SApacher0828

Efficiency and Cost-Benefit Ratio
of Biomedical Virtual Conferences

Contac person: Dr. Armando Pacher (apacher@satlink.com)

The cost/benefit ratio for the virtual conferences on biomedicine will be analyzed, through experiences from Argentine Federation of Cardiology, Virtual Congresses on Cardiology, Pathology, Neurology and Nephrology, and the Virtual Oncology Symposium.

Methods & Results

Argentine Federation of Cardiology: The aspects of three subjects related to virtual conferences on Biomedicine in the Argentine Federation of Cardiology (FAC) will be explained: scope of Argentine National Congresses on Cardiology, Latin American Clinical Rounds on Cardiology, and organization of the 1st Virtual Congress on Cardiology.
The Argentine Federation of Cardiology was founded in 1965, and is a scientific entity which aims at encouraging the development and promotion of the cardiologic activities carried out throughout the whole Argentine Republic (http://www.fac.com.ar – fac@fi.uner.edu.ar).
FAC consists of a union of 28 Argentine Societies of Cardiology that covers the country’s territory, to which 18 Scientific Committees, the FAC Foundation and the FAC Informatics Center (CETIFAC) are added.
The Argentine Federation of Cardiology’s Journal has a circulation of 4,500 copies, and is published full text in Internet.
One of the Scientific Committees, the Informatics Committee carries out its activities through CETIFAC:
1.- Design, development and maintenance of the FAC’s Web Site;
2.- Internet full text edition of the FAC’s Journal;
3.- Mailing list on Cardiology (Cardio-L@ivic.ivic.ve);
4.- Latin American Virtual Clinical Rounds on Cardiology’s coordinator;
5 .- IRC Room (#cardiol – bio.hgy.es and other servers of the University Network of Integrated Telematics Services {UniNet});
6.- Development of intensive theoretical and practical Courses for the utilization of Internet tools;
7.- Development and edition of teaching material for the use of informatics tools;
8.- Digitalization and edition in diskette of the abstracts of the National Congresses on Cardiology;
9.- Design and development of the Multimedia Area in National Congresses on Cardiology;
10.- Informatics support for multicenter trials;
11.- Entre Ríos Virtual Hospital’s Management;
12.- Video-conferences through ISDN links;
11.- Organization of the First Virtual Congress on Cardiology;
Multimedia area: Since 1996, CETIFAC has designed and implemented the Multimedia Area in the National Congresses of Cardiology. It is physically located in the Congress’s commercial exhibitors foyer. The staff is made up of two physicians, both CETIFAC members, and two Bioengineering advanced students. It is sponsored by the Faculty of Engineering – Bioengineering from the Entre Rios National University at Paraná, Argentina, and it is financially supported by contributions from farmacological and medical equipment companies. Computers, two access lines to Internet, and a VGA projection device are available in the Area. Various services are given there, among them e-mail, explanatory talks about Internet, surfing through the Web, text-conferences, etc. All these activities can be projected in an extended screen.
In the XVII National Congress (17-20/6/1998, more than 3,500 participants) these activities were added:
1.- making summaries of the main scientific activities;
2.- daily publication of summaries on paper and in the Web;
3.- daily transmission of summaries through IRC (#cardiol at UniNet servers);
4.- carrying out of bidirectional text-conferences with Congress Speakers through IRC (#cardiol at UniNet servers).
Summary of National Congresses on Cardiology activities: In order to make the summary of the Congress main scientific activities, a specific work team was created, made up of three coordinators and ten assistants, all physicians. Both the coordinators and the Congress Scientific Committee selected the activities to be summarized. The assistants responsible for each activity were appointed, and they were distributed in the different lecture halls.
In the Multimedia Area, the coordinators received the manuscripts and checked their contents together with each assistant. The material that was already approved, was than written in a word processor in .htm and text formats. Once each summary has been approved, the assistant would attend the next scheduled activity.
Transmission and publication of summaries in Internet: At 5 PM, the summaries would be transmitted through IRC through the UniNet to the #cardiol lecture hall, in flat text format, through the play command (e.g. play facvier.txt to #cardiol with 10000 ms delay). At 7 PM, they were published in www.fac.com.ar/congreso.
Summaries paper edition: During the night, a Congress Journal was printed. In order to speed up the work and to reduce the costs, four pages were composed, which would be distributed in a single A3 size landscape sheet of paper (on one side pages 4 and 1, and on the other one, pages 2 and 3). The original was printed by an ink-jet printer and photocopied. The copies were distributed in the morning of the following day, when entering the lecture halls and the Multimedia Area.
Bidirectional text-conferences: For the bidirectional text-conferences, speakers on specific subjects were invited to answer the questions of the #cardiol lecture hall attendants. The activity was scheduled daily at 7:30 PM. Questions about primary and secondary prevention, hear failure, dyslipidemias, pediatric cardiology, neonatologic cardiology, cardiovascular drugs, Doppler Echocardiography, medical informatics, etc., were answered. Argentine physicians and related professionals attended the text-conferences in the lecture hall #cardiol (UniNet servers) during the four days, as well as physicians from many Latin American countries, Spain, Canada, USA, and New Zealand.
Cost/Benefit ratio of this activity: The cost/benefit ratio of this activity tended markedly towards benefit. The cost of the related activities was met by the contributions from farmacological and medical equipment companies. The work team labored voluntarily and for free. The Bioengineering students received an equivalent of a student’s scholarship. The Internet link was made through conventional telephone lines, with costs of local calls. The Internet access accounts were obtained for free through local suppliers, in exchange for advertising in the Multimedia Area. Printing on paper by photocopying the printed original permitted a reduction of costs, by separating the conventional composition and printing works. The benefits can be summarized in that, besides the 3,500 physical congress attendants, numerous physicians and related professionals obtained current information without having to move from their usual living and working places.

Virtual Congresses: Virtual congresses are scientific meeting celebrated entirely in Internet. Since 1994, that INABIS activities began, virtual meetings are becoming increasingly frequent, and their special characteristics have demonstrated a series of mayor advantages in comparison with "presence" (physical) meetings, that are carefully detailed in this presentation.
Until now, most virtual biomedical congresses have been free and open to all the scientific community with access to Internet. This has been the case of the Internet World Congress of Biomedical Sciences (INABIS,), Virtual Congress of Pathology, Spanish-American Virtual Congress of Pathology, Latin-American Virtual Congress of Neurology and the 1st Virtual Congress of Cardiology.
What is a virtual Congress?: Presentations consists of web pages, that are discussed used linked forms included in web pages or by interchange of e-mails (manages by mailing lists). Virtual congresses, similarly to other meetings, are generally composed of invited symposia or conferences and posters or communication presentations. Internet has gained such a big diffusion, that nowadays million of people are connected to this Network, and this fact has been used to broadcast information of conventional meetings to thousands of scientists, not only by specific mailing list bust also using other Internet services (www, chat, FTP, etc.). At the same time, virtual meetings have become increasingly popular because they allow and unlimited number of participants to send and receive scientific information.
Initially, some medical specialties are particularly interested in the celebration of virtual meetings (pathology, neurology, and radiology) because the graphical information could be easily transmitted via Internet, without a limitation in the number of images representing each case. But many other specialties (nephrology, genetics, etc.) have realized that clinical information interchange complemented with imaging, ECG, EEG, and any other studies can be easily translated into a Internet format (web pages, e-mails, etc.).
Although Internet has a limited bandwidth, most of the graphical information can be compressed or adapted to this limitations, and the expectation of a new Internet-2, makes us very optimistic in the integration of even more exigent multimedia information to be transmitted in the Network.
Objectives of a virtual congress: They commonly includes:
1.- generating an easy way of sharing scientific information through Internet (and related computers network, such as Infovia in Spain or other Latin-American countries).
2.- to create a permanent forum in a specific language of a scientific community.
3.- connecting remotely located professionals with common interests.
4.- to offer support to scientists with few opportunities of continuing education.
5.- broadcasting to the rest of the world the activities of a local or national professional association.
6.- to communicate with other communities with related fields of activity.
7.- Promoting the rest of the scientific community to create their own virtual meetings.
Advantages of virtual congresses are:
1.- the number of delegates is unlimited
2.- it can reach a very specific group of interest.
3.- new bridges are established between professionals that normally are not connected (for instance, pathologists and veterinary pathologists).
4.- permanent actualization of program
5.- direct access of the delegates to the most up to date content
6.- information, amenable to change, for delegates and authors about their subscription data or published data.
7.- information about all other delegates and authors.
8.- since no limit exists in the number of presentations, isolated cases can be presented.
9.- indexes of conferences and posters, classification by areas, and searches facilities allow a fast access to information.
10.- in order to achieve a greater participation, since virtual congress don’t have the same limit of time of conventional events, they can last from a few days to several months. Longer events allow delegates to decide when to participate. We can sit, relax, and enjoy the congress when we decide
11.- presentations don’t celebrate at the same time and the whole congress can be reviewed.
12.- there is no limit in time or space for the discussion of conferences or posters.
13.- lesser costs in the organization and infrastructure.
How much a virtual congress costs?: The approximate budget in the realization of a virtual congress (2-month duration event, with about 50 conferences and 150 posters, without translation) is $6,200 (USA dollars).
The server: Basically an Internet server with www, FTP and mail services are all that is needed to celebrate a congress in Internet. Internet server can be based in Unix (including linux) systems or Windows NT servers. In our experience, NT servers are easy to implement and manage, and the grater amount of facilities and software for this platform makes it very easy to create a complete low cost service for a virtual community. In the UNIX systems there are also a lot of freeware or shareware tools. The estimated cost for an NT server complete operative system is approximately of $900. Sometimes, additional software is needed (mailing list, activeX controls, java applets, etc ), with an estimated cost of $400.
It is necessary to include services of audio and streaming video (RealVideo, Microsoft Netshow, etc.), because although compressed short video can be downloaded as separate files, this is not an adequate solution for on-line demonstrations.
We usually install our virtual congress in National Universities servers already functioning in Internet, so that the real annual cost of implementing new services specific for our activities rarely exceeds $200.
Design and elaboration of web pages: In the first years we used to elaborate almost all the pages of the conferences and posters sessions. Although a increasing number of authors are beginning to get used to the design of web pages, and templates are provided to generate easily web pages, nowadays authors usually prefer to send their presentations in a word processing format.
Files are sent to the organization by e-mail or by FTP. In fact, no limit exists in the number of accepted pages, depending only of the quality of the presentations and the capacity of the scientific committee to review all the papers. For that reason the Scientific committee is usually numerous, with 20 collaborating professionals that are used to Internet. President of Scientific committee coordinates what members of the committee will receive each abstract to be reviewed. E-mail is the usual way of communication.
We encourage to most advance users to apply the templates for their web pages, to obtain more uniform results.
Authors with a good knowledge of web design like to include audio or video in their pages. Thus, we can receive a poster and just hear it at the same time we visit other pages. Audio is welcome by people with visual deficiencies.
In the last event we organized (2nd Virtual Hispano-American Pathology Congress, http://bio.hgy.es/conganat) we have applied new server-side technologies that allow the automatic creation of web pages at demand. Actually, all the information corresponding to presentations are structured to be stored in a database. A server side program elaborates on the fly the requested presentation. This is the best way to obtain uniform web pages. The modification performed to this program affects to all the presentations at the same time, and the maintenance is simplified.
In the first edition of the Spanish-American Virtual Congress of Pathology, a total of more than 2.000 web pages were created. The classification of pages was: information and registration of delegates and papers (100), conferences (600), posters (1,000), other languages (20), indices (200), seminaries (100).
Since only 20% of the poster presentations (about 200 pages) presentations were received in HTML format, a total of 1.800 pages were entirely created by the organization of the congress. The cost of realization of pages by a private company was about $75 per 100 pages when a template was used (in about 1.700 pages, i.e. $1.275) and $10 per page when the page required a complete design (in about 100 pages, i.e. $1.000). The total amount may be around $2400.
Furthermore, a total of 3.000 pictures (JPG and GIF) are usually presented in a virtual congress. Since a 40% of the authors used the digitalization service (that is also free) that included the adequacy of images formats, size and compression, and the digitalization of 35mm slides, about 1,200 images needed some kind of work. The cost of the service of digitalization was normally included in the elaboration of the pages, except for 10 conferences in with more that 50 graphics had to be included. These additional 500 images had an additional cost of $800.
Diffusion: Internet is an obvious way to publish the event: using search services like Yahoo, Altavista, Ole, etc.; in mailing lists and News, using links in other pages, etc.
However we have found essential to announce these events in the conventional journals, bulletins and specialized newspapers, because many potential delegates are not frequent Internet users.
Anyway, collaborating medical Associations or Societies make these announcements, with no additional cost.
Organizing and technical meetings: The organization celebrated their meetings by IRC, usually once a week. But e-mail was also an important communication way between organizers.
Two members of the organizing committee maintained the web.
Since most of the members in the committees access Internet by telephone lines, the total cost in this item was estimated in $800 for the 4 main months of duration of the congress.
CD-ROM:The edition of CD-ROM with the whole congress allows a permanent record of the event. It is nor only a very easy way to access this information but also can be used to access the congress from the server, without using hard disk space.
The cost of the publication of a CD-ROM is $2 per copy, with a total of 1,000 copies ($2,000).
Incomes: Exhibition halls and links to private company are a main source of financing for virtual congresses. Unfortunately, in our media, very few companies trust this new way of scientific meetings, being the most interested the communications, and software companies. We hace find an essential support in medical associations and National Research Funding.
Conventional Congresses: It is becoming more difficult to distinguish between a "presence" congress and a virtual congress because conventional events usually also publish and broadcast their program and presentations (not only abstracts but also complete text) in Internet. Furthermore, a connection to Internet is almost always present in every conventional congress, not only in the presentation rooms but also in exhibition halls.
On the other side, for several reasons, during the preparation or the celebration of virtual congress, delegates and organizers and sponsors may celebrate a meeting (simultaneously or subsequently transmitted in Internet). We have found this necessary in the following situations:
1.- Educating professionals with little experience in the Internet world.
2.- To celebrate telepathology sessions between 2 or more groups.
3.- To inform about virtual congresses.
4.- To practice with news technologies (ISDN devices, cameras, etc) presented by companies.
One of the main costs in conventional congress is the rooms and halls to celebrate the conferences, posters and paper sessions, and exhibitions. "Space" factor is the main limitation for the number of participants. In Spain the cost of a Hotel to celebrate a 4 days congress is about $30,000 to $65,000.
Every room in the congress must be equipped with screens, transparencies, 35 mm slides, video devices connected to PC, etc. This cost may easily reach the amount of $5,000.
The little participation in discussions in virtual congress is probably due to a loss of the direct contact with authors, which seems to stimulate the present people to raise their hands and begin asking. However in long sessions, generally very interesting delegates frequently get tired and discussion if often missed. We have to educate ourselves and learn how to participate in the discussion of web forums.
Demonstration of hardware or software is easily made in a conventional meeting. About software, the new collaboration tools in Internet allow nowadays to share applications and manage them remotely. This will also soon be possible in microscopes, and automation devices.
In Argentina, the budget for the 17th National Congress of Cardiology (June 1998, more than 3,500 participants) was $400,000.
1st Virtual Congress of Cardiology: With the agreement and help of many Institutions and Organizations, the Argentine Federation of Cardiology is organizing the 1st Virtual Congress of Cardiology. The Steering and Scientific Committees are multinational and they carry out their workshops (planning and organization) virtually by text conferences through IRC channels and by e-mail. Some of its members know each other only virtually and they met by activities through mailing lists (Cardio-L, PROCOR, Cardio-Consult, SIM-L) and clinical rounds (http://www.fac.com.ar/ateneos).
The Congress will be held between October 1999 and April 2000. The different activities will be accessed through Web, E-mail and chat, and is going to be free. It will have, as any real congress, conferences, symposiums, courses, abstracts and posters.
In general, with adaptations to each activity, the lectures will be on the Web pages; opinions and questions will be sent by E-mail through specific mailing lists and there will be discussions on line by chat. Once the activity is finished, everything is going to be permanently on the Web pages.
There will be many servers with mirroring information in them to ensure access in case of troubles. Currently, the Web pages are in http://www.fac.com.ar/cvirtual.
To facilitate access to the participants, instructions will be given at the beginning of 1999 by conventional mail, e-mail and/or on the Web. We are trying to encourage subcommittees in each country to make courses and educational activities to facilitate access to Internet tools.
The official languages are English, Spanish and Portuguese. The Steering Committee will receive the lectures in any of these languages and will translate them. The mailing list messages will be translated so that each mail will be in two languages. The chats will be translated also.
The estimated budget for this six months Virtual Congress, including translation, is about $140,000.
Other Virtual Congresses and Symposia in Uninet and RedIris: The First Iberian-American Virtual Congress on Neurology is been carried out now (October-November 1998) in Internet at http://cvneuro.org. Until now the current figures are: brief communications: 115; conferences: 150; text-conferences by IRC: 8; authors: 268; registered: 700. The First Iberian-American Virtual Congress on Nephrology will be held in Internet at http://bio.hgy.es/nefrocon. And the 4th Oncological Reunion at the Oncological Institute of San Sebastian, Spain was fully performed in IRC (Uninet servers) in April 1998 at and its proceedings are at http://bio.hgy.es/biomed/logs/jornadas/joronc.

Conclusion

The cost/benefit ratio of these activities tended markedly towards benefit.
Virtual congresses, even when much cheaper, are only complementary to conventional meetings and these last will never disappear. Human being needs to communicate directly with other persons, and we are not used to talk fluently to a machine. But these educational limitations will soon disappear in the next generations.
However we won’t have to wait long to receive an increasing continuing education, congresses, and demonstration entirely celebrated in Internet. This greater offer will probably increase the quality of "presence" meetings, were only selected works will be presented.
At the end, we will find in Internet the information of virtual and conventional congress and a "Medline" will be created for all these events, so that we won’t have to wait several months for the results of an investigation to be published in scientific journals. For that reason, although a greater number of people can read these papers and express their opinion, will have to be very cautious to accept some of the results of these investigations.
Since the presence of these journals in extending in Internet, the review work of the editorial committees will maintain a high level of quality in their publications, which will be published in a shorter time.
It is the responsibility of the scientific community, through the current and new associations and organisms to maintain and structure the huge amount of information we are dealing with in Internet.

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Presentation Number SApacher0828
Keywords: virtual, congress, chat, irc, mailing list

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