The Internet and Medicine in The Internet and Medicine in 2004: cyberNephrology, 2004: cyberNephrology, Telepathology, Internet Telepathology, Internet

VideoconferencingVideoconferencing

Kim Solez, M.D. with assistance of Kim Solez, M.D. with assistance of Michele HalesMichele Hales

Every Audience Now Diverse!Every Audience Now Diverse!

Because the Internet is now mainstream, many of Because the Internet is now mainstream, many of you have already solved most or all of the you have already solved most or all of the Internet related problems in your professional Internet related problems in your professional life. Nevertheless there are still many positive life. Nevertheless there are still many positive surprises, technology advances which can surprises, technology advances which can greatly enhance pathology activities which you greatly enhance pathology activities which you probably are not aware of, telepathology, virtual probably are not aware of, telepathology, virtual slide, Internet video conferencing, advanced slide, Internet video conferencing, advanced searching etc. Plus it is always nice to have the searching etc. Plus it is always nice to have the perspective of history. So hopefully this perspective of history. So hopefully this presentation will have something for everyone!presentation will have something for everyone!

NKF cyberNephrology -NKF cyberNephrology -Human Centered ComputingHuman Centered Computing

Fostering Fostering nephrology’s embrace nephrology’s embrace of the Internet and of the Internet and new technology since new technology since 1994 with Email and 1994 with Email and web resources. ISN web resources. ISN homepage, websites homepage, websites which allow virtual which allow virtual attendance at attendance at meetings.meetings.

www.cybernephrology.orgwww.cybernephrology.org

www.cyber-medicine.orgwww.cyber-medicine.org

Technology Evolution Need Technology Evolution Need Not be Complex!Not be Complex!

Machines should serve human beings, making Machines should serve human beings, making our lives easier.our lives easier.

The latest technology in cell phones, the windup The latest technology in cell phones, the windup charger.charger.

Video Conferencing can also be simple like this.Video Conferencing can also be simple like this.

Technology Evolution Need Technology Evolution Need Not be Complex!Not be Complex!

Machines should serve human beings, making Machines should serve human beings, making our lives easier.our lives easier.

Virtual full size keyboards for cell phones and Virtual full size keyboards for cell phones and PDAs which project on any surface.PDAs which project on any surface.

Video Conferencing can also be simple like this.Video Conferencing can also be simple like this.

Evidence-Based MedicineEvidence-Based MedicineSir Austin Bradford Hill, British Researcher: Sir Austin Bradford Hill, British Researcher: "All scientific work is incomplete- whether it be "All scientific work is incomplete- whether it be observational or experimental. All scientific observational or experimental. All scientific work is liable to be upset or modified by work is liable to be upset or modified by advancing knowledge. This does not confer advancing knowledge. This does not confer upon a freedom to ignore the knowledge we upon a freedom to ignore the knowledge we already have, or to postpone the action that it already have, or to postpone the action that it appears to demand at a given time. Who knows, appears to demand at a given time. Who knows, asked Robert Browning, but that the world may asked Robert Browning, but that the world may end tonight? True, but on available evidence end tonight? True, but on available evidence most of us make ready to commute on the 8:30 most of us make ready to commute on the 8:30 next day."next day."

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Internet Now Mainstream - Internet Now Mainstream - Searching - A Wonderful Searching - A Wonderful

World Out There! World Out There!

General Search ToolsGeneral Search Tools Beyond Pubmed!Beyond Pubmed!

http://www.alltheweb.com/http://www.alltheweb.com/

Currently searching Currently searching 3,151,743,117 web pages3,151,743,117 web pages

http://www.google.com/http://www.google.com/

Google - Searching Google - Searching 3,307,998,701 web pages3,307,998,701 web pages

Searching Web Pages of the Searching Web Pages of the Past - “Wayback Machine”Past - “Wayback Machine”

http://www.archive.org/http://www.archive.org/

Search 11 billion pages of the Wayback Search 11 billion pages of the Wayback MachineMachine

The Internet Archive is building a digital The Internet Archive is building a digital library of Internet sites and other cultural library of Internet sites and other cultural artifacts in digital form. Like a paper library, artifacts in digital form. Like a paper library, provides free access to researchers, provides free access to researchers, historians, scholars, and the general public.historians, scholars, and the general public.

Searching The “Invisible Web”Searching The “Invisible Web” Database pages and pages with a ? In the Database pages and pages with a ? In the URL are excluded from standard searches.URL are excluded from standard searches.

Search engine databases are created by robot Search engine databases are created by robot programs calledprograms called spiders spiders, computer robot programs , computer robot programs that crawl the web seeking search engine content. that crawl the web seeking search engine content. These spiders crawl or navigate the Web by These spiders crawl or navigate the Web by following the links in the web pages that are already following the links in the web pages that are already in the database of their parent search engine. If there in the database of their parent search engine. If there is no link to a page, a spider cannot "see" it. They is no link to a page, a spider cannot "see" it. They lack the ability to type or think of any string of lack the ability to type or think of any string of characters. They not only lack fingers for typing, but characters. They not only lack fingers for typing, but also lack a brain capable of judgment.also lack a brain capable of judgment.

Searching The “Invisible Web”Searching The “Invisible Web”

One can seach the Invisible Web using the following One can seach the Invisible Web using the following tools:tools:

http://lii.org/http://lii.org/

http://www.academicinfo.net/http://www.academicinfo.net/

http://www.completeplanet.com/http://www.completeplanet.com/

Video conferencing/Video conferencing/Telemedicine/Telepathology The Telemedicine/Telepathology The

near future of medical near future of medical education and practice!education and practice!

Internet video-conferencing affordable. There Internet video-conferencing affordable. There are two practical ways to establish this: are two practical ways to establish this:

1.1. Dedicated videoconferencing equipment from Dedicated videoconferencing equipment from Sony or Polycom using Internet2/Abilene Sony or Polycom using Internet2/Abilene “research” Internet with guaranteed “research” Internet with guaranteed bandwidth.bandwidth.

2.2. Desktop videoconferencing using iSight and Desktop videoconferencing using iSight and iChatAV on Macintosh G4 or G5 computers.iChatAV on Macintosh G4 or G5 computers.

Dedicated Internet Video-Conf. Dedicated Internet Video-Conf. Equipment Practical Now in Equipment Practical Now in Many Regions. India soon!Many Regions. India soon!

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CA*net 4 Architecture: CA*net 4 Architecture: 22.5 GB/sec!

Calgary ReginaWinnipeg

OttawaMontreal

Toronto

Halifax

St. John’s

Fredericton

Charlottetown

ChicagoSeattle

New York

CANARIEOptical switches

CANARIEGigaPOPORAN DWDMCarrier DWDM

Thunder Bay

CA*net 4 node

Possible future CA*net 4 node

Quebec

Windsor

Edmonton

Saskatoon

VictoriaVancouver

Sudbury

In Jan. 20th, 2004 The Hindu In Jan. 20th, 2004 The Hindu Plans for India’s Own 2.5GB/sec Plans for India’s Own 2.5GB/sec Research Internet AnnouncedResearch Internet Announced

1.1. Will allow very high bandwidth connections Will allow very high bandwidth connections between educational institutions in India and between educational institutions in India and with other institutions connected to with other institutions connected to Internet2/Abilene around the world.Internet2/Abilene around the world.

2.2. Starting with connection between all Indian Starting with connection between all Indian Institutes of Technology and Indian Institutes Institutes of Technology and Indian Institutes of Management.of Management.

3.3. Will allow countrywide classrooms using Will allow countrywide classrooms using MHRDNet, routine videoconeferencing.MHRDNet, routine videoconeferencing.

In 2004 iSight and iChatAV on In 2004 iSight and iChatAV on Mac G4/G5 computers practical, Mac G4/G5 computers practical, easy in India and elsewhere.easy in India and elsewhere.

Comparable systems evolving Comparable systems evolving for Windows: Squidcam/iBot.for Windows: Squidcam/iBot.

QuickTime™ and aTIFF (LZW) decompressor

are needed to see this picture.

QuickTime™ and aTIFF (LZW) decompressorare needed to see this picture.

QuickTime™ and aTIFF (LZW) decompressor

are needed to see this picture.

Works by IP address rather than by AIM handle or Works by IP address rather than by AIM handle or mac.com Email address as iSight does.mac.com Email address as iSight does.

Can send images in iChatAV by Can send images in iChatAV by just dragging image icon just dragging image icon to chat window.to chat window.

iSight/IChatAV Internet Video iSight/IChatAV Internet Video Conferencing Demo - Conferencing Demo - Medical Student Cynthia Luk in Edmonton, Canada Medical Student Cynthia Luk in Edmonton, Canada discusses ISN Video Legacy Project - Living History discusses ISN Video Legacy Project - Living History Project in Nephrology - the main purpose of our Project in Nephrology - the main purpose of our travel to Chandigarh on Friday to interview Prof. travel to Chandigarh on Friday to interview Prof. Chugh.Chugh.

iSight/IChatAV Internet Video iSight/IChatAV Internet Video Conferencing Demo - Conferencing Demo - Medical Student Cynthia Luk in Edmonton, Canada Medical Student Cynthia Luk in Edmonton, Canada discusses ISN Video Legacy Project - Living History discusses ISN Video Legacy Project - Living History Project in Nephrology - the main purpose of our Project in Nephrology - the main purpose of our travel to Chandigarh on Friday to interview Prof. travel to Chandigarh on Friday to interview Prof. Chugh.Chugh.

iSight/IChatAV Internet Video iSight/IChatAV Internet Video Conferencing Demo - Conferencing Demo - Medical Student Cynthia Luk in Edmonton, Canada Medical Student Cynthia Luk in Edmonton, Canada discusses ISN Video Legacy Project - Living History discusses ISN Video Legacy Project - Living History Project in Nephrology - the main purpose of our Project in Nephrology - the main purpose of our travel to Chandigarh on Friday to interview Prof. travel to Chandigarh on Friday to interview Prof. Chugh.Chugh.

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Telepathology - The Past,Telepathology - The Past,the Futurethe Future

In the past meant mainly real time In the past meant mainly real time robotic stage connection usingrobotic stage connection usingdedicated ISDN lines, largely dedicated ISDN lines, largely impractical for developing countries.impractical for developing countries.

In the future, Internet based using In the future, Internet based using static images from inexpensive digitalstatic images from inexpensive digitalcameras, practical for developingcameras, practical for developingcountries.countries.

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The Camera to Buy Changes Daily! The Camera to Buy Changes Daily! Becoming cheaper, better.Becoming cheaper, better.

The Nikon Coolpix 990The Nikon Coolpix 990with MXB29005 adaptorwith MXB29005 adaptor

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Details - The Nikon Coolpix 990Details - The Nikon Coolpix 990

3.34 Megapixel Resolution3.34 Megapixel ResolutionHigh-Speed USB ConnectionHigh-Speed USB Connection

Today less than $500 US.Today less than $500 US.

Photographic results Photographic results indistinguishable from film!indistinguishable from film!

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Telepathology Resources on Telepathology Resources on the WWWthe WWW

http://www.afip.org/http://www.pathoindia.com/tele.htmlhttp://www.pathoindia.com/tele.htmlhttp://telepathology.upmc.edu/http://telepathology.upmc.edu/(Yukako Yagi, Director of TelePathology(Yukako Yagi, Director of TelePathologyUPMC )UPMC )

Consultation/Education/StandardizationConsultation/Education/Standardization

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Virtual Pathology SlideVirtual Pathology Slide

http://www.http://www.telepathologytelepathology..dcudcu..ieie/vps02.php3/vps02.php3 VPS Breast Needle Core Study (JMIR 2003)

http://www.medicine.http://www.medicine.uiowauiowa..eduedu/pathology//pathology/uarepuarep_histopathology/_histopathology/ Virtual slidebox of histopathologyVirtual slidebox of histopathology

http://alf3.http://alf3.urzurz..unibasunibas..chch//pathopatho/pub/2002-11./pub/2002-11.htmhtm Human Pathology Human Pathology -- Volume 34, No. 10 (October -- Volume 34, No. 10 (October 2003) -- pages 968-974 2003) -- pages 968-974 Katharina Katharina Glatz-Krieger , Dieter Glatz , Michael Glatz-Krieger , Dieter Glatz , Michael J. Mihatsch J. Mihatsch Virtual Slide: high Virtual Slide: high quality demand, physical quality demand, physical limitations and affordability.limitations and affordability.

http://vmic.unibas.chhttp://vmic.unibas.ch

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Digital Microscope - Control /access from Digital Microscope - Control /access from Web Interface anywhere in the worldWeb Interface anywhere in the world

Easier to use then Easier to use then conventional microscope.conventional microscope.

Image contains more Image contains more information than regular information than regular microscope image!microscope image!

Makes telepathology as Makes telepathology as easy as surfing the web!easy as surfing the web!

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QuickTime™ and aTIFF (LZW) decompressor

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QuickTime™ and aTIFF (LZW) decompressor

are needed to see this picture.

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Wireless Connectivity - Not Just for Wireless Connectivity - Not Just for Landlubbers Anymore!Landlubbers Anymore!

BALTIC SEA  MAKING WAVES Now travelers in the Scandinavian region (which has long been in the forefront of wireless technology) can get wi-fi while crossing the Baltic Sea. Passengers on Silja ferries running between Helsinki, Stockholm and Tallinn, Estonia, log on for free while seated near the bar.

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Wireless Connectivity - Many Wireless Connectivity - Many applications within hospital practiceapplications within hospital practice

BOSTON  DOCTORS WITHOUT BORDERSPhysicians at Beth Israel Deaconess Medical Center in Boston use wireless handhelds and laptops to submit prescriptions, r ead laboratory results and view X rays and ultrasounds. Above, an emergency -room doctor checks a PDA equipped with a plug-in wi-fi card .

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Wireless Connectivity - An important Wireless Connectivity - An important focus of national connectivity initiatives.focus of national connectivity initiatives.

KRAKOW  HIP TO BE SQUAREFor decades, visitors to Krakow's main city square have admired the historic buildings, browsed the souvenir stands and sipped coffee at the many outdoor cafés. This year, for the first time, they get to browse online for free-thanks to a nationwide effort to bring wi-fi to Poland .

Medicine of the FutureMedicine of the FutureNew Medicine - New Medicine -

Individualized MedicineIndividualized Medicine

The Microscope and the The Microscope and the Megamacroscope Megamacroscope

(The Internet and The Digital (The Internet and The Digital Age):Age):

Impact on Medicine’s future!Impact on Medicine’s future!

Kim Solez, M.D.Kim Solez, M.D.

Slide Slide 3737Visioning Broadly Defined!Visioning Broadly Defined! The Microscope. The Microscope.

When Anton Van Leeuwenhoek built the When Anton Van Leeuwenhoek built the first practical microscope in Holland in first practical microscope in Holland in 1674 it changed the horizons of human 1674 it changed the horizons of human beings forever, allowing them to see with beings forever, allowing them to see with their own eyes the structure of life itself. their own eyes the structure of life itself. Today's high science marvels - gene chip Today's high science marvels - gene chip technology,laser capture technology,laser capture microdissection, genomics, and microdissection, genomics, and proteomics - are a direct extension of proteomics - are a direct extension of Van Leeuwenhoek's original discovery.Van Leeuwenhoek's original discovery.

Slide Slide 3838Visioning Broadly Defined!Visioning Broadly Defined! The Microscope. The Microscope.

Slide Slide 3939Visioning Broadly Defined!Visioning Broadly Defined! The Microscope. The Microscope.

Anton Van Leeuwenhoek’s original Anton Van Leeuwenhoek’s original microscope had magnifications of 270 microscope had magnifications of 270 diameters and a simple screw thread diameters and a simple screw thread focus adjustmentfocus adjustment

Slide Slide 4040Visioning Broadly Defined!Visioning Broadly Defined! The Microscope. Long The Microscope. Long Life.Life. Van Leeuwenhoek lived 91 years (1632-Van Leeuwenhoek lived 91 years (1632-

1723) and during his long life he used his 1723) and during his long life he used his lenses to make pioneering studies on an lenses to make pioneering studies on an extraordinary variety of things, both extraordinary variety of things, both living and non-living, reporting his living and non-living, reporting his findings in over a hundred letters to the findings in over a hundred letters to the Royal Society of England and the French Royal Society of England and the French Academy.Academy.

Slide Slide 4141Visioning Broadly Defined! Visioning Broadly Defined! The Microscope. Long Life. The Microscope. Long Life. Knowledge.Knowledge. In 1716 at the age of 84 he wrote:In 1716 at the age of 84 he wrote:

"My work, which I've done for a long time, "My work, which I've done for a long time, was not pursued in order to gain the was not pursued in order to gain the praise I now enjoy, but chiefly from a praise I now enjoy, but chiefly from a craving after knowledge, which I notice craving after knowledge, which I notice resides in me more than in most other resides in me more than in most other men. And therewithal, whenever I found men. And therewithal, whenever I found out anything remarkable, I have thought out anything remarkable, I have thought it my duty to put down my discovery on it my duty to put down my discovery on paper, so that all ingenious people might paper, so that all ingenious people might be informed thereof."be informed thereof."

Slide Slide 4242The Internet /Digital Age: Examining The Internet /Digital Age: Examining the basic structure of information the basic structure of information itself.itself... Knowledge and information were of Knowledge and information were of

foremost importance to Van foremost importance to Van Leeuwenhoek. Today computers, the Leeuwenhoek. Today computers, the Internet, the Digital Age, allow us to Internet, the Digital Age, allow us to examine the basic structure of examine the basic structure of information itself.information itself.

Slide Slide 4343The Internet /Digital Age: Seeing Big The Internet /Digital Age: Seeing Big Things: The MegamacroscopeThings: The Megamacroscope.. Microscope means "seeing small things". Today's Microscope means "seeing small things". Today's

connected computers of the Internet allow us connected computers of the Internet allow us to see and conceptualize very big things, to see and conceptualize very big things, constructs that otherwise would be completely constructs that otherwise would be completely out of our reach. So connected computers out of our reach. So connected computers become "Megamacroscopes" and again the become "Megamacroscopes" and again the horizon has been changed very greatly. horizon has been changed very greatly. Connections between people and ideas are Connections between people and ideas are being made at an increasing rate that benefit being made at an increasing rate that benefit every area of human endeavor.every area of human endeavor.

Slide Slide 4444Capturing the imagination of Capturing the imagination of the public and health care the public and health care providers.providers. Providing a future vision of the benefits of Providing a future vision of the benefits of

technology without losing the higher technology without losing the higher elements of the human spirit. elements of the human spirit.

1.1. Data compression. Data compression. 2.2. Point of service information. Point of service information. 3.3. High impact education. High impact education. 4.4. Measuring impact of interventions on Measuring impact of interventions on

health.health.