A target of telehealth is to maintain or improve the health of people outside the normal healthcare infrastructure. A modern paradigm in healthcare, and one which fits perfectly with telehealth, is "person self-monitoring", and this fits with the concept of "personal health record"(PHR). One factor in maintaining health is to monitor physiological parameters; this is of course especially important in people with chronic maladies such as diabetes or heart disease. Parameters to be monitored include blood pressure, pulse rate, temperature, weight, blood glucose, oxygen saturation, electrocardiogram (ECG), etc. So one task within telehealth would be to help monitor an individual's physiological parameters outside of healthcare institutions and store the results in a PHR in a way which is available, comprehensible and beneficial to the individual concerned and to healthcare providers. To date many approaches to this problem have been fragmented - emphasizing only part of the problem - or proprietary and not freely verifiable. We describe a framework to approach this task; it emphasizes the implementation of standards for data acquisition, storage and transmission in order to maximize the compatibility among disparate components, e.g. various PHR systems. Data from mobile biosensors is collected on a smartphone using the IEEE 11073 standard where possible; the data can be stored in a PHR on the phone (using standard formats) or can be converted in real-time into more useful information in the PHR, which is based on the International Classification for Primary Care (ICPC2e). The phone PHR data or information can be uploaded to a central online PHR using either the Wi-Fi or GSM transmission protocol together with the Continuity of Care Record message format (CCR, ASTM E2369).

Utilizing the multiple degrees of freedom offered by the data glove for each finger and the hand, a novel on-line signature verification system using the Singular Value Decomposition (SVD) numerical tool for signature classification and verification is presented. The proposed technique is based on the Singular Value Decomposition in finding r singular vectors sensing the maximal energy of glove data matrix A, called principal subspace, so the effective dimensionality of A can be reduced. Having modeled the data glove signature through its r-principal subspace, signature authentication is performed by finding the angles between the different subspaces. A demonstration of the data glove is presented as an effective high-bandwidth data entry device for signature verification. This SVD-based signature verification technique is tested and its performance is shown to be able to recognize forgery signatures with a false acceptance rate of less than 1.2%.

I suggest that the extended maturation time of some regions of the human neocortex is the uniquely human factor which allows the development of language, creativity and madness. The genetic event or events which contribute to the long delay to final maturation occurred at or after the speciation of Homo sapiens sapiens. Neocortical growth may follow the previously detailed "balloon model", which suggests that intra- and subcortical myelin production during development physically stretches each local area of the cortex tangentially to the pial surface, thereby causing neuronal columns to become more disjoint and more functionally independent, thereby increasing the functional capacity of the area [Seldon HL. Does brain white matter growth expand the cortex like a balloon? Hypothesis and consequences. Laterality 2005;10(1):81-95]. This occurs in addition to Hebbian synaptic modeling. Therefore, the size and functional capacity of each cytoarchitectonic area of each individual adult neocortex are the outcomes of partly deterministic (e.g., genetic) and partly statistical growth processes with numerous factors including environmental stimuli and fatty acid content in diets. The possible functional capacity and variation among growth outcomes increase with the length of time allowed to "finalize" synaptic weights, myelination and other plastic processes. For example, acquisition of quite differing linguistic skills becomes possible only in Homo sapiens because of the extended, decades-long plasticity of temporal lobe areas; in contrast, tactile skills vary little among human races and cultures, or even among higher primates, because of the faster maturation of the somatomotor areas. Some of the statistically extreme variations of the neocortical growth processes lead to abnormal cognition and behavior called "madness" or "genius". This maturation hypothesis overcomes some problems with those based purely on fatty acid metabolism or on functional asymmetry (non-human species show functional asymmetry, but no language. Neanderthals had brains comparable in size and shape to ours, but failed to develop language or creativity). This hypothesis implies that the search for genetic factors should include those which influence the temporal regulation of neuronal and myelin growth, but it also allows the development of unusual creativity or madness as a statistical extreme in the absence of any deterministic factors. It has implications about our attitudes toward mental "disorders" and about potential approaches to treating some of them - for example, attempting communication and conditioning via those senses and cortical areas which show less variation and are less affected.

BACKGROUND There is a lack of literature about health information systems (HIS) in "developing" countries, including Vietnam. However, computerization and network development are proceeding in these places, although not in a systematic, transparent way. OBJECTIVE This is a preliminary overview of HIS's and healthcare communications in Vietnam's four-tiered public healthcare system. It is to indicate the direction that nation might take in order to establish a modern, standards-compliant, national HIS. METHODS We conducted site visits and interviews in Hanoi and nearby provinces. Additional information was derived from publications of the Vietnamese government and the United Nations. RESULTS Many of the top-level "central" hospitals have HIS's, although their quality and daily usage varies. Fewer provincial hospitals have networks; district hospitals have a few stand-alone computers, and commune health centers have no computers. Patients often go directly to higher-level providers, due to a widely held perception of better care at such sites. Communications among healthcare units are largely on paper, consisting mostly of administrative matters and some hand-written patient referrals. Telephones are used for discussions of specific matters. Internet connections are almost all dial-up and often belong to individual staff members rather than the healthcare units. Lower-level units derive much of their general medical information from television and newspapers. However, there is considerable interest in computerization among healthcare workers at all levels. CONCLUSION Familiarization with computerized communications, i.e., training and hardware at all healthcare levels, must be the first step towards a modern healthcare communications network in Vietnam. The skills to do this already exist. The aim of such a network must be to raise the level of information and quality of care at the lower levels. Adherence to international standards, such as HL7, from the beginning would enable the country to bypass many years of haphazard development.

Horrobin (2001) has proposed that phospholipid metabolism is linked to human brain growth, and that deviations in the metabolism may be linked to creativity as well as mental disorders. The present literature review leads to a framework or model which states that brain white matter growth causes the overlying cortex to expand tangentially, like a balloon, and that this expansion affects the cortex's capacity to differentiate afferent signals. The neuroanatomical description of this model is based on publications linking human white matter growth and mass to the thickness of the overlying cortex, and of some linking cortical thickness and surface area (inversely). The link between the surface area of a cortical region and its differentiation capacity is based on previous work on hemispheric differences and functional lateralisation in the human auditory cortices. The link between differentiation capacity and inappropriate responses or "loose associations" is based on publications linking perceptual deficits and abnormal cortical structure, especially abnormal laterality. Finally, perceptual deficits have been linked to aspects of schizophrenia or other "disorders".

This department highlights topics in nursing outcomes, research, and evidence-based practice relevant to nurse administrators. In this article, the authors describe patient access to personal health information as it relates to the meaningful-use requirement, technologies that have been used to enhance patient engagement, and the nursing leadership implications.

OBJECTIVE: The Department of Veterans Affairs (VA) operates one of the largest nationwide healthcare systems and is increasing use of internet technology, including development of an online personal health record system called My HealtheVet. This study examined internet use among veterans in general and particularly use of online health information among VA patients and specifically mental health service users. METHODS: A nationally representative sample of 7215 veterans from the 2010 National Survey of Veterans was used. Logistic regression was employed to examine background characteristics associated with internet use and My HealtheVet. RESULTS: 71% of veterans reported using the internet and about a fifth reported using My HealtheVet. Veterans who were younger, more educated, white, married, and had higher incomes were more likely to use the internet. There was no association between background characteristics and use of My HealtheVet. Mental health service users were no less likely to use the internet or My HealtheVet than other veterans. DISCUSSION: Most veterans are willing to access VA information online, although many VA service users do not use My HealtheVet, suggesting more education and research is needed to reduce barriers to its use. CONCLUSION: Although adoption of My HealtheVet has been slow, the majority of veterans, including mental health service users, use the internet and indicate a willingness to receive and interact with health information online.

BACKGROUND The Internet has become one of the most important means to obtain health and medical information. It is often the first step in checking for basic information about a disease and its treatment. The search results are often useful to general users. Various search engines such as Google, Yahoo!, Bing, and Ask.com can play an important role in obtaining medical information for both medical professionals and lay people. However, the usability and effectiveness of various search engines for medical information have not been comprehensively compared and evaluated. OBJECTIVE To compare major Internet search engines in their usability of obtaining medical and health information. METHODS We applied usability testing as a software engineering technique and a standard industry practice to compare the four major search engines (Google, Yahoo!, Bing, and Ask.com) in obtaining health and medical information. For this purpose, we searched the keyword breast cancer in Google, Yahoo!, Bing, and Ask.com and saved the results of the top 200 links from each search engine. We combined nonredundant links from the four search engines and gave them to volunteer users in an alphabetical order. The volunteer users evaluated the websites and scored each website from 0 to 10 (lowest to highest) based on the usefulness of the content relevant to breast cancer. A medical expert identified six well-known websites related to breast cancer in advance as standards. We also used five keywords associated with breast cancer defined in the latest release of Systematized Nomenclature of Medicine-Clinical Terms (SNOMED CT) and analyzed their occurrence in the websites. RESULTS Each search engine provided rich information related to breast cancer in the search results. All six standard websites were among the top 30 in search results of all four search engines. Google had the best search validity (in terms of whether a website could be opened), followed by Bing, Ask.com, and Yahoo!. The search results highly overlapped between the search engines, and the overlap between any two search engines was about half or more. On the other hand, each search engine emphasized various types of content differently. In terms of user satisfaction analysis, volunteer users scored Bing the highest for its usefulness, followed by Yahoo!, Google, and Ask.com. CONCLUSIONS Google, Yahoo!, Bing, and Ask.com are by and large effective search engines for helping lay users get health and medical information. Nevertheless, the current ranking methods have some pitfalls and there is room for improvement to help users get more accurate and useful information. We suggest that search engine users explore multiple search engines to search different types of health information and medical knowledge for their own needs and get a professional consultation if necessary.

UNLABELLED ABSTRACT: BACKGROUND Over the last few decades, the ever-increasing output of scientific publications has led to new challenges to keep up to date with the literature. In the biomedical area, this growth has introduced new requirements for professionals, e.g., physicians, who have to locate the exact papers that they need for their clinical and research work amongst a huge number of publications. Against this backdrop, novel information retrieval methods are even more necessary. While web search engines are widespread in many areas, facilitating access to all kinds of information, additional tools are required to automatically link information retrieved from these engines to specific biomedical applications. In the case of clinical environments, this also means considering aspects such as patient data security and confidentiality or structured contents, e.g., electronic health records (EHRs). In this scenario, we have developed a new tool to facilitate query building to retrieve scientific literature related to EHRs. RESULTS We have developed CDAPubMed, an open-source web browser extension to integrate EHR features in biomedical literature retrieval approaches. Clinical users can use CDAPubMed to:(i) load patient clinical documents, i.e., EHRs based on the Health Level 7-Clinical Document Architecture Standard (HL7-CDA),(ii) identify relevant terms for scientific literature search in these documents, i.e., Medical Subject Headings (MeSH), automatically driven by the CDAPubMed configuration, which advanced users can optimize to adapt to each specific situation, and (iii) generate and launch literature search queries to a major search engine, i.e., PubMed, to retrieve citations related to the EHR under examination. CONCLUSIONS CDAPubMed is a platform-independent tool designed to facilitate literature searching using keywords contained in specific EHRs. CDAPubMed is visually integrated, as an extension of a widespread web browser, within the standard PubMed interface. It has been tested on a public dataset of HL7-CDA documents, returning significantly fewer citations since queries are focused on characteristics identified within the EHR. For instance, compared with more than 200,000 citations retrieved by breast neoplasm, fewer than ten citations were retrieved when ten patient features were added using CDAPubMed. This is an open source tool that can be freely used for non-profit purposes and integrated with other existing systems.

More and more people use internet search engines, especially Google, to learn about diseases and possible treatments. We conducted a hallway testing to evaluate the effectiveness of Google in obtaining medical information. We searched 'Breast Cancer' using Google. Six volunteers scored their experience for each of the top 500 websites. Our study shows that 50 hits of Google often help lay users in getting medical information, but some highly useful websites may be buried beyond top 200. Hence, the specificity of using Google in searching for medical information is satisfactory while the sensitivity of the search has significant room for improvement.

OBJECTIVE Describe commercially available products and services designed to convey personal health information in emergencies. METHODS The search engine Google®, supplemented by print ads, was used to identify companies and organizations that offer relevant products and services to the general market. Disease-specific, health system, and health plan-specific offerings were excluded. Vendor web sites were the primary sources of information, supplemented by telephone and e-mail queries to sales representatives. Perfect inter-rater agreement was achieved. RESULTS Thirty-nine unique vendors were identified. Eight sell engraved jewelry. Three offer an embossed card or pamphlet. Twelve supply USB drives with various features. Eleven support password-protected web sites. Five maintain national call centers. Available media differed markedly with respect to capacity and accessibility. Quoted prices ranged from a one-time expenditure of $3.50 to an annual fee of $200. Associated features and annual fees varied widely. CONCLUSION A wide range of products and services exist to help patients convey personal health information. Health care providers should be familiar with their features, so they can access the information in a disaster or emergency.

Internet has provided patients with a new source of variable medical information. Osteoporosis is a major public health concern and providing patients with accurate information regarding diseases and treatment is an essential component of medical care. The primary objective of this study was to assess the quality of Internet based nutrition information for osteoporosis patients. The search items "osteoporosis","diet","nutrition", and "bone loss" were entered into the five most consulted search engines: Google, Yahoo, Bing, AOL and Lycos. The first 20 website matches generated by each search engine were 400 and grouped together by URL (uniform resource locators) suffix. 326 websites were excluded from the study as they had insufficient information, nonfunctioning links, websites not in English and duplicate websites. Of the remaining 74 sites, 64% were .Com sites followed by 18%.Org sites..Org websites received the highest interface and content scores. Raters with healthcare and technical background rated the website interface and quality of content on the internet differently and this could be largely due to different training of the two raters and the manner in which they perceived the content. Health information websites should take into account the users' diverse backgrounds when presenting content to consumers.

INTRODUCTION Surveys have shown that many people now turn to the Internet for health information when making health-related decisions. This study systematically analyzed the HPV vaccine information returned by online search engines. HPV is the most common sexually transmitted disease and is the leading cause of cervical cancers. METHODS We conducted a content analysis of 89 top search results from Google, Yahoo, Bing, and Ask.com. The websites were analyzed with respect to source, tone, information related to specific content analyzed through the lens of the Health Belief Model, and in terms of two content themes (i.e., conspiracy theories and civil liberties). The relations among these aspects of the websites were also explored. RESULTS Most websites were published by nonprofit or academic sources (34.8%) and governmental agencies (27.4%) and were neutral in tone (57.3%), neither promoting nor opposing the HPV vaccine. Overall, the websites presented suboptimal or inaccurate information related to the five behavioral predictors stipulated in the Health Belief Model. Questions related to civil liberties were present on some websites. CONCLUSION Health professionals designing online communication with the intent of increasing HPV vaccine uptake should take care to include information about the risks of HPV, including susceptibility and severity. Additionally, websites should include information about the benefits of the vaccine (i.e., effective against HPV), low side effects as a barrier that can be overcome, and ways in which to receive the vaccine to raise individual self-efficacy.

Although Web-based personal health records (PHRs) have been widely deployed, the existing ones have limited intelligence. Previously, we introduced expert system technology and Web search technology into the PHR domain and proposed the concept of an intelligent PHR (iPHR). iPHR provides personalized healthcare information to facilitate users' daily activities of living. The current iPHR is passive and follows the pull model of information distribution. This paper introduces triggers and monitoring into iPHR to make iPHR become active. Our idea is to let medical professionals pre-compile triggers and store them in iPHR's knowledge base. Each trigger corresponds to an abnormal event that may have potential medical impact. iPHR keeps collecting, processing, and analyzing the user's medical data from various sources such as wearable sensors. Whenever an abnormal event is detected from the user's medical data, the corresponding trigger fires and the related personalized healthcare information is pushed to the user using natural language generation technology, expert system technology, and Web search technology.

The use of Electronic Health Records (EHR) is wide spread in healthcare. One of the most challenging tasks for EHR systems is to achieve computable semantic interoperability. To address EHR interoperability, a number of standardization efforts are progressing, however these standards are either incomplete in terms of functionality or lacking specification of precise meaning of underlying data. This paper describes an interoperable EHR framework that uses an ontology-based approach to facilitate exchange of information and knowledge among EHR. Based on the proposed framework, an interoperability scenario between a Personal Health Record System, an EHR and a Laboratory System is described.