An overview of the CERC ARTEMIS project

The basic premise of this effort is that health care can be made more effective and affordable by applying modern computer technology to improve collaboration among diverse and distributed health care providers. Information sharing, communication, and coordination are basic elements of any collaborative endeavor. In the health care domain, collaboration is characterized by cooperative activities by health care providers to deliver total and real-time care for their patients. Communication between providers and managed access to distributed patient records should enable health care providers to make informed decisions about their patients in a timely manner. With an effective medical information infrastructure in place, a patient will be able to visit any health care provider with access to the network, and the provider will be able to use relevant information from even the last episode of care in the patient record. Such a patient-centered perspective is in keeping with the real mission of health care providers. Today, an easy-to-use, integrated health care network is not in place in any community, even though current technology makes such a network possible. Large health care systems have deployed partial and disparate systems that address different elements of collaboration. But these islands of automation have not been integrated to facilitate cooperation among health care providers in large communities or nationally. CERC and its team members at Valley Health Systems, Inc., St. Marys Hospital and Cabell Huntington Hospital form a consortium committed to improving collaboration among the diverse and distributed providers in the health care arena. As the first contract recipient of the multi-agency High Performance Computing and Communications (HPCC) Initiative, this team of computer system developers, practicing rural physicians, community care groups, health care researchers, and tertiary care providers are using research prototypes and commercial off-the-shelf technologies to develop an open collaboration environment for the health care domain. This environment is called ARTEMIS--Advanced Research TEstbed for Medical InformaticS.

ARTEMIS: a collaborative framework for health care

Patient centered healthcare delivery is an inherently collaborative process. This involves a wide range of individuals and organizations with diverse perspectives: primary care physicians, hospital administrators, labs, clinics, and insurance. The key to cost reduction and quality improvement in health care is effective management of this collaborative process. The use of multi-media collaboration technology can facilitate timely delivery of patient care and reduce cost at the same time. During the last five years, the Concurrent Engineering Research Center (CERC), under the sponsorship of DARPA (Defense Advanced Research Projects Agency, recently renamed ARPA) developed a number of generic key subsystems of a comprehensive collaboration environment. These subsystems are intended to overcome the barriers that inhibit the collaborative process. Three subsystems developed under this program include: MONET (Meeting On the Net)--to provide consultation over a computer network, ISS (Information Sharing Server)--to provide access to multi-media information, and PCB (Project Coordination Board)--to better coordinate focussed activities. These systems have been integrated into an open environment to enable collaborative processes. This environment is being used to create a wide-area (geographically distributed) research testbed under DARPA sponsorship, ARTEMIS (Advance Research Testbed for Medical Informatics) to explore the collaborative health care processes. We believe this technology will play a key role in the current national thrust to reengineer the present health-care delivery system.

The role of syllabic and orthographic properties of letter cues in solving word fragments

The present research examined the role of phonological and orthographic properties of cues in mediating the retrieval of words from the mental lexicon. The task required subjects to resolve fragmented words when provided with semantically related cues (e.g., spiteful:---DIC----). Phonological properties of the letter cues were manipulated such that the letters either corresponded to the syllables (e.g., DIC in vindictive) or nonsyllables (NDI) in the word. Orthographic properties of the letter cues were manipulated by selecting letter groups that either co-occurred frequently in the language or did not. In two experiments, results revealed little or no effect of the phonological variable (syllables) but a reliable effect of the orthographic variable (letter-cue frequency). Letter cues with a low frequency of co-occurrence in the language led to better completion of the fragmented words. We interpret these findings as support for models of lexical representation that are based on orthographic properties (e.g., Seidenberg & McClelland, 1989) rather than those based on phonological constraints.

Specifying criteria for postulating memory systems

We have examined four criteria commonly used to distinguish separate memory systems: functional dissociation, independent neural systems, stochastic independence, and functional incompatibility. Current evidence fails to jointly satisfy these criteria in establishing independent systems, at least by our assessment. However, the proposed criteria are not all weighted equally in the literature. Certainly dissociation experiments, especially of neuropsychological patients, are weighted strongly in most formulations relative to the other three criteria. If all four criteria are considered equally important, as they should be in our opinion, evidence for the putative systems is much less clear-cut at this point, as indicated in our review.

High incidence of subacute sclerosing panencephalitis in south India

During 1983-7 a clinical diagnosis of subacute sclerosing panencephalitis (SSPE) was confirmed by the detection of measles virus haemagglutination inhibiting antibody in the cerebrospinal fluid (CSF) in 81 subjects resident in Tamilnadu. The antibody titre (reciprocol of the end-point dilution) in the CSF ranged from 2 to 32 and in the sera from 8 to 2048. The CSF:serum ratios of titres were 1:4-1:64 in 80 cases and 1:128 in one case. The median age at onset of SSPE was 10 years and 97% of cases were diagnosed at stage 2 and beyond. Based on the geographic distribution of 72 cases in an estimated population of 8.4 million, the annual incidence of SSPE was calculated to be 2.14 per million population, or 4.3 cases per million children below 20 years. Assuming that only 10% of all cases would have reached the level of laboratory diagnosis, the incidence may be as high as 21 cases per million population.

Sodium valproate in Sydenham's chorea

Five patients with a moderate to severe degree of Sydenham's chorea were treated with sodium valproate for their involuntary movements. Within a week of commencement of treatment, the choreic movements disappeared completely. Sodium valproate appears to be a promising drug in the management of Sydenham's chorea.

Unusual CT scan findings in pseudohypoparathyroidism

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