The Lancet ~ January 31st, 2009 Volume 373 Number 9661 Pages 353 - 432
by: Elsevier

About The Lancet medical journal History
The Lancet’s prestigious heritage as one of the world’s leading medical journals continues to inspire our authors and editors today as they strive for medical excellence in all that they publish.

When Thomas Wakley founded The Lancet in 1823, he announced “A lancet can be an arched window to let in the light or it can be a sharp surgical instrument to cut out the dross and I intend to use it in both senses”. This philosophy remains at the heart of the journal today.

The Lancet first appeared on Oct 5, 1823. From the beginning, Wakley’s aim was to entertain, instruct, and reform. Instruction came in the form of transcribed medical lectures from the London teaching establishment; entertainment in the early days of the journal came in the form of theatre reviews and piquant political comment. The Lancet has been, first and foremost, a reformist medical newspaper known for its campaigns, for example, our focus on child survival in recent years. Thomas Wakley and his successors aimed to combine publication of the best medical science in the world with a zeal to counter the forces that undermine the values of medicine, be they political, social, or commercial.

The journal was, and remains, independent, without affiliation to a medical or scientific organisation. More than 180 years later, The Lancet is an independent and authoritative voice in global medicine. We seek to publish high-quality clinical trials that will alter medical practice; our commitment to international health ensures that research and analysis from all regions of the world is widely covered. Critical appraisal of research and reviews is ensured by strong Comment and Correspondence sections; The Lancet’s opinion and personality is communicated by three editorials every week; fast dissemination of priority issues is delivered by online first publication through thelancet.com; and the continued success of our monthly specialty titles ensures that The Lancet delivers in-depth knowledge in key medical disciplines Between our first online publication in 1996 and today, 1.8 million users have registered at thelancet.com.

From those few hundred copies in London in 1823, The Lancet’s global reach has extended to the point where today it delivers the latest medical news and clinical research to every country in the world.

Whether clinical specialist or student doctor, all health professionals will find something at The Lancet online medical journals of interest to them. No longer just the printed word either: audio medical content is now an increasingly popular feature of all The Lancet medical journals.

Editorial
353
Melamine and food safety in China

The Lancet

In May, 2007, when several dogs and cats had died in the USA from kidney damage after eating melamine-contaminated pet food from China, Chinese authorities promised measures to restore confidence in the safety of its food and drugs. China’s State Council added that high production standards would be imposed, corruption addressed, and baby food would be tested. The announcement coincided with the trial of Zheng Xiaoyu, former head of the State Food and Drug Administration (SFDA), who was later found guilty of corruption and executed.
354
Appointment of PEPFAR head should be merit based

The Lancet

Last week saw the sudden departure of Mark Dybul as the US Global AIDS Coordinator, in charge of the President’s Emergency Plan for AIDS Relief (PEPFAR). PEPFAR is the largest and most successful bilateral HIV/AIDS programme worldwide and considered one of President Bush’s greatest achievements. The reauthorisation of this US$50 billion initiative to support HIV/AIDS, tuberculosis, and malaria over the next 5 years makes the position of coordinator one of the most important jobs in global health.
354
Over-the-counter medicines: in whose best interests?

The Lancet

Last week, the European union (EU) approved the anti-obesity drug, orlistat, for sale over-the-counter (OTC). Going by the trade name Alli, orlistat is already available OTC in the USA and Australia. The EU decision means that this drug can now be sold by pharmacists throughout Europe to people with a body-mass index over 28 in 60 mg tablets—half the recommended daily dose—after consultation.
Comment
355
The global financial crisis: an acute threat to health

Richard Horton

As the global economy enters a sharp and severe recession, desperate financiers are turning to astrology for inspiration.1 But last week, WHO convened something rather different: a high-level consultation on the financial and economic crisis and global health. Margaret Chan, WHO’s Director-General, sought to build awareness and identify actions. Her concern is that while governments grapple with fiscal meltdown, health may be neglected. Worse, if the evidence of past recessions is anything to go by, the impact on health will be worse than we think.
356
Measles in Europe—there is room for improvement

Jacques R Kremer, Claude P Muller

In The Lancet today, the EUVAC.NET group1 have compiled measles data for 2006–07 from 32 European countries, in the context of eliminating measles in the WHO-European Region (WHO-EURO) by 2010. It seems good news that only half as many (3909) measles cases occurred in 2007 as in 2006 (8223). However, preliminary data suggest that measles incidence was about three times higher during the first half of 2008 than in the same period in 2007.2,3
358
Laparoscopic versus open pyloromyotomy

Aydin Yagmurlu

Since the initial report of laparoscopic pyloromyotomy in 1991,1 several studies have compared outcomes after open and laparoscopic operations,2–4 including two randomised trials.5,6 These studies concluded that there was no significant difference in the complication rates and that both techniques were equally safe in experienced hands. Most of these studies are models for the various situations paediatric surgeons must consider. The subtleties are often lost in the style and flamboyance of study results.
360
Societal transition and health

Martin Bobak, Michael Marmot

The fall of communism in the 1990s and the ensuing profound societal transition in central and eastern Europe and the former Soviet union is a unique social experiment. Social, economic, and political changes affected all aspects of people’s lives, which resulted in changes in mortality, morbidity, and fertility rates.1 The experiment offers a rare opportunity to investigate societal factors that drive the health of a population.
362
Mental-health stigma: expanding the focus, joining forces

Beate Schulze

Despite ample international efforts, stigma against people with mental-health problems persists. This finding is underlined by Graham Thornicroft and colleagues’ INDIGO study, in The Lancet today.1 The results reveal high rates of discrimination on a global scale and show that many mentally ill people anticipate negative reactions even in the absence of discriminatory behaviours. This landmark study encourages us not only to continue fighting stigma in a global coalition,2 but also to step up our efforts.
363
Trade agreements and health in developing countries

Joseph E Stiglitz

Politicians champion free trade for bringing an era of high and stable growth, although the evidence supporting such claims is ambiguous. Studies that associate increases in trade with increases in gross domestic product often leave open questions of causality: high growth, the result for instance of strong industrial policies, typically leads to more trade. China and India’s growth spurts preceded trade liberalisation. A study by UN Development Programme showed little relation between trade liberalisation and growth.
365
Dietary fibre: an agreed definition

JH Cummings, JI Mann, C Nishida, HH Vorster

On Nov 4, 2008, the 30th Session of the Codex Committee on Nutrition and Foods for Special Dietary Uses (CCNFSDU) met in South Africa, and agreed a definition of dietary fibre.1 Does this matter? Yes, because this Codex Committee sets global food standards and this definition will be used as the basis for measurement, food labelling, setting reference nutrient values, and health claims.
World Report
367
New hopes for US health pinned on Daschle’s nomination

Todd Zwillich

South Dakota Democrat Tom Daschle, nominated to be the next Secretary of Health and Human Services, will have his work cut out for him in reforming US health care. Todd Zwillich reports.Former US Senator Tom Daschle seemed to be sailing towards easy confirmation as the next Secretary of Health and Human Services (HHS).
368
UK doctors hail research excellence results

Emma Wilkinson

The results of the Research Assessment Exercise were welcomed by many UK universities, which were found to be punching well above their weight internationally. Emma Wilkinson reports.Much of UK academia had cause for celebration last month as they digested the outcome of the 2008 Research Assessment Exercise (RAE)—the mammoth peer-review process that decides which universities get a share of limited government funds (see panel).
Perspectives
371
Assessing the National Children’s Study

Rosalind L Smyth

Many people are uneasy about the health effects of hazards that they cannot control. The more governments seek to reassure us about the lack or risk of any environmental agent to our health, the more cynical we become. This month the European Parliament’s draft law to limit the use of pesticides provoked fierce opposition from British farmers and calls for tougher legislation from environmental groups. Controversy reigns about whether, or to what extent, these agents are hormonal modifiers, cause birth anomalies, or malignant disease.
372
A little of a lot of history

Elizabeth Leyland

There have always been good doctors and bad doctors, and patients have always favoured good doctors. With this in mind, William Bynum starts The History of Medicine: A Very Short Introduction, and explores, in five neat sections, how medical progress changes perceptions of what constitutes a good doctor. From the Hippocratic ideal of patient-centred control of symptoms, to the notion of seeking understanding of disease in a laboratory, he more or less covers the history of medicine from beginning to end.
373
Ian Gilmore: President of the Royal College of Physicians

Geoff Watts

Thus far into his presidency of the Royal College of Physicians of London, Professor Ian Gilmore seems to be enjoying the job. “It’s hard work, but also a privilege that few people get. It’s the opportunity not only to have insight into, but also to influence, the way that health care is delivered.” Gilmore became President in July, 2006, and his delight also reflects a long-standing enthusiasm for the College. “I believe it’s seen as an honest broker, as impartial, as being able to argue the case for quality of care to patients without getting sucked into trade union issues.
374
Plague and theatre in ancient Athens

Robin Mitchell-Boyask

As the Athenian historian Thucydides first pointed out in his account of the great plague of Athens during the late 5th century BCE, the social effects of epidemics can be at least as important as their biological impact. There have certainly been many plagues throughout recorded human history, but perhaps none arrived at such a pivotal moment in the affairs of a centre of western civilisation. Yet only recently have we been able to assess the true effect of the plague that first struck Athens in 430 BCE and continued intermittently for several years.
Obituary
376
Jacob Katz

Nellie Bristol

Leader in development of biomedical ethics. Born in Zwickau, Germany, on Oct 20, 1922, he died of heart failure on Nov 17, 2008, in New Haven, CT, USA, aged 86 years.
Correspondence
377
Response to medical students’ letter of solidarity with Gaza

Rebecca Braunstein, David Faleck, David Stern, on behalf of 805 medical students, 503 doctors, 236 health professionals , 275 other concerned individuals

In a Correspondence letter (published online Jan 12),1 medical students in Boston, MA, USA implicate Israel in perpetrating a “disproportionate assault” that underlies the humanitarian disaster in Gaza. Although these doubtlessly well intended individuals seek the moral high ground in calling for “an immediate cessation of hostilities”, they unfortunately ignore the realities of the situation. As fellow medical students, we would be remiss if we did not attempt to provide a clearer picture of the reality in Gaza and address some of the troubling points of our colleagues.
378
N-3 polyunsaturated fatty acids and statins in heart failure

George Davey Smith, Marie-Jo Brion, Jonathan AC Sterne

The cover of The Lancet Oct 4 issue confidently declares that “Supplementation with N-3 polyunsaturated fatty acids should join the short list of evidence-based life-prolonging therapies for heart failure”. However, the GISSI-HF trial, on which this statement is based (p 1223),1 does not support such a strong conclusion.
378
N-3 polyunsaturated fatty acids and statins in heart failure

Lorna M Gibson

The GISSI-HF investigators provide evidence that n-3 polyunsaturated fatty acid (PUFA) supplements are safe in patients with heart failure,1 but their conclusions about the supplements’ benefits on survival and admission to hospital might be limited because the trial could be confounded by dietary n-3 PUFA intake.
378
N-3 polyunsaturated fatty acids and statins in heart failure

Heinz Rupp, Thomas P Rupp, Peter Alter, Bernhard Maisch

In the GISSI-HF study,1 there were fewer first hospital admissions for ventricular arrhythmia in patients treated with n-3 polyunsaturated fatty acids (PUFA) than in the placebo group. A major risk underlying arrhythmias is cardiac dilatation. Dilatation was the cause of heart failure in 30·1% of patients taking n-3 PUFA versus 27·9% of those on placebo.
379
N-3 polyunsaturated fatty acids and statins in heart failure

Amitabh Parashar

The results of the GISSI-HF study1 are noteworthy indeed. However, although the presence of diabetes was similar in the two groups, the degree of glycaemic control and the medications used for diabetes management were not reported.
379
N-3 polyunsaturated fatty acids and statins in heart failure

Christopher Florkowski, Sarah Molyneux, Peter George, Michael Lever, Mark Richards

In the GISSI-HF trial (Oct 4, p 1231),1 rosuvastatin failed to show a reduction in clinical outcomes in patients with chronic heart failure of any cause. One explanatory factor might be a reduction in the concentration of coenzyme Q10 or ubiquinone, which is known to be caused by statins.
380
N-3 polyunsaturated fatty acids and statins in heart failure

Vincenzo Solfrizzi, Cristiano Capurso, Gianluigi Vendemiale, Antonio Capurso, Francesco Panza

The GISSI-HF trial1 found that rosuvastatin had no effect on clinical outcomes in patients with heart failure. Similar results were seen in the CORONA trial.2 These two studies differed in some aspects of the populations enrolled (proportion with ischaemic heart failure, age, and class of heart failure symptoms), and in primary and secondary outcomes, but both trials tested rosuvastatin at 10 mg per day, and sample size, follow-up period, and mean overall reduction in the primary outcome (about 15%) were very similar.
380
N-3 polyunsaturated fatty acids and statins in heart failure – Authors’ reply

Luigi Tavazzi, Gianni Tognoni, on behalf of the GISSI-HF Steering Committee

George Davey Smith and coauthors feel that we overstated the results of the n-3 PUFA study by highlighting the results of the adjusted analysis. Actually, they conclude that the trial showed a “modest estimated effect of fish oil”, lower than those expected according to the published protocol. We share this conclusion and this is what we wrote in the paper.
381
Sure Start in England

Jay Belsky, Alastair Leyland, Jacqueline Barnes, Edward Melhuish

In her Comment (Nov 8, p 1610)1 on our second phase of evaluation of Sure Start local programmes in England,2 Penny Kane makes several points with which we could not agree more. Like her, we would have much preferred to see a randomised controlled trial done, since this would have afforded much stronger causal inferences than the quasi-experimental investigation we undertook. We also agree that the fact that we drew on data collected by two different research teams raises questions about the confidence that can be placed in conclusions drawn.
381
Sure Start in England

Anna Eleri Livingstone

The UK’s system of general practice, based on the long-term registered population, is one of the most popular, successful, and efficient ways of delivering primary health care. It allows for continuity of care, a multidisciplinary approach, and a systematic integration of individual and family acute health care with risk management, preventive interventions, and care of long-term disorders. How tragic that the potential of this horizontal approach, so often shown to be successful, has been ignored by the vertical approach in relation to health care embodied in children’s centres and the Sure Start programme.
382
Clinical use of exhaled nitric oxide measurements

D Robin Taylor, Andrew Bush

Stanley Szefler and colleagues’ conclusion that measurement of exhaled nitric oxide (FENO) does not improve asthma outcomes compared with standard care (Sept 20, p 1065)1 could dissuade clinicians from using FENO. However, the study population and FENO management protocol substantially affected the conclusions.
382
Clinical use of exhaled nitric oxide measurements – Authors’ reply

Articles
383
Measles in Europe: an epidemiological assessment

Mark Muscat, Henrik Bang, Jan Wohlfahrt, Steffen Glismann, Kåre Mølbak, for the EUVAC.NET group

The suboptimum vaccination coverage raises serious doubts that the goal of elimination by 2010 can be attained. Achievement and maintenance of optimum vaccination coverage and improved surveillance are the cornerstones of the measles elimination plan for Europe.
390
Recovery after open versus laparoscopic pyloromyotomy for pyloric stenosis: a double-blind multicentre randomised controlled trial

Nigel J Hall, Maurizio Pacilli, Simon Eaton, Kim Reblock, Barbara A Gaines, Aimee Pastor, Jacob C Langer, Antti I Koivusalo, Mikko P Pakarinen, Lutz Stroedter, Stefan Beyerlein, Munther Haddad, Simon Clarke, Henri Ford, Agostino Pierro

Both open and laparoscopic pyloromyotomy are safe procedures for the management of pyloric stenosis. However, laparoscopy has advantages over open pyloromyotomy, and we recommend its use in centres with suitable laparoscopic experience.
399
Mass privatisation and the post-communist mortality crisis: a cross-national analysis

David Stuckler, Lawrence King, Martin McKee

Rapid mass privatisation as an economic transition strategy was a crucial determinant of differences in adult mortality trends in post-communist countries; the effect of privatisation was reduced if social capital was high. These findings might be relevant to other countries in which similar policies are being considered.
408
Global pattern of experienced and anticipated discrimination against people with schizophrenia: a cross-sectional survey

Graham Thornicroft, Elaine Brohan, Diana Rose, Norman Sartorius, Morven Leese, for the INDIGO Study Group

Rates of both anticipated and experienced discrimination are consistently high across countries among people with mental illness. Measures such as disability discrimination laws might, therefore, not be effective without interventions to improve self-esteem of people with mental illness.
Series
416
Bridging the divide: global governance of trade and health

Kelley Lee, Devi Sridhar, Mayur Patel

The main institutions responsible for governing international trade and health—the World Trade Organization (WTO), which replaced the General Agreement on Tariffs and Trade (GATT) in 1995, and WHO—were established after World War 2. For many decades the two institutions operated in isolation, with little cooperation between them. The growth and expansion of world trade over the past half century amid economic globalisation, and the increased importance of health issues to the functioning of a more interconnected world, brings the two domains closer together on a broad range of issues.
Department of Ethics
423
Principles for allocation of scarce medical interventions

Govind Persad, Alan Wertheimer, Ezekiel J Emanuel

Allocation of very scarce medical interventions such as organs and vaccines is a persistent ethical challenge. We evaluate eight simple allocation principles that can be classified into four categories: treating people equally, favouring the worst-off, maximising total benefits, and promoting and rewarding social usefulness. No single principle is sufficient to incorporate all morally relevant considerations and therefore individual principles must be combined into multiprinciple allocation systems.
Case Report
432
A fisherman who could not row

Abhijit Das, Ajith Cherian, Thomas Chemmanam

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Operative Techniques in Otolaryngology - Head and Neck Surgery, Volume 19, Issue 3, Pages 161-228 (September 2008), Endoscopic Orbital and Lacrimal Surgery
by: Raj Sindwani, MD, FACS, FRCS

Product Details
pages: Pages 161-228 (September 2008)
Publisher: Copyright © 2008 Elsevier Inc. All rights reserved
ISBN: ISSN (printed): 1043-1810
Format: PDF with 3 level Chapter Bookmarks
Size: 10.3 MB RARed to 9.9 MB
Supplier:
Summary:
ABOUT OPERATIVE TECHNIQUES IN OTOLARYNGOLOGY - HEAD AND NECK SURGERY
—————————————————————————————————–
This large-size, atlas-format journal presents detailed illustrations of new surgical procedures and techniques in otology, rhinology, laryngology, reconstructive head and neck surgery, and facial plastic surgery. Feature articles in each issue are related to a central theme by anatomic area or disease process. The journal will also often contain articles on complications, diagnosis, treatment or rehabilitation. New techniques that are non-operative are also featured.

Introduction

During the past decade, the field of otolaryngology has experienced an endoscopic revolution. Improved facility with endoscopes, empowered by technological advances in surgical navigation and operative equipment, has extended our ability to endoscopically manage disorders affecting structures beyond the paranasal sinuses. The pursuit of minimally invasive but equally efficacious surgery has fueled the development of innovative endoscopic approaches to the orbit and lacrimal apparatus. Endoscopic orbital techniques
can be used to exploit key anatomic relationships, the most notable being that the sinonasal tract and orbit are separated by very thin bone. Many of these approaches are routinely performed in tandem by an otolaryngologist and an ophthalmologist.
Successful outcomes from this type of surgery require an intimate understanding of the anatomy and physiology of structures on both sides of the lamina papyracea. Many of these approaches are not difficult to do, but they may be difficult to get to do—as a result of political barriers
that may be at play between specialties.
The goal of the following series of articles is to reinforce fundamental concepts and techniques useful for endoscopic surgery of the orbit. Technical nuances of well-established procedures such as endoscopic dacryocystorhinostomy, subperiosteal abscess drainage, and orbital decompression will be highlighted, whereas early experience with novel techniques, including endoscopic extraocular muscle surgery, orbital
exenteration, and anterior ethmoidal artery ligation, will also be presented. It should be mentioned that the safety and utility of some of the more recently described procedures, although innovative and forward–thinking, have yet to be validated through extensive clinical experience and scientific scrutiny. Nevertheless, I am certain that the reader will be surprised and hopefully inspired by what some of our well-trained and experienced colleagues are able to accomplish with the endoscope.

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Operative Techniques in Otolaryngology - Head and Neck Surgery, Volume 19, Issue 2, Pages 79-160 (June 2008), Management of Facial Trauma
by: D. Gregory Farwell, MD, FACS

Product Details
pages: Pages 79-160 (June 2008)
Publisher: Copyright © 2008 Elsevier Inc. All rights reserved
ISBN: ISSN (printed): 1043-1810
Format: PDF with 3 level Chapter Bookmarks
Size: 22.7 MB RARed to 22.3 MB
Supplier:
Summary:
ABOUT OPERATIVE TECHNIQUES IN OTOLARYNGOLOGY - HEAD AND NECK SURGERY
————————————————————————–
This large-size, atlas-format journal presents detailed illustrations of new surgical procedures and techniques in otology, rhinology, laryngology, reconstructive head and neck surgery, and facial plastic surgery. Feature articles in each issue are related to a central theme by anatomic area or disease process. The journal will also often contain articles on complications, diagnosis, treatment or rehabilitation. New techniques that are non-operative are also featured.

Introduction

The management of facial trauma continues to evolve with the development of improved techniques, surgical instrumentation, and implants. From the days of wiring the jaws and closed reduction to precise open reduction and internal fixation, the otolaryngologist-head and neck surgeon has played a critical role in the treatment of patients with facial trauma.
This edition brings together many of the leaders in the fields of facial trauma, reconstructive surgery, and cosmetic surgery to summarize the state of the art approach to many different aspects of traumatic injuries of the craniofacial region. It is my belief that the information provided here will provide the reader with a broad overview of the proper workup of the patient, the surgical goals, and techniques that will optimize patient outcomes.
I would like to extend my gratitude to the authors of these articles for their hard work and contributions to this volume. It is my belief that the quality of the information in these articles will make this a very useful reference edition for Otolaryngologists for many years to come.

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Biomedical Engineering Fundamentals
by: Joseph D. Bronzino

Biomedical Engineering Fundamentals (The Electrical Engineering Handbook)
By Joseph D. Bronzino

Publisher: CRC
Number Of Pages: 1560
Publication Date: 2006-04-14
ISBN-10 / ASIN: 0849321212
ISBN-13 / EAN: 9780849321214

Product Description:

Over the last century,medicine has come out of the “black bag” and emerged as one of the most dynamic and advanced fields of development in science and technology. Today, biomedical engineering plays a critical role in patient diagnosis, care, and rehabilitation. As such, the field encompasses a wide range of disciplines, from biology and physiology to informatics and signal processing. Reflecting the enormous growth and change in biomedical engineering during the infancy of the 21st century, The Biomedical Engineering Handbook enters its third edition as a set of three carefully focused and conveniently organized books.

The first installment, Biomedical Engineering Fundamentals provides a concise survey of the major areas that constitute modern biomedical engineering. Beginning with an overview of physiology and physiological modeling, simulation, and control, the book explores bioelectric phenomena, biomaterials, biomechanics, rehabilitation and human performance engineering, and ethical issues. Preeminent experts from around the world share their expertise with many new and updated chapters representing state-of-the-art technologies and practices. A new section on neuroengineering rounds out the coverage.

With sharp focus and authoritative coverage, Biomedical Engineering Fundamentals is an ideal introduction for anyone new to the field, a convenient reference for seasoned professionals, and a valuable introductory textbook.

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The Lancet ~ Jan 24, 2009 Volume 373 Number 9660 Pages 271 - 352
by: Elsevier

About The Lancet medical journal History
The Lancet’s prestigious heritage as one of the world’s leading medical journals continues to inspire our authors and editors today as they strive for medical excellence in all that they publish.

When Thomas Wakley founded The Lancet in 1823, he announced “A lancet can be an arched window to let in the light or it can be a sharp surgical instrument to cut out the dross and I intend to use it in both senses”. This philosophy remains at the heart of the journal today.

The Lancet first appeared on Oct 5, 1823. From the beginning, Wakley’s aim was to entertain, instruct, and reform. Instruction came in the form of transcribed medical lectures from the London teaching establishment; entertainment in the early days of the journal came in the form of theatre reviews and piquant political comment. The Lancet has been, first and foremost, a reformist medical newspaper known for its campaigns, for example, our focus on child survival in recent years. Thomas Wakley and his successors aimed to combine publication of the best medical science in the world with a zeal to counter the forces that undermine the values of medicine, be they political, social, or commercial.

The journal was, and remains, independent, without affiliation to a medical or scientific organisation. More than 180 years later, The Lancet is an independent and authoritative voice in global medicine. We seek to publish high-quality clinical trials that will alter medical practice; our commitment to international health ensures that research and analysis from all regions of the world is widely covered. Critical appraisal of research and reviews is ensured by strong Comment and Correspondence sections; The Lancet’s opinion and personality is communicated by three editorials every week; fast dissemination of priority issues is delivered by online first publication through thelancet.com; and the continued success of our monthly specialty titles ensures that The Lancet delivers in-depth knowledge in key medical disciplines Between our first online publication in 1996 and today, 1.8 million users have registered at thelancet.com.

From those few hundred copies in London in 1823, The Lancet’s global reach has extended to the point where today it delivers the latest medical news and clinical research to every country in the world.

Whether clinical specialist or student doctor, all health professionals will find something at The Lancet online medical journals of interest to them. No longer just the printed word either: audio medical content is now an increasingly popular feature of all The Lancet medical journals.

Editorial
271
A dismal year for human rights abuses

The Lancet

The global community still has much work to do in the field of human rights. Such rights stretch from: the right to life and the rights to health, water, and food; to prohibition against torture and inhumane or degrading treatment or punishment; and to crimes against humanity. All these factors are of concern to health professionals, who have to deal with the consequences.
272
Investment in health systems—a priority for health and wealth

The Lancet

The interdependence of health systems, health, and wealth was recognised and accepted by European health ministers at a WHO conference in Tallinn, Estonia, in June, 2008. By signing the Tallinn Charter, health ministers from the 53 nations of WHO’s European region committed their countries to strengthen health systems because they accepted the principle that such investment improves health, boosts economic development in its own right, and leads to social wellbeing. A Viewpoint by Martin McKee and colleagues in this week’s issue discusses the research background to the triangular relationship between health systems, health, and wealth, and outlines the basis for the Charter in more detail.
272
A NICE adaptation

The Lancet

Last week, the UK’s National Institute for Health and Clinical Excellence (NICE) reconsidered its advice on four drugs for renal cell carcinoma, which it last year deemed not cost effective for the National Health Service (NHS). NICE’s decision will be made public in March but many experts expect that the drugs will now be approved because they meet new criteria set by the Institute.
Comment
273
Trade and health: time for the health sector to get involved

Rhona MacDonald, Richard Horton

There is no denying that trade is a political issue. It is perhaps for this reason, and because many health professionals perceive trade as a complex, unrelated, or remote factor in their practice and busy working lives, that the health sector has traditionally avoided getting involved in trade debates. But the fact that trade directly and indirectly affects the health of the global population with an unrivalled reach and depth undoubtedly makes it a key health issue that the global-health community can no longer ignore.
274
Radiotherapy in locally advanced prostate cancer

Alex Tan, Chris Parker

Long-term hormonal therapy has long been regarded as the mainstay of treatment for men with locally advanced prostate cancer.1,2 Four key randomised controlled trials3–6 have shown that early use of hormonal therapy leads to improved overall survival. There has been no consensus about whether or not radical local treatment should be used in addition to hormonal therapy,7,8 and SPCG-7/SFUO-3, reported in The Lancet today,9 is the first randomised trial to address this issue.
276
Clopidogrel in acute coronary syndrome: to genotype or not?

Robert F Storey

ADP has an important role in platelet activation.1 The molecule can be released by damaged cells but a major source is platelet dense granules, from which it is released on platelet activation.2 ADP initiates platelet activation via the P2Y1 receptor, while binding of ADP to the P2Y12 receptor amplifies this response such that sustained ADP-induced platelet aggregation depends on continuing activation of the P2Y12 receptor. P2Y12 also has an important role in amplifying the responses to other agonists—ADP is released from platelet dense granules regardless of the activating stimulus, be that thrombin, collagen, thromboxane A2, or other agonists.
278
Intimate-partner violence and fetal loss

Claudia Garcia-Moreno

Violence against women by their male intimate partners is an important public-health problem worldwide. Such violence is associated with a wide range of negative physical and mental-health outcomes among women, including injuries, unwanted pregnancies, and other sexual and reproductive health problems.1 The violence often continues—and at times starts—during pregnancy, and is negatively associated with maternal and fetal health outcomes, including low birthweight,2 preterm labour,3 smaller gestational weight-gain,4 and reduced levels of breastfeeding.
280
Safeguarding children: a call to action

Albert Aynsley-Green, David Hall

Since Kempe’s description, almost 50 years ago, of the “battered baby”, we have become all too familiar with sexual and emotional abuse of children, neglect, fabricated illness, bullying, and exposure to domestic violence. In many countries the catalogue of abuse and exploitation also includes female genital mutilation, child trafficking and prostitution, sweatshop labour, and coercive enrolment into military service. The Lancet’s Series on child maltreatment describes the progress that has been made in recognising maltreatment and its effects in the short and long term, and in evaluating interventions once abuse has occurred.
281
Reforming China’s health care: for the people, by the people?

Yuanli Liu

On Oct 14, 2008, the Chinese Government published a draft of its Healthcare Reform Plan, to solicit comments from the public.1 Inviting people to participate in the development of public policies is unprecedented in China. The invitation reveals signs of how far the world’s largest developing country has gone and where it might be going, and indicates open-mindedness in the current leadership or at least shows that they want to be perceived as being good listeners.
283
Paper of the year 2008: results

William Summerskill

On Dec 19, The Lancet1 posted the papers of the six finalists for paper of the year 2008 on our website and published Profiles from each research team.2–7 After 25 days of voting, during which 21 556 votes (each from a unique IP address) were cast, three papers have proved clear favourites with readers (panel). Among these, the editors’ choice was Werner Hacke and colleagues’ study of alteplase for ischaemic stroke8 and the people’s choice was the PEACE study of carbocisteine in chronic obstructive pulmonary disease (COPD) by Nan-Shan Zhong and associates.
World Report
285
South Africa heads into elections in a sorry state of health

Clare Kapp

South Africa’s ruling African National Congress has singled out health as one of the top five priorities for the next government. With good reason. Clare Kapp reports from Cape Town.President-in-waiting Jacob Zuma addressed 60 000 adoring supporters at the launch of the African National Congress’ (ANC) election manifesto on Jan 10, vaunting the social progress that has been made since the party came to power. He said that 88% of the population had access to running water, up from 62% in 1996; 12·5 million received social grants, up from 3 million; free primary health care was expanded, 1600 more clinics were built, and more than half the 400 public hospitals were refurbished.
287
Old problems still mar fight against ancient disease

Talha Burki

On the eve of World Leprosy Day, Talha Burki, reviews progress in the global fight against the disease, and finds that far from nearing eradication, much remains to be done to control leprosy.Jan 25 marks World Leprosy Day—an event that aims to publicise an ancient disease that still affects thousands of people worldwide.
Perspectives
289
The wonders of Romantic science

Steven Rose

Richard Holmes is best known for his biographies of the Romantic poets of the late 18th and early 19th centuries, notably Samuel Taylor Coleridge and Percy Bysshe Shelley. In The Age of Wonder he turns his attention to a group of men (and one woman) whom to 21st-century eyes would seem initially very far removed from these poets: explorers, adventurers, and scientists—although the latter word had not yet been invented. But as his account proceeds, the affinities between this seemingly disparate group and the poets becomes clearer.
290
The asbestos industry

Barry Castleman

Last year as chrysophiles and chrysophobes prepared to do battle once more over UN plans to restrict the worldwide asbestos trade, Defending the Indefensible put the ruthless tactics of global asbestos industry into a historical context. By chronicling the evolution of knowledge about, and the corporate response to, asbestos, Jock McCulloch and Geoffrey Tweedale explain the inexplicable: why most of the world’s people live in countries where asbestos products are still used.
291
Barbara Hogan: South Africa’s Minister of Health

Clare Kapp

Rarely has a South African Cabinet reshuffle been greeted with such enthusiasm and expectation as the appointment last September of Barbara Hogan to Minister of Health, when she took over from her discredited predecessor Manto Tshabalala-Msimang. Hogan has faced a baptism of fire, having to confront the spread of cholera from Zimbabwe over the South African border, which has added to the already daunting challenges facing the country’s health system. Many think she has passed the 100-day test with flying colours.
292
Caregiving: the odyssey of becoming more human

Arthur Kleinman

“Let the more loving one be me.”W H Auden, The More Loving OneI lead her across the living room, holding her hand behind my back, so that I can navigate the two of us between chairs, sofas, end tables, over Persian rugs, through the passageway and into the kitchen. I help her find and carefully place herself in a chair, one of four at the oval-shaped oak table. She turns the wrong way, forcing the chair outward; I push her legs around and in, under the table’s edge. The sun streams through the bank of windows.
Obituary
294
Raymond Adams

Alison Snyder

Leading neuropathologist. Born on Feb 13, 1911, in Portland, OR, USA, he died from complications of congestive heart failure on Oct 18, 2008, in Boston, MA, USA, aged 97 years.
Correspondence
295
In solidarity with Gaza

Rami Abdou, Iyah Romm, Davida Schiff, Kirsten Austad, Sam Dubal, Simeon Kimmel, Eugene Schiff, on behalf of 753 other medical students

With sadness and urgency we, medical students, express our outrage at the brutal Israeli attacks and subsequent humanitarian disaster that is occurring in Gaza. As we write, more than 600 Palestinians have been killed and more than 2700 wounded in Israel’s disproportionate assault that began on Dec 27, 2008. Not just as medical students, but as Christians, Jews, and Muslims; as Arabs, Americans, Israelis, and Palestinians, we write in solidarity with the people of Gaza as they suffer yet another major humanitarian disaster.
295
Health and human rights in the Palestinian West Bank and Gaza

David Worth, Su Metcalfe, John Boyd, Adrian Worrall, Paola Canarutto

Palestine is split geographically into the West Bank and the Gaza strip. Gaza is the most densely populated area on earth: after first being crippled by blockade of its borders since 2007, Gaza is currently being bombed by the Israeli armed forces.1
296
Neglected tropical diseases and the Global Fund

David H Molyneux, Peter J Hotez, Alan Fenwick, Robert D Newman, Brian Greenwood, Jeffrey Sachs

There is a recognised need to scale up malaria interventions rapidly if the international community is to meet the targets established in the Global Malaria Plan,1 which include improved access to artemisinin-based combination therapy, intermittent preventive treatment for pregnant women, and universal coverage with long-lasting insecticidal bednets.
297
Alma-Ata addresses cultural, economic, and political issues too

David G Legge, Wim DeCeukelaire, Fran E Baum, David McCoy, David Sanders

The Lancet Series on the renaissance of primary health care (Sept 13, 2008) is welcome. However, from our perspective, it has significant weaknesses and omissions.The call for a New International Economic Order, prominent in the Declaration of Alma-Ata but omitted from the abbreviated version provided by Joy Lawn and colleagues,1 highlighted the effect of an unfair global economic regime on health. This relation is also clearly articulated in the report of the WHO Commission on Social Determinants of Health.
298
Bias in WHO report on the social determinants of health

Philip Stevens

In your Nov 8 Editorial (Nov 8, p 1607),1 you endorse the recommendations of WHO’s Commission on Social Determinants of Health, thereby adding to the consensus that the report is a vital contribution to future health policy.
298
Governments, civil society, and social determinants of health

Wim De Ceukelaire, Pol De Vos

In The Lancet’s special issue on social determinants of health, Erik Blas and colleagues (Nov 8, p 1684)1 conclude that governments and civil society can have important positive roles in addressing health inequity if political will exists.
299
Health-care equity—for all generations?

Aishling Murray, Desmond O’Neill

The report of the Commission on Social Determinants of Health (Nov 8, p 1661)1 represents a formidable achievement. However, in a world where most older people live in the developing world, the prominent emphasis given to factors linked to inequity including gender, education, occupation, income, ethnicity, and place of residence, seems to miss out on the pervasive nature of ageism. Where later life figures in the full report, it is largely related to social protection issues such as pensions, but not to other forms of ageism which restrict access to a wide range of services including health care.
299
Green space, psychological restoration, and telomere length

Jean Woo, Nelson Tang, Eddie Suen, Jason Leung, Moses Wong

In his Comment (Nov 8, p 1614),1 Terry Hartig explores the health-promoting properties of exposure to the natural environment, independent of socioeconomic factors. He points out that determining whether the effect is mediated through psychological restoration or increased physical activity could be difficult, in view of the paucity of data on psychological restoration compared with that for physical activity. We believe that our data on geographical variation in telomere length could contribute to answering this question.
300
2009: a crucial year for progress on the health workforce crisis

Sigrun Møgedal, Mubashar Sheikh
Articles
301
Endocrine treatment, with or without radiotherapy, in locally advanced prostate cancer (SPCG-7/SFUO-3): an open randomised phase III trial

Anders Widmark, Olbjørn Klepp, Arne Solberg, Jan-Erik Damber, Anders Angelsen, Per Fransson, Jo-Åsmund Lund, Ilker Tasdemir, Morten Hoyer, Fredrik Wiklund, Sophie D Fosså, for the Scandinavian Prostate Cancer Group Study 7 , the Swedish Association for Urological Oncology 3

In patients with locally advanced or high-risk local prostate cancer, addition of local radiotherapy to endocrine treatment halved the 10-year prostate-cancer-specific mortality, and substantially decreased overall mortality with fully acceptable risk of side-effects compared with endocrine treatment alone. In the light of these data, endocrine treatment plus radiotherapy should be the new standard.
309
Cytochrome P450 2C19 polymorphism in young patients treated with clopidogrel after myocardial infarction: a cohort study

Jean-Philippe Collet, Jean-Sébastien Hulot, Anna Pena, Eric Villard, Jean-Baptiste Esteve, Johanne Silvain, Laurent Payot, Delphine Brugier, Guillaume Cayla, Farzin Beygui, Gilbert Bensimon, Christian Funck-Brentano, Gilles Montalescot

The CYP2C19*2 genetic variant is a major determinant of prognosis in young patients who are receiving clopidogrel treatment after myocardial infarction.
318
Spousal violence and potentially preventable single and recurrent spontaneous fetal loss in an African setting: cross-sectional study

Amina P Alio, Philip N Nana, Hamisu M Salihu

Spousal violence increases the likelihood of single and repeated fetal loss. A large proportion of risk for recurrent fetal mortality is attributable to spousal violence and, therefore, is potentially preventable. Our findings support the idea of routine prenatal screening for spousal violence in the African setting, a region with the highest rate of fetal death in the world.
Series
325
Managing the pursuit of health and wealth: the key challenges

David P Fidler, Nick Drager, Kelley Lee

This article forms part of a six-part Series on trade and health, and sets the stage for this Series by analysing key aspects of the relationship between trade and health. The Series takes stock of this relation and provides timely analysis of the key challenges facing efforts to achieve an appropriate balance between trade and health across a diverse range of issues. This introductory article reviews how trade and health have risen and expanded on global policy agendas in the past decade in unprecedented ways, describes how trade and health issues are respectively governed in international relations, examines the ongoing search for policy coherence between the two policy spheres, and highlights the topics of the remaining articles in the Series.
332
Promotion of children’s rights and prevention of child maltreatment

Richard Reading, Susan Bissell, Jeffrey Goldhagen, Judith Harwin, Judith Masson, Sian Moynihan, Nigel Parton, Marta Santos Pais, June Thoburn, Elspeth Webb

In medical literature, child maltreatment is considered as a public-health problem or an issue of harm to individuals, but less frequently as a violation of children’s human rights. Public-health approaches emphasise monitoring, prevention, cost-effectiveness, and population strategies; protective approaches concentrate on the legal and professional response to cases of maltreatment. Both approaches have been associated with improvement in outcomes for children, yet maltreatment remains a major global problem.
Viewpoint
344
Medical ethics and torture: revising the Declaration of Tokyo

Steven H Miles, Alfred M Freedman

Because of the duty to promote and protect prisoners’ wellbeing, physicians who work in prisons should monitor human rights during their medical work.1,2 They can discern signs of abuse even when they have not witnessed the abuse. Also, they can see prisoners who have been concealed from customary monitors, such as delegates of the International Committee of the Red Cross. Furthermore, they belong to national and international communities that include advocates for humane prison health care and for stopping torture.
349
Health systems, health, and wealth: a European perspective

Martin McKee, Marc Suhrcke, Ellen Nolte, Suszy Lessof, Josep Figueras, Antonio Duran, Nata Menabde

Countries from WHO’s European region met in Tallinn, Estonia in June, 2008, to discuss a new way of thinking about health systems. For the past three decades, much of the debate on health care in Europe has been dominated by cost containment. Informed by detailed background analyses,1,2 a 2 year consultation process began by asking “what is a health system actually for?” The answer depends on who is asking the question. For some, a health system is a means of redistributing society’s resources—from healthy to sick and from rich to poor.
Case Report
352
Amnesia, political ambition, and canned tuna

Roger CM Ho, Stanley YW Lam, Evangeline SL Tan, Pamela MY Ng, Anselm Mak

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Crime Scene to Court: The Essentials of Forensic Science
by: Peter C. White

Crime Scene to Court: The Essentials of Forensic Science
By Peter C. White

Publisher: Royal Society of Chemistry
Number Of Pages: 470
Publication Date: 2004-08-18
ISBN-10 / ASIN: 0854046569
ISBN-13 / EAN: 9780854046560

Product Description:

Forensic science has been variously described as fascinating, challenging and even frightening. If you have only a vague concept of what forensic science is, this book will provide the answer. Aimed at non-scientists, or those with limited scientific knowledge, Crime Scene to Court covers all three main areas of an investigation where forensic science is practised, namely the scene of the crime, the forensic laboratory and the court.

Coverage includes details of how crime scene and forensic examinations are conducted in the United Kingdom, the principles of crime scene investigations and the importance of this work in an investigation, and courtroom procedures and the role of the expert witness. The latest methods and techniques used in crime scene investigation and forensic laboratories are reported, cases are presented to illustrate why and how examinations are performed to generate forensic evidence and there is a bibliography for each chapter which provides further material for those readers wishing to delve deeper into the subject. This revised and updated edition also includes coverage on changes in professional requirements, the latest developments in DNA testing and two new chapters on computer based crimes and Blood Pattern Analysis.

Ideal for those studying forensic science or law, the book is intended primarily for teaching and training purposes. However, anyone with a role in an investigation, for example police, crime scene investigators or indeed those called for jury service, will find this text an excellent source of information.

Summary: Great Introductory Text to Forensic Science in the United Kingdom.
Rating: 4

Crime Scene to Court provides good information covering most aspects of forensic science in the United Kingdom. Some areas require the reader to do further reasearch or investigation into specifics but on the whole this text presents a well rounded and essential guide to forensic science. It is a great introductory text to the field and invaluable resource for beginner level studies. The language is easy to understand and any technical jargon and scientific techniques are explained in a simple, straightforward manner.

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British Journal Of Ophthalmology: Volume 93, Number 1, January 2009
by: Harminder S. Dua (UK), Arun D. Singh (USA)

British Journal Of Ophthalmology: Volume 93, Number 1, January 2009
By Harminder S. Dua (UK), Arun D. Singh (USA)

* Publisher: BMJ Publishing Group Ltd
* Number Of Pages: 150
* Publication Date: 2009-01-01
* Language: English
* ISSN: 0007-1161
* Binding: Paperback

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MobiHealthInf 2009 ~ The First International Workshop on Mobilizing Health Information to Support Healthcare-related Knowledge Work, 16th January, 2009 - Porto, Portugal
by: INSTICC Press

125 Pages

Scope
International workshop on Mobilizing health information to support healthcare-related knowledge work – MobiHealthInf 2009 aims to created bridges between diverse technical areas of mobile and wireless computing, software and hardware (like sensors) advancement, electronic health record developments and those areas related to IS more broadly like IS implementation studies management of IS, Computer-supported collaborative working (CSCW) and Knowledge management/work over a common idea, that of mobilizing health information to improve healthcare provision. The idea is to study each individual contribution paper (more than one is acceptable in any topic) collectively trying to identify how it relates with moving from “classic” clinical information systems to clinical knowledge work tools.

While much research in health informatics has focused on desktop-based infrastructures, the advent of wireless and mobile computing poses new challenges to those in health organizations wishing to get the best out of these new technologies. One of the challenges is on how to integrate Mobile Information and Communication technology (MICT) into existing Clinical/Hospital information systems. Another is how to integrate novelties from areas of sensors, remote monitoring, as well as data-mining and data-sharing capabilities into coherent and novel health information systems. By choosing to focus on information/knowledge use/sharing – thus mobilizing of health information - rather then just the technological solutions or the organizational/managerial issues only this workshop will serve as a arena of discussion for socio-technical enhancements of health information systems that are better capable of supporting the critical knowledge work functions in healthcare.

For its first edition this workshop received 13 paper submissions of
which 12 were accepted and will be presented in three cluster themes:
- Smart software to move information from silos to systems;
- From local information to global use;
- Remote monitoring: bringing patient locality to the clinician.
These presentations will be intermingled with themes in an attempt to
make all participants reflect on the overall object of the workshop –
mobilizing health information
Theme 1 - Health information; knowledge management.
iv
Theme 2 - Computer-supported collaborative working (CSCW) and
Knowledge management/work.
Theme 3 - mobilizing health information to improve healthcare.
Finally we invite all participants and other audience to participants in a
general discussion about the two workshop challenges: how to integrate
Mobile Information and Communication technology (MICT) into existing
Clinical/Hospital information systems? and how to integrate novelties
from areas of sensors, remote monitoring, as well as data-mining and
data-sharing capabilities into coherent and novel health information
systems?
January 2009,
Henrique M. G. Martins
Faculdade de Ciências da Saúde, UBI/ Serviço de Medicina 1, HFF
Portugal

Table of Contents

Table of Contents
Foreword ………………………………………………………………………………………. iii
Workshop Chairs ………………………………………………………………………….. v
Program Committee ……………………………………………………………………… v
Papers
The Velocity Effect on GEDEM Measurements ………………………….. 3
Nikos Papadakis, George Tzagarakis, N. Kampanis, Savakis K.,
P. Katonis, D. G. Christakis and K. Stergiopoulos
An Unconventional Approach to Healthcare (Geographic)
Information Systems using a Custom VB Interface
to AutoCAD ………………………………………………………………………….. 13
Ernesto Iadanza
A Three-tiered Architecture for Large-scale Wireless Hospital
Sensor Networks ……………………………………………………………………. 20
Jamila Ben Slimane, Ye-Qiong Song, Anis Koubâa and Mounir
Frikha
Supporting Registration and Treatment of Clubfoot using Mobile
Devices ………………………………………………………………………………….. 32
Weiqin Chen and Dag Skjelvik
Standard for Personalized eHealth Services …………………………………… 42
Torbjørn Sund, Nick Hine, Francoise Petersen and Mike Pluke
viii
Data Collection Methods for Analyzing Task-based Information
Access in Molecular Medicine ………………………………………………… 49
Sanna Kumpulainen, Kalervo Järvelin, Sami Serola,
Aiden R. Doherty, Daragh Byrne, Alan F. Smeaton
and Gareth J. F. Jones
A Distributed Elderly Healthcare System ……………………………………… 59
S. Nourizadeh, C. Deroussent, Y. Q. Song and J. P. Thomesse
MARIKA: A Mobile Assistance System for Supporting Home
Care ……………………………………………………………………………………….. 69
Tobias Umblia, Albert Hein, Ilvio Bruder and Thomas Karopka
Spontaneous Speech Database for the Romanian Language
with Medical Applicability ……………………………………………………… 78
Cristina Sorina Petrea, Diana Mirela Hanes, Andi Buzo,
Vladimir Popescu and Corneliu Burileanu
Remote Patient Monitoring in Home Environments …………………….. 87
Paulo Gonçalves, José Torres, Pedro Sobral and Rui Moreira
A Digital Filter Model of Cardiovascular System and its PZ Plots
in Assistance of the Medical Signal Monitoring and Heart
Condition Diagnosis ………………………………………………………………. 97
Susan Vasana and Harold Rivera
Arogyashree: A Distributed File System for Large Scale
Internet-based Telemedicine ………………………………………………….. 105
Kovendhan Ponnavaikko and D. Janakiram
Author Index ………………………………………………………………………………… 115

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MIAD 2009 ~ The First International Workshop on Medical Image Analysis and Description for Diagnosis Systems, 16th - 17th January, 2009 - Porto, Portugal
by: INSTICC Press

109 Pages

Medical Image Analysis
and Description for Diagnosis
Systems

Proceedings of the
1st International Workshop on
Medical Image Analysis and Description for Diagnosis Systems
MIAD 2009

In conjunction with BIOSTEC 2009
Porto, Portugal, January 2009

Foreword
On behalf of the program committee of the international workshop on
medical image analysis and description for diagnosis systems (MIAD’09), I
have an enormous pleasure to welcome you in Porto (Portugal) for this
manifestation. I would like to thank all those who made many valuable
contributions for success of this first workshop.
MIAD’09 aims at assembling international researchers and
practitioners working in medical and biomedical images processing
domain, for attending extensive educational high level materials,
exchanging their knowledge and talking about their future choices. I also
hope that the workshop offer a real opportunity to fill the gap between
academic researchers, practitioners and industrial parts.
The call for papers of MIAD’09 enticed a number of about 25 paper
submissions, from all over the world, the important job of the program
committee members for reviewing and selecting the technical
contributions leading to 10 papers that will be presented in 3 regular
sessions about following topics: images modelling, registration and
computer aided evaluation, medical images denoising and segmentation,
and biological images analysis.
I hope these effort and these contributions will enable fruitful
discussions and large dissemination of scientific knowledge.
January 2009,
Khalifa Djemal
University of Evry Val d’Essonne
France

Table of Contents

Table of Contents
Foreword ………………………………………………………………………………………. iii
Workshop Chair ……………………………………………………………………………. iv
Program Committee ……………………………………………………………………… iv
Image Modelling, Registration and Computer Aided
Evaluation
A Cost Efficient Approach for Automatic Non-Rigid Registration
of Medical Images ………………………………………………………………….. 3
Sami Dhahbi, Walid Barhoumi and Ezzeddine Zagrouba
Semi-Automatic Modeling of Bones for Real-Time Surgery
Support ………………………………………………………………………………….. 13
Roger Cuypers, Benjamin Weyers and Wolfram Luther
Computer Aided Evaluation of Upper Urinary Tract
Obstruction ……………………………………………………………………………. 24
V. Neeman, M. Hershko, N. Reisner, I. Leichter, G. Hidas,
D. Pode and M. Duvdevani
Medical Images Denoising and Segmentation
Automated Segmentation and Clinical Information
on Dementia Diagnosis ………………………………………………………….. 33
A. Conci, A. Plastino, A. S. Souza, C. S. Kubrusly, D. M. Saade
and F. L. Seixas
vi
3D Segmentation for the Study of Cell Cycle Progression
in Live Drosophila Embryos ………………………………………………….. 43
Chinta Rambabu, Puah Wee Choo, Janos Kriston-Vizi
and Martin Wasser
Performance Assessment of Patch-based Bilateral Denoising ……….. 52
Arnaud de Decker, John Aldo Lee and Michel Verleysen
Semi-automatic Detection of Corticalis Borders in
Two-dimensional Radiographies to Improve Pre-operative
Planning …………………………………………………………………………………. 62
Marc Schlimbach and Jürgen Wahrburg
Biological Images Analysis
Biological Qualification of Oocyte Maturity with the Use
of the Karhunen-Loeve Transform: Computer-aided
Decision for Selecting Best Oocytes Before Fertilization ……….. 77
Christian Pieralli, Bruno Wacogne, Charline André,
Christophe Roux, Christiane Joanne and Lionel Pazart
Mammographic Density Classification based on Local
Histograms …………………………………………………………………………….. 85
Rafael Llobet, Juan A. Solves, Juan C. Perez-Cortes
and Francisco Ruiz-Perales
Empirical Descriptors Evaluation for Mass Malignity
Recognition ……………………………………………………………………………. 91
Imene Cheikhrouhou, Khalifa Djemal, Dorra Sellami Masmoudi,
Hichem Maaref and Nabil Derbel
Author Index ………………………………………………………………………………… 101

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BIOSTEC DC 2009 ~ Doctoral Consortium on Biomedical Engineering Systems and Technologies, 14th - 17th Porto,Portugal
by: INSTICC PRESS

45 Pages

Proceedings of the
Doctoral Consortium on
Biomedical Engineering Systems and Technologies
In conjunction with BIOSTEC 2009
Porto, Portugal, January 2009

The purpose of the 2nd International Joint Conference on Biomedical Engineering Systems and Technologies is to bring together researchers and practitioners, including engineers, biologists, health professionals and informatics/computer scientists, interested in both theoretical advances and applications of information systems, artificial intelligence, signal processing, electronics and other engineering tools in knowledge areas related to biology and medicine.
BIOSTEC is composed of three co-located conferences, each specialized in at least one of the aforementioned main knowledge areas.

Table of Contents

CONTENTS
PAPERS
IMPROVEMENT OF AUTOMATIC ECG ANALYSIS FOR TELEMONITORING SYSTEMS BASED
ON CONTEXT SIGNALS
Malte Kirst, Jörg Ottenbacher, Christophe Kunze and Wilhelm Stork 3
INFORMATION NEEDS OF CONSUMERS OF HEALTHCARE INFORMATION SYSTEMS -
Conceptualisation of the Experiences of Informal Carers: A Research Proposal Summary
Basil Alzougool, Shanton Chang and Kathleen Gray 9
TOWARDS THE DEVELOPMENT OF A NOVEL EVALUATION FRAMEWORK FOR INFORMATION
SYSTEMS IN THE HEALTHCARE SECTOR
Noor Azizah KS Mohamadali and Jonathan M. Garibaldi 17
ASSESSING MACHINE LEARNING METHODS IN IVF PROCESS - Predictive Modeling of IVF Embryo
Selection
Asli Uyar 25
ULTRASOUND BLOOD COAGULATION MONITORING - A Pilot Clinical Trial to Assess Sensitivity
to Anticoagulant and Antiplatelet Therapy
Camille Plag, Rachel Callé, Frédéric Patat, Frédéric Ossant, Claire Pouplard, Yves Gruel and Amélie Le Gouge 32
AUTHOR INDEX 41

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Seltzer and Bender’s Dental Pulp
by: Kenneth M. Hargreaves, Harold E. Goodis, Samuel Seltzer

Seltzer and Bender’s Dental Pulp
By Kenneth M. Hargreaves, Harold E. Goodis, Samuel Seltzer

Publisher: Quintessence Publishing (IL)
Number Of Pages: 500
Publication Date: 2002-04
ISBN-10 / ASIN: 0867154152
ISBN-13 / EAN: 9780867154153

Product Description:

Univ. of Texas Health Science Center, San Antonio. Text, for practitioners, students, and residents, provides the latest research which is interpreted in terms of biologically based recommendations for restorative and endodontic dental procedures. Color and halftone illustrations and extensive references are included. DNLM: Dental Pulp.

Summary: Best academic book in endo.
Rating: 5

This book is only for serious endodontists/postdoc residents who want to understand the scientific basis of endodontics. This body of work is beyond undergraduate students who will find it too science oriented and not enough clinically based. It’s a recommended read for any endodontist trying to attain cutting edge understanding of the science behind his field. Sam Seltzer was a pioneer and one of the smartest guys I knew.

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Statistics: A Biomedical Introduction (Wiley Series in Probability and Statistics)
by: Byron Wm. Brown, Myles Hollander

Statistics: A Biomedical Introduction (Wiley Series in Probability and Statistics)
By Byron Wm. Brown, Myles Hollander

Publisher: Wiley-Interscience
Number Of Pages: 480
Publication Date: 1977-10-04
ISBN-10 / ASIN: 0471112402
ISBN-13 / EAN: 9780471112402

Product Description:

This book provides the basic methods of introductory statistics, focusing on real-life examples from medicine, public health, and the natural sciences. Probability, hypothesis testing, estimation, analysis of contingency tables, regression analysis, and analysis of variance are presented in a nonmathematical format and provide a basis for understanding statistics. This foundation is expanded to include such important topics in biomedical statistics as design and implementation of clinical trials, statistical evaluation of diagnostic tests, methods of randomization, and methods of analyzing survival data with incomplete observations.

Summary: a another classic biostatistics text
Rating: 5

Byron Brown is an MD PhD and is a professor at Stanford who works in the medical school and helps the Stanford statistics PhD students in their consulting and dissertation research. When I was at Stanford Brown along with the late Rupert Miller and Brad Efron formed the core of the Stanford biostatistics research and they produced some very fine biostatisticians in Sue Leargans, John Hyde, Nancy Reid, Beth Gladen, Gail Gong and Carol Link.

Under Rupert Miller’s leadership much of the consulting work was documented in the Biostatistics Casebook that Wiley published. Myles Hollander was a graduate student at Stanford who at an earlier time (prior to 1974) graduated and made a name for himself at Florida State University and as an author of books on nonparametric statistical methods.

Brown and Hollander teamed to write this impeccable traditional biostatistics text. It has wisely been added to the Wiley classics series and so is available at a reasonable price in paperback. There have been many advances in biostatistics over the last 25 years and this is not reflected in this book which is a reprint of a text that was originally published around 1970. This is a great reference book for anyone with the caveat that other books must be consulted for current results.

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Timebomb:The Global Epidemic of Multi-Drug Resistant Tuberculosis
by: Lee B. Reichman, Janice Hopkins Tanne

Timebomb:The Global Epidemic of Multi-Drug Resistant Tuberculosis
By Lee B. Reichman, Janice Hopkins Tanne

Publisher: McGraw-Hill Companies
Number Of Pages: 320
Publication Date: 2001-09-26
ISBN-10 / ASIN: 0071359249
ISBN-13 / EAN: 9780071359245

Product Description:

“This is an excellent book. It should be read by all who are interested in any aspect of Tuberculosis, including the growing problem of Multi-Drug Resistant Tuberculosis.” “Journal of American Medical Association “The book serves an important function, relaying statistics and TB hot spots, proposing funding and international standardized treatments. Government officials, researchers and nonprofit health organizations will likely cast this as the authoritative book on the subject.” “Publishers Weekly “Like other recent works on the threat of infectious diseases such as Laurie Garrett’s “The Coming Plague, Timebomb has the power of fiction and it is sometimes easy to forget that it is not. Unlike the Garrett book, which is more a collection of short dramatic stories collectively telling a big picture about our coexistence and evolution with microbes, Reichman selects one story and presents it in novel form with better material that most science fiction. The book is organized in a clear and riveting manner. Within the narrative style, the book is rich with up-to-the-minute details and references that add to its depth. An incredible account of politics and disease dynamics occurring at all levels, “Timebomb helps us realize that controlling or eradicating TB is not just about science and facts; likely if it were, TB would have long been relegated to the history books.”– “Nature Medicine Magazine Tuberculosis, supposedly defeated by antibiotics half a century ago, has returned in a highly contagious and fatal new form that cannot be treated with conventional drugs. Multidrug-resistant TB (MDR-TB), could cause some 10 million deaths over the next decade and is thriving in theovercrowded prisons of the former Soviet Union. As “Timebomb explains in unnerving detail, the virtual collapse of the world’s borders means that refugees, tourists, immigrants, business travelers, and others can spread the TB bacillus very efficiently. London, for example, has experienced a 100% increase in reported cases in the past 10 years. Written by the world’s preeminent TB expert and an award-winning medical and health writer, “Timebomb details the evolution and the current state of the MDR-TB epidemic, interweaving the science of MDR-TB with personal stories of people whose lives have been threatened by the deadly bacteria.

Summary: scary and revealing
Rating: 4

For those of you unfamiliar with tuberculosis: TB is a life-threatening disease that is caused by bacteria. It is treatable, but the treatment is lengthy (at least 6-8 months) and relatively costly (around $900 in the US). If patients do not receive the correct combination of antibiotics, or if they stop treatment prematurely, they may develop (or transmit) multi-drug-resistant tuberculosis, a disease which is nearly impossible to treat, treatment requiring up to 2 years of taking very expensive (up to $250,000 for 1 case of multi-drug-resistant TB) antibiotics that have a lot of side effects.

In Timebomb Lee Reichman gives a very clear description of all the factors involved in Tb, its treatment, the ways in which such treatment may fail and the dire consequences of failure. He also gives personal account of his experiences with multi-drug-resistant tuberculosis, with an emphasis on the situations in the United States and Russia. In the beginning of the 1990s there was an outbreak of (multi-drug-resistant) tuberculosis is New York: a team of very dedicated public health officials, doctors and community health workers fought the outbreak by treating patients as much as possible at home and were capable of reversing the situation, be it at very high costs (1 billion dollars in excess spending on health care). These costs would have been unnecessary if policy makers had in the past realized the threat that TB poses to the society once you become complacent.

In Russia, on the other hand, doctors are far more influential and there are a lot of very perverse incentives that stigmatise patients to such an extent that they actually do not come forward with their TB: they are locked in hospitals for up to 2 years for treatment and 1 in every 5 TB patients is operated upon, even when these operations are absolutely not necessary. And in prisons everything goes wrong that can go wrong with regard to transmission and control of TB and the emergence of multi-drug-resistant TB: overcrowded prisons, interrupted treatment and amnesty for TB prisoners that have not finished their treatment, And all this combined with an unjustified national pride that prohibits the Russians to ask for help or to accept evidence-based interventions that are promoted by the World Health Organization.

I have worked in a few of the prisons in Russia myself to try and improve the diagnosis of TB and the descriptions are very recognizable for me. I wish I had read this book before I started that job, because it had given me a better understanding of the forces I had to fight against.

Summary: anger
Rating: 2

This book is captivating and reads well, however I have found myself overcome with rage and anger while reading. Here’s a couple of thoughts. First of all intellectual imperialism. Russia lost the cold war — therefore the achievements of Soviet research, science etc are useless, primitive, unscientific. The author says, for example, that “English is the language of science”, and that Russian doctors who speak English and can therefore read scientific literature in English are far more advanced than Russian doctors who only read literature in Russian, since Russian methods of medicine are at least 50 years behind Western ones. (I have never heard of an American scientist, however, who had learned Russian and studied Russian scientific and medical literature.) The author dismisses Russian treatment methods as barbaric just because they are different from the orthodoxy of treatment prescribed in the States. That’s one point. Secondly, extremely frustrating is the absense of numerical data or statistics. DOTS is always more effective than the methods used by Russian medics, but no stats or studies as to this issue are ever sited. The one time the author does site a study (Tomsk) where 50 patients treated with DOTS were compared with 50 patients treated with the classical Soviet method, he is forced to admit that the cure rates were equal!!!!!!! So what then of his argument that Soviet medical treatment is not based on evidence and is barbaric? Also, TB was on a steady decline throughout the Soviet period, — isn’t that evidence enough that the Soviet way to treat TB is not entirely bogus?

Thirdly: the comparison between TB treatment in the US and in Russia is entirely inappropriate. It would make far more sense to compare Russia with a country that has similar rates of TB infection in the population, as well as similar economic conditions.

Fourth: The author talks about TB as if all there was to it is inhailing the bacteria. Meanwhile, the facts are that 80-90% of the people exposed to the bacteria never develop the disease. It is only when their immune systems are weakened (by poor nutrition, homelessness, stress, etc etc) that people actually get sick with TB. The author completely ignores the role that the social chaos of post-Soviet times and the sky-rocketing rates of poverty, starvation, malnutrition that followed the establishment of “democracy” play in the tuberculosis epidemic.

Finally: behind the fancy DOTS programme, all that is asked for is a dismantling of the social networks of support. Instead of putting people into hospitals where they will be fed, cared for, and constantly observed by a trained professional for signs of negative reactions to drugs — make sick people walk to clinics to get anti-TB drugs. Obviously this method of treatment is “more cost effective”. But is it really more effective? I would highly doubt it.

Summary: A Riveting and Absorbing Book!
Rating: 5

This shocking book focuses on the emerging public health threat associated with the rise of multiple drug resistant (MDR) strains of tuberculosis, especially in the former Soviet bloc of countries. In an age when worldwide travel can be accomplished in days if not hours, the connectivity between what is transpiring in the underdeveloped world and within our own borders is more striking than ever before. Therefore, we must recognize the threat posed by the emergence of such strains, and prepare to deal with the almost inevitable outbreaks of such strains of TB as they begin to occur in modern western societies.

This is not an easy read, but it is a quite fascinating and eye-opening one. The spread of MDR tuberculosis with the populations of Russia and the former satellite countries is shocking, and the total number of individuals latently infected now number some two billion people, or over one third of the total world population! Given the inability of modern medicine to counteract the course of the disease or to easily cure people infected with these new strains, the threat posed by them for people in all countries cannot be over-dramatized. Tuberculosis is indeed highly contagious, spreading freely through the air from infected individuals when they speak, cough, or sneeze. The authors refer to it as the “Ebola with wings”, making a tacit reference to this most deadly form of hemorrhagic fever which is quite lethal when contracted, but which is thankfully more difficult to spread since (unlike tuberculosis) it is not airborne.

The predictions of its consequences are dire indeed; MDR tuberculosis is anticipated to kill 30,000,000 in the next decade alone. It festers in the more humid and warmer reaches of the earth, from Brazil to India, from Russia to China, and it is especially dangerous in those area of the world that have the poorest existing public health infrastructures. The economic collapse of the former USSR condemned millions to conditions of enforced cohabitation with infected individuals in the most congested, least sanitary, and most poorly equipped social structures in the world. Given such an alarming rise ion incidence and prevalence of the disease entity, the risk for cross-cultural contamination is only a short air-flight away from a looming public health disaster in the small towns and mega-cities of Europe and North America. Indeed, it is hard to engage in hyperbole here to overestimate the threat.

This book is indeed a call to arms, a plea for enlightened action on the part of governments, public health agencies, pharmaceutical research conglomerates, and the general public in order to avoid the terrors that await us if we sit by without doing all we can do to ensure better safeguards and better screening find, isolate, and treat infected individuals before they can lay the groundwork for a tragic and unstoppable epidemic. This is an important and worthwhile book, and one that I heartily recommend.

Summary: Timebomb: The Global Epidemic of Multi-Drug-Resistant TB
Rating: 5

This lively and well-written book is packed with fascinating nuggets of historical and medical information. From the “dark, Satanic mills” of the Industrial Revolution to the squalid prison cells of contemporary Russia, from Egyptian mummies to DNA fingerprinting, you will follow the trail of the TB bacillus and the heroic researchers and public health workers who remain committed to conquering it.

“Timebomb” is a winner!

Summary: Timebomb: The Global Epidemic of Multi-Drug Rfesistant Tuber
Rating: 5

Anthrax, shmanthrax. To come down with good, productive anxiety, read about “Ebola with wings”-drug-resistant TB. And no, tuberculosis is not a thing of the past: It’s here, it’s now, it kills 2 million people every year. Several chapters of this book read like a detective novel. Timebomb starts by showing us Nicolay, a Russian, as he flies into New York in 1998, coughing highly infectious, drug-resistant TB bacteria into the plane’s air. Then Timebomb looks into risky-to-work-in TB labs; a Siberian prison (where much of the world’s TB is generated); a lung operation; the Russian medical system that’s failing to control the bug; and takes us along on the dangerous rounds of an unsung heroine, a public-health worker. The book is not only well written, it’s about a threat that individual members of the public can actually do something about-if they know the problem exists.

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Novel and Re-emerging Respiratory Viral Diseases (Novartis Foundation Symposia)
by: Novartis Foundation

Novel and Re-emerging Respiratory Viral Diseases (Novartis Foundation Symposia)
By Novartis Foundation

Publisher: Wiley
Number Of Pages: 174
Publication Date: 2008-06-23
ISBN-10 / ASIN: 0470065389
ISBN-13 / EAN: 9780470065389

Product Description:

The past decade has seen mounting global concern regarding viral outbreaks such as SARS, avian influenza and West Nile virus. In 2004 and 2005, reports of bird-to-human, and possible human-to-human, transmissions of the H5N1 influenza viruses raised fears that these viruses could cause a pandemic on the scale of the Spanish flu pandemic of 1918. Previous to this, a novel coronavirus had been identified as the aetiological agent of the severe acute respiratory syndrome (SARS), a new respiratory viral disease that emerged at the end of 2002 and caused profound disturbances in over 30 countries worldwide in 2003. It is not known whether the SARS coronavirus will re-emerge, especially since its origins and potential reservoir(s) are unresolved. However, these outbreaks have shown that these viruses can emerge in any part of the world at any time.

This book critically evaluates the latest scientific evidence on novel or re-emerging viral diseases and brings together contributions from world experts on this topic, explaining best practice in their area, and discussing lessons learned and how best to collaborate to prevent and control future outbreaks.

Topics covered include:

the latest advances in virology, particularly in the area of epidemiology
diagnostics
animal models for viral infection
antiviral and vaccine development
Novel and Re-emerging Respiratory Viral Diseases offers a comprehensive and interdisciplinary account of all aspects of the topic, from basic molecular biology to public health issues, and is therefore essential reading for virologists, infectious disease specialists, public health managers, researchers and epidemiologists, as well as those working in vaccine development, pharmaceutical medicine and drug discovery

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Lung Growth and Development (Lung Biology in Health and Disease)
by: John A. McDonald

Lung Growth and Development (Lung Biology in Health and Disease)
By John A. McDonald

Publisher: Informa HealthCare
Number Of Pages: 740
Publication Date: 1997-01-15
ISBN-10 / ASIN: 0824797728
ISBN-13 / EAN: 9780824797720

Product Description:

Reflects the explosion of information and techno-logical breakthroughs that have facilitated investi-gations into the development of the lung-including recombinant DNA technology, molecular genetics, transgenics, and advances in lung cell and mo-lecular biology. Provides nearly 2800 biblio-graphic citations and over 170 tables, drawings, and x-rays to help clarify specific discussions.

Review

…McDonald is to be commended for producing a text that includes both in-depth coverage of major advances in lung development and an assessment of important research areas that remain unexplored.
-The Physiologist

…McDonald is to be commended for producing a text that includes both in-depth coverage of major advances in lung development and an assessment of important research areas that remain unexplored.
-The Physiologist

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BioNanotechnology (Synthesis Lectures on Biomedical Engineering)

Publisher: Morgan and Claypool Publishers
Number Of Pages: 139
Publication Date: 2007-08-21
Sales Rank: 3730777
ISBN / ASIN: 1598291386
EAN: 9781598291384
Binding: Paperback
Manufacturer: Morgan and Claypool Publishers
Studio: Morgan and Claypool Publishers
ABSTRACT

This book aims to provide vital information about the growing field of bionanotechnology for undergraduate and graduate students, as well as working professionals in various fields. The fundamentals of nanotechnology are covered along with several specific bionanotechnology applications, including nanobioimaging and drug delivery which is a growing $100 billions industry. The uniqueness of the field has been brought out with unparalleled lucidity; a balance between important insight into the synthetic methods of preparing stable nano-structures and medical applications driven focus educates and informs the reader on the impact of this emerging field. Critical examination of potential threats followed by a current global outlook completes the discussion. In short, the book takes you through a journey from fundamentals to frontiers of bionanotechnology so that you can understand and make informed decisions on the impact of bionano on your career and business.

KEYWORDS

Bionanotechnology, Bionano initiatives, Bionano threats, Gold nanoparticles, Nanobioimaging, Nano drug-delivery (or nano-vectors or targeted drug-delivery), Nano synthetics, and Bionanotoxicology, MRI, Titania nanoparticles, and Zinc nanoparticles.

CONTENTS

Introduction
0.1 Bionanotechnology: A Historical Perspective
0.2 Nanotechnology and Bionanotechnology
0.3 Notable Nanoimages in Bionanotechnology
0.3.1 AFM-Qd
0.3.2 Nano-drug Delivery Chip
0.3.3 Atomic Force Microscopy Image (AFM) of SWNT
0.3.4 Scanning Electron Microscopy Image (SEM) of SWNT
0.4 Opportunities and Challenges of Bionanotechnology
0.5 Growth potential of Nanotechnology and Related Expenditures
References

1. The Significance of Nano Domain
1.1 Limitations of Micron Size
1.2 Need for Nano-Size—Surface Volume Ratio Significance
1.3 Significance and Key Features of Nano-Size
1.4 Derivation of Bohr’s Atomic Radius of a Hydrogen Atom
1.5 Comparison of Particle Behavior at Nano-Size to Macro Size: Gold and Titania
1.6 Advantages of Scaling Down—Nano-Size
References

2. Nano Drug Delivery
2.1 Conventional Drug Delivery
2.1.1 First Pass Effect
2.1.2 Routes of Delivery
2.2 Targeted Drug Delivery
2.3 Chemistry of Drug Delivery Vehicles
2.3.1 Nanocapsules
2.3.2 Unilamellar Liposomal Vesicles
2.3.3 Nanoparticles
2.3.4 Microemulsions
2.4 Delivery Profiles
2.4.1 Rate-Preprogrammed Drug Delivery Systems
2.4.2 Activation-Modulated Drug Delivery Systems
2.4.3 Feedback-Regulated Drug Delivery Systems
2.4.4 Site-Targeting Drug Delivery Systems
2.5 The Role of Nanotechnology in Drug Delivery
2.5.1 Transdermal
2.5.2 Blood Brain Barrier
2.6 Advantages of Targeted Drug Delivery Systems
References

3. BioNanoimaging
3.1 Quantum Dots
3.2 Ultrasound Contrast Agents
3.3 Magnetic Nanoparticles
References

4. Successful Applications of Bionanotechnology
4.1 Nanostructures and Nanosystems
4.1.1 Nanopore Technology
4.1.2 Nano Self-Assembling Systems
4.1.3 Cantilevers
4.1.4 Nanoarrays
4.2 Nanoparticles
4.2.1 Quantum Dots (QDs)
4.2.2 Paramagnetic Iron Oxide Crystals
4.2.3 Dendrimers
4.2.4 Carbon Nanotubes
4.2.5 Nanosomes and Polymersomes
4.3 In Vitro Diagnostics
4.4 Medical Application of Nanosystems and Nanoparticles
4.4.1 Drug Delivery Applications
4.4.2 Nanoparticles in Molecular Imaging
4.5 Summary and Conclusions
References

5. Synthesis of Gold, Titania, and Zinc Oxide
5.1 Synthesis of Gold
5.1.1 Background
5.1.2 Brust Method of Synthesis of Thiol Derivatized Gold NPs by Biphasic Reduction
5.1.3 Gold Colloids
5.1.4 Gold Nanofilm
5.1.5 Gold Nanorods
5.2 Synthesis of Titania Nanostructures
5.2.1 Background
5.2.2 Solvo-Thermal Synthesis of Titania Nano Crystals
5.2.3 Sol-Gel Template Synthesis of Titania Nano Tubes and Rods
5.2.4 Overview of Other Synthesis Methods
5.3 Synthesis of Zinc Oxide
5.3.1 Background
5.3.2 The Solid-Vapor Synthesis of ZnO
5.1
5.1.1 Brust Method of Synthesis of Thiol Derivatized Gold NPs by Biphasic Reduction
5.2
5.2.1 Solvo-Thermal Synthesis of Titania Nano Crystals
5.2.2 Sol-Gel Template Synthesis of Titania Nano Tubes and Rods
5.2.3 Overview of Other Synthesis Methods
5.3
5.3.1 The Solid-Vapor Synthesis of ZnO: Horizontal Tube Furnace
5.3.2 Wurtzite Structure of ZnO
References

6. Is Bionanotechnology a Panacea?
6.1 Background
6.2 Primary Concerns
6.3 Assessing Potential Risks
6.3.1 Inhalation
6.3.2 Contact/Dermal Delivery
6.3.3 Other Routes of Contact
6.3.4 Environmental Impacts of NPs and the Food Chain
6.3.5 Explosion Hazards
6.4 Lessons from the Past
6.5 Conclusion
References

7. Roadmap to Realization of Bionanotechnology
7.1 Introduction
7.2 Nano Vision: the Futuristic Goals of Bionanotech
7.3 Working toward Realization: Current Progress
7.4 Screenshot of Reality: Bionano-Unbiased/Uncensored
7.5 The Nano Mission: Roadmap to Realization of Translation Research
7.5.1 Bionano in the US
7.5.2 Bio-Nano in Japan
7.5.3 Bio-Nano in UK
7.5.4 UK–Japan Joint Initiative for Bionanotechnology
7.5.5 The EU Initiative in Bionanotech
7.5.6 Bionano in Asia

References
Author Biography

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Informatics for Healthcare Professionals
by: Kathleen M. Young

Informatics for Healthcare Professionals
By Kathleen M. Young

Publisher: F. A. Davis Company
Number Of Pages: 304
Publication Date: 2000-05
ISBN-10 / ASIN: 0803606192
ISBN-13 / EAN: 9780803606197

Product Description:

Western Michigan Univ., Kalamazoo, MI. Discusses basic applications of informatics in conceptual theory, evidence-based healthcare, taxonomy, security and confidentiality, electronic and Web-based tools, and telehealth. Also covered are human factors, the systems cycle, managing change, and managed care. For students. Softcover. DNLM: Medical Informatics.

Summary: Wonderfully written
Rating: 5

I worked in the USA as a hormonal health educator for nearly 25 years before coming back to live in Australia in 2001. I am a writer and published a book on Women’s Health that sold over 30,000 copies in the 1990s. I have just begun a Masters in Health Informatics at Rockhampton University. Starting my studies, I felt as though I was rowing around in circles in heavy seas, and Kathleen’s book was a great help to me by giving the big picture about Health Informatics in the U.S. and global scene. Kathleen’s book is written for undergraduates, but I understand it is also being used in postgraduate programs. Kathleen’s book is well organized, with helpful case studies, and it is written very clearly. My husband has two Ph.Ds (in other areas) and has written over 20 books. He has had a life-long interest in preventive medicine. He also felt this was a very well written book with a lot of helpful information.

Summary: An Analysis of Informatics for Healthcare Professionals
Rating: 5

AN ANALYSIS OF

INFORMATICS FOR HEALTHCARE PROFESSIONALS

Informatics for Healthcare Professionals, written by Kathleen M. Young of Western Michigan University, serves as a textbook for healthcare professionals participating in informatics courses.

VALUE OF INFORMATION
The author contributes valuable points regarding the value of information in the field of healthcare. Information is derived from processed data. Information becomes knowledge and that knowledge is then utilized to make appropriate healthcare decisions. Healthcare professionals who can appropriately manage and process information will be the most successful in affecting patient outcomes.
Information is not unique to healthcare and patient outcomes. Society, teaching/learning, and government are all affected by obtaining information, especially through the use of technology. Society has begun to change the way it communicates information by utilizing voice mail, e-mail, the World Wide Web, etc. that were not utilized in the past. Teaching and learning, such as that conducted in the Emory University Career MPH Program, are now conducting classes via distance learning tools. Technology has been utilized to further political agendas and propaganda, as well as provide an avenue for information in countries that seek to restrict information from its citizens.
Young goes further to discuss the five rights of information. For information to be considered valuable, it must be the right information, given to the right person at the right time and right place. The right amount of information must also be given. Once information is considered valuable within healthcare, it drives reimbursement, quality assurance, accreditation processes, etc. However, the key importance of information in healthcare is to expand medical knowledge.
Medical knowledge is primarily gained by evaluating information learned through research. Several types of research are employed to contribute to information, thereby increasing the body of medical knowledge. Applied research is aimed at solving specific problems. Clinical research examines outcomes related to services rendered. Administrative research focuses on all aspects of quality, accessibility and the appraisal of healthcare and its delivery. Finally, educational research investigates the effectiveness of various curricula. The trend in today’s society is to translate the information gained through research into knowledge to improve clinical outcomes. Today, research knowledge is used to develop evidence-based guidelines for medical treatment, with the goal of reducing practice variability, thereby improving clinical outcomes and reducing costs.

ORGANIZATION AND STORAGE OF INFORMATION
According to the author, information is organized and stored by various mechanisms. Databases are one of the most common methods of storage, which now have the ability to store text, voice and even images. In healthcare, some popular databases are MEDLINE, CINAHL and HEDIS. The Agency for Healthcare Research and Quality (AHRQ) is also becoming a popular database, due to its collection of evidence-based guidelines. Data repositories store multiple databases and contain tools for extraction and manipulation of data. Data warehouses are also used to store a large accumulation of data and contains selected data elements. Usually, a data warehouse serves as an enterprise-wide solution for decision support.
The future of data storage in the healthcare arena will be the electronic health record, more commonly known as the electronic medical record (EMR). Although the paper chart is still the most widely used method for data organization and storage, EMRs are the future in healthcare. EMRs provide electronic storage of patient demographic information, clinical information, test and lab results, workflow management and references to clinical information. Evidence-based guidelines are also easily integrated into EMRs, which are available for clinical decision-making throughout the patient visit. Information within an EMR system is generally stored on a centralized database server, which can be accessed by all client computer systems. Shared data is available to all users of the system at various security levels. The ideal future, according to the author, is to develop an electronic health record that is accessible worldwide by the use of a patient identifier.

EXCHANGE OF INFORMATION IN THE WORKPLACE
Information is exchanged in the workplace through several mechanisms. E-mail is the most common exchange of information within the workplace today. Listservs, voice mail, the World Wide Web, chat rooms and USENETS are other common forms of information exchange. Of course, paper charts, post-it notes and memos still have there place, but are less frequent than in the past.
The future, according to Young, will lead to a more advanced method of information exchange, which is telehealth. Telehealth utilizes mechanisms, such as video conferencing, that allow healthcare professionals to participate in healthcare delivery from remote locations. This technology will also be valuable for distance learning, consultations and bringing medical expertise to health professional shortage areas. The use of telehealth will greatly advance healthcare, although it will be costly.

KNOWLEDGE MANAGEMENT IN PUBLIC HEALTH
Young’s publication has important implications to the field of public health. Most importantly, public health professionals need to carefully process information to contribute to medical knowledge. Medical knowledge gathered through research or other means, will lead to the development of evidence-based guidelines. Public health professionals must embrace evidence-based guidelines, which will lead to improved patient outcomes, thereby improving the health of the population. Public health professionals must also begin to both develop and share databases across agencies, as well as across states. The sharing of databases and information can be effective in decision support in the field of public health. Furthermore, the sharing of information allows for public health professionals from all disciplines to provide valuable input. This ensures that information will lead to valuable knowledge, which will be instrumental in protecting the health of the population.

CONCLUSION
In conclusion, I would like to state that this textbook was insightful, well written and organized. I thought that the content was critical for healthcare professionals to understand the importance of and need for processing information, the utilization of technology in healthcare, basic technical terminology and principals that serve as the infrastructure for technology and the future of technology in healthcare. I plan on incorporating this textbook into our continuous quality improvement series for medical students, residents and faculty training programs. I would recommend Young’s publication to healthcare professionals of all specialties.

Summary: The Journey of Informatics!
Rating: 4

Having read Informatics for Healthcare Professionals, overall, I am moved to put forth efforts to improve gathering, organizing, storing and disseminating health information. I am particularly inspired by Young’s vision of universal access to both medical information and patient records, which would facilitate continuous health maintenance and care for all people, regardless of world location or medical history. In this paper, I will discuss Young’s points regarding information and knowledge, as well as how she affects my career.
Once accurately gathered and stored, disseminated health information is extraordinarily valuable. One primary value of disseminated health information is improving patient outcomes. A provider, having access to the most current, evidence-based literature will better manage a patient’s condition, for example treating tonsillitis with antibiotics or other home remedies, than if she based decisions on personal inclination, which may be to recommend an unnecessary tonsillectomy. Similarly, a well human being in his 20’s, having access to information about basic health promotion, for example blood pressure controlling diets, will manage his health more efficiently than if he waited to hear it from a physician at age 50, after necessary triple bypass surgery. From a different perspective, changing how we achieve information, for example measuring blood glucose through an external, non-invasive biosensor rather than sticking the patient, would improve quality, convenience and therefore compliance of healthy lifestyles. Patient outcomes of improved dissemination of current, accurate health information also include reducing the number of emergency room visits. Finally, with improved informatics, especially accuracy of information, providers can reduce human suffering and length of hospital stay due to medication errors.
Another primary value of improved health information is increasing time efficiency when documenting patient encounters. Young wrote that 38% of time with each patient is spent charting. In my experience, her percentage is low, but in either case, too much of the time allotted for patient care is spent on paperwork, rather than with the patient. In addition, paper charts decrease time efficiency because only one person can read or contribute to a paper chart at a time. Just as electronic journals have expedited learning among providers, implementing electronic patient records will increase efficiency of time, energy and ultimately improve patient care while reducing costs.
Not only do I believe that having access to information should be a human right, but, as Young stated, information needs to occur as the right information, for the right people, at the right time and place and in the right amount. Moreover, information can have asymmetrical or symmetrical shapes. An example of asymmetrically shaped information is a physician knowing side effects of an antibiotic such as Erythromycin but failing to tell the patient. When the patient feels noxious or develops photosensitivity, she may think the cause is one other than the antibiotic. In contrast, symmetrically shaped information is free flowing: bi-directional, thorough and honest. Ultimately, universal, symmetrical information facilitates true democracy and social justice.
Young implied that increased access to accurate information encourages (healthy) competition among health care providers. This may be true, and I also believe that providers who are determined to implement strategies based on evidence-centered information expedite evolution of efficient health and healthcare standards. These standards shape the provider culture, in essence promoting increased accuracy when interacting with patients.
Shared knowledge, or advancing knowledge across populations, promotes research findings, links education and practice, enhances practice with research based practice and determines resource consumption. Information from databases such as the World Wide Web, and database warehouses can be extracted to share knowledge. Knowledge gives power and equality. Utilizing data warehouses speeds dissemination of knowledge extracted from patient records, treatment procedures or institutional management decisions. Integrating telehealth into patient care facilitates efficient sharing knowledge among providers.
Young compared paper and electronic storage of patient information in depth. Advantages to paper storage are as follows: familiarity, including how to use, how much it costs, and how to handle legally; its portability; the fact that there are no overhead costs; and its versatility – many types of information exist in one chart: provider notes, graphs, pictures, electrocardiograms, laboratory reports, etc. Disadvantages of paper storage include the following: charts are misplaced or lost, incomplete, illegible, and can physically degrade over time; only one person can use a given chart at a time; it is difficult to store large amounts of paper data compared to electronic data; continued quality improvement becomes laborious as informaticians are forced to wade through thick, disorganized charts; there are no programmed warning signals, so information is not automatically flagged and is vulnerable to error; patients have to re-tell information to providers because providers can’t find old charts or it is too time-consuming to find charts; and information is generally fragmented and scattered. All of the aforementioned hinder provision of optimal health maintenance or care and result in consumption of costly time and energy.
In contrast, electronic health records have many advantages: required storage space is smaller than for paper, charts are accessible to many people simultaneously, information retrieval is instantaneous, programmed warning signals flag abnormal labs and reminders for preventive screening such as “time for a colonoscopy,” administrative duties are efficient and clear cut, and patients do not have to repeat telling past medical information because providers can easily access this information prior to patient interaction. Disadvantages of electronic health records include high startup costs, a steep learning curve to operate the system, confidentiality, privacy and security issues, hardware is either nonportable or wireless (portable) but breakable, data entry could be flawed and users may develop ergomatic issues.
According to Young, not one hospital has fully implemented an electronic health record system. Why? In addition to the disadvantages of electronic health records listed above, barriers to universal implementation include the lack of a common vision, the lack of standardized terminology, system architecture and indexing. Of these, overhead costs and security are perhaps the greatest barriers to implementation of electronic health records.
In order to improve information flow – assessing which information is important to acquire, accurately gathering, storing and disseminating information – change must occur. Be it a patient, EKG technician, physician or medical records official, many factors are involved in the art of change, successfully implementing change. As Young suggested, psychological factors, technological preparation, time, energy, capacities, pace of change and adequate communication are all-important factors to consider when planning change.
Changing medical records from paper to electronic is just one component of informatics that we, as health professionals, need to change in order to optimally collect and manipulate health information. Young indicated that barriers to change, for example applying evidence-based medicine rather than personal inclinations, are lack of prioritization, time, access, education and modeling. Furthermore, even if a common vision for informatics existed and health professionals prioritized improving information systems, gave time, acquired necessary education, modeling and access to change, human flaw factors may undermine improvements. Finite abilities, inhibitory environments, false perceptions, cognition, response execution, lack of attention and aging limit us humans. While, as Young quoted James Conway, “people don’t make errors because they want to or because they’re bad people,” errors do occur. Errors can be rule based (design flaw) or knowledge based (operator error) and they result from shortcomings of perception, memory and cognition. To diminish errors, Young wrote that beginning with the analysis stage of implementing new systems, designers must accommodate for limits of human performance, while exploiting our strengths. Changes must be learnable, efficient, easily memorized, and satisfying to users (…)

Summary: In-depth review of Informatics for Healthcare Professionals
Rating: 4

The book entitled Informatics for Healthcare Professionals by Kathleen M. Young, tackles the informatics of healthcare as a new specialty and disseminates the complex world of managing and processing information to support decision making in medical practice. An investigation of Medical Informatics for Healthcare Professionals reveals the circular continuum of data–to information–to knowledge as not only important, but also discusses the value, organization, storage, and exchange of information in a context that is easy to read and understand, even for the novice informatics student.

Perhaps one of the greatest strengths of Young’s book is her in-depth analysis of the evidence-based practice model, its benefits and weaknesses. The author describes the evidence-based medicine paradigm from beginning to end, giving the reader a comprehensive overview of how the decision-making structure of medical care has changed from the early 1980’s to the year 2000. Young makes her opinion known that there is a vast crevasse between the benefits of the evidence-based model and the problems in a healthcare industry not so willing to embrace the notion of just how well information technology can benefit the entire healthcare spectrum.

A powerful section of Young’s book addresses the human side of informatics, or “human factors.” The author focuses on the design, implementation, and process of information systems and how medical devices developed without the application of “human factors” incorporated into their structure, could lead to injuries and even death.

Three of the most helpful sections for any healthcare professional designing, implementing and maintaining health information systems in Young’s book are how to develop a pattern of change among healthcare professionals for facilitating acceptance, the information systems cycle, and information for managing health. Particularly valuable was the order in which information systems are developed. The reader is enticed into the actual process of information systems development from the initial idea, through the design phase, to development, and finally to implementation and rollout. The objectives of each phase are succinctly stated. The only variable missing was the same lengthy analysis as to why projects fail.

Young stresses the importance of how healthcare professionals should own the information process to produce optimum outcomes. Incorporating up-to-date information technology into healthcare systems, she says, can only improve continuity of care, ensure efficient exchange of information, and reduce costs.

Public Health professionals can glean a great deal of structural information in Young’s book regarding the order of project development for information systems. As an overview, the book is a basic introduction to informatics and provides insight for further investigation into the obviously more complex data collection systems of the healthcare industry.

Young’s book continuously reinforces how significant it will be for new healthcare professionals to utilize the current system of information to their advantage and build it into evidence-based practice for future generations.

All in all, a very good foundation book for understanding Informatics as it pertains to the healthcare industry.

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