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Biological diversity can be measured using various metrics, but existing knowledge of spatial patterns of diversity is largely based on species counts. There is increasing evidence that trends in species richness might not match trends in other biodiversity metrics, such as morphological diversity. Here, we use data from a large group of Indo-Pacific gastropods (family Strombidae) to show that the species richness of a region is a poor predictor of the morphological diversity present there. Areas with only a few species can harbour an impressive array of morphologies and, conversely, morphological diversity in the most species-rich regions is no higher than in regions with half their taxonomic diversity. Biological diversity in the Pacific is highly threatened by human activity and our results indicate that, in addition to species richness, morphological diversity metrics need to be incorporated into conservation decisions.

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Little is known about the phenotypic consequences of global climate change, despite the excellent Pleistocene fossil record of many taxa. We used morphological measurements from extant and Pleistocene populations of a marine gastropod (Acanthinucella spirata) in conjunction with mitochondrial DNA sequence variation from living populations to determine how populations responded phenotypically to Pleistocene climatic changes. Northern populations show little sequence variation as compared to southern populations, a pattern consistent with a recent northward range expansion. These recently recolonized northern populations also contain shell morphologies that are absent in extant southern populations and throughout the Pleistocene fossil record. Thus, contrary to traditional expectations that morphological evolution should occur largely within Pleistocene refugia, our data show that geographical range shifts in response to climatic change can lead to significant morphological evolution.

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In June 2000, the Telemedicine Center at the Brody School of Medicine, East Carolina University in Greenville, NC participated in a simulated disaster response in Pu'u Paa, Hawaii, a lava plain without running water, electricity, or human habitation. During the five-day exercise we evaluated the ability to establish telecommunications and the effectiveness of the infrastructure, services, and applications implemented for an operational global emergency response. Scaleable technologies were configured and systematically tested to determine the ability to provide medical and health care in an austere environment. A medical communications matrix was constructed and used throughout the evaluation. Results show that telemedicine can be an important contribution to humanitarian relief efforts and medical support following disasters. Additional research is needed to build upon the lessons learned from participation in this exercise.

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BACKGROUND: Real-time interactive teleconference clinical consultations are envisioned for increasing accessibility to medical care by patients whose demographics restrict care. There are no published studies, however, describing referrals and the referring practitioners, patients, and specialists participating in these consultations. OBJECTIVE: To assess characteristics of participants of interactive teleconference clinical consultations. DESIGN: Descriptive study, February 1, 1996, through April 30, 1999. SETTING: Eastern North Carolina: Brody School of Medicine at East Carolina University and 7 rural hospitals and clinics in its telemedicine network. SUBJECTS: Rural practitioners requesting consultations (n = 76), consulting physicians (n = 40), and patients completing evaluations following consultations (n = 495). MAIN OUTCOME MEASURES: Demographic and descriptive variables for referring providers, patients, and consulting physicians relative to the population in the region and to patients and physicians at the East Carolina University School of Medicine clinics. RESULTS: The largest number of referrals (65.2%) were made to obtain a second opinion or recommend a management plan in dermatology (33.5%), allergy (21.0%), or cardiology (17.8%). Significant patient characteristics were race (56.8% minorities), age (19.6% < or = 10 years old and 26.0% > or = 59.0 years old), sex (59% females), and insurance status (10.7% no insurance, 33.7% Medicaid, 15.4% Medicare). In addition, 38.0% had household incomes below the poverty level. Only 5.2% of the patients would have been treated by the referral practitioner, making travel necessary for consultation. Demographic characteristics of the practitioners were not statistically different. CONCLUSIONS: Participants of interactive teleconference clinical consultations are patients whose access to medical care might otherwise be limited. Use of telemedicine by practitioners is not related to age or sex. Arch Fam Med. 2000;9:1036-1040

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Endovascular aortic grafting represents a minimally invasive approach to aortic aneurysm repair. The technique requires a variety of new skills and extensive training. Telemedicine enhances mentoring and technical support for surgeons performing the technique.

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BACKGROUND: Recent advances in telecommunications technology allow physicians to consult on patients at a distance via an interactive video format. Few data exist as to the reliability of this form of consultation. OBJECTIVE: Our purpose was to measure the degree of concordance between a dermatologist seeing a patient in a clinic and another dermatologist seeing the same patient over a commercially available videoconferencing system. METHODS: Patients referred to a general dermatology clinic were seen by both a "live" dermatologist and a "teledermatologist" via a T1 connection. Diagnosis and recommendations were recorded by both physicians and compared. The physicians were also asked to rate the degree of confidence they had in their diagnosis. RESULTS: Seventy-nine diagnoses were made on 60 patients. The two physicians were in absolute agreement on 61 of the diagnoses (77.2%). Race or sex of the patient, nature of the skin problems, or which of the two physicians was the teledermatologist did not statistically correlate with the concordance of the two physicians. CONCLUSION: There was a reasonable degree of agreement between the two examining physicians. Despite the relatively high degree of concordance the teledermatologist had a significantly lower degree of confidence in his diagnoses.

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STUDY OBJECTIVE: To evaluate the efficacy of intravenous (i.v.) lidocaine in suppressing the cough reflex and increases in intraocular pressure (IOP), heart rate (HR), and mean arterial pressure (MAP) elicited by endotracheal intubation. DESIGN: Prospective, randomized, placebo-controlled, blinded study. PATIENTS: 60 ASA physical status 1 premedicated children aged 2 to 6 years undergoing induction of anesthesia with halothane-nitrous oxide (N2O) for surgery to correct strabismus. INTERVENTIONS: Patients were randomly divided into two groups of 30 each. The control group (C) received saline and the treatment group (L) received 2 mg/kg i.v. lidocaine 90 seconds prior to endotracheal intubation. MEASUREMENTS AND MAIN RESULTS: Awake HR and MAP; IOP, HR, and MAP 45 seconds prior to endotracheal intubation, immediately after endotracheal intubation, and 1 minute later, were recorded. Coughing was noted at endotracheal intubation. Lidocaine prevented coughing and a significant increase in IOP. Although significant increases in HR and MAP were observed in both groups (comparing preintubation and postintubation values), these increases were significantly less in the L group compared with the C group. CONCLUSIONS: In healthy premedicated children, aged 2 to 6 years, who are undergoing induction of anesthesia with halothane-N2O, 2 mg/kg of lidocaine given 90 seconds prior to laryngoscopy effectively suppresses the cough reflex and increase in IOP secondary to endotracheal intubation and attenuates increases in HR and MAP.

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Complaints of vertigo and imbalance are common presentations to primary care physicians, yet there are few specialists who diagnose and treat these problems as a significant part of their practices. We demonstrated the feasibility of remote consultation for a patient presenting with vertigo using a two-way digital video and audio network. It was possible to take an appropriate history, examine the patient, and provide a diagnosis and treatment. The patient had a common problem that causes dizziness: benign positional vertigo (BPV). An essential component of the examination was the use of a head-mounted display with embedded cameras. The cameras allowed viewing of the patient's eye movements, which were diagnostic.

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The definition of health information is growing to include multimedia audio, video, and high-resolution still images. This article describes the telemedicine program at East Carolina University School of Medicine, including the telemedicine applications presently in use and the virtual reality applications currently under development' Included are the major design criteria that shape the telemedicine network some of the lessons learned in developing the network, and a discussion of the future of telemedicine, including efforts to incorporate telemedicine within a fully integrated health information system.

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OBJECTIVE: To quantify the costs and benefits of medical care under a telemedicine agreement. METHODS: Two telemedicine contracts between the North Carolina Central Prison (NCCP) and the East Carolina University School of Medicine were analyzed, first from the point of view of the prison using break-even analysis and second from the societal point of view examining whether the arrangements were positive for the taxpayers of North Carolina. RESULTS AND CONCLUSIONS: While the prison system never broke even with the first contract, the break-even was attainable, as it would have required an average of only one consultation per day. The prison system attained break-even status in the latest year of the second contract, and simple forecasts indicate a good chance that usage will grow beyond the break-even point. From the societal point of view, the contracts are merely transfers of funds from one state agency to another. Therefore, the differences in them are irrelevant. What is relevant is a measure of average fixed and variable spending for telemedicine and what this expenditure buys in terms of avoided costs. Thus, we examined the average full cost per visit, as determined from the actual or estimated expenditures, and concluded that the program paid back its cost during year 4.

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OBJECTIVE: To review our experience with dermatology teleconsultations between East Carolina University School of Medicine in Greenville and Central Prison in Raleigh, NC. MATERIALS AND METHODS: Consultation forms kept on file in the Department of Internal Medicine served as the source of data. One physician reviewed the forms from the initial 22 months of our dermatology teleconsultation service to Central Prison. Patient demographics and the diagnoses made by the consulting physician were recorded. Recommendations were tabulated as either diagnostic or therapeutic. Diagnoses and recommendations for known HIV-positive individuals were separately recorded. RESULTS: One hundred thirty-eight dermatology teleconsultations were performed over the 22-month period. Seventy two per cent of the patients seen were African-American. The average age was 32 years. One hundred fifty-nine diagnoses were made. The most common problems were eczema and acneiform eruptions. Fifty-nine diagnostic and 252 therapeutic recommendations were made. CONCLUSION: Consultants generally were confident of their diagnoses and management decisions. Dermatologists can assist primary care physicians through telemedicine consultation.

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Recent trends in health care informatics and telemedicine indicate that systems are being developed with a primary focus on technology and business, not on the process of medicine itself. The authors present a new model of health care information, distributed medical intelligence, which promotes the development of an integrative medical communication system addressing the process of providing expert medical knowledge to the point of need. The model incorporates audio, video, high-resolution still images, and virtual reality applications into an integrated medical communications network. Three components of the model (care portals, Docking Station, and the bridge) are described. The implementation of this model at the East Carolina University School of Medicine is also outlined.

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A telemedicine service was established between the East Carolina University (ECU) School of Medicine in Greenville and the Central Prison in Raleigh, about 160 km away. Based on the first two years' experience of providing a prison telemedicine service, a medical education network was set up, linking the School of Medicine to health institutions in Ahoskie, approximately 160 km away, and Jacksonville, approximately 145 km away. At about the same time, a telemedicine network was installed linking the ECU to two rural hospitals, the Roanoke-Chowan Hospital in Ahoskie, and the Martin General Hospital in Williamston, both approximately 75 km away. Although it was a demonstration project, the prison telemedicine service was thought to be cost-effective. The cost of transporting a patient from prison for medical care was estimated to be $700. In comparison, a telemedicine consultation cost about $70, excluding the equipment and network costs. During the first 33 months of operation there were over 400 telemedicine consultations carried out in eastern North Carolina. The majority were dermatology consultations, with neurology and gastroenterology being next most frequent.

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The heated hydrotherapy pool is a common exercise site for patients with painful musculoskeletal conditions. Oxygen consumption of swimming is 87 to 89% of maximum in postmyocardial infarction patients according to one recent investigation. We studied 13 able-bodied subjects to test the hypothesis that enough energy could be expended during various forms of hydrotherapy to produce both an aerobic training effect and a risk to patients with coronary artery disease. Oxygen consumption (VO2) was measured in six settings: resting supine; resting seated shoulder deep in the pool (36C); walking at comfortable speed in chest-deep water; running at the fastest speed possible in chest-deep water; using hand paddles; and running in place at shoulder depth. The mean VO2 expressed in ml/kg/min (and metabolic equivalents) were 4.91 (1.00), 4.93 (1.02), 9.34 (2.01), 27.79 (6.23), 18.25 (4.30) and 29.11 (7.09) respectively, suggesting that the more vigorous exercises stress aerobic capacity heavily but not excessively.

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