===================================================================== AMERICAN VETERINARY COMPUTER SOCIETY NEWSLETTER November - December, 1993 ===================================================================== Richard B. Talbot (Virginia Tech) - President; James T. Case (UC-Davis) - Secretary Treasurer; Robert Featherston (Tulsa, OK) - President elect; Ronald D. Smith (Illinois) - Newsletter Editor. ===================================================================== IN THIS ISSUE SOCIETY NEWS From the Editor How to Contact AVCS LETTERS TO THE EDITOR Reviews of Eduational Software ROBOTS ENTER THE OPERATING ROOM PRODUCT AVAILABILITY/REVIEWS/COMPARISONS Windows-Compatible Remote Control for PCs PCs Versus Macs Mac Versus PC Multimedia Windows Databases Data Compression Programs Desktop Publishing Programs 32-bit Desktop PC Operating Systems Internet WAIS, Gopher, Newsgroup Access via AOL EDUPAGE Informatics Curricula Not Just Cows The Guide to Network Resource Tools PBLIST - Problem Based Learning in Health Sciences NEWS AND COMMENTARY IBM Speech Recognition Software Robots Dispense Drugs Database of Educational Programs in Medical Informatics MEETINGS AND EDUCATIONAL OPPORTUNITIES 5th Int'l Conference on Computers in Agriculture, Orlando/Kissimmee, FL Artificial Intelligence in Med. - Interpreting Clinical Data, Stanford, CA. First World Congress on Computational Medicine & Public Health, Austin, TX Computers In Healthcare Education Symposium, Philadelphia, PA American Medical Informatics Ass'n (AMIA) Spring Congress, San Fancisco, CA 1994 National Extension Technology Conference, Lexington, KY The Seventh IEEE Symp. on Computer-Based Med. Systems, Winston-Salem, NC 12th Conference for Computer Applications in Radiology, Winston-Salem, NC ED-MEDIA 94 - World Conf. Educ. Multimedia and Hypermedia, Vancouver, CA World Cong. on Med. Physics and Biomed. Engineering, Rio de Janeiro, Brazil Int'l Conf on Neural Networks & Expert Systems in Med. & Healthcare, Plymouth, England ITCH '94 - Info. Technology in Community Health, Victoria, B.C., Canada Itch'94 - Information Tech. In Community Health Victoria, B.C. Canada International Congress on Medical Informatics, Havana, Cuba MEDINFO'95 - 8th World Congress on Medical Informatics, Sao Paulo, Brazil Research Training Program in Medical Informatics - Harvard, MIT, Tufts Health Informatics Research Training - Oregon Health Sciences University Medical Informatics Training - The University of Missouri SUGGESTED READING CLOSING BITS ===================================================================== SOCIETY NEWS ===================================================================== FROM THE EDITOR This issue's Feature Article describes ROBODOC, a surgical robot created by Howard Paul, D.V.M., a veterinary surgeon, and William Bargar, M.D., an orthopedic surgeon. Dr. Paul died of leukemia Feb. 10, 1993. An obituary appears in the March-April 1993 AVCS Newsletter. For some time now I've been recommending America Online (AOL) to practitioners who would like to communicate electronically with university colleagues connected to the internet, and users of other mail programs such as Compuserve, MCI Mail, and Genie. This was because (1) AOL has an internet mail gateway and (2) the Veterinary Information Network (VIN) resides on AOL. Well, Prodigy just announced that it has finally offered an internet gateway for its own mail service. I recently checked out this new feature. I sent a Prodigy-user friend a message from AOL. To get to him, the message had to go through the AOL-internet gateway, traverse the country over internet, and then reach his Prodigy mailbox through the Prodigy-internet gateway. It worked, but I wasn't excited about the service. First, Prodigy users have to pay $0.10 for each 6000 bytes sent through the gateway, coming or going. Second, my friend couldn't read the message in his Prodigy mail window. Rather, the message had to be saved as a disk file and then called up in a word processing program. Result? I still recommend AOL to users who which to take advantage of the internet's worldwide connectivity. ===================================================================== HOW TO CONTACT AVCS Applications for membership, accompanied by a check for $20 payable to the AVCS, should be sent to Dr. James T. Case; AVCS Secretary Treasurer; School of Veterinary Medicine; University of California; P.O. Box 1770; Davis, CA 95617 (Phone: 916/752-4408; FAX: 916/752-5680; e-mail: jcase@ucdcvdls.bitnet). Dr. Case is responsible for distribution of the hardcopy version of the AVCS Newsletter. Newsletter items can be sent to Dr. Ronald D. Smith, AVCS Newsletter Editor; UI College of Veterinary Medicine; 2001 South Lincoln; Urbana, IL 61801. Telephone: 217/333-2449; FAX: 217/333-4628; AOL: RDSmith; Internet: r-smith19@uiuc.edu If you would like to be on the AVCS Newsletter electronic distribution list, send an e-mail message to the Newsletter Editor. Although the electronic version is only an ASCII (text) file, it's faster, searchable, easier to store and retrieve, and environmentally friendly. Current and past issues of the Newsletter can also be downloaded from the Associations and Foundations Library of America Online's Veterinary Information Network. Issues remain there for one year. ===================================================================== LETTERS TO THE EDITOR ===================================================================== REVIEWS OF EDUATIONAL SOFTWARE From: Caroline Arms Would a database of reviews of educational software be of value to you? If so, contribute a short review of your favorite computer-based learning software, and we'll get one going. The Education Working Group of the American Medical Informatics Association is attempting to compile a database of reviews of and comments on computer- based learning materials in the health sciences. The reviews will initially be made available on a gopher server at the University of Pittsburgh. Reviews can be short and discuss a single aspect of a package. I run a resource center and can best evaluate a packages by whether it gets used and if it is easy to install and maintain. Students can describe how a particular package was helpful to them (for example, because it explained a complex process, or presented review questions faster than a book). Instructional designers and developers can address issue sof user interface. Content can be evaluated by faculty or students. A single paragraph highlighting the strong points of a package from your particular point of view can be extremely valuable. In addition to the comments, we need to know unambiguously what the package is, who you are, and something about the experience on which the review is based. A second message will lay out some more explicit guidelines, but perhaps the following example will help you realize that it need not take much time to contribute to this effort. Send contributed reviews to Caroline Arms at cra@med.pitt.edu. Once a critical mass of reviews is available, the name of the gopher server will be published on the same Internet lists that this message has been distributed on. IT ONLY TAKES A FEW MINUTES TO WRITE DOWN A FEW COMMENTS. ADDRESS THE POINTS THAT MATTER TO YOU ABOUT SOFTWARE. IF OTHERS AGREE, THEY WILL ADDRESS THOSE POINTS IN THEIR COMMENTS. WE JUST NEED TO GET THE BALL ROLLING. Thanks in advance. Caroline Arms; cra@med.pitt.edu Head, Microcomputer & Media Center Falk Library of the Health Sciences University of Pittsburgh 200 Scaife Hall Desoto & Terrace Streets Pittsburgh, PA 15261 Sample review ============= HUMAN GROSS ANATOMY Scholar Educational Systems, Inc. (301) 261-6460 $595 for institutional site license in 1991 REVIEWED BY: Caroline Arms; cra@med.pitt.edu Head, Microcomputer & Media Center Falk Library of the Health Sciences University of Pittsburgh Date: 9/19/93 BASIS OF REVIEW Observation of use in computer center. BRIEF DESCRIPTION Tutorial with tests. Topics: spinal cord & spinal nerves; cardiovascular system; lymphatic system; autonomic nervous system; thoracic wall; lungs; mechanics of respiration; heart; mediastinum. Developed at Department of Anatomy, George Washington University School of Medicine and Health Sciences. RELEVANT ARTICLE "Computer-assisted instructions: a role in teaching human gross anatomy." Walsh RJ. Bohn RC. Medical Education. 24(6):499-506, 1990 Nov. OPERATING SYSTEM & HARDWARE: DOS, VGA WHO USES "HUMAN GROSS ANATOMY" IN THE MMC AND HOW? First-year medical students and students in doctoral program in the School of Pharmacy. From both groups there is substantial use to supplement lectures and support problem-based learning activities. Some medical students can be seen coming back repeatedly to use different sections of the package. They ask if there are more modules. TO WHAT EXTENT HAS "HUMAN GROSS ANATOMY" BEEN ADOPTED BY FACULTY? The coordinator of the anatomy block of the medical school curriculum spent a few hours in the MMC trying out anatomy software and asked me to develop a list of the software she picked out, with descriptions and any relevant instructions, to be included with the course packet. She had no doubt about including this on the list. For the doctoral program in pharmacy, the section on the respiratory system was identified as particularly relevant. The faculty member strongly recommends it to the students and they follow his recommendation. He has also installed the program (which is sold with a license for unlimited institutional copies) on a computer accessible to his students in the School of Pharmacy. HOW EASY WAS IT TO INSTALL IN A PUBLIC LAB? It requires about 8 MBytes of disk space and came uncompressed on a large number of diskettes. However, it was straightforward to install and runs on our Novell network without trouble. Since we upgraded to 486-based DOS machines, we often see a runtime error on launch, but it always starts after two or three tries. This is not a major problem, since we document it in the list of anatomy software given to the students. There is some sound (beeps to highlight changes on the screen and for keys pressed in error, etc.) but it can be turned off at any time. USER INTERFACE -- a personal view This program is not flashy, but has clear, colorful diagrams and effective animations. It consists of small tutorial sections organized in a topic-based hierarchy. Material is presented in small chunks on uncluttered screens. Navigation is easy by keyboard or mouse. Computer novices find it a very comfortable introduction to computer-based learning. A glossary (called "library") is reached by typing the initial letter of a term -- there are no hypertext links. Test questions have immediate feedback on the correct answer. I understand that a new module is available, on the lower limb. ===================================================================== ROBOTS ENTER THE OPERATING ROOM Food and Drug Administration News Release by Kevin L. Ropp Reprinted from the Health Info-Com Network Medical Newsletter Volume 6, Number 20, July 12, 1993, pp 25-29. ===================================================================== Imagine you're having a hip replacement, a fairly common operation, especially if you're an older American. As you're wheeled into the operating room, you notice the nurses and anesthetist preparing for your surgery. But wait, someone's missing. Your surgeon. You look around the room and finally spot the surgeon, off in the corner keying information into a computer terminal. And there, next to the doctor and computer is a 500-pound, 7-foot-high, jointed steel arm, with a tiny drill attached to one end. It's Robodoc. And it's going to assist in your surgery. During the procedure it will drill the hole in your thigh bone (femur) that will hold the anchor of your new hip joint. While robots have long been used to assist surgeons during operations, the devices may soon take a more active role in surgical procedures such as hip replacements, removal of brain tumors, prostate surgery, and laparoscopy. But, while medical robots may make some surgical procedures easier or help the surgeon perform an operation more precisely, the Food and Drug Administration, which regulates these new devices, has several concerns. One concern is software. Today's robotics devices typically have a computer software component that controls the moving, mechanical parts of the device as it acts on something in its environment. FDA reviewers evaluate the software components of such devices because the software is "command central" for the device's operation. When evaluating the devices, FDA looks to see if the company is following good software engineering practices in writing and designing the software. These practices often include establishing device requirements, writing good specifications, evaluating the software and device, analyzing the device's potential hazards, and implementing controls that specifically address those hazards. Other concerns include the safety and effectiveness of the hardware component of the device. Robodoc Robotics devices being developed today take computer technology to a new level of sophistication. One of the most ambitious projects, and probably the best known in the United States, is Robodoc--a modified industrial robot that performs certain aspects of a surgical procedure. It was created by Howard Paul, D.V.M., a veterinary surgeon, and William Bargar, M.D., an orthopedic surgeon. (Paul died of leukemia Feb. 10, 1993.) The device made history and headlines late last year when it drilled a hole in a femur to hold a patient's hip implant in place without cement. Ten robot-assisted human hip replacements using Robodoc were performed at Sutter General Hospital, Sacramento, Calif., under an investigational device exemption (IDE) approved by FDA Oct. 9, 1992. The first was done Nov. 7, 1992, on a 64-year-old man suffering from osteoarthritis, the condition most commonly necessitating hip replacement. The surgery took nearly six hours, about double the usual time for more traditional hip replacement procedures. The last, performed Feb. 11, 1993, took two hours and 40 minutes--about the same amount of time it takes a surgeon to perform the operation using traditional tools. Before approving the IDE, FDA paid particular attention to the software and back-up safety systems. "When you talk about things that are computer-controlled or automated, people tend to believe that if it's automatic it's better," says FDA biomedical engineer Theodore Stevens. "But, like any computer, [Robodoc] only does what you tell it to do. "It takes sophisticated software to run a robot or milling machine. As a result, there's some really serious software questions, especially for a device that actually operates on humans." FDA uses two criteria to classify all medical devices. The first is whether a device is equivalent to an existing device that has been on the market since before May 28, 1976--the day FDA began implementing the Medical Device Amendments to the Food, Drug, and Cosmetic Act. If it is equivalent, the new device is classified the same as the existing device. If a device does not meet the first criteria, FDA evaluates it according to a second criterion: It is considered a class III device that must undergo clinical testing and have FDA approval before it can be sold. Robodoc falls into this classification. Because they may pose a significant risk to the patient's health, all new class III devices must be evaluated for safety and effectiveness. Robodoc, for example, cuts the patient without direct human control of the cutting tool, according to Mark Melkerson, acting chief of the orthopedic devices branch in the Center for Devices and Radiological Health's office of device evaluation. As a result, there has to be a very well-controlled software development program and there have to be physical limits on how much the device's cutting tool can move. In fact, there are built-in safeguards to make sure the device drills only the femur and doesn't cut into soft tissue, Stevens adds. Robodoc was born out of Paul's and Bargar's desire and attempts to improve the fit of implants in the femur in cementless total hip replacements. About one-third of the 250,000 hip replacements performed in the United States each year are cementless. Unlike procedures that use cementing materials to fix the implant in place, porous cementless hip implants, introduced in the mid-1970s, are made with porous coatings that allow tissue to grow directly to the implant, holding it firmly in place. "Our hypothesis was that if we could do the surgery more precisely, then the outcome would be better," Bargar says. FDA's Stevens explains that with traditional replacements, free space between the implant and the bone may allow the implant to move, which could be painful. The implant also might take more time to "fix" rigidly or might not "fix" at all. Theoretically, Robodoc makes possible very close physical contact between the bone and the implant stem, reducing pain and improving the "fix" of the replacement. In planning for a traditional hip replacement, the surgeon takes a picture of the patient's femur using computed tomography (CT) or magnetic resonance imaging (MRI). The surgeon then overlays these pictures with acetate templates of implants until a close match is found for that particular patient. During surgery, the doctor removes both the hip socket and the top of the femur. Using a hammer and broach (a cylindrical cutting tool with teeth on the surface), the surgeon chisels an 8- to 10-inch-deep hole down the length of the bone--an imprecise method at best. The surgeon then hammers the steel or titanium implant into place, attaches it to the hip socket, and sews up the incision. In preparing for robotics surgery, about a week before the actual procedure the doctor places three small titanium pins in the patient's femur. Robodoc will later use these as markers to locate the precise point to begin drilling. Next, three-dimensional pictures of the patient's femur are taken using a CT scanner or MRI system. These pictures are then fed into a computer along with other patient data the doctor uses to select the best implant for that patient. Using this information, along with already loaded data that defines the specific size and shape of the implant, the surgeon programs the robot to make specific cuts in the patient's femur. These cuts mill out a cavity matching the shape and size of the implant. During surgery, the doctor removes the hip socket and top of the femur, immobilizes the bone in a "fixator," aligns Robodoc to the three pins, and, if all information and alignment is correct, hits the "start" button, which tells the robot to begin drilling. Robodoc, using its high-speed drill, then cuts the hole down the length of the femur. The resulting cavity almost exactly matches the size and shape of the implant. The cavity Robodoc creates is up to 10 times more precise than that created by surgeons with hammers and broaches, according to a report in the journal Clinical Orthopedics. "The robot can cut with far greater accuracy than any human hand. We looked at radiographs taken just before patients left the hospital and, over the implant's surface, we didn't see any gaps, unlike with hand tools," Bargar says. Now that 10 surgeries are done, Bargar says, Integrated Surgical Systems, the company formed to develop Robodoc, plans to ask FDA for permission to conduct full-scale clinical trials at five or six medical centers around the country, including Shadyside Hospital in Pittsburgh and New England Baptist Hospital in Boston. The results of the clinical trials will be compared with results of surgeries using traditional methods. Brain Cancer Surgery Robodoc isn't the only robot used in the operating room. Neurosurgeon James Drake at the Hospital for Sick Children in Toronto uses a robotics device to remove previously inoperable brain tumors in seriously ill children, as well as in epilepsy and vascular malformation surgeries. He and the three other neurosurgeons on the hospital's staff use the ISG Viewing Wand--an imaging computer and a jointed arm with a probe attached to the end. The device, currently under FDA review, "is calibrated like a robot but it doesn't move under any of its own power," Drake says. In preparing for surgery using the device, the doctor takes CT scans or MRI images of the patient's brain. These images, which outline the tumor boundaries, are then fed into a computer, which reformats the pictures into a "three-dimensional picture that looks just like the patient," he says. The robot arm holds the 5-inch to 10-inch probe. With the 3-D pictures on a computer screen during the operation, the surgeon directs the robot arm to slide the probe into the patient's brain. The position of the arm in space is relayed to the computer, which "shows you on the reconstructed images [on the computer screen] exactly where you are in the brain. "Without the ISG Viewing Wand, some of these kids would not have been operated on or the surgery would not have been as successful in removing tumors," Drake says. Prostate and Abdominal Surgeries Prostate surgery using robots is being tested in Great Britain although this technology has not yet been tried in the United States. Brian Davies, senior lecturer in the Department of Mechanical Engineering's Robotics Center at London's Imperial College, is working with the Institute of Urology to test a computer-driven robotics device that removes diseased prostate glands. It has a special-purpose framework consisting of a tiny ring that rotates 360 degrees. The ring holds a small sliding carriage that carries an endoscope (an instrument for viewing inside a hollow organ) and cutter. The entire system is attached to a thin, flexible catheter, which is motorized and computer controlled. "We preoperatively image the size of the gland using transrectal [through the rectum] ultrasound and then program into the computer control system the size of the gland," Davies says. The computer system automatically generates the shape and sequence of cuts. Watching the progress on a nearby video monitor, the surgeon inserts the catheter with instruments into the patient's penis until the computerized system reaches the correct place. At this point, the surgeon turns the operation over to the robot, which performs the necessary preprogrammed cuts, according to Davies. So far, the procedure has been used on only five patients, Davies says, and it's too early to draw any conclusions about the device's safety. In addition to the prostate device, the Robotics Center is designing rehabilitative robots, as well as those to machine the ends of bones for prosthetic implants in knee surgery. Another area in which robotics may soon take on a role is that of laparoscopy used in surgery. To perform laparoscopy, the surgeon threads a fiber-optic cable that holds a tiny video camera and cutting tool on the end through a small incision in the patient's abdomen. The surgeon monitors the operation by images on the monitor. The video camera is usually operated by an assistant. Though these procedures are less traumatic for the patient than traditional surgery with its larger incisions, they are more difficult for the surgeon. Some U.S. companies are working on devices that would make these procedures easier for the surgeon. For example, IBM Corp. is currently developing a robot to move and manipulate the tiny camera and cutting tool. The camera would be guided by the surgeon's voice. While it may be some time before patients see something as friendly as R2-D2, the famous "Star Wars" movie robot, in the operating room, less dramatic-looking robots have begun to assist surgeons with a good number of surgical procedures. ------------------------------------------- Compilation Copyright 1993 by David Dodell, D.M.D. All rights Reserved. License is hereby granted to republish on electronic media for which no fees are charged, so long as the text of this copyright notice and license are attached intact to any and all republished portion or portions. The Health Info-Com Network Newsletter is distributed biweekly. Articles on a medical nature are welcomed. If you have an article, please contact the editor for information on how to submit it. If you are interested in joining the automated distribution system, please contact the editor. Editor: David Dodell, D.M.D.; 10250 North 92nd Street, Suite 210, Scottsdale, Arizona 85258-4599 USA; Telephone +1 (602) 860-1121; FAX +1 (602) 451-6135 E-Mail Address: Internet: david@stat.com; FidoNet = 1:114/15; Bitnet = ATW1H@ASUACAD Newsletter distribution: LISTSERV = MEDNEWS@ASUACAD.BITNET (or internet: mednews@asuvm.inre.asu.edu); anonymous ftp = vm1.nodak.edu Notification List = hicn-notify-request@stat.com FAX Delivery = Contact Editor for information ===================================================================== PRODUCT AVAILABILITY/REVIEWS/COMPARISONS ===================================================================== WINDOWS-COMPATIBLE REMOTE CONTROL FOR PCS The July 19, 1993 issue of InfoWorld evaluated three Windows-compatible programs for remote control of a desktop PC. Scores were (from 1 to 10 with 10 being highest): Carbon Copy 2.0 (5.1); pcAnywhere 1.0 (7.4); Remotely Possible 1.0b (4.0). ===================================================================== PCS VERSUS MACS The August 2, 1993 issue of InfoWorld compared the overall value of five Apple Macintosh models and eight PC-compatibles varying in CPUs and configuations. Scores were (from 1 to 10 with 10 being highest): Compaq Deskpro 66M (7.4); AST Bravo 4/66d (7.1); Dell 4/33M Information Station (7.1); AST Bravo 4/25s (6.8); Compaq Deskpro 4/66i (6.7); Compaq ProLinea 4/25s Model 120 (6.6); Apple Macintosh Quadra 950 (6.5); Apple Macintosh LC III (6.4); Compaq ProLinea 3/25s (6.4); Apple Macintosh Color Classic (6.3); Compaq ProLinea 4/25s Model 240 (6.1); Apple Macintosh Centris 650 (6.0); Apple Macintosh IIvx (5.9). (Personally, I'm very fond of my Mac Powerbook 180 - Editor) ===================================================================== MAC VERSUS PC MULTIMEDIA The August 9, 1993 issue of InfoWorld compared two of the leading multimedia authoring programs: Macromedia Inc.'s Authorware Professional for the Macintosh 2.0.1 and AimTech Corp.'s IconAuthor 5.0 for Windows. Scores were (from 1 to 10 with 10 being highest): Authorware for the Mac (7.3) and IconAuthor for Windows (6.8). ===================================================================== WINDOWS DATABASES The August 16, 1993 issue of InfoWorld compared four Microsoft Windows relational database products. Scores were (from 1 to 10 with 10 being highest): Paradox for Windows, Version 1.0 (7.6); Access, Version 1.0 (7.1), FoxPro for Windows, Version 2.5 (7.1); Superbase, Version 2.0A (5.0). ===================================================================== DATA COMPRESSION PROGRAMS The September 13, 1993 issue of InfoWorld compared four data compression products for PCs. Scores were (from 1 to 10 with 10 being highest): Stacker Version 3.1 (8.5); SuperStor Version 1.3 (7.5); DoubleSpace (7.3); XtraDrive Version 3.0 (7.3). ===================================================================== DESKTOP PUBLISHING PROGRAMS The October 25, 1993 issue of InfoWorld evaluated three Windows-compatible and two Macintosh-compatible desktop publishing programs. Scores were (from 1 to 10 with 10 being highest): QuarkXPress 3.2 for the Mac (7.2); QuarkXPress 3.12 for Windows (6.7); Aldus PageMaker 5.0 for Windows (6.2); Aldus PageMaker 5.0 for the Mac (6.1); Ventura Publishing 4.1.1 for Windows (5.8). ===================================================================== 32-BIT DESKTOP PC OPERATING SYSTEMS The November 22, 1993 issue of InfoWorld evaluated six 32-bit desktop operating systems. Scores were (from 1 to 10 with 10 being highest): OS/2, Version 2.1 (7.56); NextStep, Version 3.2 (6.88); Windows NT, Version 3.1 (6.75); Solaris, Version 2.1 for x86 (6.09); UnixWare Personal Edition, Version 1.0 (5.53); Open Desktop, Version 3.0 (5.38). ===================================================================== INTERNET WAIS, GOPHER, NEWSGROUP ACCESS VIA AOL Press release downloaded from America Online VIENNA, VA, September 20, 1993 -- America Online, Inc. today unveiled plans to introduce a series of new features intended to make the Internet -- the information superhighway connecting more than 10 million users in over 50 countries -- more accessible and easy to use for millions of Americans. The Company is working to leverage its award-winning software interface to provide simple and affordable connections to the Internet to a much broader audience than is currently served by Internet connections in corporations and schools. "There's growing interest in connecting to the Internet, but there's still no easy way to do it," said Steve Case, President and CEO of America Online. "Our goal is to be the first online service to break down that technical wall by making the Internet easy to connect to and easy to use, so millions of citizens will be able to take part in this dynamic interactive community." The Company already provides an e-mail gateway between America Online and Internet; since being launched last year, the gateway has become one of America Online's most popular features. Next month, America Online will launch Internet Center, an information center designed to educate consumers about the Internet and provide expanded access into the Internet's rich content. The center will include connections to WAIS and Gopher databases, as well as Newsgroups. Additional features and functionality will be added in stages over the coming year. "We're eager to bring these new Internet capabilities to our customers as quickly as we can, but we will do it in stages to make sure we do it right," said Case. America Online plans to test its new offerings with novices, to make sure the Internet connection is, in fact, very easy to use. The Company is also creating an advisory council composed of experts who are sensitive to the social dynamics of Internet. Case added: "As we bring these two rapidly-growing electronic communities together, we want to do it with sensitivity to give consumers the best of both worlds." The new Internet Center will feature graphical icons, to provide simple navigation through the intimidating complexity of the Internet. All of the services of America Online -- including the new Internet Center -- are available to consumers at for a low monthly fee of just $9.95 a month, providing up to five hours of access. America Online, Inc. (NASDAQ: AMER) is the nation's fastest growing provider of online services to consumers. The Company offers its more than 350,000 subscribers a wide variety of services, including electronic mail, conferencing, software, computing support, electronic magazines and newspapers, and online classes. The Company has established strategic alliances with dozens of companies, including Time-Warner, CNN, Knight-Ridder, Tribune Company, IBM, and Apple. The Company completed an initial stock offering in March 1992. Personal computer owners can obtain the America Online start-up kit at major software retailers and bookstores, or by calling 1-800-827-6364. ===================================================================== EDUPAGE EDUPAGE is a twice-weekly summary of news items on information technology. It is provided as a service by EDUCOM -- a consortium of leading colleges and universities seeking to transform education through the use of information technology. For free subscription to Edupage, our electronic news service, send e-mail to listserv@bitnic.educom.edu, containing the following text: SUB EDUPAGE yourfirstname yourlastname. To unsubscribe, send e-mail containing the text: UNSUB EDUPAGE. To send comments about Edupage, send mail to comments@educom.edu. Back issues of Edupage are available by WAIS, Gopher, and anonymous ftp from educom.edu. ===================================================================== INFORMATICS CURRICULA From: BEADENKOPF@medcolpa.bitnet The International Medical Informatics Association now has an Internet Gopher that includes a database of educational programs in medical informatics. To access it, Telnet to consultant.micro.umn.edu (134.84.132.4) at the University of Minnesota and log in as . Select and then , , , , and from succeeding menus. For more information send email to Miriam Jaffe (mjaffe@trout.ab.umd.edu). ===================================================================== NOT JUST COWS From: BILL DREW Version 2.0 of my guide to INTERNET Resources in Agriculture is now available via our gopher and from me via e-mail requests. The description below is from the SURANET guide maintained by Michael Taranto of NIC Services at SURAnet. NOT JUST COWS - A Guide to INTERNET/Bitnet Resources in Agriculture and Related Sciences; Written and Compiled by Wilfred Drew, 5/8/92; SUNY at Morrisville College of Agriculture and Technology. The purpose of this Guide is to list Agricultural and Related Sciences information resources available through the INTERNET. Agricultural information resources listed include; an index of over 40 libraries with extensive collections in agriculture; INTERNET BBS such as Advanced Technology Information Network and CENET; a collection of mail based services such as Almanac Servers and over 60 Listserve Discussion Groups; other miscellaneous information resources such as WAIS and FEDIX. In addition to the above; I have greatly expanded the guide to include gopher, a far greater number of libraries are now listed, many more Almanac servers, NEWS Groups, and new electronic bulletin boards. Please discard any earlier editions dated before 1993. Version 2.0 is the only up-to-date edition. The latest copy will always be available via our gopher. There is also only the plain vanilla ascii release at the present time. Our server does not support binary files yet. As soon as it does, I will put up a WordPerfect version and possibly some others as well. I will not put up a postscript version. Please feel free to use this guide in any way you want as long as YOU DO NOT CHARGE ANY ONE FOR A COPY. Please also credit me for my work. It took a lot of digging to assemble this guide. I could have put the standard copy right statement in it but I hate those things and will only do that if necessary. Please feel free to put this in your gophers. Also please delete any earlier copies of it from your ftp archives. It has gone by the file name of agricultural.list or agriucture.dos or agriculture.wp depending on the whims and policies of local administrators. Please feel free to add it to your ftp sites but please make it evident that it is release 2.0. I will attempt to track down gopher links that need updating. Gopher Link Information Type=0; Name= Internet/BITNET Resources in Agriculture by Wilfred Drew Path=0gopher_root1:_library-docs_NOT_JUST_COWS.GUIDE Host=SNYMORVB.cs.snymor.edu Port=70 URL: gopher://SNYMORVB.cs.snymor.edu:70 /00gopher_root1:_library-docs_NOT_JUST_COWS.GUIDE ===================================================================== THE GUIDE TO NETWORK RESOURCE TOOLS From: David Sitman The Guide to Network Resource Tools describes many of the key tools in use today among the academic networking community for accessing resources on the net. The tools described in this guide have been divided into six functional areas. The first section, "Exploring the Network", covers Gopher and World-Wide Web. WAIS is documented in section two, "Searching Databases". The third section, "Finding Network Resources", deals with archie. WHOIS, X.500 and Netfind are discussed in section four, "Finding People and Computers". Trickle and BITFTP are covered in section five on "Getting Files". The sixth section, "Networked Interest Groups", explains Listserv and Netnews. A final section gives a brief description of other tools of interest: Prospero, ASTRA, Netserv, Mailbase, Relay and IRC. For each tool, the guide provides a general overview and details on availability, intended audience, basic usage, and examples. The Guide to Network Resource Tools is available electronically from: LISTSERV@EARNCC.BITNET in Postscript and plain text format. To get the Guide to Network Resource Tools, send the command: GET NETTOOLS PS (Postscript format) GET NETTOOLS TXT (plain text format) ===================================================================== PBLIST - PROBLEM BASED LEARNING IN HEALTH SCIENCES From: DEAHL@thorin.uthscsa.edu The PBLIST list exists to promote discussion of problem-based learning (PBL) in health sciences education. Topics may include case-writing; tutoring and training of tutors; collaboration between departments and institutions; student perspectives on PBL; research and experiences with PBL in various courses and institutional settings; evaluation methods; and the fostering of collegial relationships in support of the goal of this list. The owners hope that interpersonal computing will enhance the use of PBL in health sciences education and bring together those educators and students who wish to share their thoughts on this subject. To subscribe to PBLIST, send the following command to MAILSERV@UTHSCSA.EDU or MAILSERV@UTHSCSA.BITNET in the BODY of e-mail: SUBSCRIBE PBLIST This is a moderated list. A complete mission statement is available from the list owners/moderators. Owners/Moderators: Tom Deahl Bill Hendricson ===================================================================== NEWS AND COMMENTARY ===================================================================== IBM SPEECH RECOGNITION SOFTWARE IBM will start shipping its Personal Dictation System software for PCs by year's end. The package has a 32,000-word vocabulary, with much of it oriented toward the medical and legal professions. The software is considered 97% accurate. (Wall Street Journal 11/3/93 B6) ===================================================================== ROBOTS DISPENSE DRUGS. Hospitals are finding that using robots to dispense drugs frees pharmacists to spend "more time monitoring patient therapy and teaching [patients] how to take medication," according to a doctor at the University of Wisconsin Hospital & Clinics. Meanwhile, nurses at the University of California San Diego Medical Center use an ATM-like machine that issues drugs for patients when the correct personal code is punched in. (Wall Street Journal 11/4/93 A1) ===================================================================== DATABASE OF EDUCATIONAL PROGRAMS IN MEDICAL INFORMATICS From: Beadenkopf@ccc.medcolpa.edu The International Medical Informatics Association now has an Internet Gopher that includes a database of educational programs in medical informatics. To access it, Telnet to consultant.micro.umn.edu (134.84.132.4) at the University of Minnesota and log in as . Select and then , , , , and from succeeding menus. For more information send email to Miriam Jaffe (mjaffe@trout.ab.umd.edu). ===================================================================== MEETINGS AND EDUCATIONAL OPPORTUNITIES ===================================================================== February 5-9, 1994 5th International Conference on Computers in Agriculture, Orlando/Kissimmee, FL From:"Jodi Horigan" . The Communication, Information, and Technology staff, Extension Service, U.S. Department of Agriculture, Washington, D.C. The 5th International Conference on Computers in Agriculture is scheduled for February 5-9, in the Orlando/Kissimmee, FL, area. The conference will provide an exchange of information on microcomputer application in all agricultural disciplines. More than 150 papers representing 19 subject areas are planned for the comprehensive program. Sessions are scheduled concurrently so that many choices are available. Hands-on experience on current software applications will be offered in open demonstrations during the conference. For complete information, contact DENNIS WATSON, University of Florida, at watson@gnv.ifas.ufl.edu; telephone: 904-392-7853, ===================================================================== March 21-23, 1994 Artificial Intelligence in Medicine - Interpreting Clinical Data, Stanford, CA. (See the Sep-Oct 1993 issue of the AVCS Newsletter for details) ===================================================================== April 24-28, 1994 First World Congress on Computational Medicine & Public Health, Austin, TX (See the May-June 1993 issue of the AVCS Newsletter for details) ===================================================================== April 27-29, 1994 Computers In Healthcare Education Symposium, Philadelphia, PA (See the Sep-Oct 1993 issue of the AVCS Newsletter for details) ===================================================================== May 4-7, 1994 American Medical Informatics Association (AMIA) Spring Congress, San Fancisco, CA The themes of the 1994 AMIA spring congress will be (1) integration of medical information systems (including patient record systems) at the institutional or enterprise level and (2) the clinical use of personal mobile computing and wireless communication systems. For further information contact: frisse@medicine.WUstl.EDU (Mark Frisse) ===================================================================== May 15-18, 1994 1994 National Extension Technology Conference, Lexington, KY ROBERT DE MATTINA, Chair, NETC-94, announces an invitation to participate in the 1994 National Extension Technology Conference, in one or more conference presentations. This year's conference, scheduled at the Lexington (KY) Radisson Plaza Hotel, May 15-18,1994, will focus on three areas: Networking and Communication; Technology; and The Human Interface. Contributors will have a variety of professional interaction formats, including traditional presentation of papers, research findings, etc.; demonstrations; and poster sessions. For more information, contact the program chairs Lee Meyer at lmeyer@ca.uky.edu, or TONI POWELL at tonilib@ukcc.uky.edu. To receive an e-mail application, contact De Mattina, at rdematti@ca.uky.edu. Deadline for submission: DECEMBER 15, 1993. ===================================================================== June 10-11, 1994 The Seventh IEEE Symposium on Computer-Based Medical Systems, Winston-Salem, NC ===================================================================== June 13-15, 1994 12th Conference for Computer Applications in Radiology, Winston-Salem, NC ===================================================================== June 25-29, 1994 ED-MEDIA 94 - World Conf. Educ. Multimedia and Hypermedia, Vancouver, Canada (See the Jul-Aug 1993 issue of the AVCS Newsletter for details) ===================================================================== August 21-26, 1994 World Congress on Medical Physics and Biomedical Engineering, Rio de Janeiro, Brazil (See the Jan-Feb 1993 issue of the AVCS Newsletter for details) ===================================================================== August 24-26, 1994 Int'l Conf on Neural Networks & Expert Systems in Med. & Healthcare, Plymouth, England For further information contact: C. Ifeachor; Plymouth Postgraduate Medical School; University of Plymouth Medical Centre; Derriford, Pymouth, United Kingdom, PL6 8DH. ===================================================================== October 16-19, 1994 ITCH '94 - Information Technology in Community Health, Victoria, B.C., Canada (See the Mar-Apr 1993 issue of the AVCS Newsletter for details) ===================================================================== October 30 - November 3, 1994. Itch'94 - Information Tech. In Community Health Victoria, B.C. Canada For further information contact James H. Coward, Chairman; Itch'94 - Information Technology In Community Health Organizing Committee; Sponsors And Exhibitors, 220; 1641 Hillside Avenue; Victoria, Bc V8t 5g1 Phone: (604) 598-3681; Fax: (604) 592-6341. ===================================================================== November 8 - 11, 1994 International Congress on Medical Informatics, Havana, Cuba For further information contact the Organizing Committee at: Congreso Internacional Informatica Medica, Habana 94; Calle M, 260; Vedado; Habana 10400; Cuba; Telephone: 53-7-329003 / 53-7-321691; Fax: 53-7-333511 / 53-7-331657; E-Mail: Swmedic@Infomed.Cu ===================================================================== September 9-14, 1995 MEDINFO'95 - 8th World Congress on Medical Informatics, Sao Paulo, Brazil (See the Jan-Feb 1993 issue of the AVCS Newsletter for details) NOTE: THE CONFERENCE LOCATION IS CHANGED TO VANCOUVER, BC, CANADA ===================================================================== RESEARCH TRAINING PROGRAM IN MEDICAL INFORMATICS - HARVARD, MIT, TUFTS We are seeking qualified applicants for the Harvard Medical School, MIT, Tufts/New England Medical Center combined training program in medical informatics, for July, 1994 or later. The combined training program offers a wide range of opportunities for education, research, and collegial interaction among the training sites. A large variety of course offerings at Harvard, MIT, and Tufts, many seminars, journal clubs, and other opportuities for exchange of information provide all trainees with opportunities to learn about the variety of work occurring at the various laboratories and in the affiliated institutions, as well as in the larger field of medical informatics. A number of associated faculty participate in the program through the research activities of each of the training sites. In addition to the research programs of the participating laboratories, we encourage the fellows to develop projects that may involve unique collaborative relationships. For more information, contact the training program office: Medical Informatics Training Programl ATTN: Robert A. Greenes, MD, PhD; Decision Systems Group, Brigham and Women's Hospital 75 Francis Street, Boston, MA 02115; (617) 732-6281; FAX: (617) 732-6317; email: greenes@harvard.edu ===================================================================== HEALTH INFORMATICS RESEARCH TRAINING - OREGON HEALTH SCIENCES UNIVERSITY The Biomedical Information Communication Center (BICC) at Oregon Health Sciences University (OHSU) is seeking qualified applicants for its National Library of Medicine-sponsored postdoctoral research training program in health informatics. With six appointed and seven adjunct faculty, the BICC is one of the country's leading institutions in health informatics research. Its health informatics training program is designed to prepare individuals for many types of careers in the application of information technology in health care. The primary focus of the program is to provide a structured research experience in one or two of the areas listed below (under Faculty Interests), along with course work in informatics. Fellows will survey the field broadly during their two to three year fellowship and will be expected to complete research projects. Upon completion of their training, they should be able to describe their results clearly in both oral and written form. The overall goals are to prepare trainees to (a) direct their own health informatics research efforts at medical centers that actively embrace the Integrated Advanced Information Management Systems (IAIMS) agenda, or (b) take leadership positions in the growing number of hospital and/or commercial efforts in health informatics. There are many opportunities for classroom learning in the program. The BICC faculty itself teaches several courses, including an introductory informatics course as well as those on advanced topics, such as information retrieval and medical decision making. Most fellows have availed themselves to a seminar series for fellows in the Division of General Internal Medicine and/or formal courses available in statistics, computer science, and decision science at nearby Portland State University. There is a degree option for a Master of Public Health with a specialization in health informatics. The BICC also provides a bi- weekly seminar, with a combination of inside and outside speakers. Applications are now being accepted for January 1, July 1, and September 1, 1994 start dates. Applications for the July and September start dates should be received no later than February 1, 1994. For more information, please contact: Kent A. Spackman, M.D., Ph.D.; Chief Medical Information Officer; Associate Director of Health Informatics BICC; Oregon Health Sciences University; 3181 SW Sam Jackson Park Rd.; Portland, OR 97201-3098; Voice: 503-494-4502; Fax: 503-494-4551; Email: spackman@ohsu.edu William Hersh, M.D.; Assistant Professor of Medicine and Medical Informatics Oregon Health Sciences University; BICC; 3181 SW Sam Jackson Park Rd.; Portland, OR 97201-3098; Voice: 503-494-4563; Fax: 503-494-4551; Email: hersh@ohsu.edu ===================================================================== MEDICAL INFORMATICS TRAINING - THE UNIVERSITY OF MISSOURI The University of Missouri offers as flexible and strongly interdisciplinary program to train both pre- and post-doctoral fellows for a career in medical informatics. The program teaches fellows how to develop, use, and evaluate innovative information systems for the health care environment. The core curriculum, consisting of seven courses from five divisions on campus, emphasizes the retrieval, synthesis, organization, management, and communication of knowledge. Upon completion of the program, all fellows are expected to have basic competency in decision support systems, computer networks, expert systems, artificial intelligence, medical subject analysis, database management systems, and applied statistics. FACULTY: One of the strengths of the MU Medical Informatics Program is the interdisciplinary nature of its faculty. The three co-directors (Drs. Mitchell, Hahn, and Sievert) hold appointments in the Schools of Medicine, Veterinary Medicine, and Library and Information Science, respectively. Seven other core faculty and numerous clinical faculty, representing the School of Nursing and programs in Health Services Management, Health Related Professions, Computer Engineering, Industrial Engineering, Computer Science, Statistics, Education, Molecular Biology, Sociology, and Anthropology, provide ample opportunity for a variety of learning experiences and research projects. Ongoing research projects include: - Expert systems, reminder systems, and knowledge-based systems - High Performance Communications and Computing (HPCC) - Clinician and student workstations - Multimedia systems for education and clinical uses - Full-text information retrieval and search heuristics - Molecular biology computing - Applications of the Unified Medical Language System - Integrated Advanced Information Management Systems (IAIMS) - Cognitive processing models - Computer-assisted continuous quality improvement - Computer vision and image analysis - Computer-generated cardiac profiles in health and disease - Randomized controlled clinical trials of informational interventions - Meta-analysis of controlled information service trials - Use of computers in the integration of clinical and business functions In addition to classwork, all fellows work with a senior researcher or team of reseachers on a research project and have weekly seminar meetings to share their research and hear invited speakers. Fellows are also provided opportunities to present their research at national meetings and publish in professional journals. Predoctoral fellows obtain PhDs in fields particulary suited to their interests and background. Suggested doctoral programs offered at MU include Electrical and Computer Engineering, Industrial Engineering, Educational and Counseling Psychology, Higher and Adult Education, and Nursing. All PhD programs allow for considerable work in outside areas; courses of study are worked out jointly by the candidate and his or her advisors, both within the Medical Informatics Group (MIG) and the department of choice. Post-doctoral fellows receive advanced training in information system development and medical informatics research, working with a faculty mentor to develop independent research projects. They will have the opportunity to write proposals, develop and evaluate systems, and publish the results of their research. Post-doctoral fellows holding clinical doctorates (MD, DO, DVM, DDS, etc) could also obtain an advanced degree such as a PhD in Electrical and Computer Engineering, Industrial Engineering, Educational and Counseling Psychology, Higher and Adult Education, or Nursing; or a master's degree in any of the above fields or in Computer Science, Health Services Management, Biostatistics, or Library and Information Science. A short-term fellowship (3-6 months) for medical and veterinary students who would like to work with a senior researcher on a research project of mutual interest is also available. Short-term fellows must be students currently enrolled in a medical or veterinary medical school. Current Trainees: In 1993-94, there are eight full-time medical informatics trainees: four predoctoral and four post-doctoral fellows. Backgrounds range from those with MDs and DVms to those with preparation in nursing, education, mathematics, computer sciences, and health services management. Requirements: All fellows must be US citizens of permanent residents of the US. Application Process: Applicants should submit a transcript of their graduate and undergraduate work, a curriculum vitae, three letters of reference, and a two-page typed statement outlining their past achievements in the medical, computer, health, and library sciences, mathematics and statistics, and education and demonstrating their interest and commitment to a career in medical informatics. Applications are considered until positions are filled. For priority consideration, please send application materials by January 1. Predoctoral fellows must also apply to and be accepted by an academic department at MU for their degree program. Students can expect to begin study in July or August 1994. For more information, contact: Joyce A. Mitchell, PhD, Director and Professor Medical Informatics Group; 605 Lewis Hall; University of Missouri-Columbia; Columbia, MO 65211; (314) 882-6966; Fax (314) 884-4270; MIGJOYCE@MUCCMAIL.MISSOURI.EDU ===================================================================== SUGGESTED READING ===================================================================== BOOKS COMPUTER-BASED DIAGNOSIS - THESIS Carter, Craig N. A Computer-Based Zoonoses Differential Diagnosis And Reference System For The Health Professions. Texas A&M University Ph.D. 1993, 215 pages. The zoonoses and the infectious and parasitic diseases common to man and animals present a difficult diagnostic challenge for health professionals. Many of the over 200 diseases which fall into this classification are rare, mimic more common illnesses, and are sparsely covered in the medical literature. As a result, they are often misdiagnosed and patients may wait weeks, months, or even years for a definitive diagnosis and appropriate treatment. To address this problem, a computer-based system and a knowledge engineering methodology has been developed which can be used as a diagnostic screening test and a medical knowledge management system for this class of diseases. The system will accept clinical signs and symptoms, occupational data, travel history, animal and vector exposure history, food and water consumption data, results of laboratory tests and diagnostic procedures and will generate a comprehensive differential diagnosis list of possible diseases using simple pattern-matching techniques. In addition, the system enables the user to build a diagnostic plan and to gain quick access to concise, engineered clinical information regarding each disease process. An historical prospective intervention study was performed using actual cases provided by the Texas Department of Health to evaluate the system. The computer intervention significantly decreased the time from first patient visit to the time of suspecting the correct diagnosis for murine typhus (p =.001) and brucellosis (p =.0001). This demonstrates that the system has the potential to be a sensitive screening mechanism. However, in order to test the specificity, field trials which include a representative sampling of patients and illnesses will have to be carried out. It is hoped that this research will result in a prototype which can then be used to develop other medical diagnostic and reference systems. ARTICLES L Gill, M Goldacre, H Simmons, G Bettley, M Griffith. Computerised Linking of Medical Records - Methodological Guidelines. Journal of Epidemiology and Community Health 47: 4 (AUG 1993):316-319 H Warner, O Barnett, R Greenes, J Cimino. A View of Medical Informatics as an Academic Discipline. Computers and Biomedical Research 26: 4 (AUG 1993):319-326 CE Kahn. Graphical Knowledge Presentation in a MUMPS-Based D:159-166 A Friede, JA Reid, HW Ory. CDC Wonder - A Comprehensive on-Line Public Health Information System of the Centers for Disease Control and Prevention. American Journal of Public Health 83: 9 (SEP 1993):1289-1294 WP Mckinney, G Bunton. Exploring the Medical Applications of the Internet - A Guide for Beginning Users. American Journal of the Medical Sciences 306: 3 (SEP 1993):141-144 JHM Zwetslootschonk, JWH Leer. Decision Analysis - A Helpful Tool for Clinicians to Establish Diagnostic Therapeutic Guidelines?. Acta Oncologica 32: 4 (1993):379-391 SR Glore, C Walker, A Chandler. Brief Communication - Dietary Habits of 1st-Year Medical Students as Determined by Computer Software Analysis of 3-Day Food Records. Journal of the American College of Nutrition 12: 5 (OCT 1993):517-520 CL Sistrom, SB Gay. Facsimile Transmission of Radiographic Images - Preliminary Experiments with a Personal Computer and a Fax Modem Board. Investigative Radiology 28: 9 (SEP 1993):860-867 UJ Balis, RD Aller, ER Ashwood. Informatics Training in United-States Pathology Residency Programs - Results of a Survey. American Journal of Clinical Pathology 100: 4 Suppl. 1 (OCT 1993):S44-S47 M Rizzardi, MS Mohr, DW Merrill, S Selvin. Interfacing United-States Census Map Files with Statistical Graphics Software - Application and Use in Epidemiology. Statistics in Medicine 12: 19-20 (OCT 1993):1953-1964 WE Marsh, DG Thawley. Information Technology, Disease and Preventive Medicine. Advancement of Veterinary Science : the Bicentenary Symposium Series, Vol 1 (1993):143-150 AD Leman. nformation Skills for Food Animal Veterinarians in the 21st-Century. Advancement of Veterinary Science : the Bicentenary Symposium Series, Vol 1 (1993):151-155 JA Longstaffe. Introduction to Computer-Based Learning and Multimedia in Veterinary and Medical-Education. Advancement of Veterinary Science : the Bicentenary Symposium Series, Vol 2 (1993):147-161 HA Verbeek, DH Scarff. Computer-Assisted Clinical Teaching - A Simulated Case Examination. Advancement of Veterinary Science : the Bicentenary Symposium Series, Vol 2 (1993):163-174 D Fletcher. New Technology for Interactive Teaching and Case Simulation. Advancement of Veterinary Science : the Bicentenary Symposium Series, Vol 2 (1993):175-180 E Schmisseur, MJ Gamroth. Dxmas - An Expert-System Program Providing Management Advice to Dairy Operators. Journal of Dairy Science 76: 7 (JUL 1993):2039-2049 DAB Lindberg, ER Siegel, BA Rapp, KT Wallingford, SR Wilson. Use of Medline by Physicians for Clinical Problem-Solving. JAMA - Journal of the American Medical Association 269: 24 (JUN 23 1993):3124-3129 MA Varner, RA Cady. Dairy-L - An Electronic Information Exchange Network for Professionals Advising Dairy Producers. Journal of Dairy Science 76: 8 (AUG 1993):2325-2331 LP Fielding. Computers in Cancer Management. Lancet 342: 8868 (AUG 14 1993):428 JL Black, GT Davies, JF Fleming. Role of Computer-Simulation in the Application of Knowledge to Animal Industries. Australian Journal of Agricultural Research 44: 3 (1993):541-555 PA Bushby. Computer-Applications in Veterinary Practice. Veterinary Practice Staff 5: 3 (MAY-JUN 1993):U1 MS Bauer. A Survey of the Use of Live Animals, Cadavers, Inanimate Models, and Computers in Teaching Veterinary Surgery. Journal of the American Veterinary Medical Association 203: 7 (OCT 1 1993):1047-1051 ===================================================================== TECHNOLOGY AND TELECOMMUNICATIONS From: Richard Holbert