The synergies among biology, computing and other formal disciplines continue to produce a unique blend of domain-specific and methodological advances that is shaping the very fabrics of the new scientific method. Among the many examples of this phenomenon, the one offered by the unrelenting growth of bioinformatics and computational biology is unique in that nowhere else is the native lexicon of a natural science more directly conducive to digital representation and manipulation.Research in Computational Molecular Biology Tenth Annual International Conference on (RECOMB 2006), which was held in Venice, Italy, on April 2–5, 2006. The RECOMB conference series was started in 1997 by Sorin Istrail, Pavel Pevzner and Michael Waterman. The previous meetings were held in Santa Fe, NM (USA); New York, NY (USA); Lyon, France; Tokyo, Japan; Montréal, Canada; Washington, DC (USA); Berlin, Germany; San Diego, CA (USA); and Boston, MA (USA). RECOMB 2006 was hosted by University of Padova in the Venice Convention Center at Cinema Palace, Venice Lido, Italy.The research articles contained in this Supplement originate from posters presented at the The Tenth Edition of RECOMB was special in several ways. For one, the Program Committee, consisting of 38 specialists of the highest distinction in the field, included all past Committee and Conference Chairs as well as the Members of the Steering Committee. The Committee selected 40 papers out of the received submissions of well over 200. Some of the accepted papers were further expanded and refereed in order to appear in the special issue traditionally devoted to the Conference. For the Tenth Edition, however, in view of the high quality of the contributions submitted for poster presentation, it was felt that another Special Issue, devoted to expanded and duly refereed versions of poster submissions was also warranted.Thus, the present Supplement constitutes one more innovation brought about by the Tenth Anniversary of RECOMB. The eight enclosed papers emerged at the outset of a rigid selection and review and represent a vivid snapshot of work mature enough to be reported within vibrant frameworks still in the making. We hope that they will start one more tradition for RECOMB.This Issue was made possible thanks to the effort of many, in particular, the special task force set up for handling posters, which consisted of Luca Bortolussi , Giovanni Ciriello , Matteo Comin , Claudio Garrutti , Giosué Lo Bosco , Sabrina Mantaci  Cinzia Pizzi , Simone Scalabrin , and Nicola Vitacolonna .We are also grateful to the external reviewers, the members of the Steering Committee and other colleagues who helped in the process. Finally, we express our thanks to the institutions and corporations who provided financial support for the conference: Broad Institute of MIT and Harvard, USA; College of Computing, Georgia Tech., USA; Department of Energy, USA; Department of Information Engineering, University of Padova, Italy; IBM Corporation, USA; ISMB, International Society for Computational Biology; AICA, Italian Association for Informatics and Automatic Computation; National Science Foundation, USA; University of Padova, Italy.


The Appalachian mountains comprise a system of ranges that begins in Quebec, Canada, passes through New York, and reaches south along the U.S. eastern seaboard to Georgia and Alabama. Portions of the mountain system are in 12 states and include ranges such as the Allegheny Mountains of Pennsylvania and the Great Smoky Mountains of Tennessee. The land is heavily forested, rocky, and sparsely populated. Traditionally, the region known as Appalachia offered two sources of income: mining in the north and farming in the south.In the 18th century, the primary inhabitants of Appalachia were American Indians, particularly the Shawnee tribes in the north and the Cherokee tribes in the south. European immigrants from Scotland, England, and Ireland followed. The descendents of these groups and of southern African Americans now comprise the primary populations of Appalachia. The northern and southern communities of this region have distinct cultures, especially in music. Coal miner songs such as "Sixteen Tons" speak to the dangers and miseries for miners and their families who reside in northern Appalachia. In southern Appalachia, vocal and instrumental music is drawn from the traditional mountain instruments of banjo and fiddle.But one common cultural trait is shared by northern and southern mountain people: poverty. Overall, the people of Appalachia are unemployed more often than people in the rest of the United States, have a lower median family income, and have lower educational levels . They alPreventing Chronic Disease (PCD) explores health-risk behaviors among the Appalachian populations. We thank Dr Eugene Lengerich of The Pennsylvania State University for serving as guest editor on this topic.Where there is poverty, there are high rates of disease. Compared with the U.S. population as a whole, residents of Appalachia have higher death rates from heart disease, cancer, cerebrovascular disease, obstructive pulmonary disease, diabetes, and infant mortality. In this issue, PCD music that reflects the region's multicultural blend.Henry Reed (1884–1968) was an accomplished West Virginia fiddler with a broad repertoire of traditional Appalachian tunes. In 1966 and 1967, folklorist Alan Jabbour recorded 184 of Reed's tunes; this collection is now housed in the American Folklife Center at the Library of Congress . In the


By Ronald J. TrentAmsterdam:Elsevier, 2005. 320 pp. ISBN: 0-12-699057-3, $79.95Molecular Medicine: An Introductory Text, like the previous editions, continues to provide a contemporary and succinct overview of DNA in medicine. Chapter topics include a history of molecular medicine, DNA, RNA, genes, and chromosomes; Mendelian genetic traits; complex genetic traits; genomics, proteomics, and bioinformatics; genetic and cellular therapies; reproduction and development; infectious diseases; forensic medicine and science; and ethical, legal, and social issues. The new chapters added to this edition represent the developments in genomics, proteomics, and bioinformatics.The third edition of Molecular Medicine valuable because the author pulls together a comprehensive assessment, highlighting Internet-based resources that greatly assist readers in further exploring the depths and details of the related topics.Many books describe DNA in medicine, from monographs to multiple-author heavy volumes, but the uniqueness of this single-author introductory textbook of molecular medicine is that it simplifies the seemingly complex concepts of DNA in medicine so that readers can find an easy entry into the world of molecular medicine. This certainly helps medical students and biomedical researcher trainees to grasp the fundamentals of the field. This book also contains many clinical examples that make the reading more relevant to practice and raise the level of interest. Senior scientists and health care professionals will also find This introductory textbook presents a well-balanced incorporation of the basic concepts, applicable clinical examples, advances in molecular biology and their impact on medicine, and gaps that will be filled by further developments in DNA biology and medicine. Emphasizing the role of DNA in molecular medicine, the book provides an interesting history of the development in DNA knowledge, covering the early discovery of DNA structure to the completion of human genome project. Detailed relationships among DNA structure, biology, and medicine highlight the role of DNA in medicine, which is further enhanced by an explanation of traditional and complex genetic traits. The incorporation of genomics, proteomics, and bioinformatics adds a new dimension. The author’s presentation of the principles of using DNA information for genetic and cellular therapies and their applications for reproduction and development, infectious diseases, forensic medicine, and basic science provides a more practical view of DNA in medicine. Finally, the discussion of ethical and legal issues, of concern to the public, brings health care professionals and laboratory scientists an awareness of the social implications of molecular medicine.The author’s definition of molecular medicine in this book—used to describe the role that knowledge of DNA is having on medical practice—may mislead readers to assume that molecular medicine has to do only with the manipulation of DNA. Posttranslational modification of proteins is a critical part of molecular medicine. Although the author has covered this aspect within the context of the book, the definition should have considered the independent role of proteins in molecular medicine as a basis for the text.This book can be recommended to medical students, health care providers, and laboratory researchers as an entry-level textbook, introductory reference, and fundamental resource for knowledge of molecular medicine. It would easily open the door for all medical professionals to molecular medicine, its past, present, and future.


This paper reviews trends and issues in health and in the information and communication technologies (ICT) market as they relate to the deployment of eHealth solutions in Latin America and the Caribbean. Heretofore designed for industrialized countries and large organizations, eHealth solutions are being proposed as an answer to a variety of health-system management problems and health care demands faced by all health organizations including those in developing societies. Particularly, eHealth is seen as especially useful in the operational support of the new health care models being implemented in many countries. The authors examine those developments vis-à-vis the characteristics of the Latin American and the Caribbean health-sector organizational preparedness and technological infrastructure, and propose policy and organizational actions to foster the development of eHealth solutions in the region. Advances in ICT and the dissemination of networked data processing created a new environment of universal access to information and the globalization of communications, businesses, and services. In the health sector, this trend is exemplified by the growing consolidation of eHealth - an area distinguished by the combined utilization of electronic communication and information technology to transmit, store, and retrieve digital data for clinical, educational, and administrative purposes, both at the local site and at distant sites. Barely in use before 1999, the concept of eHealth evolved to serve as a general designation to characterize not only networked health applications, but also virtually everything related to computers and medicine. It followed a trend started by other "e-words," such as e-Commerce, e-Business, e-Finance, e-Learning, e-Government, e-Solutions, and e-Strategies . Among lMost eHealth solutions build on e-Commerce and e-Government strategies and experiences in using Internet-based networked technologies to rethink, redesign, and rework how businesses and public services operate. Typically, such developments have been aimed at the improvement of productivity, effectiveness, and efficiency, both internally and in the relationships with clients, customers, suppliers, and partners. Reaping the full benefits of such innovative data processing and use depends on the clear definition of goals, collaboration among stakeholders, technology infrastructure, systems integration, standards, and the implementation of performance metrics.The business imperative for eHealth is concrete, is driven by the operational requirements of health reforms, and is aligned to many of the determinants found to be relevant in e-Commerce - 8:Growth of a global marketplace and the ubiquity of interactive communications.Networks of producers, suppliers, customers, and clients.Global demand for telehealth services is estimated to be of US $1.25 trillion, of which about two-thirds is for direct services and the rest for second opinion, consumer information, continuing education, management, and other services.Leasing, membership, service agreement, and strategic-alliance models replace traditional business organizations based on ownership of physical assets and long-term structures.Lifetime value of customer retention replaces "one-time sell."Economies of speed, forecasting demand, and customer service and satisfaction replace economies of scale and impersonal service provision.Customization capable of achieving a "one-of-a-kind" product or service.Leveling effect by reducing entry barriers, thus allowing small firms and poor countries and populations to have access to markets, information, and other resources, and therefore balancing the vertical integration competitive advantage of large corporations.The essence of eHealth, as in e-Commerce, is reliable transaction delivery in a fast-changing environment involving people, processes, and a business infrastructure focused on the ill or healthy citizen. In developed countries, eHealth has rapidly evolved from the delivery of online medical content toward the adaptation of generic e-Commerce solutions to the processing of health-related administrative transactions and logistical support of clinical tasks. Emerging eHealth applications are oriented to professional networking, integration of the clinical care process management, and the provision of Web-based health information and patient care, including remote monitoring and health care. This expanded view of eHealth has been promoted as the final stage in bringing the entire health care industry online.The health sector faces two demands that appear, on first examination, to be contradictory: firstly, to provide expanded and equitable access to quality health care services and, secondly, to reduce or at least control the rising costs of health care services. Although the health sector is key to the welfare of the population and the formation of human capital, the sector has not kept pace with the momentum of change that the region has experienced in recent years in other areas of economic, political, and social life.Health sector expenditures in Latin America and the Caribbean comprise 6% to 17% of the service sector that, in turn accounts for 50% to 65% of the GDP (Gross Domestic Product) in almost all countries. The market for health goods and services in the countries of the region represent 9% of the global health market, about half of that for the European Union, above that of the combined markets of Eastern Europe and Central Asia, and just below that of East Asia and the Pacific. The average per capita expenditure on health in 1999 was US $452 followed by US $1868 for the European Union, US $2206 for Canada, and US $3978 for the United States. (PPP dollars). PPP (Purchase Power Parity) relates to the purchase value of the dollar at the local market. PPP rates allow a standard comparison of real price levels between countries. The PPP for a specific country is based on market price surveys conducted by the International Comparison Program, a joint project of the World Bank and the regional economic commissions of the United Nations. The present values of PPP are based on the last survey done in 1996 and is based on a 1993 reference year.There is a marked variation  in the nChanging demographics (particularly age structures) and lifestyles  highlight the need to reorient care models. In high-income and middle-income countries, about 40% of the population has one or more chronic conditions and, in many societies, chronic conditions account for up to two-thirds of health care expenditures. In each care setting, a limited set of health conditions account for most of the cost due to the growing demand on the care system for additional and high-cost diagnostic and therapeutic resources. Significant opportunities do exist to improve health status but there are still a considerable number of preventable diseases and premature deaths, both in absolute and relative terms, and there is great inequity of access to basic health services resulting in regions, communities, and social groups being left without access to the most basic health care.In most countries, the health sector is underfinanced; this has led to quantitative and qualitative deficiencies in the delivery of health services and to growing gaps in basic care. There is inefficient allocation of scarce resources and lack of coordination between health subsectors, institutions, and other social agents and stakeholders - with duplication of efforts, overlapping responsibilities, and resource wastage. All countries are in some stage of sector reform, a process aimed at introducing substantive changes in the health sector and in the relationships among stakeholders and the roles they perform, with a view to increasing equity in benefits, efficiency in management, and effectiveness in satisfying the health needs and expectations of the population .Health reform processes have many facets and there is no single model being adopted by all countries. Each country is moving at a different pace in the implementation of its own particular health system model but the economic and globalization changes of the last 10 years have brought a new urgency to the reform processes. There are, however, common trends and responses that characterize most health sector reform processes occurring in the region: (a) the universalization of a high cost-benefit basic package of health services; (b) a set of standardized public health interventions; (c) cost containment and recovery; (d) administrative decentralization and operation of health care services; (e) recognition of the role of the private subsector and the intersectorality of health interventions ; (f) health models oriented towards primary care and centered on people; (g) focus on quality and accountability; and (h) moving away from the reactive delivery of care to a more proactive management approach of the health status of individuals and population groups . With thTechnology distribution and access problems represent the most acute issue in the dissemination of ICT applications. In a more limited focus, the "digital divide" encapsulates the dramatic worldwide variation in access to computer-based information technologies, usually more narrowly in terms of levels of Internet access, available to individuals and communities. Information-technology utilization inequalities are found in both industrialized and developing countries and are determined by level of education and income .Digital divides, like social and economic divides, exist within and not just between societies and are integral parts of a much broader and intractable "development divide" that include insufficient telecommunications infrastructure, high telecommunications tariffs, inappropriate or weak policies, organizational inefficiency, lack of locally-created content, and uneven ability to derive economic and social benefits from information-intensive activities - 18. TheIn the health sector, development and digital divides between industrialized and Latin American countries are wider than the gap observed in other productive and social sectors. In some cases, the changes brought about by the privatization of health care did add to the already high degree of structural inequity that prevails in the countries of the region. Besides achieving reliable transaction delivery, a technologically successful "e-Architecture" must provide superior client service, customization of products and services, interactivity, and maximum convenience .The deployment and operation of "e-Solutions" share technology-infrastructure and operational-deployment issues involving reliability of service that directly depend on: (a) degree of information preparedness and information technology insertion in society; (b) appropriate and functioning network, hardware and software platforms, and physical infrastructure; (c) the understanding of market relationships among the different actors in the informatics and telecommunications areas; (d) managing knowledge about health, individual client medical history, environment, and enterprises; (e) data-protection measures and regulatory framework to ensure transaction security; and (f) auditing processes that are quite different from traditional paper-trail solutions. A pervasive public-sector information infrastructure ("infostructure"), the essential prerequisite for continuous health care to the community, is still an incipient component of health systems. Penetration of information systems in health institutions is low. The hospital subsector is the area better served by information systems. Considering all facilities, public hospitals, including those belonging to the social security, account for 44.51%; private total 46.98%; philanthropic total 7.75%; and military the remaining 0.75%. There are significant differences in the utilization of computerized information systems. The relative distribution of information systems shows that social-security hospital facilities constitute only 5.29% of all establishments, but 50% have computerized information systems, followed by philanthropic (39.3%), private (36.7%), military (23.2%), and public non-social security (21.5%). However, in the group of all hospitals with computerized systems, private hospitals represent the majority (54.7%). The disparity between the existence of systems in the two types of public hospitals  is evident.Facility size is a major determinant in the capability of an institution to implement ICT and in the selection of the portfolio of applications. Of all Latin American and Caribbean hospitals, 10027 (60.53%) have 50 or fewer beds  and of tIn the past decade, the information technology sector in Latin America and the Caribbean consistently showed a growth of 17%, above all other world regions. During the last 5 years there has been fast expansion of the telecommunications market (from 7 million fixed-line and 50 million mobile subscribers in 1995 to 25.3 million and 69 million subscribers respectively in the year 2000) and very fast diffusion of the Internet . Investments in ICT as percentage of the GDP is comparable to that of developed countries although the absolute value per capita is low . Data usLow penetration of telephony, averaging 12% in the region and cost of annual subscription , and very low ownership of personal computers , and low Internet connectivity (average 3%) are major challenges to be overcome . About 2Poor telecommunications infrastructure, limited number of Internet Service Providers (ISPs), lack of access to international bandwidth, and lack of affordable Internet-access costs are readiness issues that continue to be major impediments to diffusion of Internet applications to the point of care in developing societies. Dependable connectivity is needed for reliable transactions. Fast connectivity is still limited and is usually by dial-up access. A study across different industries showed that only about one-third of the connected organizations in the region had access with speed higher than 56 Kbps (Kilobits per second) .The access-site problem can be further illustrated by the result of a 1999 survey of 42744 physicians in Brazil . The study revealed that 52% used the Internet - a level of diffusion equivalent to the general US population - however, when 23603 physicians users were asked from where they predominantly accessed the Internet, 85% indicated their home, 10% the office, and only 2% and 3% indicated the site as the university or the hospital respectively. In comparison, US physicians have the following Web access profile: 40% at the workplace, 56% at the office, 87% at home, and only 7% were not connected.On a positive note, reform of the telecommunications sector is bringing significant improvement in services and drop in tariffs as a result of greater competition and expanding markets. With the recent rapid trade liberalization and modernization of the telecommunications sector in Latin America and the Caribbean, the telecommunications infrastructure is improving. One-fourth of the 89 major public telephone operators that were privatized throughout the world by the end of 1999 were in Latin America and the Caribbean .Many market segments are becoming increasingly information-technology dependent as part of globalization ,22- 24. As is usually the case with innovation, the agents that first move into the market quickly attain a dominant position, block the entry of new competitors, and capture a large part of potential proceeds. It has been stated that the success of developed countries, particularly the United States, in taking advantage of ICT partly reflects its flexible and competitive markets. Possibly, smaller benefits can be expected in more-regulated economies or in the case of implementation environments characterized by rigid labor and trade rules and by inefficient commodity markets and capital exchanges .Cross-border challenges are particularly pressing due to the growing number of national, international, and nongovernmental actors involved in transnational and global concerns. Market capture by strong, organized, and well-funded health-provider organizations, some of international nature, is happening at a fast pace in Latin America and regulatory methods have been advocated to safeguard local competition. Intangible health "e-Solutions" products and services offered by foreign providers - as is the case with investment, insurance, knowledge dissemination, and health care applications - present great challenges to developing and poorly-developed countries and may result in flight of capital, tax evasion, employment reduction, capture of the health market, and "cultural colonization."In the area of information technology, the emphasis of intellectual rights has changed from the protection of the author/inventor to that of the investor. Implications for developing countries , welfareIntellectual property rights have been a major area of concern and conflict. The promotion of innovation is essential to any development strategy, particularly to increase international competitiveness of national enterprises. However, limiting acquisition of innovative technology only to those that are captured by the patent system ("inventions") makes a society permanently dependent on external sources. The universalization of standards for protection of intellectual-property rights has been enabled by the World Trade Organization General Agreement on Trade and Services (GATS) adopted in 1995 at the Uruguay Round of negotiations, reinforcing protection in 3 key information technology areas: computer programs, databases, and design of the layout of integrated circuits. Stakeholders concerned with such issues include nation-states; multinational business organizations; subregional trade blocks, and integration groups . In addition, country initiatives, professional and nongovernmental groups, and international organizations provide an operational and legal framework for tackling these issues. Some of these entities are being increasingly overwhelmed by market access challenges not envisioned before the diffusion of ICT.People are central in the value-added creation of eHealth products and services and an organization's human resource is the key to success . SystemsMany public health organizations in Latin America and the Caribbean are not taking advantage of existing ICT opportunities and most existing information systems are inadequate to meeting the requirements of the new models of health care being deployed in the context of health-reform initiatives. Besides the common perception among physicians that health-information systems are mostly a source for scientific and technical information, often public health authorities have a view of clinical-administrative information systems that is obsolete and frozen in a "statistical-epidemiological" archetype, designed for the collection of numerical data representing only counts of events and mostly generating only highly-aggregated statistical data and time series related to mortality, morbidity, and to service utilization and coverage. Those information systems have very little practical interest to direct-care professionals and unit managers and are far behind in providing the logistical and longitudinal individual client-based data required to operate and manage the sort of health care models being deployed in many countries.Worse still, most public health authorities are totally oblivious to the broad variety of possibilities offered by modern information and communication technologies to manage client-based data, support operations, and mine large databases. Indeed, the health sector has not applied the range of options provided by information and telecommunication technologies as effectively as have other social sectors, and health has been conspicuously underrepresented in national technology-development policies and plans. Such concerns have also been raised by traditional national statistics organizations .As a counterpoint to the passiveness of the public sector, private providers and health groups recognized that a "different" type of information system and data elements are required to run their organizations and survive in a competitive environment driven by increasing consumer demands and expectations and to deliver personalized evidence-based services. Besides using ICT resources to boost productive specialization  there are many new areas of application that are rapidly gaining ground and reducing care costs while improving the continuity and quality of care - 30. TheResources, products, and markets that are highly specialized, closed, and regulated are being swiftly opened to new players in a marketplace that is still mostly unregulated and, at the same time, when novel and untried health reform models are being introduced. These circumstances carry with them a very high unpredictability of outcomes. Although businesses and public organizations are adapting with varying speed to new processes and models, the organizational "culture," and the nature and frequency of those business-environment changes may create friction, desirable and undesirable impacts, and personal behaviors that may impede the sequence of the expected project results. Broad objectives are difficult to achieve, the best strategy is to identify the most-repetitive tasks associated with significant costs - eg, the automation of claims and reimbursement procedures - and then proceed area by area. The results of the experience with e-Commerce and e-Business over the last 2 years clearly show that the emergence, adaptation, and real-world deployment of new technologies is a complex issue teeming with uncertainties. For a number of reasons, chiefly related to the technology employed, even in the most-industrialized and computer-literate societies e-Commerce has not developed smoothly.Unfounded vendor-driven expectations of how the Internet will revolutionize health care have too often overshot their target . OverestThe lesson to be learned for eHealth is that technology is a tool, which can be justified economically only if organizations deploy it in a real-practice environment and closely track how managers and direct-care professionals are using it. This requires the stepwise development and implementation of processes and metrics to monitor productivity and impact ,31,32.Web enabling business and government operations is expensive. The United States can be used as a case example: Internet-based marketplaces can lower operational costs and improve efficiencies but deployment expenses will ordinarily cost a typical business US $5.4 million to US $23 million over 5 years. Required procedures involve changing procurement processes, integrating online and internal systems, buying applications, and paying transactions fees and intermediaries. In general, such costs have the following distribution: 32% for internal preparation; 26% for initial contracts and fees; 20% for ongoing internal management; and 22% for ongoing fees and external services . It is dAs providers and insurers soon realized, the simple automation of current processes and services and putting them in a Web-enabled environment is not feasible . A greatData security and privacy of personal health data are universal concerns and a high-priority issue in many countries. There is a growing concern regarding the protection of health records against intrusion, unauthorized use, data corruption, intentional or unintentional damage, theft, and fraud. Health data transmitted over national and international networks offer unprecedented opportunities for better patient care and community health interventions by facilitating data exchange among professionals but pose new challenges to confidentiality. The promise of the Internet to improve care by timely access to the right information can only be realized through secure connections shared across all platforms.Given the sensitive nature of health care information, and the high degree of dependence of health professionals on trustworthy records, the issues of reliability , security , and privacy (subject of data can control its use and dissemination) are of particular significance and must be clearly and effectively addressed by health and health-related organizations and professionals. Reliability, security, and privacy are accomplished by the implementation of a number of preventive and protective policies, tools, and actions that address the areas of physical protection, data integrity, access to information resources, and protection against unauthorized disclosure of information ,35. A coThis is probably one of the most serious issues in the area of Internet-based interactive health communications. The Internet offers unprecedented power to provide all users of health care information - patients, professionals, families, caregivers, educators, researchers, insurers, regulators, and policymakers - with data of unprecedented timeliness, accuracy, depth, and diversity. Yet it is equally clear that the very qualities that make the Internet such a rich marketplace of ideas - its decentralized structure, its global reach, its leveling of access to the tools of publication, its immediacy of response, and its ability to facilitate free-ranging interchange - also make the Web a channel for potential misinformation, concealed bias, covert self-dealing, and evasion of legitimate regulation. It is very difficult to ascertain and provide recommendations about the credibility, motives, sponsorship, and eventual conflicts of interest in the more than 50000 health Web sites in existence. Many websites are profit driven, others promote unproven and even dangerous forms of treatment or products, while others may be well intentioned, but contain misleading or false information ,36- 47.The Presidential Declaration of the 1998 Summit of the Americas and a number of international meetings held since then  made clear that all countries of the Americas have a common stake in improving access to and delivery of health care through communications and information technology. The recommendations presented here follow the spirit of the principles agreed by the governments of the region in the above-mentioned high-level meetings.The immediate objective is to promote the deployment of core eHealth applications and support functions by incorporating an advanced informatics component into health programs and projects, supported by a combination of funding programs, incentive grant programs, and prototype development funding programs. Elements for the development and implementation of a comprehensive national technology and policy vision, mission, and action plans for eHealth must address the following issues:Develop a telecommunications infrastructure that is comprehensive, reliable, ubiquitous, and compatible across applications - such an infrastructure must provide affordable bandwidth that is sufficient to serve the wide variety of users' specific needs. Its development will be dependent upon the continued deregulation of the telecommunications industry and will involve the leveraged use of many ICT technologies that have been spawned by and for other industries.Provide technological interfaces that facilitate effective use of the infrastructure and its component systems - these interfaces may involve systems capable of rendering information from multiple modalities, in conjunction with a variety of applications as aids to health services operational support and decision making. They will require modularity and connectivity compliant with standardized interface protocols.Implement legal and regulatory infrastructure that will facilitate medical communication - at the professional level, such issues as interstate/province licensure and credentialing of service providers must be addressed, the telecommunications and information industries must develop rational and affordable tariff structures, and legislation must be passed to ensure the protection of personal health information.Implement rational and technologically-neutral policies for public and private payers - coverage and payment policies should be established to address the entire range of eHealth applications and technologies. Means should be developed for assessing the appropriateness of health services provided via telemedicine applications. Outcome-based quality-improvement programs will be of great importance in assuring quality and cost-effective medical care.Make available appropriate content to consumers, patients, and service providers with the objective of enhancing health care outcomes - the process for conveying quality evidence-based information must permit the user to follow the links between data, inferences, and conclusions. Authentication, access control, confidentiality, integrity, and attribution are key requirements for health-related advice and decision making.A retrospective of experiences shows that continuity and sustainability of information-systems projects continue to be a major problem in the region. Externally-funded projects frequently collapse upon funding termination and this demonstrates that all projects need justification in terms of cost-benefit and long-term financial sustainability besides organizational capacity to develop and implement information systems. This further indicates that spreading the financial risk across several stakeholders may be appropriate as cost sharing increases overall awareness, utilization, and long-term potential for success.Standards development and implementation must be carried out with the public and private sectors to achieve consensus on a set of information principles for the collection, transfer, storage, and use of health data over national and global information infrastructures. Standards will be defined by a consortium of users; researchers; government, technical and scientific bodies; and the industry at 3 distinct levels: first, in terms of standardization of data and information; second, in terms of the computational facilities required to manipulate and store the information; and third, in terms of telecommunications facilities, employed to transfer information among dispersed sites.Six areas are envisioned for government involvement in eHealth development and deployment: (a) promotion of education, training, and national planning capacity in information systems and technology; (b) convening groups for the implementation of standards; (c) providing funding for research and development; (d) ensuring the equitable distribution of resources, particularly to places and people considered by private enterprise to provide low opportunities for profit; (e) protecting rights of privacy, intellectual property, and security; and (f) overcoming the jurisdictional barriers to cooperation, particularly when there are conflicting regulations.The attainment of this mandate involves participation of a large number of stakeholders, but the coordinating effort will necessarily concentrate on the public sector.Only a more-active role of government and public-private partnerships in supporting appropriate technology transfer and adaptation through indigenous research and development and the implementation of specific policies to protect local development will create an environment conducive to a reduction of the present ICT development divide. Increasing the general population's capacity to take advantage of information and communication technologies requires heavy investment in general education and training in computer skills. A serious problem for Latin America and the non-English speaking Caribbean is that most of the Internet is directed to native speakers of English and most sites and exchanges are carried out in English. Even physicians, who can generally be expected to have a working knowledge of English, may have problems with such sites. This means that investment is required to develop applications, user interfaces, and contents in national languages.Developing countries of Latin America and the Caribbean may take advantage of the accumulated knowledge and mistakes and may leapfrog developmental stages; however, this is not expected to be readily achieved due to the barriers posed by the general institutional underdevelopment, low income, illiteracy, and financial constraints that afflict many countries. It is improbable that the bridging of the health-sector development divide will be accomplished easily. In industrialized countries, it took several decades and countless institutional and organizational transformations for the consolidation of economic, institutional, and technological changes and the crystallization of long-term structural patterns necessary for information and communication technologies to spread to vast sectors of the society.The current health-sector organizational structure and national regulatory framework in Latin America and the Caribbean are not conducive to problem-oriented, interdisciplinary, rapid-response collaborative technical work, and the implementation of political, regulatory, and managerial tasks required to address multifaceted complex technological problems. Organizational and human-resources development through awareness programs, education of health staff, continuous training, and career opportunities must be institutionalized from the inception of the developmental effort. Transference of technical expertise and the appropriation of knowledge by health personnel are necessary for the full participation of end-users in the development process and the best insurance for successful implementations. Success in the deployment of institutional eHealth applications depends on the existence of staff with the right mix of skills in all functions and levels. Recommended strategies include:A structured human-resource development program defined with the goal of increasing awareness of eHealth opportunities and training health professionals to assume a leadership role and actively participate in all aspects of systems design and implementation.The training strategy will take into account issues associated with: the development, the organizational environment in which systems are expected to operate, and the specific circumstances of the local health system. The following guidelines for training should be implemented: identify target groups based on functions and training needs; develop training programs to meet identified target groups' needs; and establish a network of training focal points, taking into account the specific organization and circumstances of national characteristics and local health-unit requirements and undertakings.Target groups to be considered are: those who originate, collect and supply data; operational decision makers ; managers, planners, and policy makers; information systems managers; information technology and computing specialists; data analysts; and statisticians and researchers.Each country will develop its own strategy for initial and continuing training in health-information systems, considering the overall development of health information systems and its particular health care, educational, research, and market environment.Given that the worldwide market for information technology, products, and services in 2001 was valued at US $1086 billion and expected to grow 32% to US $1436 billion by 2004 , developDevelopment of Health Informatics in the region must be conducted in the context of a framework linking public, private, and social efforts to speed the development of priority ICT solutions. Technical knowledge, experience, and financial investments needed to establish large and complex information system projects require tapping into resources and expertise that no single organization retains. Public and private institutions, academic organizations, the industry, and financing agents must find ways to pool their assets through project partnerships and to add social value to applications of informatics by providing new employment opportunities, socioeconomic development, and educational opportunities, by promoting health, and by supporting cost-effective health services.In the international setting, cooperation between developed and less-developed countries is essential but special care must be taken to avoid interventionist behavior that ignores users' real needs, fails to understand host capacities, demands action without allowing sufficient time for conceptual assimilation, neglects cultural constraints, and ignores hosts' knowledge basis. As in many other areas of international cooperation the danger is to have too much too soon or too little too late. A possible framework for collaborative work should include support to international health issues, health care reform implementation, application development, education, and economic and technological cooperation.By demonstrating that social projects, especially health care and education, can be advanced through improved information infrastructure, international technical cooperation and multilateral agencies must collaborate with national and international authorities and experts to demand that funding institutions finance projects in such areas. Consistent with these objectives, governments must demand that international and multilateral agencies must promote and support technical cooperation activities in the development of eHealth, primarily involving knowledge transfer, technical support, facilitation of the exchange of experiences between countries, and fostering the use of appropriate technology and knowledge assets. Priority areas for technical cooperation include: priority assessment, technology evaluation and selection criteria, implementation issues, emerging technologies linking patients and providers, access to knowledge databases, consumer informatics, and the utilization of Internet and Internet-enabled technologies.Many Latin American and Caribbean countries are committed to reform their telecommunications systems. They recognize that progress in the telecommunications sector is essential to establishing health informatics and to ensuring the global competitiveness of their economies, and attention has been on liberalizing the markets. Recommendations include actions in the following areas: market access issues ; standards ; regulation ; promoting competition ; and protecting technology and intellectual-property rights.Experts agree that to be effective and efficient the health care industry must operate in a digital environment, encompassing connectivity, commerce, and community/content sites. But no one can pinpoint exactly when everything will converge. Nudging the health sector toward compliance is a valid and effective approach. The European and Canadian health care systems have used this strategy and HIPAA, the US federal Health Insurance Portability & Accountability Act, is a prime example of how the industry can be coached into complying with a variety of guidelines related to standardization, security, and privacy. In effect, HIPAA is forcing an eHealth solution on the US health care industry.Health care organizations in Latin America and the Caribbean, particularly in the public sector, are not yet prepared to adopt ICT effectively. The goal of a national health ICT vision and strategic plan of action is to establish a coherent national arrangement directed to facilitating projects and infrastructure development, maximizing the benefits for invested financial resources, and enabling people to accept and function more effectively in an informatized, evidence-based, and competitive health practice environment.Governments should focus on their role as sponsors of basic scientific and technological research, bridging the digital divide, fostering public-private partnerships, managing international cooperation efforts, and establishing the regulatory and incentive components. All stakeholders must work collaboratively to grapple with the many standardization and infrastructure-development issues and the transnational and global eHealth aspects that must be addressed in a comprehensive manner. International aspects of eHealth services form a critical and urgent area still to be addressed by the World Trade Organization and regional trade blocks. Legislation proposals should be initiated to ensure that the technology does not abridge patients' rights to confidentiality or security of medical records, and that agreement on practice parameters be developed to include aspects related to informed consent, physician liability, nonphysician liability, reimbursement, practice standards, and physician-patient relationships.The public sector, the industry, and partnerships have the responsibility for assuming an active leadership role in educating the medical community and in coordinating and encouraging the effective implementation of relevant applications. Health organizations must be provided with information about the opportunities as well as the risks of eHealth solutions. Technology-evaluation sources and results must be made available and health managers must be guided in the difficult process of specifying systems, procuring, acquiring, and contracting for ICT products and services. Knowledge repositories must be established in cooperation with the industry, centers for technology evaluation, academic research groups, and centers of excellence.


Herman P. Schwan [1915–2005] was a distinguished scientist and engineer, and a founding father of the field of biomedical engineering. A man of integrity, Schwan influenced the lives of many, including his wife and children, and his many students and colleagues. Active in science until nearly the end of his life, he will be very much missed by his family and many colleagues. Herman Paul Schwan, renowned scientist and engineer, loving and devoted husband and father, died quietly in his home in Radnor, Pennsylvania on March 17, 2005. Herman P. Schwan was born in Aachen, Germany in 1915. He obtained the German superior school certificate with distinction in Goettingen, 1934. He studied mathematics, physics, and engineering in Goettingen and then biophysics in Frankfurt. He obtained his Ph.D. in biophysics at the University of Frankfurt in 1940 with distinction, his teaching certificate at the University and his professional doctorate (Dr. habil) in the fields of physics and biophysics in 1946.Schwan worked in 1936–37 and again in 1938 with Telefunken on high frequency and microwave measuring techniques. He became a research associate with the Max Planck Institute of Biophysics in Frankfurt in 1937, an assistant professor with the University of Frankfurt and associate director of the Max Planck Institute in 1946. In 1947 he came to the United States, working at the Aeromedical Equipment Laboratory of the U.S. Naval Base in Philadelphia. He joined the University of Pennsylvania in 1950. In 1952 he was appointed Head of the Electromedical Division of the Moore School and in 1961 Chairman of the Graduate School of Arts and Sciences Group on Biomedical Electronic Engineering. In 1972 he became Chairman of the Bioengineering Department. He retired as the Alfred Fitler Moore Professor Emeritus in 1983.Over the course of his long career, Schwan published more than 300 scientific papers and gave countless lectures. He received numerous awards in recognition of his contributions, including the Edison Medal of the IEEE and the first d'Arsonval Award of the Bioelectromagnetics Society, membership in the National Academy of Engineering, and several honorary degrees. An extended biography of Schwan was published recently in the Annual Reviews of Biomedical Engineering .As a scientist, Schwan is best known for many biophysical studies related to electrical properties of cells and tissues, and on nonthermal mechanisms of interaction of fields with biological systems. He discovered or provided important theoretical insights into phenomena such as the large low-frequency dielectric dispersion that is found in biological material, and electrically induced forces on cells.2  became the basis for exposure standards in the U.S. and elsewhere. Among his many other committee activities in this field, he chaired the committee that established the first (1965) U.S. exposure limit for radiofrequency energy, for the American National Standards Institute. This standard evolved into the present IEEE C95.1 standard and was widely influential in the development of exposure limits around the world.Schwan was also deeply involved in the issue of possible health effects of nonionizing electromagnetic fields. His letter to the U.S. Navy in 1953, proposing a safe limit for human exposure to microwave energy of 100 W/mSchwan was married in 1949 to Anne Marie Del Borrello of Philadelphia. In addition to his wife, Herman is survived by five children and six grandchildren. He was a mentor to all of them, first and foremost teaching them always to think for themselves and never to just follow the crowd. A man of integrity, Schwan influenced the lives of many, including his wife and children, and his many students and colleagues.


The ultimate goal of this program announcement is to encourage the development of health research that integrates knowledge from the biomedical and social sciences. This involves the further development of health-related social science research relevant to the missions of the NIH Institutes and Centers (ICs) and the development of multi- or interdisciplinary research that blends the theories and approaches of the social and biomedical sciences. Within the broad spectrum of research identified in this announcement, applicants are encouraged (but are not required) to employ multiple  levels of analysis.This announcement invites applications to 1) elucidate basic social and cultural constructs and processes used in health research; 2) clarify social and cultural factors in the etiology and consequences of health and illness; 3) link basic research to practice for improving prevention, treatment, health services, and dissemination; and 4) explore ethical issues in social and cultural research related to health.http://obssr.od.nih.gov/Documents/Conferences_And_Workshops/HigherLevels_Final.PDF. Also see “Social Science and Health Research: Growth at the NIH,” American Journal of Public Health, 94(1) Jan. 2004:22–28. You may request these publications from the Office of Behavioral and Social Sciences Research, Office of the Director, National Institutes of Health, Bethesda, MD 20892.This program announcement is a conversion and revision of PA-02-043 and is based on recommendations submitted to the NIH in conjunction with the conference titled “Toward Higher Levels of Analysis: Progress and Promise in Research on Social and Cultural Dimensions of Health,” 27–28 June 2000, Bethesda, MD. For a summary of the conference, see Social scientists have made significant strides in shedding light on the basic social and cultural structures and processes that influence health. Social and cultural factors influence health by affecting exposure and vulnerability to disease, risk-taking behaviors, the effectiveness of health promotion efforts, and access to, availability of, and quality of health care. Social and cultural factors also play a role in shaping perceptions of and responses to health problems and the impact of poor health on individuals lives and well-being. In addition, such factors contribute to understanding societal and population processes such as current and changing rates of morbidity, survival, and mortality.Numerous reports from the Institute of Medicine and National Research Council have pointed to the importance of social and cultural factors for health and the opportunities for improving health through a better understanding of mechanisms linking the social and cultural environment to specific health outcomes. To realize these opportunities, social science research related to health must be further developed and ultimately integrated into interdisciplinary, multilevel studies of health. Linking research from the macrosocietal levels, through behavioral and psychological levels, to the biology of disease will provide the integrative health research necessary to fully understand health and illness.This program announcement invites applications for research on the social and cultural dimensions of health in five areas: 1) basic social and cultural constructs and processes used in health research; 2) etiology of health and illness; 3) consequences of poor health for individuals and social groups; 4) linking science to practice to improve prevention, treatment, health services, and dissemination; 5) ethical issues in social and cultural research.http://www.nih.gov/icd/.The goal of this announcement is to encourage further development of health-related social sciences research relevant to the missions of the ICs. These missions encompass a broad range of scientific questions related to the health and well-being of our nation's people. Information about the specific missions of the ICs participating in this program announcement is posted at Advances in social science research on health depend on a foundation of basic theory and knowledge that describes social structures, the dynamics of social and cultural processes, and the ways in which individuals are located in and interact with the environment, social structures, and cultural factors. Several key sociodemographic constructs, including race, ethnicity, gender, age, and socioeconomic status, are widely used in studies of the etiology of health and disease and in research that describes and monitors the distribution of disease across social categories, geographic areas, and time. However, the meanings of such constructs depend on their cultural, geographical, and historical context, and their utility in health research depends on their use in ways that are theoretically and historically grounded. In addition, the concept of culture requires careful theoretical grounding in health studies. Most social scientists agree that the concept of culture is complex and implies a dynamic and ever-changing process.This program announcement encourages research on basic social and cultural constructs and processes in the following areas:Research is needed to explore the implications of different conceptualizations and measurements of social stratification systems and processes, such as socioeconomic status (SES) and social class, age, gender, and race/ethnicity for understanding health at the individual and higher levels of aggregation . Research to improve the monitoring and understanding of inequalities in health and disease among diverse groups, and the implications for monitoring of strategies used to measure basic constructs such as socioeconomic status and social class, age, gender, race, and ethnicity.Critical Perspectives on Racial and Ethnic Differences in Health in Late Life, Washington, DC:National Academies Press, 2004.)The National Research Council‘s study of Critical Perspectives on Racial and Ethnic Differences in Health and Late Life discusses several issues related to racial and ethnic inequalities in health, including the nature of racial and ethnic differences, an outline of causal pathways implicated in health disparities, and a research agenda in the field of racial and ethnic differences in health. , and in social or professional organizations. However, at these levels processes contributing to social cohesion, social support, social control, social and cultural conflict, and the development and enforcement of social and cultural norms play a larger role. In families and small groups, interpersonal processes such as conflict and support, socialization, and sharing of resources play a dominant role.A valuable contribution of the social sciences is to understand health and disease not solely as an individual biological problem, but as a social phenomenon associated with social ties and other forms of social influences. From this perspective, research must address how mechanisms that link social and cultural phenomena to health operate within and emerge from specific social contexts. Social contexts provide the stage for social and cultural factors to influence health, and the characteristics of social context directly affect social and cultural processes.This program announcement encourages research on topics and questions such as the following:Research is needed to improve understanding of how macrolevel  factors, such as social policies, structures, and cultural norms, are linked to microlevel  factors, such as a person's behaviors, and ultimately to health. What are the causal pathways that lead from the sociocultural environment to general vulnerability to disease and disease-specific outcomes? Research that integrates theories and methods from the social and biomedical sciences is particularly encouraged to address these questions.Essential are studies of the implications for health of the characteristics and content of network ties and of how individuals and groups organize themselves into networks and other social arrangements, including the mechanisms through which social integration/ cohesion, social influence, and other social processes affect the health of individuals and contribute to health disparities. More research is needed on cultural processes and belief systems , at the individual, family, community, and institutional levels, and their relationships to health, including recovery from disease and addiction, with particular attention to potential mediating mechanisms .Research is considered necessary on the role of social contexts  in mediating or moderating sociocultural influences on health of individuals. Studies are required to conceptualize and measure social contexts in order to specify which particular aspects of social context are relevant to health and the mechanisms through which they operate. This includes research on how health policies impact on diverse populations, such as those defined by immigration status, gender, race/ethnicity, sexual orientation, or age, and on the pathways through which social policies  affect the health of diverse populations.Connections among health, functional capacity, and productivity are complex and difficult to disentangle, but empirical research is emerging that addresses the consequences of poor health for economic well-being at the individual, family, and population levels. Understanding the consequences of health and illness is important to the mission of the NIH. First, health disparities among groups varying in SES result in part from the reciprocal influence of SES on health and health on SES. The nature of these feedbacks needs to be fully understood if we are to understand the mechanisms underlying health disparities. Second, the value of investment in improving health can be only partially understood by focusing on health outcomes alone. For example, improvements in quality of life resulting from social, economic, and cultural change at both the individual and societal level are an important part of the picture.This program announcement encourages research on the consequences of poor health, such as the following:Research is desired on self care or self-regulation  as a response to illness and in the management of health conditions, considering the influence of social, cultural, and economic factors on the adoption and consequences of this strategy.Required are investigations of the coping strategies people use to adapt to illness and disability, the influence of social, cultural, and economic factors on these strategies, and the impact of these strategies on health and well-being at the individual, family, and community level. Research on the consequences of death and dying for the health and well-being of the deceased's relatives and friends as well as on the coping strategies people use to adapt to illness, disability, and death of a relative or close friend.Needed are studies of stigma across physical and mental health conditions (including addictions), care settings, outcomes and groups, including research on the social and cultural origins of stigmatization of illnesses. What are the implications of stigma for access to care and treatment? How does stigma affect outcomes across health conditions?http://grants.nih.gov/grants/guide/rfa-files/RFA-TW-01-001.html)Research is necessary to examine how the health of individuals impacts upon macrolevel processes and systems is also needed. How does the health of individual members of a group  affect the composition and functioning of the group? Also of interest is research on the influence of poor health on economic performance of organizations and societies. .Research is needed on cultural competence at multiple levels, including health systems, agencies and providers, with an emphasis on primary care and mental health settings. Also, research is essential to define what constitutes “culturally competent care,” develop and test different models (best practices) of culturally competent care, and test models in randomized controlled trials. Research is desired that explores the interface between traditional/ alternative and allopathic/Western medicine and health maintenance practices and identifies the circumstances under which either or both function more effectively.Research on the development, dissemination, and accessibility of new therapies, technologies and services, such as retrovirals and antipsychotics. How do social and cultural factors affect these processes and what impact do they have on services and treatment? How do social, cultural, economic, and policy mechanisms influence equitable access to health care and the quality of care received?Research is essential on the processes through which social and behavioral interventions are incorporated into general practice. What accounts for success or failure ? How does this differ from the adoption of biomedical treatments and interventions? Systematic research is required on methods to increase the adoption of tested and effective preventive interventions, treatment models, and service delivery strategies. Also increased research is needed that will allow rigorous comparisons of the effects of alternative methods of diffusion and dissemination.The development of new and more complex research methods in the social sciences, combined with dramatic advances in computing power, complicates standard ethical concerns of confidentiality, privacy, and consent. Higher levels of analysis imply analysis of data at the group, institution, or community level, raising the prospects of consent at these levels and how such consent might be obtained. Sensitivity exists not only at the individual level but also for the groups and institutions with which individuals affiliate.This program announcement encourages social sciences research on ethical issues in the following areas:Ethical issues arising from research that links the individual to groups, organizations, neighborhoods, or communities.Threats to confidentiality of data collected in multilevel studies by advancing statistical methods for masking or altering individual data and studying how such procedures impinge on the ability to conduct valid analyses.Unintended consequences of research aimed at understanding variation among individuals and among groups. How can we avoid overemphasizing individual and group differences and thereby reinforcing existing patterns of stratification in health care or other areas?Community consultation in research projects involving identified population groups. How can individual informed consent best be accomplished in this setting?This Funding Opportunity Announcement (FOA) will use the Research Project Grant (R01) award mechanism.The applicant will be solely responsible for planning, directing, and executing the proposed project.http://grants.nih.gov/grants/funding/modular/modular.htm).This FOA uses “Just-in-Time” information concepts. It also uses the modular as well as the non-modular budget formats , use the PHS398 Modular Budget component provided in the SF424 (R&R) Application Package and SF424 (R&R) Application Guide .U.S. applicants requesting more than $250,000 in annual direct costs and all foreign applicants must complete and submit budget requests using the Research & Related Budget component found in the application package for this FOA. See NOT-OD-06-096Applicants must download the SF424 (R&R) application forms and the SF424 (R&R) Application Guide for this FOA through Grants.gov/Apply.Note: Only the forms package directly attached to a specific FOA can be used. You will not be able to use any other SF424 (R&R) forms , although some of the "Attachment" files may be useable for more than one FOA.GrantsInfo@nih.gov.For further assistance, contact GrantsInfo, 301-435-0714, (telecommunications for the hearing impaired: TTY 301-451-0088), or by e-mail:http://grants.nih.gov/grants/funding/submission-schedule.htm.The application submission dates are available at http://grants.nih.gov/grants/guide/pa-files/PA-07-045.html.The complete version of this PA is available at http://grants.nih.gov/grants/guide/pa-files/PA-07-045.html.Contacts: The complete list of agency contacts is available at Reference: PA-07-045.


EHP provided a much-needed overview of the prevalence of environment noise and its effects on health  and to interact with noise exposure yielding either additive or synergistic impairment of the auditory apparatus. Research on such processes has received support in the United States from multiple agencies, including the National Institute of Environmental Health Sciences, the National Institute for Deafness and Other Communication Disorders, the National Institute for Occupational Safety and Health, and the U.S. Environmental Protection Agency.The January 2005 issue of n health . Indeed,Occupational epidemiology studies have demonstrated noise–chemical interactions in the workplace, and laboratory animal models have been effective in identifying ototoxicants, establishing dosimetry, identifying targets of toxicity, and determining the mechanisms for such ototoxicity. For example, occupational epidemiologic studies of In laboratory animals, the pioneer experiments on the ototoxicity of solvents were initiated by Pryor and Rebert in the 1980s e.g., . Since tUsing developmental models, In this laboratory, we have demonstrated that a series of chemical contaminants with potential to disrupt intrinsic antioxidant pathways or to enhance reactive oxygen species (ROS) generation can produce permanent hearing loss in the presence of noise. These agents include carbon monoxide , 2000, hThe existing evidence has clear implications for both environmental and occupational health, and it highlights the continuing need for research on the issue. In Europe, the scientific information available has influenced public health policy. In February 2003, the


Saline Systems addresses the publication needs of scientists conducting basic and applied research on coastal and inland saline environments and their flora and fauna. The journal covers research at all levels, from individual genes to whole genomes and entire ecosystems. Rapid progress in the molecular biology and microbial ecology of halotolerant and halophilic organisms and the sensitivity of many saline environments warrants an online journal with fast turnaround times. Many saline environments are threatened and the need for an Open Access journal to address the dissemination and sharing of knowledge on their conservation and management is compelling. Saline Systems provides an interdisciplinary forum for scientists working within all of the relevant fields. Saline Systems is being launched to address the publication needs of researchers exploring all aspects of saline environments. The journal is timely because rapid progress is being made in the molecular biology, genomics, and ecology of halotolerant and halophilic organisms inhabiting saline environments [ronments ,2. The aSaline environments, including coastal and inland ecosystems, harbour a substantial fraction of the biodiversity of the world. These serve as a major source of food for humankind through commercial fishing and aquaculture. About 3 billion people live near coastal communities, and escalating population growth and development are degrading the habitats critical to biodiversity and threatening the sustained vitality of coastal economies . GreaterThe primary aim of the journal is to enhance communication between and among scientists concerned with saline environments. Integration is intended to foster a deeper understanding of these critical environments world-wide, and of the halophilic and halotolerant organisms which inhabit them, as well as the underlying fundamental processes operating in them. Integration of knowledge at various levels is the hallmark of the systems biology approach. Such an approach permits information from interdisciplinary studies, from genetics and genomics, through physiology and biochemistry, to ecology and environmental biology, to be considered together, and sets the stage for predictive modelling of systems.Saline Systems include both coastal and inland regions, including natural lakes, marshes, springs, lagoons, and estuaries, and solar panes and other evaporitic and arid environments, and also their diverse micro- and macro-flora and -fauna. Specific approaches and research areas of interest include (1) the genomics, molecular biology, and environmental biology of halophilic and halotolerant organisms; (2) the limnology of salt lakes including microbial ecology, biogeochemical cycling, paleolimnology, and trophic and ecosystem dynamics; (3) the biodiversity, conservation, and resource management of saline environments; and (4) biotechnological applications of saline environments, including aquaculture.The environments of concern to Saline Systems covers the entire scope of the journal. The editorial board membership includes experts in the chemistry and biology of saline environments, including general limnology and biogeography, nutrient cycling, ecological modelling, and biostatistics, biology, taxonomy and phylogeny of halophilic archaea and bacteria, biology and ecology of halotolerant eukaryotes, including algae, fungi, protists, invertebrates, and plants, biology of Artemia, crustaceans, fish, and waterbirds, genomics and postgenomics of micro- and macroflora and fauna of saline environments, and aquatic conservation biology.The expertise of the editorial board of Saline Systems is an Open Access, online journal publishing high quality manuscripts on all aspects of basic and applied research on halophilic organisms and saline environments. A wide range of article types are published in the journal: research, book reviews, database articles, commentaries, methodology articles, short reports and reviews. Articles in Saline Systems are submitted and peer-reviewed via an online manuscript handling system, and accepted articles are published online immediately upon acceptance. In addition to the journal web site, the full text of each Open Access article is permanently archived in online repositories separate from the journal, including PubMed Central [Saline Systems become universally accessible online, and so an author's work can be freely read by anyone at no cost. Moreover, the authors hold copyright for their work, and they may grant anyone the right to reproduce and disseminate the article, provided that it is correctly cited and no errors are introduced [ Central , the US troduced .Saline Systems' policy of Open Access is highly beneficial for science and the general public. Traditional barriers to accessing research results are removed, resulting in dissemination to the widest possible audience. Authors become free to reproduce and distribute their work, for example on their institution's website. Articles are accessible beyond the traditional scientific audiences through increasingly powerful web search engines, which likely results in greater citations and higher impact [Saline Systems is not limited by library budgets, which are increasingly strained. Research published in the journal is accessible to all citizens, not just those with access to a library with a subscription. Importantly, scientists from resource-poor countries and institutions, as long as they have a connection to the internet [Saline Systems. It is very likely that our policy of Open Access will contribute toward levelling the scientific playing field and advance science.r impact ,8. Accesinternet , can accSaline Systems is that decisions about a manuscript are based solely on the quality of the work, not on whether the authors' can pay the article-processing charge. A fraction of the papers published in Saline Systems will have publication fees waived, at the discretion of the editors. Editors have no financial incentive or competing interest in articles published in the journal, and journal policies are intended primarily to advance science. We invite the entire community of scientists to contribute to the success of this timely field and its Open Access journal, Saline Systems.Another important policy of


The main objective of the developed Digital Textbook is to present the Technology associated to the most important Diagnostic and Treatment Procedures, applied in contemporary Biomedical Practice. The target-group of this on-line volume comprise of both, students and those who are already engaged in professional work, such as physicians, nurses, engineers, physicists and other people trained in health-care related activities.The educational method used includes the presentation of the physical principles, upon which the procedures and equipment under investigation are based, as well as, the most common technical implementation of them. Furthermore, care has be taken to relate the described devices to the corresponding Hospital Departments or Health-Care Facilities, and some simple demonstrations and quizzes are included, that give the user the opportunity to become a little bit more familiar with the clinical hardware. For the development of the digital textbook, HTML was used, so that it can be used on any platform. The content of the presentation is a combination of theoretical knowledge and practice oriented information. Because of the enormous extend of the subject matter, the structure of the text, is rather that of an overview. The languages used are Greek and English.The developed system consists of educational modules, which presently include topics on the following subjects:In vivo Diagnostics Technology.In vitro Diagnostics Technology.Medical Imaging Technology.Operating Room and Intensive Care Technology.Radiation Treatment Technology.Environmental Protection in the Modern Hospital.Hospital Organization and Biomedical Technology Management.The textbook covers educational needs concerning the physical principles, the most common implementations of the medical equipment and the management of the infra-structure of the basic units of the modern Hospital. The new electronic media may offer a cost-effective "digital alternative", for individuals and Institutions. An appropriate combination of traditional and on-line educational activities, could contribute to the promotion of interdisciplinary research and to the improving of the interaction between senior and junior colleagues, in the training procedure.


The authors note that the above article  containeZandagi Nawin located in the Dai Afghanan section of the city.Second, the name of the outreach and NEP program in Kabul is Last, the current locations for counseling and prevention activities are Kabul, Herat, Faizabad, Gardez, and Kandahar with Nejat Center (Kabul) and GTZ working as separate entities. GTZ is working with NGO partners KOR in Kabul and Faizabad, with Wadan in Gardez and Kandahar, and with SHRO in Herat. We apologize for any misrepresentation and thank Dr. Bayan Shairshah for bringing this to our attention.


The first results from the population-based cancer registry for the city of Hanoi, in northern Vietnam, are presented. In men, incidence rates are moderate-low with the most common cancers being lung, stomach and liver. Cancer of the penis, reportedly very common in early case series from Vietnam, is now rarely seen. In women, incidence rates are low with the most common cancer, breast cancer, having a recorded incidence similar to that in China. Cervix cancer incidence is very low, which contrasts strongly with hospital series from the south of Vietnam, and of 30 years earlier in Hanoi. The incidence of choriocarcinoma is high, and that of nasopharynx cancer (in both sexes) moderately so; both findings are typical of southeast Asian populations. The incidence rates are coherent with the results from recent studies of Vietnamese migrants in the USA and UK.


Successful commercial marketing can mean the difference between a company's profit and loss, jobs or layoffs, growth or bankruptcy. Mention the word marketing to public health professionals, and you may get blank stares, head shakes, or looks of confusion . Marketing is not well-known or understood in the public health community, in part because it is rarely taught in public health or medical schools. Nonetheless, the time has come to increase our awareness, training, and application of health marketing strategies and principles, because the field holds great promise for increasing the adoption of health promotion and protection information and interventions.Mention the word benefit the organization and its stakeholders" (emphasis added). The Centers for Disease Control and Prevention (CDC) has adapted this definition by defining health marketing as "creating, communicating, and delivering health information and interventions using consumer-centered and science-based strategies to protect and promote the health of diverse populations." Health marketing uses the science and strategies of commercial marketing to promote its products, namely, evidence-based health information and interventions. Although the ultimate goal of commercial marketing is to benefit the product "sellers" and shareholders, the ultimate goal of health marketing is to benefit the product "consumers" and the public.As we grapple with ways to best reach the public and improve health, principles of commercial marketing are an underused resource. According to the American Marketing Association , marketiThe science and practice of health marketing draws heavily from several related and often overlapping disciplines and models. Market research, marketing strategy, and public relations allow for a customer-focused approach and an emphasis on strategic planning and dissemination. Health communication, risk communication, and health promotion provide a theoretical and practical basis for message development, design, and delivery. Health marketing also draws on such diverse disciplines as relationship management; social marketing; mass and speech communication; public affairs and journalism; health education; instructional design; sociology and psychology; and the creation of audio, video, and multimedia products, among others. Almost all of the aforementioned health marketing foundations emphasize the fundamental importance of audience engagement, a creative aesthetic, and extensive formative evaluation.Preventing Chronic Disease, Maibach et al , one of the newest among 12 national centers at CDC, was established in 2004 as a result of an agencywide strategic planning process known as the Futures Initiative. The mission of NCHM is to protect and promote health and advance CDC's goals through innovative health marketing programs, products, and services that are consumer centered, high impact, and science based. All of NCHM's people and programs are committed to being customer centered by identifying and meeting the needs of our audiences and partners; being high impact by leveraging our assets, strengths, and partnerships for maximum health impact; and being science based by using and generating scientific evidence and established best practices.product design, research, and development, with our primary product being CDC's science-based health information and messages. This group includes professionals in health communication, risk and crisis communication, market research and evaluation, marketing strategy, behavioral science, and our newest area consisting of multilingual translation, cultural communication, and health literacy activities. Maibach et al note the importance of customer research to effective marketing programs, and this NCHM unit has expertise in all aspects of customer and market research, as well as access to audience-specific databases and resources useful for developing messages and campaigns. Working with subject matter and communication experts throughout CDC, this group has extensive experience developing urgent and planned health messages and campaigns on almost any health issue for diverse audiences throughout the United States and the world.NCHM's activities and capacities fall into four functional categories of marketing. First, we have a unit focused on product production and packaging, and its primary products are health information and messages. This group includes professionals in graphic art and design; audio, video, and multimedia production; animation; photography; Web development; broadcast engineering; and instructional design and production experts in other related fields. The group also has access to state-of-the art design, media, and production technology through the Global Communications Center that recently opened on the CDC campus in Atlanta, Ga.Second, NCHM has a unit focused on product distribution, which contains many of CDC's external communication channels through which health information and message products are disseminated and delivered. Maibach et al note that marketing and distribution channels are generally considered to be the most important element in the marketing mix, and CDC is fortunate to have many powerful channels for communicating with health professionals and partners, including the Morbidity and Mortality Weekly Report (MMWR), the Guide to Community Preventive Services, the Epidemic Information Exchange (Epi-X), the Health Alert Network (HAN), a professional conference exhibit booth, and many others. CDC's channels for communicating with the public include CDC's Web site (www.cdc.gov), the CDC hotline (800-CDC-INFO), the Global Communications Center gallery and exhibits, the forthcoming HHS-TV channel on the Dish Network, and many others. Together, we have a powerful array of distribution channels with which our customers can easily access and implement our products and programs.Third, we have a unit focused on customer relationship management, which coordinates CDC's new and ongoing relationships with our external partners. The active input from and relationships with our partners are one of CDC's greatest strengths. This unit works with collaborators throughout CDC to make our partner relationships as strong and as engaging as possible. As CDC's director, Dr Julie Gerberding, has noted, "CDC's partners, current and future, are critical to achieving our public health goals and to delivering our products."Finally, we have a unit focused on As Maibach et al explain, partners can also serve as a "powerful and sustainable distribution channel." In addition to relationship management, we work closely with our partners to encourage the public distribution and amplification of CDC's health information and to ensure greater alignment and consistency of health messages, particularly during crises or emergencies. Maibach et al also note the importance of engaging all sectors of society, including emerging public health partners such as for-profit businesses. NCHM actively works with all partnership sectors, including public health systems, health care organizations, education institutions and groups, and faith and community organizations, and has recently embarked on projects to form several new partnerships and products to serve for-profit businesses.Through our health marketing work, we strive to achieve our vision: a world in which all people actively use accessible, accurate, relevant, and timely health information and interventions to protect and promote their health and the health of their families and communities. Like the application of marketing to public health, NCHM is in its early days. More research, evaluation, and accumulated experience are required to effectively translate and apply the principles of marketing to public health.At the end of their article, Maibach et al state that significant public health resources, including training, should focus on health marketing strategies and that NCHM should cultivate these opportunities to blend marketing and public health. We accept our leadership role in this endeavor. We call on our colleagues and partners in public health and health marketing at all levels from all sectors to become involved and advocate for the advancement and proliferation of this discipline and perspective. Through our collaborative efforts, the blank stares, head shakes, and looks of confusion will turn to knowing, affirmative nods and smiles of recognition and understanding. We thank Maibach et al for drawing attention to marketing's usefulness and potential in advancing the field of public health.


Natural philosophy once spanned the fields of philosophy, science, and medicine. Scientific disciplines and medical specialties have rapidly achieved independence, and the availability of the internet and open-access publishing promises a further expansion of knowledge. Nevertheless, a consideration of the grounding concepts and ethical principles that underlie health care remains paramount. It is timely, therefore, to contribute to the global conversation on health care with an open-access journal that focuses on addressing the conceptual basis of medicine and related disciplines, considering the ethical aspects of clinical practice, and exploring its intersection with the humanities (including history of medicine). Open-access publishing has been a spectacular innovation for science and medicine, giving readers rapid and free access to new information, and launching a global conversation on health care. Health care researchers and practitioners have, in turn, busily produced new basic experiments, clinical trials, and reviews and guidelines for publication on the world-wide web, spurring further virtual debate and discussion. It is timely, we believe, to contribute to this conversation by making space for an open-access journal that takes a particularly broad view of health care, addressing the conceptual basis of medicine and related disciplines, considering the ethical aspects of clinical practice, and exploring its intersection with the humanities (including history of medicine).Those interested in the conceptual and historical roots of medicine will not need reminding that early on work in natural philosophy spanned philosophy, science, and medicine. While scientific advances have led to the development of an ever-growing range of scientific disciplines and medical specialties, a consideration of the grounding concepts and ethical principles that underlie health care remains as crucial as ever. Indeed, advances in knowledge, and changes in practice, mean that these grounding concepts and ethical principles require constant reconsideration and reworking. This, then, is the work of philosophy of medicine, of bioethics, and of work at the overlap between the clinic and the humanities.Philosophy, Ethics, and Humanities in Medicine is the first open-access journal that aims to expand the discussion on health care by focusing on the intersection between philosophy, ethics, and the humanities and clinical theory and practice. The arguments for open access have been outlined previously; authors are ensured of wide dissemination of their work and are at liberty to further reproduce and disseminate their articles, readers can find articles on standard search engines and obtain ready access regardless of the quality of their libraries, and taxpayers are easily able to review the outputs of publicly funded research [To our knowledge research . The advIn the spirit of open-access publishing and the internet conversation on health care, we will encourage a broad range of submissions, hoping to attract authors from different disciplines. Details of our editorial board and editorial policy are available on the journal's website . The jouWe hope that those working at the intersection between philosophy, ethics, the humanities and clinical theory and practice will become increasingly aware of the value of open-access publication, and will use the journal to contribute to the ongoing global conversation on health care. We are aware, on the other hand, that this is an intersection that has relatively little funding and few full-time researchers, and so attracting a steady flow of articles and discussion represents a considerable challenge. But if the good practice of medicine necessarily requires a good conceptual base – then we have little choice but to launch this journal, and to attempt to extend the virtual debate on health care to address its foundational constructs and practices.Dan Stein has received research grants and/or consultancy honoraria from Astrazeneca, Eli-Lilly, GlaxoSmithKline, Lundbeck, Orion, Pfizer, Pharmacia, Roche, Servier, Solvay, Sumitomo, and Wyeth.


Concerning the 25 year history and milestones of the National Toxicology Program (NTP), Among others, Congressman David Obey (Wisconsin) was convinced by Rall and key colleagues that a coordinated national program was needed to better promote the health of the American people by protecting them from exposures to hazardous chemicals in the workplace, environment, and home. Obey was instrumental in getting Congress to endorse this need for a national program and, after Rall’s untimely death, encouraged Congress to name the main structure housing NIEHS/NTP in Research Triangle Park, North Carolina, as the David P. Rall Building.Rall was supported in this innovative and monumental NTP-forming effort by several other distinguished pioneers in environmental health research and public health, including Eula Bingham, then director of the Occupational Safety and Health Administration; Joseph Califano, then Secretary of the Department of Health, Education, and Welfare ; Donald Fredrickson, then director of the National Institutes of Health; Donald Kennedy, then director of the Food and Drug Administration; Cesare Maltoni, then director of the Bologna Centre for the Prevention and Detection of Tumours and Oncological Research; Norton Nelson, then director of the Institute of Environmental Medicine  New York University School of Medicine; Irving Selikoff, then director of the Mt. Sinai Medical Center in New York City ; Lorenzo Tomatis, then chief of the Unit of Chemical Carcinogenesis, International Agency for Research on Cancer (later director of IARC); and Arthur Upton, then director of the National Cancer Institute.Report on Carcinogens (Environmental Health Perspectives. Of course, during his illustrious career as physician, assistant surgeon general, scientist, and staunch public health advocate, Rall made many more and varied contributions to basic sciences and public health (Also, during that NTP-formative era, Rall helped establish the 1978 Public Law that initiated the innovative cinogens . Now in c health .David P. Rall, a dedicated physician and scientist, is among a relativity small group of exceptional public servants who have had a deep and lasting positive impact on human health by showing us how to understand and improve the environment in which we live, work, and play. To many of us who joined with him to make a safer environment, we clearly recognize the void he has left.