Medical image quality as a socio-technical phenomenon.

OBJECTIVES: The study aims to interpret image quality in laparoscopic surgery not only as a technical parameter but also as the result of the situation of use. METHODS: Observational studies of laparoscopy in use, semi-structured and informal interviews with laparoscopists. RESULTS: When medical images are digitized to exploit novel technical possibilities, image quality becomes a paramount issue. Image quality is often discussed exclusively in technical terms, but the socio-technical study of image quality in surgical telemedicine presented in this paper showed that it is definitely more than a purely technical parameter. CONCLUSIONS: While the resulting quality of the image was significantly shaped by the persons involved, the concept of "quality" itself was also relative and changing with the situation of use. A given technology does not determine image quality. Rather than focusing only on the technical quality, the attention of designers and decision makers should also be directed to the socio-technical network surrounding the image and its use.

Design as bootstrapping. On the evolution of ICT networks in health care.

OBJECTIVES: This paper assumes that in addressing major challenges related to telemedicine as networks enabling huge improvements of heath services we need to move beyond complexity and rather focus on the very nature of such networks. METHODS: The results of this paper are based on an interpretive analysis of three case studies involving telemedicine, i.e. broadband networks in minimal invasive surgery, EDI infrastructures and telemedicine in ambulances. RESULTS AND CONCLUSION: The well-known concept of "critical mass" focuses on the number of users as a significant factor of network growth. We argue however, that we should not only consider the size of the network, but also the heterogeneity of its elements. In order to discuss heterogeneity along several dimensions, we find Granovetter's and Schelling's models of diversity in individual preferences helpful. In addition to the heterogeneity of the individual users, we discuss heterogeneity related to use areas and situation, to technologies, etc. The interdependencies and possible conflicts between these dimensions are discussed, and we suggest "bootstrapping" as a concept to guide the navigation/exploitation in/of these dimensions.

Hormones and metabolites of arctic foxes (Alopex lagopus) in response to season, starvation and re-feeding.

Svalbard's arctic foxes experience large seasonal variations in light, temperature and food supply throughout the year, which may result in periods of starvation. The aim of this work is to investigate if there are seasonal variations in post-absorptive plasma thyroid hormones (free thyroxin (fT(4)), free triiodothyronine (fT(3)) and reverse triiodothyronine (rT(3))) and metabolites (free fatty-acids (FFA) and beta-hydroxybutyrate (beta-OHB)) with season and their response to starvation and re-feeding. The concentrations of post-absorptive free triiodothyronine were significantly higher in November than May, while those of thyroxin, reverse triiodothyronine, free fatty-acids and beta-hydroxybutyrate remained unchanged. Possible explanations for the seasonal variations in free triiodothyronine are discussed. There were no significant changes from post-absorptive concentrations of thyroxin and reverse triiodothyronine in starved and re-fed foxes. However, free triiodothyronine concentrations decreased during starvation and increased again with re-feeding both in May and November. Starvation induced high levels of free fatty acids in both May and November, indicating increased lipolysis. There was a significant increase in beta-hydroxybutyrate in November only, indicating that arctic foxes are capable of protein conservation during starvation.

[Telemedicine collaboration between the Rikshospitalet and the Ulleval hospital]. / Telemedisinsk samarbeid mellom Rikshospitalet og Ullevål sykehus.

BACKGROUND: During the last two years the Intervention Centre at the Nation Hospital of Norway and Ullevål Hospital have pursued a research programme in telemedicine aimed at exploring the potential of inter-hospital collaboration. MATERIAL AND METHODS: Both hospitals established a communication network between operating rooms and lecture halls. Sound and video from minimally invasive surgical and radiology procedures were transmitted on a wide bandwidth ATM network (34 Mbits/s) to gain experience with the use of telemedicine for educational purposes and the treatment of patients. RESULTS: Evaluations of technical off-line and clinical line transmissions have given us helpful information about the potential of telemedicine and what it will take to utilise this potential. With the MPEG2 standard, a wide bandwidth network yields sufficient sound and image quality for educational and clinical collaboration. However, multimedia communication requires changes in the organisation to secure quality of service in relation to technical management and telemedical production. INTERPRETATION: Inter-hospital collaboration on telemedicine may be a resource in clinical practice, facilitating professional enhancements, particularly in surgery, radiology and internal medicine. Changes in the organisation are needed, but they are feasible.

Epidermal growth factor stimulates the prolactin synthesis and secretion in rat pituitary cells in culture (GH4C1 cells) by increasing the intracellular concentration of free calcium.

Epidermal growth factor (EGF) stimulated the prolactin (PRL) synthesis and release from the GH4C1 cells in a dose-dependent manner. The ED50 was between 10(-11) and 10(-10) mol/l. The maximal effect was obtained at 10(-9) mol/l EGF for the release, and 10(-8) mol/l EGF for the synthesis. EGF stimulated the release of PRL from cell perfusion columns after a lag period of about 30 s. The maximal secretion of PRL occurred about 60 s after the start of stimulation. The PRL secretion declined to basal levels within 2 min. The EGF-stimulated PRL release was additive to the secretion evoked by thyrotropin-releasing hormone (TRH) and vasoactive intestinal peptide (VIP). An instantaneous increase in the intracellular concentration of free calcium, [Ca2+]i, of the GH4C1 cells was observed after the administration of EGF. EGF modified neither the basal nor the TRH-stimulated inositoltrisphosphate production in the GH4C1 cells, and EGF did not show any effect on the cyclic adenosine monophosphate production of these cells.