What’s New in cyberNephrology ISN Dubai Update, Feb. 6, 2001 Kim Solez, M.D.

Most physicians are learning about the Internet and new technology “on the fly”. Inefficient, unpredictable, leaves gaps.

A short 2-3 hour period of formal teaching with mixed didactic/interactive format and hands on experience can provide enormous benefit. That is the plan of the computer workshops at this meeting.

Slide 4 Key Points ISN Informatics Commission/NKF cyberNephrology partnership ISN Informatics Commission/NKF cyberNephrology partnership New Technologies Division of NKF - Gary Green New Technologies Division of NKF - Gary Green History, Nephrology born of technology. History, Nephrology born of technology. ISN Informatics/NKF cyberNephrology ISN Informatics/NKF cyberNephrology ISN Informatics/NKF cyberNephrology beyond 2001 ISN Informatics/NKF cyberNephrology beyond 2001

Slide 5 Ray Kurzweil "Technology is the continuation of evolution by other means.... "Technology is the continuation of evolution by other means.... It is in the nature of exponential growth that events develop extremely slowly for extremely long periods of time, but as one glides through the knee of the curve, events erupt at an increasingly furious pace. And that is what we will experience as we enter the twenty-first century." It is in the nature of exponential growth that events develop extremely slowly for extremely long periods of time, but as one glides through the knee of the curve, events erupt at an increasingly furious pace. And that is what we will experience as we enter the twenty-first century." --Ray Kurzweil - The Age of Spiritual Machines, When Computers Exceed Human Intelligence (a)When computers exceed human intelligence (b)When computers and humans become indistinguishable from each

Slide 6 Arthur C. Clarke "When a scientist states that something is possible, he is almost certainly right. "When a scientist states that something is possible, he is almost certainly right. When he states that something is impossible, he is very probably wrong. When he states that something is impossible, he is very probably wrong. The only way of discovering the limits of the possible is to venture a little way past them into the impossible. The only way of discovering the limits of the possible is to venture a little way past them into the impossible. Any sufficiently advanced technology is indistinguishable from magic." Any sufficiently advanced technology is indistinguishable from magic." -- Arthur C. Clarke's three laws of technology

Slide 7 First Phase of ISN Informatics/NKF cyberNephrology Many accomplishments discussion groups - NEPHROL, NEPHDEVEL, NEPHKIDS and progeny WWW sites - virtual attendance at meetings AJKD Forum Schrier Atlas Renal-Tech computer donation project Internet videoconferencing, wireless connectivity, panoramas. WWW site

Support of NKF and ISN Programs. Furthering of new technologies. WWW sites:

Slide 9 Support of ISN Programs COMGAN COMGAN RENAL-TECH Computer Donation Project RENAL-TECH Computer Donation Project Video Legacy Project Video Legacy Project ISN Archive ISN Archive Sister Centers Program Sister Centers Program Teaching Resources Teaching Resources Discussion Groups Discussion Groups Assistance to National Societies Assistance to National Societies

Slide 10 Support of NKF Programs KEEP, RISE KEEP, RISE K/DOQI K/DOQI PARADE PARADE People like Us People like Us Spring Clinical Meeting, ASN Spring Clinical Meeting, ASN Publications Publications Donor Families, Donor Quilt Donor Families, Donor Quilt Transplant Games Transplant Games

Slide 11 Making Full Use of the Favorable Local Environment in Canada Canada is way ahead of the U.S. in the deployment and adoption of next-generation broadband services: The cross-Canada high- speed network backbone, CA*net3, is the world's first national optical research network. Canada is way ahead of the U.S. in the deployment and adoption of next-generation broadband services: The cross-Canada high- speed network backbone, CA*net3, is the world's first national optical research network. By the end of this year nearly 17% of Canadian on-line homes will have a broadband connection compared to 8.6% in the U.S. By the end of this year nearly 17% of Canadian on-line homes will have a broadband connection compared to 8.6% in the U.S. Expect to have 100 MB/sec. connectivity from University of Alberta to College Plaza cyberNephrology complex by March Expect to have 100 MB/sec. connectivity from University of Alberta to College Plaza cyberNephrology complex by March 2001.

Slide 12 New Operating Systems and Electronic Data Transmission Formats Palm computing platform Palm computing platform Macintosh OS 10 Macintosh OS 10 Wireless transmission - AirPort hub Wireless transmission - AirPort hub XML document presentation XML document presentation

Slide 13 The hand held device 1971 Hoff - Microprocessor 1971 Hoff - Microprocessor 1972 Alan Kay - PARC - Dynabook 1972 Alan Kay - PARC - Dynabook 1993 Newton MessagePad 1993 Newton MessagePad 2001 – palm OS – fastest growing platform in history 2001 – palm OS – fastest growing platform in history

Slide 14 Internet use becomes “mainstream” in even in the Middle East! 1.Most health care workers using the Internet. 2.Access becoming faster, cheaper. 3.Computers themselves inexpensive. 4.No longer necessary to type. Voice recognition reaches 98% accuracy and still improving! Internet use becomes “mainstream” in even in the Middle East! 1.Most health care workers using the Internet. 2.Access becoming faster, cheaper. 3.Computers themselves inexpensive. 4.No longer necessary to type. Voice recognition reaches 98% accuracy and still improving!

Slide 15 The World is Changing - Now! September 26, 2000 New Hewlett Packard CEO Carly Fiorina stated that the world is now entering the "renaissance of the information age" -- a time when emerging technologies and an "always-on Internet" could transform human experience and entire industries. "This world is clearly emerging before our eyes," "The shifts ahead, the opportunities ahead are massive." February 2, 2001 Cars that alert their owners when stolen, tracking thief location. (CNN) September 26, 2000 New Hewlett Packard CEO Carly Fiorina stated that the world is now entering the "renaissance of the information age" -- a time when emerging technologies and an "always-on Internet" could transform human experience and entire industries. "This world is clearly emerging before our eyes," "The shifts ahead, the opportunities ahead are massive." February 2, 2001 Cars that alert their owners when stolen, tracking thief location. (CNN)

Slide 16 The World is Changing - Now! February 1, 2001 The Media Development Loan Fund, backed by some of the world's largest philanthropies including the MacArthur and Soros foundations, lends money at low interest rates to news organizations in developing countries and helps them use technology to facilitate the flow of information…. Rather than beam their reports via satellite, the stations transmit audio and text files via the Internet, creating a network that covers most of the country. February 1, 2001 The Media Development Loan Fund, backed by some of the world's largest philanthropies including the MacArthur and Soros foundations, lends money at low interest rates to news organizations in developing countries and helps them use technology to facilitate the flow of information…. Rather than beam their reports via satellite, the stations transmit audio and text files via the Internet, creating a network that covers most of the country.

Slide 17 The World is Changing - Now!... continued November 21, 1999 Clinton Calls for Widespread Internet Access - The New York Times FLORENCE, Italy -- President Clinton called Sunday for developed nations to ensure their citizens have access to the Internet "as complete as telephone access," saying that would dramatically reduce the income gap between rich and poor. November 21, 1999 Clinton Calls for Widespread Internet Access - The New York Times FLORENCE, Italy -- President Clinton called Sunday for developed nations to ensure their citizens have access to the Internet "as complete as telephone access," saying that would dramatically reduce the income gap between rich and poor. November 21, 1999 Clinton Calls for Widespread Internet Access - The New York Times FLORENCE, Italy -- President Clinton FLORENCE, Italy -- President Clinton called Sunday for developed nations to ensure their citizens have access to the Internet "as complete as telephone access," saying that would dramatically reduce the income gap between rich and poor. November 21, 1999 Clinton Calls for Widespread Internet Access - The New York Times FLORENCE, Italy -- President Clinton FLORENCE, Italy -- President Clinton called Sunday for developed nations to ensure their citizens have access to the Internet "as complete as telephone access," saying that would dramatically reduce the income gap between rich and poor.

Slide 18 The World is Changing - Now! … continued - The “Digital Divide” November 21, 1999 Clinton Calls for Widespread Internet Access - The New York Times FLORENCE, Italy -- President Clinton called Sunday for developed nations to ensure their citizens have access to the Internet "as complete as telephone access," saying that would dramatically reduce the income gap between rich and poor. November 21, 1999 Clinton Calls for Widespread Internet Access - The New York Times FLORENCE, Italy -- President Clinton called Sunday for developed nations to ensure their citizens have access to the Internet "as complete as telephone access," saying that would dramatically reduce the income gap between rich and poor. At a gathering of world leaders who adhere to "third way" politics, Clinton said one of the greatest domestic problems facing developed countries is the "digital divide" that gives those who have computers an enormous advantage over those who do not. At a gathering of world leaders who adhere to "third way" politics, Clinton said one of the greatest domestic problems facing developed countries is the "digital divide" that gives those who have computers an enormous advantage over those who do not.

Slide 19 The Internet in Europe, Asia, and the Middle East - including UAE November 21, 1999 Clinton Calls for Widespread Internet Access - The New York Times FLORENCE, Italy -- President Clinton called Sunday for developed nations to ensure their citizens have access to the Internet "as complete as telephone access," saying that would dramatically reduce the income gap between rich and poor. November 21, 1999 Clinton Calls for Widespread Internet Access - The New York Times FLORENCE, Italy -- President Clinton called Sunday for developed nations to ensure their citizens have access to the Internet "as complete as telephone access," saying that would dramatically reduce the income gap between rich and poor. Up until now there have been three main barriers to Internet use in Europe, Asia, and Middle East: 1. Cost (Much higher than in North America and quite heterogeneous) 2. Lack of high speed Internet access (Often nothing faster than standard modem or ISDN) 3. Language (because most Internet activity is in English it may seem like a very foreign and not-very-attractive culture) Up until now there have been three main barriers to Internet use in Europe, Asia, and Middle East: 1. Cost (Much higher than in North America and quite heterogeneous) 2. Lack of high speed Internet access (Often nothing faster than standard modem or ISDN) 3. Language (because most Internet activity is in English it may seem like a very foreign and not-very-attractive culture)

Slide 20 The Internet in Europe, Asia, and the Middle East - Solutions! November 21, 1999 Clinton Calls for Widespread Internet Access - The New York Times FLORENCE, Italy -- President Clinton called Sunday for developed nations to ensure their citizens have access to the Internet "as complete as telephone access," saying that would dramatically reduce the income gap between rich and poor. November 21, 1999 Clinton Calls for Widespread Internet Access - The New York Times FLORENCE, Italy -- President Clinton called Sunday for developed nations to ensure their citizens have access to the Internet "as complete as telephone access," saying that would dramatically reduce the income gap between rich and poor. 1. Cost - Communications reform. Flat rate. 2. High speed Internet access DSL and cable modem coming, faster than ISDN and cheaper! 3. Language - Increasing success with non-English resources on the Internet. 1. Cost - Communications reform. Flat rate. 2. High speed Internet access DSL and cable modem coming, faster than ISDN and cheaper! 3. Language - Increasing success with non-English resources on the Internet.

Slide 21 Bandwidth considerations November 21, 1999 Clinton Calls for Widespread Internet Access - The New York Times FLORENCE, Italy -- President Clinton called Sunday for developed nations to ensure their citizens have access to the Internet "as complete as telephone access," saying that would dramatically reduce the income gap between rich and poor. November 21, 1999 Clinton Calls for Widespread Internet Access - The New York Times FLORENCE, Italy -- President Clinton called Sunday for developed nations to ensure their citizens have access to the Internet "as complete as telephone access," saying that would dramatically reduce the income gap between rich and poor. The Internet in high bandwidth environments: Only 35% of human communication is words. With Internet video conferencing can capture gestures, body language, inflections of the voice, facial expression etc. plus share images, documents, software applications with "shared white board" or complete remote control of other computer! Requres 56 K modem or faster connection. Allows telemedicine/telepathology. The Internet in high bandwidth environments: Only 35% of human communication is words. With Internet video conferencing can capture gestures, body language, inflections of the voice, facial expression etc. plus share images, documents, software applications with "shared white board" or complete remote control of other computer! Requres 56 K modem or faster connection. Allows telemedicine/telepathology.

Slide 22 Bandwidth considerations November 21, 1999 Clinton Calls for Widespread Internet Access - The New York Times FLORENCE, Italy -- President Clinton called Sunday for developed nations to ensure their citizens have access to the Internet "as complete as telephone access," saying that would dramatically reduce the income gap between rich and poor. November 21, 1999 Clinton Calls for Widespread Internet Access - The New York Times FLORENCE, Italy -- President Clinton called Sunday for developed nations to ensure their citizens have access to the Internet "as complete as telephone access," saying that would dramatically reduce the income gap between rich and poor. The Internet in low bandwidth situations: Web site educational content can be placed on CD-ROMs cheaply and easily so sites can be accessed without going to the World Wide Web. -based low bandwidth discussion has been enormously successful in nephrology and transplantation while WWW-based discussion has not. So potentially everyone has access to the Internet resources that have proven most valuable. The Internet in low bandwidth situations: Web site educational content can be placed on CD-ROMs cheaply and easily so sites can be accessed without going to the World Wide Web. -based low bandwidth discussion has been enormously successful in nephrology and transplantation while WWW-based discussion has not. So potentially everyone has access to the Internet resources that have proven most valuable.

Slide 23 Few Countries Out of Reach! November 21, 1999 Clinton Calls for Widespread Internet Access - The New York Times FLORENCE, Italy -- President Clinton called Sunday for developed nations to ensure their citizens have access to the Internet "as complete as telephone access," saying that would dramatically reduce the income gap between rich and poor. November 21, 1999 Clinton Calls for Widespread Internet Access - The New York Times FLORENCE, Italy -- President Clinton called Sunday for developed nations to ensure their citizens have access to the Internet "as complete as telephone access," saying that would dramatically reduce the income gap between rich and poor. Almost all countries can benefit from Internet-based discussion. connectivity has reached almost everywhere. Very few exceptions: Countries lacking Internet access include only Afghanistan, Angola, Cape Verde, the Comoros Islands, Equatorial Guinea, Libya, Mauritania, São Tome and Principe, Somalia and Western Sahara. Almost all countries can benefit from Internet-based discussion. connectivity has reached almost everywhere. Very few exceptions: Countries lacking Internet access include only Afghanistan, Angola, Cape Verde, the Comoros Islands, Equatorial Guinea, Libya, Mauritania, São Tome and Principe, Somalia and Western Sahara.

Slide 24 "We strongly believe that better telecommunications will enhance our ability to deliver improved quality of life, electronic health and learning services to previously disadvantaged areas in the continent". President Nelson Mandela in an address to the Africa TELECOM 98 Exhibition and Forum Johannesburg 4-9 May 1998 "We strongly believe that better telecommunications will enhance our ability to deliver improved quality of life, electronic health and learning services to previously disadvantaged areas in the continent". President Nelson Mandela in an address to the Africa TELECOM 98 Exhibition and Forum Johannesburg 4-9 May 1998

Slide 25 Factors Influencing Second Phase of NKF cyberNephrology onward Digital photography now inexpensive and superior/equal to film photography. Video panoramas, 3D panoramas Video panoramas, 3D panoramas “Virtual microscope” panoramas “Virtual microscope” panoramas Books with “digital paper” pages Books with “digital paper” pages Circuits that combine digital and analog signaling just as the human brain does Circuits that combine digital and analog signaling just as the human brain does Human-centered rather than machine- centered computing, near perfect voice recognition Human-centered rather than machine- centered computing, near perfect voice recognition

Slide 26 Factors Influencing Second Phase of NKF cyberNephrology - Continued Gene chip DNA Microarrays for instant genetic diagnosis Gene chip DNA Microarrays for instant genetic diagnosis The wearable computer, digital clothing The wearable computer, digital clothing The bioartificial kidney The bioartificial kidney Evolution of new ethical standards for e- health Evolution of new ethical standards for e- health Quantum computing Quantum computing Optical switching/Optical Internet Optical switching/Optical Internet Nanomachines/near molecular level organ repair in disease Nanomachines/near molecular level organ repair in disease

Slide 27 Why not talk about distant future of technology/cyberNephrology? Because if Ray Kurzweil is right and people and machines will be indistinguishable from each other in 2099, what will be the relevance of nephrology then? Because if Ray Kurzweil is right and people and machines will be indistinguishable from each other in 2099, what will be the relevance of nephrology then? Machines/computers don’t have kidneys ! Machines/computers don’t have kidneys !

So follow our progress and remember: “Any sufficiently advanced technology is indistinguishable from magic.”