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Basic aspects of and recent developments in telepathology in Europe, with specific emphasis on quality assurance.

Telepathology is the diagnostic work of a pathologist from a distance and includes all specific fields of diagnostic pathology, such as frozen section services, expert consultation, cytometric and histometric measurement, and continuous education. For about 15 years experience has been collected at several universities in the United States and Europe based upon analog telephone lines (9.2 kbaud), digitized lines (ISDN, 64 kbaud), broad band connections (1.5 Mbaud) and the World Wide Web (28 kbaud). Potential use can be expected in the application of telepresentation, remote slide preparation, remote central diagnostics and telediscussion. The transfer of still images is well developed; that of live images is used in only a few institutions for frozen section services. The image quality and spatial resolution as well as the transfer speed are sufficient for expert consultations, morphometric measurements, quality assurance and education. All applications focus on discontinuous work flow. Although the European Community focuses on user needs and standardization aspects of telepathology by sponsoring a widespread telepathology project (Europath), implementation of telepathology into routine application in the continuous work flow has still to be developed. The technical equipment has still to be adjusted to the labor flow charts in routine pathologic diagnostic procedures. Telepathology seems to be the appropriate technique to offer both improvement in diagnostic quality and inclusion of the "control institution" into diagnostic responsibility.

Critical Pathways↗

The Research Funding Service: a model for expanded library services.

Traditionally, libraries have provided a modest amount of information about grants and funding opportunities to researchers in need of research funding. Ten years ago, the University of Washington (UW) Health Sciences Libraries and Information Center joined in a cooperative effort with the School of Medicine to develop a complete, library-based grant and funding service for health sciences researchers called the Research Funding Service. The library provided space, access to the library collection, equipment, and electronic resources, and the School of Medicine funded staff and operations. The range of services now includes individual consultation appointments, an extensive Web site, classes on funding database searching and writing grant applications, a discussion series that frequently hosts guest speakers, a monthly newsletter with funding opportunities of interest to the six health sciences schools, extensive files on funding sources, and referral services.

Libraries, Medical↗

Enabling clinicians, researchers, and educators to build custom web-based biomedical information systems.

We describe an open-source toolkit that enables clinicians, researchers, and educators to build their own web-based biomedical information systems. The Web Interfacing Repository Manager (Wirm) is a high-level application server aimed at medical professionals, allowing them to create individually tailored systems for managing their multimedia data and knowledge. We provide an overview of the features of Wirm, explaining how they meet the requirements for supporting biomedical information management, and describe four applications that are currently being developed with Wirm: MyPACS, a teaching file authoring system for radiologists, Fathom, an experiment management system for natural language processing, the Digital Anatomist Repository, an image archiving tool for medical schools, and Ontolog, a browser for medical vocabularies.

Anatomy↗

[Using biological, hydrochemical and hydrological data on freshwater in Russia and neighboring countries for constructing a computerized information system].

Raw hydrobiological (population, biomass, and numbers of phytoplankton, zooplankton, zoobenthos, periphyton, and bacterioplankton species) and physicochemical indices of ecosystems are integrated into information system "Ecology of Freshwater in Russia and Neighboring Countries." This system is dedicated to environmental control by biotic indices in former USSR countries. The information system is realized as an Ecograde application relying on Microsoft Access software as well as a web site.

Animals↗

Virtual reality and 3D visualizations in heart surgery education.

BACKGROUND: Computer assisted teaching plays an increasing role in surgical education. The presented paper describes the development of virtual reality (VR) and 3D visualizations for educational purposes concerning aortocoronary bypass grafting and their prototypical implementation into a database-driven and internet-based educational system in heart surgery. MATERIALS AND METHODS: A multimedia storyboard has been written and digital video has been encoded. Understanding of these videos was not always satisfying; therefore, additional 3D and VR visualizations have been modelled as VRML, QuickTime, QuickTime Virtual Reality and MPEG-1 applications. An authoring process in terms of integration and orchestration of different multimedia components to educational units has been started. RESULTS: A virtual model of the heart has been designed. It is highly interactive and the user is able to rotate it, move it, zoom in for details or even fly through. It can be explored during the cardiac cycle and a transparency mode demonstrates coronary arteries, movement of the heart valves, and simultaneous blood-flow. Myocardial ischemia and the effect of an IMA-Graft on myocardial perfusion is simulated. Coronary artery stenoses and bypass-grafts can be interactively added. 3D models of anastomotique techniques and closed thrombendarterectomy have been developed. Different visualizations have been prototypically implemented into a teaching application about operative techniques. CONCLUSIONS: Interactive virtual reality and 3D teaching applications can be used and distributed via the World Wide Web and have the power to describe surgical anatomy and principles of surgical techniques, where temporal and spatial events play an important role, in a way superior to traditional teaching methods.

Computer Simulation↗

[Informatics system at the Croatian Institute of Health Insurance today and plans for future].

Basic information is provided on the informatics system at the Croatian Institute of Health Insurance (CIHI). The focus is on the newwork infrastructure, which connects 130 locations 24 hours on line and installed hardware and software equipment at CIHI. A modern network infrastructure makes technical basis of modern informatics system. Technical data on the safe and reliable communication system with FR telecommunication capacity are presented. UNIX servers at the headquaters and branch offices, INFORMIX database and the own application ZOROH provide a basis for core business. Active Directory, web pages www.hzzo-net.hr, Intranet and CIHI IT portal are the main parts of the modern CIHI office info subsystem. Basic information is given about the system for production and.distribution of health insurance cards--plastic cards with magnetic strip for basic and additional health insurance. Informatics Department of CIHI has issued more than 13,000,000 basic health insurance cards and over 1,500,000 additional health insurance cards. Data storage and reporting system as part of the CIHI informatics system is essential for analyzing and planning health insurance business. CIHI IT has created a modern reporting system with: (a) superior performance and power of analytical and reporting possibilities; (b) scalable and flexible platform; (c) proactive reporting (Web, SMS, WAP, e-mail, fax, voice); (d) web interface for users. The presentation is concluded with basic information on the current projects such as introduction of digital signature in CIHI and plans for the introduction of smart cards instead of plastic cards with magnetic strip. Today, CIHI IT plays the major role in the process of health system computerization in Croatia. CIHI is technically and personnel equipped for computerization of the entire health system. The informatics system of CIHI can serve as a backbone for the informatics health system in the future.

Academies and Institutes↗

Agent based simulations in healthcare.

Agent Based Simulations (ABS) is a relatively recent computer paradigm. As opposed to "top down" conventional computer simulations, the ABS approach is a "bottom-up" modelling technique where a medium to high number of independent agents is modelled. These agents' interactions sometimes cause unexpected "emergent" system behaviour. ABS is particularly suitable in the social context such as healthcare where a large number of human agents interact and co-operate for common goals. Today ABS in the social context is often used together with the recently introduced network analysis techniques and network visualization tools for modelling and simulating social agents within organisations. At Akdeniz University we are starting a number of projects for applying ABS technology in healthcare. In this paper we present two of the ongoing projects in this field. Firstly we have developed a prototype simulator for the long term monitoring of Chronic Obstructive Pulmonary Disease (COPD) as a major public health problem. We present the COPD simulator, its agents, parameters and working principles. Secondly we want to apply ABS and the network analysis techniques to visualise and explore informal social networks amongst staff at the Akdeniz University Hospital to assess and evaluate properties of the organisation in terms of its ability to innovate and share knowledge. In our applications, we primarily aim to use ABS in a web-based platform to create a virtual environment for discussion, visualising and running what-if scenarios to test out various options for managing healthcare, as well as sharing information and creating a virtual community.

Computer Simulation↗

On the thickness of the red cell membrane skeleton: quantitative electron microscopy of maximally narrowed isthmus regions of intact cells.

The thickness of the red cell membrane skeleton was deduced from measurements of the isthmus zones of intact cells that were maximally narrowed by one of two independent methods. The first method involved application of viscous drag to red cells entrapped between spider web fibers. The second method utilized cellular dehydration followed by spectrin denaturation at 49.5 degrees C. Measurements on thin sections showed that the isthmus is narrowed to approximately 120 nm by either method, suggesting that the membrane skeleton occupies a zone beneath the lipid bilayer that is up to 60 nm in thickness. The tertiary and quarternary structure of band 3, a major integral membrane protein that anchors the membrane skeleton to the lipid bilayers may be a critical determinant of the location of the membrane skeleton within the red cell.

Biomechanical Phenomena↗

Going, going, still there: using the WebCite service to permanently archive cited web pages.

Scholars are increasingly citing electronic "web references" which are not preserved in libraries or full text archives. WebCite is a new standard for citing web references. To "webcite" a document involves archiving the cited Web page through www.webcitation.org and citing the WebCite permalink instead of (or in addition to) the unstable live Web page. This journal has amended its "instructions for authors" accordingly, asking authors to archive cited Web pages before submitting a manuscript. Almost 200 other journals are already using the system. We discuss the rationale for WebCite, its technology, and how scholars, editors, and publishers can benefit from the service. Citing scholars initiate an archiving process of all cited Web references, ideally before they submit a manuscript. Authors of online documents and websites which are expected to be cited by others can ensure that their work is permanently available by creating an archived copy using WebCite and providing the citation information including the WebCite link on their Web document(s). Editors should ask their authors to cache all cited Web addresses (Uniform Resource Locators, or URLs) "prospectively" before submitting their manuscripts to their journal. Editors and publishers should also instruct their copyeditors to cache cited Web material if the author has not done so already. Finally, WebCite can process publisher submitted "citing articles" (submitted for example as eXtensible Markup Language [XML] documents) to automatically archive all cited Web pages shortly before or on publication. Finally, WebCite can act as a focussed crawler, caching retrospectively references of already published articles. Copyright issues are addressed by honouring respective Internet standards (robot exclusion files, no-cache and no-archive tags). Long-term preservation is ensured by agreements with libraries and digital preservation organizations. The resulting WebCite Index may also have applications for research assessment exercises, being able to measure the impact of Web services and published Web documents through access and Web citation metrics.

Archives↗

Industrial sustainability in China: practice and prospects for eco-industrial development.

China is a large densely populated country undergoing rapid industrialization and is becoming one of the world's biggest consumers of natural resources. This circumstance provides a sharp contrast with other countries. As China is so significant in the global economy, studies of its eco-industrial development are very important. In this study we examined the state of eco-industrial development in China and have drawn conclusions from this analysis about some of the future prospects for sustainable development. In the analysis, we investigated the application of industrial ecology concepts by reference to several case studies. We have therefore described the current environmental situation in China, and have provided an overview of eco-industrial development and its implementation. Constraints to industrial sustainability in China have also been examined. We consider that eco-industrial development in China is in its infancy, and that closed loops involving chains and industrial symbiotic webs are the technological key and core of successful initiatives in the application of industrial ecology. In the case studies, we found that each system has different characteristics and management concerns. Our major conclusion is that even though China's Agenda 21 highlights the principles and sets the directions for eco-industrial development, these have not yet become essential ingredients in the country's industrial policy and practice for implementing Agenda 21.

China↗

Personal computers in forensic psychiatry.

Because forensic psychiatry is a relatively small field, there are few computer applications designed particularly for it. Forensic psychiatrists use personal computer in many ways that are similar to other psychiatrists, but certain aspects of forensic practice, such as an emphasis on precise reports, regular interactions with attorneys, use of legal databases and materials, and travel, call for utilizing available programs in different ways. Since forensic psychiatry draws on the knowledge of psychiatry, law, and criminology, the World Wide Web has become a particularly useful resource for information. An array of applications and resources of particular interest to forensic psychiatrists are presented. Computer education, "telemedicine," and teleconferencing are still in their infancy in forensic psychiatry, but are likely to increase in use as these technologies mature.

Forensic Psychiatry↗

MRD: a microsatellite repeats database for prokaryotic and eukaryotic genomes.

MRD is a database system to access the microsatellite repeats information of genomes such as archea, eubacteria, and other eukaryotic genomes whose sequence information is available in public domains. MRD stores information about simple tandemly repeated k-mer sequences where k= 1 to 6, i.e. monomer to hexamer. The web interface allows the users to search for the repeat of their interest and to know about the association of the repeat with genes and genomic regions in the specific organism. The data contains the abundance and distribution of microsatellites in the coding and non-coding regions of the genome. The exact location of repeats with respect to genomic regions of interest (such as UTR, exon, intron or intergenic regions) whichever is applicable to organism is highlighted. MRD is available on the World Wide Web at http://www.ccmb.res.in/mrd and/or http://www.ingenovis.com/mrd. The database is designed as an open-ended system to accommodate the microsatellite repeats information of other genomes whose complete sequences will be available in future through public domain.

Animals↗

A radiology department intranet: development and applications.

An intranet is a "private Internet" that uses the protocols of the World Wide Web to share information resources within a company or with the company's business partners and clients. The hardware requirements for an intranet begin with a dedicated Web server permanently connected to the departmental network. The heart of a Web server is the hypertext transfer protocol (HTTP) service, which receives a page request from a client's browser and transmits the page back to the client. Although knowledge of hypertext markup language (HTML) is not essential for authoring a Web page, a working familiarity with HTML is useful, as is knowledge of programming and database management. Security can be ensured by using scripts to write information in hidden fields or by means of "cookies." Interfacing databases and database management systems with the Web server and conforming the user interface to HTML syntax can be achieved by means of the common gateway interface (CGI), Active Server Pages (ASP), or other methods. An intranet in a radiology department could include the following types of content: on-call schedules, work schedules and a calendar, a personnel directory, resident resources, memorandums and discussion groups, software for a radiology information system, and databases.

Computer Communication Networks↗

The GENIUS web portal--an easy way to access the Grid.

OBJECTIVE: The development of computational Grids is making huge amounts of computing power and data storage available for a lot of scientific applications. At this stage of development, the use of the Grid is mainly based on Command Line Interface (CLI) tools that are not very friendly and can be considered an obstacle to the use of these powerful tools. The objective of this paper is to present a solution to this problem. METHODS: To ease the access of new users to the grid the GENIUS (Grid Enabled web eNvironment for site Independent User job Submission) grid portal has been jointly developed by INFN and NICE within the context of both the Italian INFN Grid and the European DataGrid Projects. Here we devote particular care to the description of job creation and submission and the services for transparent access to user's data and applications. RESULTS: Using GENIUS, the obstacle of complicated CLI can be overtaken and simple web interfaces can be built for specific user communities and applications. Here we show examples in the field of bio-medical applications. CONCLUSIONS: The use of Grid can be made easy with the use of Grid portals such as GENIUS.

Algorithms↗

Collaboration using Internet for the development of case-based teaching files: report of the Computer and Instrumentation Council Internet Focus Group.

UNLABELLED: The Internet and particularly the World-Wide-Web is becoming a useful tool for the nuclear medicine community. METHODS: The Computer and Instrumentation Council of the Society of Nuclear Medicine convened an Internet Focus group to discuss collaboration using the Internet. The prototype application considered was development of case-based teaching files using the World-Wide-Web. Teaching file cases (clinical history, images, description of findings and discussion) on World-Wide-Web servers at different institutions are integrated using the Internet. The user can navigate from case to case using point-and-click hypertext linking. RESULTS: The initial experience with collaboration has been encouraging. An etiquette to help foster collaboration has been proposed. Development of quality control mechanisms and introduction of peer review were identified as issues needing further work. CONCLUSION: The World-Wide-Web offers great potential for new forms of collaboration. There is, however, a need to learn how to make best use of this new resource.

Computer Communication Networks↗

Feasibility of collecting diary data from asthma patients through mobile phones and SMS (short message service): response rate analysis and focus group evaluation from a pilot study.

BACKGROUND: Self-management of asthma may improve asthma outcomes. The Internet has been suggested as a tool for the monitoring and self-management of asthma. However, in a recent study we found that a Web interface had some disadvantages and that users stopped using the application after a short while. OBJECTIVE: The primary objective of this study was to evaluate, from a user perspective, the feasibility of using short message service (SMS) for asthma diary data collection through mobile phones. The secondary objective was to investigate patient compliance with an SMS diary, as measured by response rates over time. METHODS: The study included quantitative response rate data, based on SMS collection, and qualitative data from a traditional focus group setting. In a period of 2 months, the participants received 4 SMS messages each day, including a medication reminder, a request to enter peak flow, data on sleep loss, and medication dosage. Participants were asked to reply to a minimum of 3 of the messages per day. Diary inputs were collected in a database and the response rate per patient was expressed as the number of diary inputs (SMS replies) divided by diary requests (product of number of days in the study and the number of diary questions per day) for each participant. After the study period, the participants were invited to a focus group interview addressing the participants' attitudes to their disease, their experience with the SMS asthma diary, and their future expectations from the SMS asthma diary. RESULTS: Twelve patients with asthma (6 males, 6 females) participated in the data collection study. The median age was 38.5 (range: 13-57) years. The median response rate per patient was 0.69 (range: 0.03-0.98), ie, half the participants reported more than about two thirds of the requested diary data. Furthermore, response rates were relatively steady during the study period with no signs of decreasing usage over time. From the subsequent focus group interview with 9 users we learned that, in general, the participants were enthusiastic about the SMS diary--it became an integrated part of their everyday life. However, the participants wished for a simpler diary with only one SMS message to respond to and a system with a Web interface for system customization and graphical display of diary data history. CONCLUSION: This study suggests that SMS collection of asthma diary data is feasible, and that SMS may be a tool for supporting the self-management of asthma (and possibly other chronic diseases) in motivated and self-efficacious patients because mobile phones are a part of people's everyday lives and enable active requests for data wherever the patient is. The combination of SMS data collection and a traditional Web page for data display and system customization may be a better and more usable tool for patients than the use of Web-based asthma diaries which suffer from high attrition rates.

Adolescent↗

A task framework for the web interface W2H.

SUMMARY: The W3H task framework allows the execution of compound jobs utilizing the description of work and data flows in a heterogeneous bioinformatics environment using meta-data information. By means of these descriptions, the task system can schedule the necessary execution of applications available in the environment, depending on rules specified in the meta-data. By integrating this task framework into the publicly available web interface W2H, similarly based on meta-data, web access and data management are immediately available for each task description. Authors of task descriptions can base their work on the underlying classes and objects to be able to describe dependency rules between previously independent applications. The result of a compound task is given as XML data that is translated according to XSLT data into web pages or plain text to report the result of the task to the user. AVAILABILITY: Within the HUSAR environment at DKFZ http://genome.dkfz-heidelberg.de/

Database Management Systems↗