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The development of technical and spectrum requirements for meeting federal, state and local public safety agency communication requirements through the year 2010, establishment of rules and requirements for priority access service--FCC. Proposed rule.

The federal Communications Commission (Commission) adopted a Third Notice of Proposed Rule Making ("Third Notice") contemporaneously with a First Report and Order ("First Report") that is summarized elsewhere in this edition of the Federal Register. By its Third Notice, the Commission makes a range of proposals and seeks comment relating to public safety communications in the 746-806 MHz band ("700 MHz band") and in general. The Commission invites comment on how to license the 8.8 megahertz of 700 MHz band spectrum designated as reserved in the First Report and on whether to directly license each state or use a regional planning process to administer the nationwide interoperability frequencies (2.6 MHz of spectrum designated in the First Report) pursuant to the national interoperability plan to be established by the National Coordination Committee. The Third Notice also discusses protection requirements for the Global Navigation Satellite Systems and offers proposals to facilitate use of nationwide interoperability in public safety bands below 512 MHz. Finally, because many of the automated and intelligent machines and systems on which public safety entities depend for their operations were not designed to take into account the date change that will occur on January 1, 2000, the Commission also seeks comment on how best to ascertain the extent, reach, and effectiveness of Year 2000 compliance initiatives that have been or are being undertaken by public safety entities, to better understand the nature of the Year 2000 problem and the potential risks posed to public safety communications networks. This action addresses an urgent need for additional public safety radio spectrum and the need for nationwide interoperability among local, state, and federal entities. By this action, the Commission also takes additional steps toward achieving its goals of developing a flexible regulatory framework to meet vital current and future public safety communications needs and ensuring that sufficient spectrum to accommodate efficient, effective telecommunications facilities and services will be available to satisfy public safety communications needs into the 21st century.

Emergency Medical Service Communication Systems↗

MTS and WATS market structure--Federal Communications Commission. Fourth supplementary notice of inquiry and proposed rule.

The Commission releases a Supplemental Notice of Inquiry and Proposed Rulemaking regarding the MTS and WATS market structure and is seeking comment on the development of an access charge to compensate local exchanges for exchange facilities to originate or terminate interstate or foreign telecommunications. Comments are sought on principles of charging, extent of aggregation, implementation mechanisms, and on determination of an appropriate rate of return. This action is taken to secure information needed to develop access charge principles.

Costs and Cost Analysis↗

The grapefruit diet.

According to major research studies, 50 percent of all distributed data processing is really distributed document delivery. Up to 70 percent of all telephone calls do not reach the intended party, resulting in what has been aptly called, "telephone tag." Electronic mail is a rapidly emerging technology using computers and telecommunications networks to transmit notes, messages and documents instantaneously. Online information systems for document management, distribution and retrieval is an area of electronic mail far more powerful. Computer teleconferencing, as it is often called, allows for ongoing meetings online with persons from remote locations without regard to time zone limitations. This article will focus on the definitions of computer teleconferencing and other new "online" technologies, and how they will impact document development, management and distribution. It is based on the author's presentation at the 1983 NMA Annual Conference & Exposition in Philadelphia.

Computers↗

Rural docs. Narrowing the gaps.

Small-town practice looks more inviting as telecommunications bridges the distances to bring specialist consults and CME to remote areas. As Medicare reforms give country doctors better incomes, the arrival of more colleagues should help reduce the work load, long hours, and isolation.

Education, Medical, Continuing↗

[Fusion of medicine and technology in endoscopic surgery].

Although endoscopic surgery has become widespread and is currently used in a wide range of general, thoracic, urologic, gynecologic, and orthopedic procedures, many major difficulties remain because sensorial information is restricted to a two-dimensional image, and effector instruments have limited maneuverability due to the rigid shaft axis fixed to the abdominal wall by the entry trocar. To overcome these problems, advanced engineering technology has been introduced in laparoscopic surgery which includes three-dimensional video imaging, robotic laparoscopic cameraholders, telemanipulated flexible effector instruments, and tactile feedback. A voice-controlled robotic laparoscopic holder (AESOP200, Computer Motion Inc. USA) provides stable support for the laparoscope during laparoscopic surgery performed by a single surgeon. A new computer-assisted telemanipulation robot (Intuitive Surgical Inc. USA) permits the performance of completely endoscopic coronary artery bypass and Nissen fundoplication. Furthermore, price reductions and technological advances in telecommunications have made telementoring in endoscopic surgery available for routine clinical use, and intercontinental surgical video teleconferences fruitful opportunities for discussing technical details. The fusion of medicine and technology in endoscopic surgery would overcome difficulties in the conventional endoscopic approach.

Humans↗

Ethnographic interviews to elicit patients' reactions to an intelligent interactive telephone health behavior advisor system.

Information technology is being used to collect data directly from patients and to provide educational information to them. Concern over patient reactions to this use of information technology is especially important in light of the debate over whether computers dehumanize patients. This study reports reactions that patient users expressed in ethnographic interviews about using a computer-based telecommunications system. The interviews were conducted as part of a larger evaluation of Telephone-Linked Care (TLC)-HealthCall, an intelligent interactive telephone advisor, that advised individuals about how to improve their health through changes in diet or exercise. Interview findings suggest that people formed personal relationships with the TLC system. These relationships ranged from feeling guilty about their diet or exercise behavior to feeling love for the voice. The findings raise system design and user interface issues as well as research and ethical questions.

Anthropology, Cultural↗

Mobile technologies in the management of disasters: the results of a telemedicine solution.

Nowadays a great number of applications are used to compile and transmit casualties and disasters information but there are many troubles associated with the technology as can be the communications reliability and the size and weight of the devices medical staff has to carry with. Telecommunication infrastructures support information movement among geographically dispersed locations. Recently a large family of little devices has appeared in the buyer's market. They are called Personal Digital Assistants and because of their physic and technical features, they are very useful in the emergency field. As for the communications reliability, many technologies have been developed in the last years but it is necessary to find a solution that can be used in whatever situation independently of the emergency circumstances. Facing this reality, the Spanish government funded REMAF, an ATYCA (Initiative of Support for the Technology, Security and Quality in the Industry) project. REMAF joined research groups (UPM), phone operators (Fundación Airtel Móvil) and end users (SAMUR) to build a disaster data management system conceived to use modern telemedicine systems to optimize the management in these situations, taking the advantage of the above mentioned mobile communication tools and networks.

Disasters↗

Video communication visions.

In a recent study, entitled: Study on the Use of Advanced Telecoms by Healthcare Establishments, commissioned by the Information Society Directorate General of the European Commission, it was emphasised that: "Telecommunications networks and services are central to the achievement of seamless care, where patients' needs are addressed smoothly and efficiently, by whatever services they need, as and when they need it." Video communications, as part of an integrated information and communications strategy, has the capability to provide a continuum of care throughout a person's lifespan--from the cradle to the grave. Moreover in the future, video-enabled healthcare will help the government redesign the health service around the patient. It is a fast developing area and estate managers will need to be part of any implementation strategy, as exemplified in the IP network being developed across the Welsh healthcare estate. Motion Media is a founding member of the UK e-Health Association, a circle member of the American Telemedicine Association and a member of the European Health Telematics Association (EHTEL). The company was chosen recently by the EHTEL to run the first approved Telehealth demonstration centre in Europe. In October 2001 Motion Media appointed Dr Jay Sanders as its Consulting Medical Director. Dr Sanders is known throughout the US healthcare industry as the "Father of Telemedicine."

Europe↗

[The Budapest agglomeration, 1980-1990].

"The study analyses the development of Budapest and [the] 6 towns and 37 communes forming its conurbation between 1980 and 1990." Consideration is given to the city's population dynamics; housing conditions, including availability of utilities, transportation, telecommunications, and retail stores; health conditions of the population; and educational opportunities for residents. (SUMMARY IN ENG AND RUS)

Communication↗

Communication infrastructure in a contact center for home care monitoring of chronic disease patients.

The Citizen Health System (CHS) is a European Commission (EC) funded project in the field of IST for Health. Its main goal is to develop a generic contact center which in its pilot stage can be used in the monitoring, treatment and management of chronically ill patients at home in Greece, Spain and Germany. Such contact centers, which can use any type of communication technology, and can provide timely and preventive prompting to the patients are envisaged in the future to evolve into well-being contact centers providing services to all citizens. In this paper, we present the structure of such a generic contact center and in particular the telecommunication infrastructure, the communication protocols and procedures, and finally the educational modules that are integrated into this contact center. We discuss the procedures followed for two target groups of patients where two randomized control clinical trials are under way, namely diabetic patients with obesity problems, and congestive heart failure patients. We present examples of the communication means between the contact center medical personnel and these patients, and elaborate on the educational issues involved.

Chronic Disease↗

International distance education and the transition from ISDN to high-bandwidth Internet connectivity.

The Thailand-Hawaii Assessment of Interactive Healthcare Initiative (THAI-HI) is an international distance-education project between two teaching hospitals in Honolulu and Bangkok that uses videoconferencing over three ISDN lines. A 'morning report' format is used to discuss clinical cases primarily covering infectious disease and critical-care topics. An audience response system is used at both sites to add interactivity. From July 2001 to May 2002, 816 health-care providers attended 20 clinical conferences. Audiences rated the conferences as highly relevant and as having high training value. Since the ISDN connection is expensive, we plan to convert the telecommunications to a high-bandwidth Internet connection. The Honolulu site will use a 45 Mbit/s commercial connection to the Hawaii Intranetwork Consortium, which links to the Abilene Network on the US mainland. The Bangkok hospital will use a 155 Mbit/s wireless optical connection to UNINET Thailand, which has a 45 Mbit/s circuit to Abilene.

Attitude of Health Personnel↗

[Good experiences with telemedicine in the regional hospital of Tromsø].

The University Hospital of Tromsø and the Norwegian Telecom Research project "Telemedicine in North Norway" has used video conferences as a tool in making remote diagnosis in the medical areas: Pathology, diagnosis from microscope images; dermatology, endoscopy in otorhinolaryngology, echocardiology and radiology. The project has also developed a communication system between general physicians and the department of the clinical chemistry in which test results are transported electronically from the laboratory to the physicians. Experience to date suggests that the quality of telecommunication in diagnostic services is good and that access to such facilities is beneficial to the users.

Diagnostic Imaging↗

[Telementoring in surgery].

Tele-mentoring is an interactive experimental method that allows young surgeons' education by distant learning tutoring of an expert surgeon. The problem about assessment of efficacy and quality of computer-assisted instruction is under evaluation today. Tele-mentoring is supported by videoconferencing system and it is not an exclusive methodology but an additional methodology to traditional didactic for clinicians and surgeons. It allows personal virtual trainings by computers and telecommunication systems. Videoconference allows tutoring for telemedicine, teletriage and telesurgery also.

Education, Distance↗

High-performance computing, high-speed networks, and configurable computing environments: progress toward fully distributed computing.

The next several years will see the maturing of a collection of technologies that will enable fully and transparently distributed computing environments. Networks will be used to configure independent computing, storage, and I/O elements into "virtual systems" that are optimal for solving a particular problem. This environment will make the most powerful computing systems those that are logically assembled from network-based components and will also make those systems available to a widespread audience. Anticipating that the necessary technology and communications infrastructure will be available in the next 3 to 5 years, we are developing and demonstrating prototype applications that test and exercise the currently available elements of this configurable environment. The Lawrence Berkeley Laboratory (LBL) Information and Computing Sciences and Research Medicine Divisions have collaborated with the Pittsburgh Supercomputer Center to demonstrate one distributed application that illuminates the issues and potential of using networks to configure virtual systems. This application allows the interactive visualization of large three-dimensional (3D) scalar fields (voxel data sets) by using a network-based configuration of heterogeneous supercomputers and workstations. The specific test case is visualization of 3D magnetic resonance imaging (MRI) data. The virtual system architecture consists of a Connection Machine-2 (CM-2) that performs surface reconstruction from the voxel data, a Cray Y-MP that renders the resulting geometric data into an image, and a workstation that provides the display of the image and the user interface for specifying the parameters for the geometry generation and 3D viewing. These three elements are configured into a virtual system by using several different network technologies. This paper reviews the current status of the software, hardware, and communications technologies that are needed to enable this configurable environment. These interdependent technologies include: (1) user interface and application program construction methodologies, (2) the interprocess communication (IPC) mechanisms used to connect the software modules of the application, (3) the network protocols and interface hardware used by the IPC for communicating between modules running on separate and independent computing system elements, (4) the telecommunications infrastructure that provides the low-level data transfer functions for the networks that connect the geographically distributed elements used by the application, and (5) the nature of the functional elements that will be connected to form virtual systems.

Computer Communication Networks↗

Rural health care support mechanism. Final rule; denial of petition for reconsideration.

In this document, the Commission modifies its rules to improve the effectiveness of the rural health care support mechanism, which provides discounts to rural health care providers to access modern telecommunications for medical and health maintenance purposes. Because participation in the rural health care support mechanism has not met the Commission's initial projections, the Commission amends its rules to improve the program, increase participation by rural health care providers, and ensure that the benefits of the program continue to be distributed in a fair and equitable manner. In addition, the Commission denies Mobile Satellite Ventures Subsidiary's petition for reconsideration of the 1997 Universal Service Order.

Cost-Benefit Analysis↗

Is telehealth the right tool for remote communities? Improving health status in rural Australia.

The health status of people in rural and remote areas, particularly of Indigenous Australians, has been widely reported to be poorer than their urban counterparts. Health care in rural and remote Australia has relied on the work of nurses, often in the absence of medical or allied health personnel other than via telecommunication. Over the last 5 years telehealth has been heavily promoted as an innovative and effective way of improving the health status of people in rural and remote areas by providing improved access to specialist care. Through national infrastructure development and funding for a vast array of pilot projects, telehealth provision has been promoted as progressive, effective, and modern. This Editorial reviews the literature and highlights a need for additional research around telehealth-mediated patient practitioner relationships.

Australia↗

Applying sustainable water management concepts in rural and urban areas: some thoughts about reasons, means and needs.

Serving the world population with adequate drinking water and sanitation is an important prerequisite, not only to hygienic safety, but to prosperity and political stability as well, and will foster the adaptive capacity of the societies in the developing countries and beyond. To avoid hygienic and political disasters impacting the world economy, investment in water supply and sanitation must urgently be made. Whether the classical system of urban water supply and sanitation is appropriate to satisfy the needs of the developing world, however, and whether this system meets the general criteria of sustainability is questionable. The costs and the time needed for installation of sewers and wastewater treatment plants are tremendous. In water shortage areas, the amount of tap water required to transport pollutants to the treatment plant is hardly affordable. Recovery and re-introduction of valuable substances, including water, into the urban cycle of materials is impossible because of mixing and dilution effects inherent in the system. Decentralized water and wastewater management should be seriously taken into account as an alternative. Source separation of specific fractions of domestic and industrial wastewater, separate treatment of these fractions and recovery of water and raw materials including fertilizer and energy are the main characteristics of modern high-tech on-site treatment/reuse systems. Mass production of the key components of the system could reduce the costs of the treatment units to a reasonable level. On-site units could be installed independently of the development stage of the urban sewer system. In conjunction with building new housing complexes a stepwise improvement of the hygienic situation in urban and peri-urban areas could be achieved, therefore. Remote control of the satellite systems using modern telecommunication methods would allow reliable operation, and comfort for the users. Intensive research is required, however, to develop this system and bring it to a standard allowing efficient application worldwide.

Conservation of Natural Resources↗