Network design for telemedicine--e-health using satellite technology.

Over the last decade various international Information and Communications Technology networks have been created for a global access to high-level medical care. OP 2000 has designed and validated the high-end interactive video communication system WinVicos especially for telemedical applications, training of the physician in a distributed environment, teleconsultation and second opinion. WinVicos is operated on a workstation (WoTeSa) using standard hardware components and offers a superior image quality at a moderate transmission bandwidth of up to 2 Mbps. WoTeSa / WinVicos have been applied for IP-based communication in different satellite-based telemedical networks. In the DELTASS-project a disaster scenario was analysed and an appropriate telecommunication system for effective rescue measures for the victims was set up and evaluated. In the MEDASHIP project an integrated system for telemedical services (teleconsultation, teleelectro-cardiography, telesonography) on board of cruise ships and ferries has been set up. EMISPHER offers an equal access for most of the countries of the Euro-Mediterranean area to on-line services for health care in the required quality of service. E-learning applications, real-time telemedicine and shared management of medical assistance have been realized. The innovative developments in ICT with the aim of realizing a ubiquitous access to medical resources for everyone at any time and anywhere (u-Health) bear the risk of creating and amplifying a digital divide in the world. Therefore we have analyzed how the objective needs of the heterogeneous partners can be joined with the result that there is a need for real integration of the various platforms and services. A virtual combination of applications serves as the basic idea for the Virtual Hospital. The development of virtual hospitals and digital medicine helps to bridge the digital divide between different regions of the world and enables equal access to high-level medical care. Pre-operative planning, intra-operative navigation and minimally-invasive surgery require a digital and virtual environment supporting the perception of the physician. As data and computing resources in a virtual hospital are distributed over many sites the concept of the Grid should be integrated with other communication networks and platforms.

Collaborative work during interventional radiological procedures based on a multicast satellite-terrestrial network.

Collaboration is a key requirement in several contemporary interventional radiology procedures (IRPs). This work proposes a multicast hybrid satellite system capable of supporting advanced IRP collaboration, and evaluates its feasibility and applicability. Following a detailed IRP requirements study, we have developed a system which supports IRP collaboration through the employment of a hybrid satellite-terrestrial network, a prototype multicast version of wavelet based interactive communication system (WinVicos) application, and a partition aggregation and conditional coding (PACC) wavelet codec. A semistructured questionnaire was also used to receive evaluative feedback from collaborating participants. The departments of interventional radiology of University Hospital of Patras, Greece and of Charite Hospital of Berlin, Germany have been connected on the system. Eight interventional radiologists and a vascular surgeon participated periodically in three satellite-terrestrial "fully collaborative" IRPs (average time 90 min) of high complexity and in four terrestrial educational sessions with great success, evidenced by considerable improving the IRP outcomes (clinical and educational). In case of high complexity, where the simultaneous presence of remote interventional expert and/or surgeon is required, advanced collaboration among staff of geographically dispersed international centers is feasible via integration of existing networking and other technologies.

New trends in the virtualization of hospitals--tools for global e-Health.

The development of virtual hospitals and digital medicine helps to bridge the digital divide between different regions of the world and enables equal access to high-level medical care. Pre-operative planning, intra-operative navigation and minimally-invasive surgery require a digital and virtual environment supporting the perception of the physician. As data and computing resources in a virtual hospital are distributed over many sites the concept of the Grid should be integrated with other communication networks and platforms. A promising approach is the implementation of service-oriented architectures for an invisible grid, hiding complexity for both application developers and end-users. Examples of promising medical applications of Grid technology are the real-time 3D-visualization and manipulation of patient data for individualized treatment planning and the creation of distributed intelligent databases of medical images.

Virtual hospital and digital medicine--why is the GRID needed?

The promise of telemedicine to enable equal access to high-level medical care can only be realised by the development of virtual hospitals, digital medicine and a bridging of the digital divide between the various regions of the world. For this, the concept of the Grid should be integrated with other communication networks and platforms. A promising approach is the implementation of service-oriented architectures for an invisible grid, hiding complexity for both application developers and end-users. Therefore integrated Grid Tools Suites for application programmers must be developed. Thus enhancing development and deployment of Grid applications can bring us closer to the simplicity of use that is desired for grid infrastructures not only within the medico-clinical field.

Structural Change of the Mn Cluster during the S2→S3 State Transition of the Oxygen-Evolving Complex of Photosystem II. Does It Reflect the Onset of Water/Substrate Oxidation? Determination by Mn X-ray Absorption Spectroscopy.

The oxygen-evolving complex of Photosystem II in plants and cyanobacteria catalyzes the oxidation of two water molecules to one molecule of dioxygen. A tetranuclear Mn complex is believed to cycle through five intermediate states (S0-S4) to couple the four-electron oxidation of water with the one-electron photochemistry occurring at the Photosystem II reaction center. We have used X-ray absorption spectroscopy to study the local structure of the Mn complex and have proposed a model for it, based on studies of the Mn K-edges and the extended X-ray absorption fine structure of the S1 and S2 states. The proposed model consists of two di-µ-oxo-bridged binuclear Mn units with Mn-Mn distances of ~2.7 Å that are linked to each other by a mono-µ-oxo bridge with a Mn-Mn separation of ~3.3 Å. The Mn-Mn distances are invariant in the native S1 and S2 states. This report describes the application of X-ray absorption spectroscopy to S3 samples created under physiological conditions with saturating flash illumination. Significant changes are observed in the Mn-Mn distances in the S3 state compared to the S1 and the S2 states. The two 2.7 Å Mn-Mn distances that characterize the di-µ-oxo centers in the S1 and S2 states are lengthened to ~2.8 and 3.0 Å in the S3 state, respectively. The 3.3 Å Mn-Mn and Mn-Ca distances also increase by 0.04-0.2 Å. These changes in Mn-Mn distances are interpreted as consequences of the onset of substrate/water oxidation in the S3 state. Mn-centered oxidation is evident during the S0→S1 and S1→S2 transitions. We propose that the changes in Mn-Mn distances during the S2→S3 transition are the result of ligand or water oxidation, leading to the formation of an oxyl radical intermediate formed at a bridging or terminal position. The reaction of the oxyl radical with OH-, H2O, or an oxo group during the subsequent S state conversion is proposed to lead to the formation of the O-O bond. Models that can account for changes in the Mn-Mn distances in the S3 state and the implications for the mechanism of water oxidation are discussed.

Interactive telemedicine as a tool to avoid a digital divide in the world.

An efficient way of closing the gap in medical care between the EU and its Mediterranean partners is the use of satellite-based networks for telemedical applications. Using standard hardware components and specially designed communication software (WinVicos) various telemedical applications (teleconsultation, telementoring, teleteaching, etc.) have been realized. Two telemedical networks which have been designed and developed recently, MEDASHIP (Medical Assistance for Ships) and EMISPHER (Euro-Mediterranean Internet-Satellite Platform for Health, medical Education and Research), are presented.

Interactive telemedical applications in OP 2000 via satellite.

Using off-the-shelf hardware components and a specially developed high-end software communication system (WinVicos) satellite networks for interactive telemedicine have been designed and developed. These networks allow for various telemedical applications, like teleteaching, telementoring, intraoperative teleconsultation, second opinioning, etc.. Based on the successful GALENOS network, several projects are currently being realized: MEDASHIP (Medical Assistance for Ships); DELTASS (Disaster Emergency Logistic Telemedicine Advanced Satellites Systems) and EMISPHER (Euro-Mediterranean Internet-Satellite Platform for Health, medical Education and Research).