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The HealthGrid White Paper was published at the third annual conference in Oxford in 2005. Starting from the conclusions of the White Paper, the EU funded SHARE project (http://www.eu-share.org) has aimed at identifying the most important steps and significant milestones towards wide deployment and adoption of healthgrids in Europe. The project has defined a strategy to address the issues identified in the action plan for European e-Health (COM(2004).356) and has devised a roadmap for the major technological and ethical and legal developments and social and economic investments needed for successful take up of healthgrids in the next 10 years. A "beta" version of the road map underwent full review by a panel of 25 prominent European experts at a workshop in December 2007. The present document is an executive policy summary of the final draft road map. It has sought to reconcile likely conflicts between technological developments and regulatory frameworks by bringing together the project's technical road map and conceptual map of ethical and legal issues and socio-economic prospects. A key tool in this process was a collection of case studies of healthgrid applications.

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Over the last four years, a community of researchers working on Grid and High Performance Computing technologies started discussing the barriers and opportunities that grid technologies must face and exploit for the development of health-related applications. This interest lead to the first Healthgrid conference, held in Lyon, France, on January 16th-17th, 2003, with the focus of creating increased awareness about the possibilities and advantages linked to the deployment of grid technologies in health, ultimately targeting the creation of a European/international grid infrastructure for health. The topics of this conference converged with the position of the eHealth division of the European Commission, whose mandate from the Lisbon Meeting was "To develop an intelligent environment that enables ubiquitous management of citizens' health status, and to assist health professionals in coping with some major challenges, risk management and the integration into clinical practice of advances in health knowledge." In this context "Health" involves not only clinical procedures but covers the whole range of information from molecular level (genetic and proteomic information) over cells and tissues, to the individual and finally the population level (social healthcare). Grid technology offers the opportunity to create a common working backbone for all different members of this large "health family" and will hopefully lead to an increased awareness and interoperability among disciplines. The first HealthGrid conference led to the creation of the Healthgrid association, a non-profit research association legally incorporated in France but formed from the broad community of European researchers and institutions sharing expertise in health grids. After the second Healthgrid conference, held in Clermont-Ferrand on January 29th-30th, 2004, the need for a "white paper" on the current status and prospective of health grids was raised. Over fifty experts from different areas of grid technologies, eHealth applications and the medical world were invited to contribute to the preparation of this document.

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OBJECTIVES: The GEMSS project is developing a secure Grid infrastructure through which six medical simulations services can be invoked. We examine the legal and security framework within which GEMSS operates. METHODS: We provide a legal qualification to the operations performed upon patient data, in view of EU directive 95/46, when using medical applications on the GEMSS Grid. We identify appropriate measures to ensure security and describe the legal rationale behind our choice of security technology. RESULTS: Our legal analysis demonstrates there must be an identified controller (typically a hospital) of patient data. The controller must then choose a processor (in this context a Grid service provider) that provides sufficient guarantees with respect to the security of their technical and organizational data processing procedures. These guarantees must ensure a level of security appropriate to the risks, with due regard to the state of the art and the cost of their implementation. Our security solutions are based on a public key infrastructure (PKI), transport level security and end-to-end security mechanisms in line with the web service (WS Security, WS Trust and SecureConversation) security specifications. CONCLUSION: The GEMSS infrastructure ensures a degree of protection of patient data that is appropriate for the health care sector, and is in line with the European directives. We hope that GEMSS will become synonymous with high security data processing, providing a framework by which GEMSS service providers can provide the security guarantees required by hospitals with regard to the processing of patient data.

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Male Fischer rats were fed a low-iodine diet containing thiouracil for 21 days to produce hyperplastic thyroid glands, and then fed a high-iodine diet for various time intervals, from 5 hr to 180 days, in order to study the morphological changes that occur during involution. Thyroids were fixed by perfusion fixation and embedded in Epon. Sections were examined by light microscopy. Initially at 0 days of involution (at the time of the change to the high-iodine diet), follicular lumens were very narrow and capillary lumens were very wide. The capsule was thick and infiltrated with mononuclear leukocytes. No obvious changes occurred for 1 day after the change in diet, but shortly thereafter capillary lumens began to narrow. By 4 days, most capillary lumens were close to normal size; capillaries formed a more or less normal bed except that many were embedded in a relatively thick or wide interfollicular matrix. This matrix was largely gone by 21 days. Between 1 and 21 days, follicular lumens dilated progressively as colloid accumulated. The density of staining of the accumulated colloid varied from follicle to follicle, and this variation was also observed in older controls. Inflammatory cells gradually disappeared from the capsule and most were gone by 15 days. Starting at approximately 15 days and continuing to 180 days, one or more disintegrating cells were found in some lumen profiles. Colloid goiters were not observed in these rats even after several months of involution. Some lumens were rather large, however, and small fractions of the follicles, both small and large, were bounded by flat cells and resembled "cold" follicles morphologically.

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To study blood capillary growth in the hyperplastic thyroid gland, rats were fed 0.25% thiouracil in a low iodine diet for time intervals up to 100 days. Thyroids were fixed by vascular perfusion and embeded in Epon. Whole lobes were sectioned from pole to pole and slides were prepared of sections every 0.3 mm. Capillaries were clearly enlarged by 3 days and they enlarged progressively thereafter. By 3 days, the cells of many neighboring capillaries came into close apposition and from this time on, there was evidence of fusion of capillary walls in the form of partial septa in the capillary lumens. Fusion continued until 20 days, when follicles were almost completely surrounded by a continuous endothelial sheet and unfused capillary walls were separated by connective tissue. The vascular pattern around peripheral follicles changed in a way similar to interior follicles, except that in places, capillaries were gradually excluded from the space between epithelium and thyroid capsule. Vascular enlargement was restricted to the thyroid blood vessels. There was no obvious enlargement of the blood capillaries of the parathyroid despite its close proximity to the thyroid.

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Young adult male Fischer rats were fed 0.25% thouracil in a low-iodine diet to produce hyperplasia of the thyroid gland. The capsule of the thyroid gland increased in thickness from approximately one cell in controls to a substantial multilayered structure. Increase in capsule thickness was noted by 3 days. The cell population of the capsule was largely fibroblasts, but during a period within the interval from 14 to 28 days, the capsule tended to be exceptionally thick and contained many mononuclear leukocytes. At later times the capsule was not quite as thick and the leukocytes largely disapproved. Capillaries developed in the capsule probably by sprouting. The capsule growth was so extensive that certain neighboring tissues were often incorporated into the capsule, including arteries, veins, nerves, striated muscle, and lymph nodes. There was some regional specificity in the development of capsular hyperplasia. Connective tissue increased around the thyroid and parathyroid glands but not between them. Connective tissue in partitions with the thyroid gland also increased in thickness, although the extent of accumulation of cells and intercellular matrix was much less than in the capsule.

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1. Two acid phosphatases (beta-glycerophosphatase and phenylphosphatase), acid beta-glucuronidase and cathepsin were demonstrated in the 0.25m-sucrose homogenates from whole calf thyroid tissue and from isolated calf thyroid cells. 2. The main kinetic characters of these enzymes were studied. 3. All these acid hydrolases are partially sedimentable and display a latency that is unmasked by treatment with Triton X-100 and on dilution in hypo-osmotic media. It is concluded that these acid hydrolases belong to the lysosomes.

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