined to be the bottleneck causing a large increase in delay time under heavy loads.

Computer Communication Networks

The networked environment and the challenge of change.

The way for librarians to manage the environment of the future is to hold fast to their traditional skills and professional abilities. The challenges in the future environment include technology adoption, copyright, scholarly communication, and the role of professional medical societies. Four major areas in which librarians have skills valuable in this environment are the organization of knowledge, quality assurance of information, custodianship, and user instruction.

Catalogs, Library

Access to DNA and protein databases on the Internet.

During the past year, the number of biological databases that can be queried via Internet has dramatically increased. This increase has resulted from the introduction of networking tools, such as Gopher and WAIS, that make it easy for research workers to index databases and make them available for on-line browsing. Biocomputing in the nineties will see the advent of more client/server options for the solution of problems in bioinformatics.

Amino Acid Sequence

Remote connection to the Kyushu University Medical Center LAN using digital and analog telephone lines.

SOHO (Small Office/Home Office) has recently become popular, as it makes working at home possible. Computers or Local Area Networks(LAN) connected to the office network from home are necessary for the implementation of this concept. Kyushu University has begun a service connecting home computers to the campus LAN for researchers, staff and students of the Faculty of Medicine. We have two different telephone connection methods. One connects the campus LAN and the home computer LAN using routers through the Integrated Services Digital Network (ISDN). The other connects computers at home to the workstation in the university, using modems and the PPP (Point to Point Protocol) through a public telephone analog line. This paper outlines our university SOHO connection system and discusses the merits and demerits of using telephone line connections.

Academic Medical Centers

Web-based access to an online atlas of anatomy: the Digital Anatomist Common Gateway Interface.

A World Wide Web Common Gateway Interface package is described for accessing existing online interactive atlases of anatomy. The Web interface accesses the same 2-D and 3-D images of human neuroanatomy, knee anatomy and thoracic viscera that are currently accessed by a custom interactive atlas in distance learning courses. Although the Web interface is too slow to replace the existing atlas, it provides a parallel access path that has much broader potential for development of a distributed distance learning network in anatomy. By maintaining both access methods to the same information sources we continue to satisfy the fast interactivity needs for our local courses, while at the same time providing a migration path to the Web as the capabilities of Web browsers evolve.

Anatomy, Artistic

Privacy and security issues in a wide area health communications network.

In 1993 the first national health information service went live in New Zealand, using commercial network services for all communications. This system provides a point of connection for all health personnel, and for those with a legitimate interest in health care information (e.g. insurers): it also provides access to a number of information resources managed on behalf of the government of New Zealand (e.g. index of health care users), as well as to those developed by individual network service providers. Much of the data exchanged across this network is personalised. Since the recipient may not be known personally to the sender, it is vital that the sender has confidence that the recipient will treat personal information according to agreed criteria for privacy. A Code of Practice covering health information was developed under the New Zealand Privacy Act to ensure that the confidence to share confidential data was supported. For large organisations such as hospitals to function efficiently, they need the flexibility to be able quickly to assign user privileges to selected staff without the need for extra paperwork seeking approval from the centre. But the audit trail requires unique identification of the individual undertaking each transaction. This requirement has been addressed. Some of the data moved across the network relates to life-critical issues, e.g. clinical warnings about allergies or serious medical conditions. A failure of communications causing this vital information to be improperly represented in some way on the receivers system could have disastrous consequences. To ensure the integrity of data transfers, user installations have to be certified compliant with standard test scripts before they are authorized for access to these resources.

Accreditation

The use of clinical computer workstations as an educational adjunct in prosthodontics.

Current computer systems improve the health professional's ability to store, retrieve, and present visual data in a way never before possible. Health professionals in general are beginning to use computer-based digital imaging to improve the diagnosis and treatment planning of disease processes. The use of computer-based networks to transmit medical and dental data is in its infancy but promises to be the main form of data transmission of the future. This article outlines a few applications presently being used and developed at the Ohio State University College of Dentistry in the preclinical and clinical courses in prosthodontics.

Computer Communication Networks

A component-based, distributed object services architecture for a clinical workstation.

Attention to an architectural framework in the development of clinical applications can promote reusability of both legacy systems as well as newly designed software. We describe one approach to an architecture for a clinical workstation application which is based on a critical middle tier of distributed object-oriented services. This tier of network-based services provides flexibility in the creation of both the user interface and the database tiers. We developed a clinical workstation for ambulatory care using this architecture, defining a number of core services including those for vocabulary, patient index, documents, charting, security, and encounter management. These services can be implemented through proprietary or more standard distributed object interfaces such as CORBA and OLE. Services are accessed over the network by a collection of user interface components which can be mixed and matched to form a variety of interface styles. These services have also been reused with several applications based on World Wide Web browser interfaces.

Computer Communication Networks

Remote instrument telemaintenance.

In the past decade, great technological progress has been made in telemaintenance of mainframe and mini computers. As hardware technology is now available at an acceptable cost, computer aided trouble-shooting can be adapted to laboratory instrumentation in order to significantly improve repair time, avoid instrument downtime by taking advantage of predictive methods, and provide general diagnostic assistance. Depending on the size of the instrument, the telemaintenance facility can be dedicated to a single instrument or alternatively a telemaintenance server can manage multiple distributed small instruments through a Local Area Network. As complex failures can occur, the local diagnosis capabilities may be exceeded and automatic dialing for connection to computerized Remote Maintenance Centers is needed. The main advantages of such a centre, as compared to local diagnosis systems, are the increased access to more information and experience of failures from instrument installations, and consequently the provision of training data updates for Artificial Neural Networks and Knowledge Based Systems in general. When an abnormal situation is detected or anticipated by a diagnosis module, an automatic alert is given to the user, local diagnosis is activated, and for simple solutions, instructions are given to the operator. In the last resort, a human expert can be alerted who, with remote control tools, can attend to the failures. For both local and remote trouble-shooting, the data provided by the instrument and connected workstation is of paramount importance for the efficiency and accuracy of the diagnosis. Equally, the importance of standardization of telemaintenance communication protocols is addressed.

Clinical Laboratory Information Systems

An X-protocol based medical teleconsultation system using low or high speed networks. A specific-design approach.

The objective of this proposal is to provide solutions for the necessities of teleconsultation or telediagnosis among medical professionals, using work stations within the X-Windows environment and applicable in communication lines with an extensive range of bandwidths and operating system independence. Among the advantages sought are savings in transportation, improvement in the quality of the medical attention provided and continued training for the medical professional.

Computer Communication Networks

Development of interactive patient-based multimedia computer programs in veterinary orthopedic radiology.

Three computerized multimedia programs on large and small animal veterinary orthopedic radiology were developed and implemented for the radiology curriculum as an alternative to traditional film-based laboratory learning. Programs utilized "hot words" (colored text words that displayed an overlaid image label that highlighted lesions) and interactive quizzes which responded appropriately to selected answers. "Hot words" helped students develop confidence in accurate lesion detection and the interactive quizzes transformed learning from a passive to an active process. Multiple examples were provided for reinforcement and concepts were incorporated from other clinical disciplines for curriculum integration. Programs were written using a presentation software program, Toolbook for DOS based platform, and contained radiographic images made by laser-scanning digitization. Multiple students could simultaneously access the programs through a network server. These pilot programs were implemented successfully and computerized multimedia presentation proved to be well suited to teaching radiology. Development of the programs required attention to a number of hardware, software, time and cost factors.

Computer Communication Networks

Implementation of multi-vendor DICOM standard image transfer in hospital wide ATM network.

At Hamamatsu University Hospital, an ATM + FDDI network was installed in January 1995, when the hospital information system was upgraded. With its unique 'wheel' shape configuration, FDDI automatically backs up in case of an ATM switch failure. The authors implemented a DICOM image database server and DICOM viewer in the Hamamatsu University Hospital ATM + FDDI network. The DICOM standard worked well between different vendor products. In sending 512 x 512, 2 byte CT images, 40% of the transfer time was spent for the network data transfer, which is 70% of the theoretical value of 10 Mb peripheral transfer rate. Meanwhile, ATM load factor increased less than 0.5%. As we have a very fast data transfer network, we must check display speed, hard disc access time, PC bus speed, and display software, in order to enjoy the high speed network transfer fully. The sequence of image transmission within a study is not stated in the DICOM document and is depending on the server. Therefore, there should be an agreement between server and clients, still more than DICOM, in order to make better PACS.

Computer Communication Networks

Networking consumer health information: bringing the patient into the medical information loop.

The Library of the Health Sciences at the University of Illinois at Chicago obtained a grant from the Illinois State Library to implement a statewide demonstration project that would provide consumer health information (CHI) using InfoTrac's Health Reference Center CD-ROM database. The goals of the project were to cooperate with targeted public libraries and clinics in providing CHI at the earliest point of need; to provide access to the database via a dial-up network server and a toll-free telephone number; and to work with targeted sites on database training, core CHI reference sources, and referral procedures. This paper provides background information about the project; describes the major systems and technical issues encountered; and discusses the outcomes, impact, and envisioned enhancements.

CD-ROM