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Collaborative development of a uniform graphical interface.

A uniform graphical user interface to informational databases is evolving at the University of Washington through a collaborative development process. The interface, called WILLOW, has grown from model analysis and preliminary design to working prototype. The design replicates a natural flow of search retrieval. Development continues in a spiral of test and linear improvements based on user analysis. WILLOW's internal structure is built on a Unix client-server model communicating over the campus TCP/IP backbone network. Its external structure is an X-Windows/Motif visual presentation emphasizing a simple, consistent, graphical face to disparate information databases. The WILLOW collaborators have grown from an initial group composed of the Health Sciences Library & Information Center and Computing & Communications' Information Systems to the University Libraries, Computing & Communications divisions, Medical Center Information Systems, and departments throughout the health sciences.

Information Systems↗

National library of medicine regional medical library program.

The National Library of Medicine is charged with the development and management of a National Biomedical Communications Network. The Regional Medical Library Program is a forerunner of such a network; the product and institutions involved will be critical elements in its evolution. The immediate objective of the RMLP, the facilitation of biomedical information transfer, presents a logistical problem requiring substantial commitment from the health sciences community and extensive cooperation among libraries in each region.

Journal Article↗

The uncertain future of Canadian academic medicine.

During the 1960's and 70's, academic medicine in Canada grew rapidly in size and scope and a number of research and clinical programs of the highest quality emerged. During the 1980's not only was this impetus not sustained, in some disciplines and regions there was likely a reversal of previous success. These adverse effects were produced by continued uncertainty and insufficiency of federal funding of research, underfunding of Canadian universities and of teaching hospitals, and by a decline within Canadian society of the images of both the physician and the teaching hospital with its technologically-based clinical and research programs. These negative influences were mitigated somewhat by the development during the 80's of more sources of research support from certain provincial governments and of a number of new biomedical research institutes and networks. The adverse influences of the 1980's will likely be perpetuated into the 1990's. Indeed an impending economic downturn and the return of constitutional disarray will worsen the climate for longterm growth in science and related health care research and technology. For Canadian academic medicine to survive these adverse influences, it must seek relationships and sources of support external to government. Most importantly however, it must strike new arrangements with provincial governments such that the imperatives of the academic health center and government become recognized in the planning process of the other party. For the academic health center this will mean involvement in government approaches to cost containment and health promotion; for provincial governments it will mean a commitment to health research and faculty renewal.(ABSTRACT TRUNCATED AT 250 WORDS)

Academic Medical Centers↗

The Visible Human data set: an image resource for anatomical visualization.

The National Library of Medicine (NLM) has long been a world leader in the archiving and distribution of the print-based images of biology and medicine. NLM has also been a pioneer in the use of computer systems to encode and distribute textual knowledge of the life sciences. NLM's Long Range Planning effort of 1985-86 foresaw a coming era where NLM's bibliographic and factual database services would be complemented by libraries of digital images, distributed over high speed computer networks and by high capacity physical media. The NLM Planning Panel on Electronic Imaging recommended that NLM should undertake the building of a digital image library consisting of computer-assisted tomography (CAT), magnetic resonance interferometry (MRI), and cryosection images of a representative, carefully selected and prepared male and female cadaver--the "Visible Human Project." The male Visible Human data set is now being made available through a license agreement with the NLM. A wide range of educational, diagnostic, treatment planning, and commercial uses is predicted. The Visible Human data set and its associated identification maps will serve as a "Boston Teapot" for medical imaging, a common public domain data set against which all medical imaging algorithms can be tested, and a cornerstone for future sets of related image libraries.

Adult↗

Reinforcement learning control.

Reinforcement learning refers to improving performance through trial-and-error. Despite recent progress in developing artificial learning systems, including new learning methods for artificial neural networks, most of these systems learn under the tutelage of a knowledgeable 'teacher' able to tell them how to respond to a set of training stimuli. Learning under these conditions is not adequate, however, when it is costly, or even impossible, to obtain this kind of training information. Reinforcement learning is attracting increasing attention in computer science and engineering because it can be used by autonomous systems to learn from their experiences instead of from knowledgeable teachers, and it is attracting attention in computational neuroscience because it is consonant with biological principles. Recent research has improved the efficiency of reinforcement learning and has provided some striking examples of its capabilities.

Animals↗

[EUREGIO-projekt MRSA-net Twente/Münsterland. Creation of a regional network to combat MRSA].

Over the last years, Germany has observed an increase in the prevalence of methicillin-resistant Staphylococcus (MRSA) in all S. aureus isolates from 2 % to about 25 % whereas in The Netherlands this proportion has continuously been kept below 1 % thanks to a consistent "search & destroy" policy. Both countries increasingly register so-called community-acquired (CA) MRSA which are a threat also to the healthy population without any known risk factor for MRSA carriership. The EUREGIO project "MRSA-net Twente/Münsterland" has made it its main goal to set up a German-Dutch network serving as a basis for a quality association which includes all those who are actively involved in health care provision on both sides of the border and to implement a coordinated strategy for MRSA control and prevention. The project is being carried out with the financial support of the European Union under the INTERREG-IIIA Community initiative and of the Ministry of Economics of the State of North Rhine-Westphalia. The epidemiological backbone of the MRSA-net is a genetic-based MRSA typing strategy (spa-typing) which has been developed by the Institute for Hygiene, University Hospital, Münster and which allows regional and cross-border comparability of laboratory results. The Faculty of Behavioural Sciences of the University of Twente examines MRSA hygiene protocols with regard to their acceptability and realisability with the intention of developing user-friendly, target group-oriented MRSA protocols for the EUREGIO. The health departments involved in the project play a central role in the coordination of the network partners in the municipalities. By performing their function of surveillance in accordance with Sections 23 and 36 of the Infectious Disease Control Act they provide an important contribution to enhancing MRSA control and prevention strategies. Thanks to its cross-border cooperation and exchange of knowledge and technology the EUREGIO project "MRSA-net" contributes to controlling the proliferation of MRSA in the EUREGIO and thus to removing obstacles to the free cross-border movement of patients and personnel.

Community Networks↗

Integrated case studies and medical decision making: a novel, computer-assisted bridge from the basic sciences to the clinics.

This article describes a novel course that was designed to bridge the gap between the basic science years and clinical experiences in medical school by using information science and computer technology as major components of problem-based learning (PBL) sessions. The course, Integrated Case Studies and Medical Decision Making, was first given to second-year students at the University of Pittsburgh School of Medicine in the spring of 1994. It consists of 13 PBL exercises, each of which explores a clinical case. The cases, including images and gated access to information, are housed on a computer. Using one of 16 networked terminals in specially designed small-group rooms, groups of nine students progress through the cases with a faculty facilitator. The responses of students and faculty to the initial year of the course were favorable. In comparison with traditional PBL sessions, enhanced quality of and access to images and accountability for accessing case information in sequential fashion were cited as major strengths of the course. Juxtaposition of basic science and clinical material and utility in reviewing for the United States Medical Licensing Examination were also cited as strengths. The diversity of the basic science material involved in completing the cases drew overwhelming enthusiasm from students and facilitators alike. In conclusion, the course successfully employs computer and information science technology, which will be of increasing importance to future physicians. The course also serves as an effective bridge to the clinical years of medical school and as a study adjunct for the USMLE.

Clinical Competence↗

Computer and the thought process.

Modelling of brain is an eternal problem and was revitalized by arrogant claims of some computer scientists. Several basic results of mathematics, especially in problems of uncertainty, computational complexity and logic prove limits of computation and indications that the brain works otherwise. The complexity of brain is not accessible by current electronic technology. However, brain research and computer science can learn a lot from each other by revealing relevant analogies.

Artificial Intelligence↗

Virtual management of radiology examinations in the virtual radiology environment using common object request broker architecture services.

In the Department of Defense (DoD), US Army Medical Command is now embarking on an extremely exciting new project--creating a virtual radiology environment (VRE) for the management of radiology examinations. The business of radiology in the military is therefore being reengineered on several fronts by the VRE Project. In the VRE Project, a set of intelligent agent algorithms determine where examinations are to routed for reading bases on a knowledge base of the entire VRE. The set of algorithms, called the Meta-Manager, is hierarchical and uses object-based communications between medical treatment facilities (MTFs) and medical centers that have digital imaging network picture archiving and communications systems (DIN-PACS) networks. The communications is based on use of common object request broker architecture (CORBA) objects and services to send patient demographics and examination images from DIN-PACS networks in the MTFs to the DIN-PACS networks at the medical centers for diagnosis. The Meta-Manager is also responsible for updating the diagnosis at the originating MTF. CORBA services are used to perform secure message communications between DIN-PACS nodes in the VRE network. The Meta-Manager has a fail-safe architecture that allows the master Meta-Manager function to float to regional Meta-Manager sites in case of server failure. A prototype of the CORBA-based Meta-Manager is being developed by the University of Arizona's Computer Engineering Research Laboratory using the unified modeling language (UML) as a design tool. The prototype will implement the main functions described in the Meta-Manager design specification. The results of this project are expected to reengineer the process of radiology in the military and have extensions to commercial radiology environments.

Algorithms↗

Systems of medicine and nationalist discourse in India: towards "new horizons" in medical anthropology and history.

While accepting medical "pluralism" as a historical reality, as an intrinsic value inherent in any medical system, and as an ideal or desired goal that any multicultural society ought to achieve, this paper argues the need to go beyond the liberal pluralist tendencies that have dominated the debate so far. It holds that while documenting or dealing with the "co-existence" of varied medical traditions and practices, we must not ignore or underplay issues of power, domination and hegemony and must locate our work in a larger historical, social and political context. With this perspective, and based essentially on Assembly proceedings, private papers, official documents and archival materials from the first half of the 20th-century, this paper identifies three major streams in the nationalist discourse in India: conformity, defiance and the quest for an alternative. It shows that while the elements of conformity to biomedicine and its dominance remained more pronounced and emphatic, those of defiance were conversely weak and at times even apologetic. The quest for alternatives, on the other hand, although powerful and able to build trenchant civilizational and institutional critique of modern science and medicine, could never find adequate space in the national agenda for social change. The paper further holds that although the "cultural authority" and hegemony of biomedicine over indigenous science and knowledge were initiated by the colonial state, they were extended by the mainstream national leaderships and national governments with far more extensive and profound implications and less resistance. In light of the growing global networking of "traditional", "complementary" and "alternative" health systems on the one hand and the hegemonic and homogenizing role and presence of multilateral organizations (such as the World Bank and IMF) in shaping national health policies on the other, such insights from history become extraordinarily important.

Anthropology↗

Periodically ordered nanoscale islands and mesoporous films composed of nanocrystalline multimetallic oxides.

Innovative strategies to produce well-defined nanoparticles and other nanostructures such as nanofibres, quantum wells and mesoporous materials have revitalized materials science for the potential benefit to society. Here, we report a controlled process, involving soft-chemistry-based deposition, template-assisted mesostructured growth, and tuned annealing conditions that allows the preparation of ordered mesoporous crystalline networks and mesostructured nano-island single layers, composed of multicationic metal oxides having perovskite, tetragonal or ilmenite structures. This strategy to obtain meso-organized multi-metal-oxide nanocrystalline films (M(3)NF) bridges the gap between conventional mesoporous materials and the remarkable properties of crystalline ternary or quaternary metallic oxides. Nanocrystalline mesoporous films with controlled wall thickness (10-20 nm) of dielectric SrTiO(3), photoactive MgTa(2)O(6) or ferromagnetic semi-conducting Co(x)Ti(1-x)O(2-x) were prepared by evaporation-induced self-assembly (EISA) using a specially designed non-ionic block-copolymer template. A tuned thermal treatment of the mesoporous films permits the transfer of the wall structure into nanocrystallites, with all tectonic units being tightly incorporated into mechanically stable ordered tri- or bidimensional nanocrystalline networks. This methodology should allow multifunctionalization, miniaturization and integration during development of devices such as smart sensors and actuators, better-performing photocatalysts, and fast electrochromic devices. On the other hand, organized arrays of dispersed ferromagnetic or ferroelectric nanoparticles are promising materials for spintronics and for cheap, non-volatile 'flash' memories.

Crystallization↗

Toward a standardised information system for dentistry.

Information technology is growing rapidly in both its capability and capacity to support the delivery of health care. This paper describes the work of the Dental Interspec project, commissioned by the Department of Health. The aim of the project is to provide a framework for the development of information management and technology in dentistry. It is hoped that the work of this project can be built on to eventually produce integrated information systems which would have the potential to improve primary dental care delivery for both patients and dentists.

Computer Communication Networks↗

Attention and hypnosis: neural substrates and genetic associations of two converging processes.

Although attention is a central theme in psychological science, hypnosis researchers rarely incorporate attentional findings into their work. As with other biological systems, attention has a distinct anatomy that carries out basic psychological functions. Specific brain injuries, states, and drugs can all influence attentional networks. Investigation into these networks using modern neuroimaging techniques has revealed important mechanisms involved in attention. In this age of genomics, genetic approaches can supplement these neuroimaging techniques. As genotyping becomes an affordable and technologically viable complement to phenotyping, exploratory genetic assays offer insights into the genetic bases of both attention and hypnotizability. This paper discusses relevant aspects of attentional mechanisms and their underlying neuroanatomy as they relate to hypnosis. Underlining data from attentional networks, neuroimaging, and genetics, these findings should help to explain individual differences in hypnotizability and the neural systems subserving hypnosis.

Arousal↗

Benchmark for evaluating the quality of DNA sequencing: proposal from an international external quality assessment scheme.

BACKGROUND: In the past 15 years, clinical laboratory science has been transformed by the use of technologies that cross the traditional boundaries between laboratory disciplines. However, during this period, issues of quality have not always been given adequate attention. The European Molecular Genetics Quality Network (EMQN) has developed a novel external quality assessment scheme for evaluation of DNA sequencing. We report the results of an international survey of the quality of DNA sequencing among 64 laboratories from 21 countries. METHODS: Current practice for DNA sequence analysis was established by use of an online questionnaire. Participating laboratories were provided with 4 DNA samples of validated genotype. Evaluation of the results included assessing the quality of sequence data, variant genotypes, and mutation nomenclature. To accommodate variations in mutation nomenclature, variants indicated by participants were scored for compliance with 3 acceptable marking schemes. RESULTS: A total of 346 genotypes were analyzed. Of these, 19 (5%) genotyping errors were made. Of these, 10 (53%) were false-negative and 9 (47%) were false-positive results. A further 27 (8%) errors were made in naming mutations. Results were analyzed for 3 indicators of data quality: PHRED quality scores, Quality Read Length, and Quality Read Overlap. Most laboratories produced results of acceptable diagnostic quality as judged by these indicators. The results were used to calculate a consensus benchmark for DNA sequencing against which individual laboratories could rank their performance. CONCLUSIONS: We propose that the consensus benchmark can be used as a baseline against which the aggregate and individual laboratory standard of DNA sequencing may be tracked from year to year.

Benchmarking↗

[Community nutrition strategy project: an innovation in community health].

The strategy of the community nutrition project is based on the utilization of the community development structures to deliver the nutrition services. These structures, represented in Senegal by youth associations, women groups, GIEs and NGOs, are part of the decentralization process, and as such play an important role in health and health development activities in poor urban districts. The Community Nutrition Project (CNP), funded for five years by the World Bank, German Cooperation (KFW), World Food Program (WFP) and the Senegalese government aims to halt further deterioration in the nutrition status of the most vulnerable groups in the poorest urban districts of Senegal. All nutrition services and particularly the IEC services have been entirely contracted out the first year to 76 GIEs involving 323 unemployed persons, operating as micro-enterprises "MIC" and 17 "GIEs" of unemployed physicians, pharmacists, and social workers for a total of 34 persons, organized as "maître d'Oeuvre communautaires "MOC", in charge of the supervision tasks. Each community nutrition center recruits and monitors every six months 460 to 600 beneficiaries composed of women at six months of pregnancy, lactating mother of children under 6 months, and a group of children aged from 6 to 35 months old. An average of 87% of registered children in the nutrition centers are weekly or monthly weighted. Thus the proportion of malnourished children in cohort of children followed from January to July 1996 has decreased from 70% to 25% within six months. The malnutrition rate has been reduced up to 65% after six months.

Adult↗

[A method for collecting data on kinship in demographic surveys: a compromise with the anthropological method].

"We present herein a solution to operationalize the concept of kinship using the experience of the IFAN-ORSTOM survey carried out in Dakar [Senegal]. Our results confirm the increased dependence of the younger generation on older generations [during life cycle changes or demographic crises]. The urban way of life does not seem to disorganize family structures in Dhaka. At present, it is through family solidarity that the shock of the crisis is absorbed." (SUMMARY IN ENG AND SPA)

Africa↗