Powerful connections for public health: the National Library of Medicine and the National Network of Libraries of Medicine.

As incorporated in Healthy People 2010 objectives, data and information systems and a skilled workforce are 2 of the critical components of the public health infrastructure. The National Library of Medicine (NLM) and the National Network of Libraries of Medicine (NN/LM) are important resources for improving Internet access and providing related training to the public health workforce and to those in training for public health careers. The NLM and the NN/LM have joined forces with the Centers for Disease Control and Prevention, the Health Resources and Services Administration, the Association of State and Territorial Health Officials, the National Association of County and City Health Officials, and the Public Health Foundation. The goal of this collaboration is to improve electronic resources useful in public health practice and increase awareness of them, to train public health professionals to use electronic information services, and to help public health agencies obtain the equipment and Internet connections needed to use these services effectively. The databases, outreach programs, and connection grants available to public health professionals from the NLM, and the training and ongoing support available from the NN/LM for accessing these programs and services, are described.

Community hospitals and the Internet: lessons from pilot connections.

Community hospitals in rural and isolated areas have had little access to the Internet. In 1992, the National Library of Medicine funded a pilot project to be conducted by the University of Washington and seven community hospitals in the northwestern United States. The goals of the project were to connect the hospitals to the Internet and study the uses made of this resource. A number of administrative, technical, financial, and organizational problems were dealt with in the attempt to establish the Internet connections and introduce this resource to these health care settings. This paper examines these issues and presents conclusions drawn from the experiences of the project team.

An operational view of the role of health librarians in informatics.

The National Library of Medicine is currently funding the Pilot Connections project to promote and support use of the INTERNET in community health care settings. With previous networking applications of this kind largely confined to academic and research environments, the health librarian has emerged as the agent with the unique knowledge and skills to participate in and manage organizational change. An experiment in applied informatics, the Pilot Connections project shows how health librarians should be aware of the expanding opportunities that exist for them to help their organizations cope more effectively with the external trends and forces currently affecting the role and value of information.

From bench to bedside: research and testing of Internet resources and connections in community hospital libraries.

Access to information becomes more valuable with the continuing proliferation of medical knowledge and the increasing economic pressure being experienced by health care organizations. This is particularly so for community hospitals in rural or isolated areas, where the economic pressures are at least as great as in urban areas and where access to information is often inadequate. These conditions have implications for the quality of patient care and for economic viability. In response to this, the National Library of Medicine, the University of Washington, and seven community hospitals in five Pacific Northwest states have joined forces in a broad-scale technology diffusion project to facilitate the application of research work to clinical care. There are three components to the project: 1) a pilot connections component to extend Internet access to the community hospitals, 2) a research component to test the performance of a client/server model for network access to anatomical text and images, and 3) a clinical component to develop a registry of DNA diagnostic laboratories facilitating the provision of genetic information to clinicians. The pilot connections component is described and preliminary findings are reported.

Tissue compliance in superficial tissues along body axis in man.

A previously described miniature plethysmograph which allowed the measurement of tissue volumes in superficial tissues was enclosed in a small plexiglass chamber and attached to the frontal area, sternum, dorsum and the tibia. The tissues interposed between bone and skin underneath the chamber were exposed to pressures between +/- 3 and +/- 15 mmHg in order to test tissue deformability. The pressure application induced within the first 5 s a fast component of tissue deformation comprising between 75-90% of the total deformation followed by a slow component which lasted till the end of the pressure application. The highest deformability was found in the tissues of the sternum and dorsum whereas the stiffest tissues were in the pretibial area. Assuming the tissue deformation is due to a translocation of fluid into or out of the pressurized tissue, the tissue compliance was calculated. This calculated tissue compliance was 19.2 ml . 1,000 ml-1 . mmHg-1 in the sternum and 6.4 ml . 1,000 ml-1 . mmHg-1 (P < 0.01) in the pretibial area applying a pressure of +/- 3 mmHg. The differences observed are due to the morphological arrangement of the tissue fibres which in turn have to counteract the gravity forces to which the tissues are usually exposed during upright standing.