1. The Internet and Medicine in 2004: cyberNephrology, Telepathology, Internet Videoconferencing Kim Solez, M.D. with assistance of Michele Hales

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

3. NKF cyberNephrology - Human Centered Computing Fostering nephrology’s embrace of the Internet and new technology since 1994 with Email and web resources. ISN homepage, websites which allow virtual attendance at meetings. www.cybernephrology.orgwww.cyber-medicine.org

4. Technology Evolution Need Not be Complex! Machines should serve human beings, making our lives easier. The latest technology in cell phones, the windup charger. Video Conferencing can also be simple like this.

5. Technology Evolution Need Not be Complex! Machines should serve human beings, making our lives easier. Virtual full size keyboards for cell phones and PDAs which project on any surface. Video Conferencing can also be simple like this.

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

7. Slide 7

8. Slide 8

9. Internet Now Mainstream - Searching - A Wonderful World Out There!

10. General Search Tools Beyond Pubmed! http://www.alltheweb.com/ Currently searching 3,151,743,117 web pages http://www.google.com/ Google - Searching 3,307,998,701 web pages

11. Searching Web Pages of the Past - “Wayback Machine” http://www.archive.org/ Search 11 billion pages of the Wayback Machine The Internet Archive is building a digital library of Internet sites and other cultural artifacts in digital form. Like a paper library, provides free access to researchers, historians, scholars, and the general public.

12. Searching The “Invisible Web” Database pages and pages with a ? In the URL are excluded from standard searches. Search engine databases are created by robot programs called spiders, computer robot programs that crawl the web seeking search engine content. These spiders crawl or navigate the Web by following the links in the web pages that are already in the database of their parent search engine. If there is no link to a page, a spider cannot "see" it. They lack the ability to type or think of any string of characters. They not only lack fingers for typing, but also lack a brain capable of judgment.

13. Searching The “Invisible Web” One can seach the Invisible Web using the following tools: http://lii.org/http://www.academicinfo.net/http://www.completeplanet.com/

15. Video conferencing/ Telemedicine/Telepathology The near future of medical education and practice! Internet video-conferencing affordable. There are two practical ways to establish this: 1. Dedicated videoconferencing equipment from Sony or Polycom using Internet2/Abilene “research” Internet with guaranteed bandwidth. 2. Desktop videoconferencing using iSight and iChatAV on Macintosh G4 or G5 computers.

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

17. Slide 17

18. CA*net 4 Architecture: CA*net 4 Architecture: 22.5 GB/sec! Calgary Regina Winnipeg Ottawa Montreal Toronto Halifax St. John’s Fredericton Charlottetown Chicago Seattle New York CANARIE Optical switches CANARIE GigaPOP ORAN DWDM Carrier DWDM Thunder Bay CA*net 4 node Possible future CA*net 4 node Quebec Windsor Edmonton Saskatoon Victoria Vancouver Sudbury

19. In Jan. 20th, 2004 The Hindu Plans for India’s Own 2.5GB/sec Research Internet Announced 1. Will allow very high bandwidth connections between educational institutions in India and with other institutions connected to Internet2/Abilene around the world. 2. Starting with connection between all Indian Institutes of Technology and Indian Institutes of Management. 3. Will allow countrywide classrooms using MHRDNet, routine videoconeferencing.

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

21. Comparable systems evolving for Windows: Squidcam/iBot. Works by IP address rather than by AIM handle or mac.com Email address as iSight does.

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

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

26. Slide 26 Telepathology - The Past, the Future In the past meant mainly real time robotic stage connection using dedicated ISDN lines, largely impractical for developing countries. In the future, Internet based using static images from inexpensive digital cameras, practical for developing countries. In the past meant mainly real time robotic stage connection using dedicated ISDN lines, largely impractical for developing countries. In the future, Internet based using static images from inexpensive digital cameras, practical for developing countries.

27. Slide 27 The Camera to Buy Changes Daily! Becoming cheaper, better. The Nikon Coolpix 990 with MXB29005 adaptor

28. Slide 28 Details - The Nikon Coolpix 990 3.34 Megapixel Resolution High-Speed USB Connection Today less than $500 US. Photographic results indistinguishable from film! 3.34 Megapixel Resolution High-Speed USB Connection Today less than $500 US. Photographic results indistinguishable from film!

29. Slide 29 Telepathology Resources on the WWW http://www.afip.org/ http://www.pathoindia.com/tele.htmlhttp://telepathology.upmc.edu/ (Yukako Yagi, Director of TelePathology UPMC ) Consultation/Education/Standardization http://www.afip.org/ http://www.pathoindia.com/tele.htmlhttp://telepathology.upmc.edu/ (Yukako Yagi, Director of TelePathology UPMC ) Consultation/Education/Standardization

30. Slide 30 Virtual Pathology Slide http://www.telepathology.dcu.ie/vps02. php3 http://www.telepathology.dcu.ie/vps02. php3 VPS Breast Needle Core Study (JMIR 2003) http://www.telepathology.dcu.ie/vps02. php3 http://www.telepathology.dcu.ie/vps02. php3 http://www.medicine.uiowa.edu/path ology/uarep_histopathology/ Virtual slidebox of histopathology http://www.medicine.uiowa.edu/path ology/uarep_histopathology/ Virtual slidebox of histopathology http://www.medicine.uiowa.edu/path ology/uarep_histopathology/ http://www.medicine.uiowa.edu/path ology/uarep_histopathology/ http://alf3.urz.unibas.ch/patho/pub/2 002-11.htm Human Pathology -- Volume 34, No. 10 (October 2003) -- pages 968-974 Katharina Glatz- Krieger, Dieter Glatz, Michael J. Mihatsch Virtual Slide: high quality demand, physical limitations and affordability. http://alf3.urz.unibas.ch/patho/pub/2 002-11.htm Human Pathology -- Volume 34, No. 10 (October 2003) -- pages 968-974 Katharina Glatz- Krieger, Dieter Glatz, Michael J. Mihatsch Virtual Slide: high quality demand, physical limitations and affordability. http://alf3.urz.unibas.ch/patho/pub/2 002-11.htm http://alf3.urz.unibas.ch/patho/pub/2 002-11.htm http://vmic.unibas.ch http://vmic.unibas.ch

31. Slide 31 Digital Microscope - Control /access from Web Interface anywhere in the world Easier to use then conventional microscope. Easier to use then conventional microscope. Image contains more information than regular microscope image! Image contains more information than regular microscope image! Makes telepathology as easy as surfing the web! Makes telepathology as easy as surfing the web!

32. Slide 32 Wireless Connectivity - Not Just for 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. 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.

33. Slide 33 Wireless Connectivity - Many applications within hospital practice BOSTON DOCTORS WITHOUT BORDERS Physicians 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. BOSTON DOCTORS WITHOUT BORDERS Physicians 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.

34. Slide 34 Wireless Connectivity - An important focus of national connectivity initiatives. KRAKOW HIP TO BE SQUARE For 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. KRAKOW HIP TO BE SQUARE For 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.

35. Medicine of the Future New Medicine - Individualized Medicine

36. The Microscope and the Megamacroscope (The Internet and The Digital Age): Impact on Medicine’s future! Kim Solez, M.D.

37. Slide 37 Visioning Broadly Defined! The Microscope. When Anton Van Leeuwenhoek built the first practical microscope in Holland in 1674 it changed the horizons of human beings forever, allowing them to see with their own eyes the structure of life itself. Today's high science marvels - gene chip technology,laser capture microdissection, genomics, and proteomics - are a direct extension of Van Leeuwenhoek's original discovery.

38. Slide 38 Visioning Broadly Defined! The Microscope.

39. Slide 39 Visioning Broadly Defined! The Microscope. Anton Van Leeuwenhoek’s original microscope had magnifications of 270 diameters and a simple screw thread focus adjustment

40. Slide 40 Visioning Broadly Defined! The Microscope. Long Life. Van Leeuwenhoek lived 91 years (1632-1723) and during his long life he used his lenses to make pioneering studies on an extraordinary variety of things, both living and non-living, reporting his findings in over a hundred letters to the Royal Society of England and the French Academy.

41. Slide 41 Visioning Broadly Defined! The Microscope. Long Life. Knowledge. In 1716 at the age of 84 he wrote: "My work, which I've done for a long time, was not pursued in order to gain the praise I now enjoy, but chiefly from a craving after knowledge, which I notice resides in me more than in most other men. And therewithal, whenever I found out anything remarkable, I have thought it my duty to put down my discovery on paper, so that all ingenious people might be informed thereof."

42. Slide 42 The Internet /Digital Age: Examining the basic structure of information itself.. Knowledge and information were of foremost importance to Van Leeuwenhoek. Today computers, the Internet, the Digital Age, allow us to examine the basic structure of information itself.

43. Slide 43 The Internet /Digital Age: Seeing Big Things: The Megamacroscope. Microscope means "seeing small things". Today's connected computers of the Internet allow us to see and conceptualize very big things, constructs that otherwise would be completely out of our reach. So connected computers become "Megamacroscopes" and again the horizon has been changed very greatly. Connections between people and ideas are being made at an increasing rate that benefit every area of human endeavor.

44. Slide 44 Capturing the imagination of the public and health care providers. Providing a future vision of the benefits of technology without losing the higher elements of the human spirit. 1. Data compression. 2. Point of service information. 3. High impact education. 4. Measuring impact of interventions on health.