Internet and World Wide Web‐Based Tools for Neuropathology Practice and Education

Abstract

The Internet and the World Wide Web (www) serve as a source of information and a communication network. Together they form a so‐called web or network that allows for transmission and dissemination of information in unprecedented speed, volume and detail. This article presents an overview of the current status of neuropathology content on the www. As well as considering the Internet as a resource for neuropathology practice, education and research, we also address the issue of quality assurance when evaluating Internet and www content. Four major categories of websites (archival, broker, news and blog) are discussed and resources relevant to neuropathology of each type are highlighted. We believe that our report and similar attempts can provide an opportunity to discuss appropriate and effective use of the Internet by the neuropathology community.

INTRODUCTION

From printed media to radio, television and finally computers, advances in communication technology have continued to transform the ways we exchange ideas and information. These advances have affected not only the qualitative and quantitative aspects of communication but also the nature in which we communicate. Nowhere are these transformational powers more apparent than in the development of the Internet and the World Wide Web (www). The diversity, selectivity, depth and breadth of information being transmitted through this network have improved our abilities to understand complex biologic systems in an unprecedented way. These advances have significantly affected the practice of medicine and medical education, which have been widely discussed in recent publications 5, 8, 12, 15, 18, 22, 23, 24, 25, 33, 35, 37, 46).

The aim of this article was to provide a readily accessible guide to neuropathology content in the www and to present some pertinent examples. Hopefully, this article will result in further discussions about how neuropathologists can use the Internet and www to enhance the practice of neuropathology and to accurately and responsibly inform the public. As the web content continually expands at an impressive speed, this article is not intended to be an exhaustive review of all neuropathology‐related websites, but rather to provide examples of this communication medium's potential.

THE IMPACT OF THE INTERNET AND THE WWW

The ability to store and manipulate data in electromagnetic media has led to an exponential growth in the amount of stored and exchanged information. The term “Internet” was first used in December 1974 to describe a particular single global computer network for the exchange of electronic data 11, 29). This network did not evolve into the current user‐friendly form until Tim Berners‐Lee, a British scientist, created the www in 1989 (6). In essence, the www has numerous interlinked websites, and websites are composed of interlinked web pages.

According to a recent study, the Internet transmitted 532 897 terabytes of stored information in 2002, of which 82.7% was in the form of electronic mail (e‐mail). The remaining 17.3% was contained in the surface Web (visible or indexable web information) and the deep Web (invisible or hidden web information). Information in the surface Web has grown rapidly, expanding from an estimated 20–50 terabytes in 2000 to 167 terabytes in 2003. The deep Web contained an additional 91 850 terabytes in 2003. (26). Internet Usage Statistics estimates that 21.9% of the entire human population (about 1.46 billion) will have used the Internet in 2008 as compared to 5.4% in year 2000. The expansion of internet use is fast but also asymmetrical. About 73.6% of the population in North America uses the Internet, approximately 17% of all the users in the world, a rate much higher than all other geographic regions. Furthermore, between 2000 and 2008, the increase in the number of internet users was 2.3‐fold in North America, 5.1‐fold in Asia and 11.3‐fold in Africa (31).

The explosive increase in the sharing and processing of information has had profound effects on the practice of medicine. Patients with sufficient resources now have a realistic possibility of becoming as informed about their medical conditions as a general practitioner. This alters the flow of information in patient care from a unidirectional physician‐to‐patient mode to a bidirectional interactive process that often involves one or more content experts. In pathology practice, with the strong emphasis on consultation, introduction of these technologies has been less disconcerting than in other specialties. The emerging technologies have enhanced information and image sharing, facilitating a more interactive consultative environment, especially for academic pathologists. This is particularly true in neuropathology, in which there has always been a strong emphasis on clinical and neuroradiology correlations, as well as close translational and basic research interfaces. Like many academic pathologists, neuropathologists often find themselves in the position of using or generating web content to accomplish their teaching, training and research objectives. Search engines such as PubMed and Google are now indispensible tools for their goals.

Despite the advantages, a few challenges have also emerged with the ease of creating and accessing web content. The large number of websites makes it difficult for both patients and professionals to sift through and to find the pertinent information they need. Depending on the key words used for the search, informational websites may still be missed, while many “junk websites” are included among the often thousands of “hits” on your generated list. A coordinated effort to publicize the relevant links to existing substantive neuropathology websites would therefore be a useful feature.

Assuring the usefulness of information in the websites is another challenge. Online search engines such as Google provide a link analysis algorithm rating system (PageRank™) and hypertext‐matching analysis to help users find (presumably) the most useful sites. As the content validity cannot be defined through such algorithm and text matching analysis, the professionals and professional societies still bear the burden of providing accurate and current content while ensuring reliable information for all internet users.

THE QUALITY OF WEBSITES

At the dawn of the internet era, websites were technically difficult to create, maintain and update, while server space was expensive to rent. The new generation of website and blog creating programs is user‐friendly and requires practically no programming knowledge. A small website or a blog can now be created and operated by a single interested person with minimal technical expertise. The development of these programs has led to a dramatic increase in websites in the past several years. According to a recent publication, there was an increase in the total number of active websites from 15.6 million in April 2002 to 68.6 million in January 2008 (1). However, the resources to design, implement and maintain high‐quality, comprehensive and professional‐level websites are substantially greater and technically more challenging. The expertise and expense required for these efforts are typically prohibitive for individuals or small groups. Without public or private funding, a viable business plan is needed to generate revenue through advertisements or subscriptions. However, the audience for websites that provide neuropathology information to the public, trainees and the professionals, is far too small to draw meaningful revenue by advertisements or subscriptions. Currently, the larger neuropathology websites that exist are mostly affiliated with academic institutions which provide variable levels and types of support.

The quality of online images is of paramount importance to pathologists. Until recently, the vast majority of pathology content consisted primarily of texts, static digital images or digitized photomicrographs. The recent introduction of whole‐slide imaging (WSI, also known as digitized slide or virtual slide) is beginning to change this situation. WSI technology, discussed in greater detail by Guzman and Judkins in this mini symposium, is an exciting addition to pathology web content. The interactive nature of WSI is particularly powerful in education and training when combined with internet‐based programs. This setup allows several individuals from different parts of the world to simultaneously view the same slide, akin to a multiheaded microscope session.

The ease of developing, searching, creating or copying internet content has led to marked variations in both the relevance and the quality of medical information available in the Internet. It is difficult for both patients and physicians to sift through this maze and to find the information they need. Thus, it is critical to develop guidelines and a “code of conduct” for web designers and to help users to identify credible content. The “Health on the Net Foundation” is a nongovernmental organization that has been created to improve the quality of information aimed at both patients and medical professionals, and to facilitate quick access to the most relevant and up‐to‐date medical information. The foundation has published a code of conduct (HONcode) consisting of eight principles (authoritativeness, complementarity, privacy, attribution, justifiability, transparency, financial disclosure and advertising policy) that provide a good framework for generating a sound and reliable resource for patients and physicians. The HONcode project certifies and lists the websites that have undergone its scrutiny and presents an added means to justify the content in specific websites. It seems prudent for all providers of health care to develop or to abide by well‐recognized principles of conduct in the Web. Multiple articles have been published on the issue of website evaluation both from the perspectives of professionals 7, 34, 47) and the general public (17). Based on shared criteria from these publications and on our own experience with website design and administration, we present a list of criteria for the development and design of future neuropathology websites (Table 1).

Table 1.

Criteria for evaluation of neuropathology websites as proposed by the authors.

Criteria for evaluation of neuropathology websites
General
1. Does the website comply with the Health Insurance Portability and Accountability Act (HIPAA)?
2. Is the site relevant to the practice of clinical and experimental neuropathology?
3. Is this site aimed at the general public or professionals?
4. Does this website contain more than one component such as quiz, study cases and didactic material?
5. Does the website target a specific group of professionals (trainees versus practicing pathologists)?
6. Is the website free and easy to access?
7. Is there appropriate disclosure of information regarding the webmaster, contributors, source of information and affiliation of the website?
8. Is there appropriate disclosure of source of commercial and/or noncommercial support and sponsorship?
Scientific merits
1. Is the content (text, graphics and images) accurate?
2. Is the content readable, well organized and well written?
3. Is the style consistent?
4. Is the content and discussion objective and balanced?
5. Does the quality of the website vary significantly between different sections?
6. Is the depth of discussion appropriate for the designated audience?
7. Is there any clinical imaging and neuroanatomic correlation in the discussion?
8. Are the web pages furnished with relevant links and references pertinent to the material under discussion?
9. Are the materials dated?
10. Are the authors of individual pages disclosed?
11. Are the sources of material, references and links well trusted and respectable?
Technical merits
1. Is the site user‐friendly (well functioning, logical, easy to follow, easy to navigate)?
2. Are the images of high quality?
3. Are whole‐slide images (WSI) available? Are these slides of high quality? Do the virtual slides function well?
4. Is there a contact address and contact mechanism?
5. Is there an evaluation form provided?
6. Is the website aesthetically pleasing?
7. Is the website complete?
8. Does the website provide a local/internal search function?

As we master the concepts of quality assurance and total quality management in pathology and neuropathology, we should be able to find means to apply them to the Internet and the web content. However, these concepts have not found standardized interpretation in pathology subspecialties and would be more challenging to apply to the Internet. It is most likely that through the efforts of specialty boards and professional societies, guidelines will be defined and implemented to protect the interest of the public. It is important to recognize that while the medical societies and professional organizations can and should judge the reliability of information on the Web, no restrictions should be imposed on the freedom of using the Internet. It is more than appropriate to provide certain “seals of approval” to sites with reliable information, but there should be no attempt by the governments, national or local, to restrict an individual's freedom to populate the Web.

PROFESSIONAL NEUROPATHOLOGY CONTENT ON THE WWW

Health‐related websites can roughly be classified into those intended for professional use and those for the general public. Both the websites exclusively dedicated to neuropathology and the general pathology websites contain significant neuropathology content. Table 2 provides a list of current neuropathology or general pathology websites with significant neuropathology content. Most of these websites represent the work of an individual or a small group. The others are the work of teams with significant technology expertise and support. Most of these websites are found in academic institutions. There seems to be four major categories of websites that provide neuropathology content on the Web, although it is also quite common to find websites that are hybrids of these categories.

Table 2.

Neuropathology websites. The following list provides links to websites exclusively for neuropathology and also general pathology websites that have significant neuropathology content.

Website	URL address
Neuropathology websites
American Association of Neuropathologists, USA	http://www.ouhsc.edu/pathologyaanp‐oren/
Atlas of Veterinary Neuropathology, Cornell University, USA	http://web.vet.cornell.edu/public/oed/neuropathology/index.asp
Brain Atlas, Harvard Medical School, USA	http://www.med.harvard.edu/AANLIB/home.html
Brain Pathology, International Society of Neuropathology, USA	http://www.wiley.com/bw/journal.asp?ref=1015‐6305&site=1
Introduction to Neuropathology, State University of New York, Stony Brook, USA	http://www.path.sunysb.edu/faculty/woz/NPERESS/webclasstitle.htm
Neuroanatomy & Neuropathology on the Internet, University of Debrecen, Hungary	http://www.neuropat.dote.hu/
NeuroLearn, University of Oklahoma, USA	http://moon.ouhsc.edu/kfung/JTY1/index.htm
Neuropathology, Stony Brook University Medical Center, USA	http://www.stonybrookmedicalcenter.org/body.cfm?id=1176
Neuropathology‐ An Illustrated Interactive Course for Medical Students and Residents, Northeastern Ohio University, USA	http://www.neuropathologyweb.org/
Neuropathology and Neuroimaging Laboratory, University of Rochester, USA	http://www.urmc.rochester.edu/neuroslides/index.html
Neuropathology and Neurology, Tulane University, USA	http://www.som.tulane.edu/classware/pathology/medical_pathology/neuropathology/start_here.htm
Neuropathology Case Study, State University of New York, Upstate Medical University, USA	http://pathed.upstate.edu:8080/neuro_cases/Frame.htm
Neuropathology Image Library, Washington University, USA	http://www.strokecenter.org/prof/pathology/
Neuropathology Image Review, State University of New York, Upstate Medical University, USA	http://pathed.upstate.edu:8080/neuro_img/frame.htm
Neuropathology Mini‐Course, Virginia Commonwealth University, USA	http://www.pathology.vcu.edu/WirSelfInst/tumor‐2.html
Neuropathology Resource, College of American Pathologist, USA	http://www.cap.org/apps/cap.portal?_nfpb=true&cntvwrPtlt_actionOverride=%2Fportlets%2FcontentViewer%2Fshow&_windowLabel=cntvwrPtlt&cntvwrPtlt%7BactionForm.contentReference%7D=committees%2Fneuro_edu_prog.html&_state=maximized&_pageLabel=cntvwr
Prion disease surveillance
National Creutzfeldt‐Jakob Disease Surveillance Unit (NCJDSU), UK	http://www.cjd.ed.ac.uk/index.htm
National Prion Surveillance Center, USA	http://www.cjdsurveillance.com/contact.html
Neuromuscular pathology
Neuromuscular Disease Center, Washington University, USA	http://www.neuro.wustl.edu/neuromuscular/index.html
General websites with significant neuropathology and neuroanatomy contents
Anatomy Atlases, University of Iowa, USA	http://www.anatomyatlases.org/
Immunoquery, USA	https://immunoquery.pathiq.com/PathIQ/Login.do
International Association of Chinese Pathologists, USA	http://moon.ouhsc.edu/kfung/IACP‐OLP/Default.htm
Knowledge Hub, US and Canadian Academy of Pathology, USA	http://www.uscap.org/
Online Case Studies, University of Pittsburgh, USA	http://path.upmc.edu/cases/index.html
Patho Basiliensis, Univ.of Basel, Switzerland	http://pathorama.ch/
PathMax, Yale University, USA	http://www.pathmax.com/main.html
Pathology Outlines, USA	http://www.pathologyoutlines.com/
Pathology Slides and Laboratory Units, Indiana University, USA	http://medsci.indiana.edu/c602web/602/c602web/toc.htm
Pathweb, University of Connecticut, USA	http://pathweb.uchc.edu/
PEIR (Pathology Education Instructional Resource), University of Alabama, USA	http://peir.path.uab.edu/
Tapir: Teaching Archive of Pathology Image Resources, Cambridge University, UK	http://tapir.caret.cam.ac.uk/tapir/jsp/menu.jsp
Virtual Microscopy, University of California at Davis, USA	http://sommedia.ucdavis.edu/slides/
Virtual Pathology, University of Leeds, UK	http://www.virtualpathology.leeds.ac.uk/index.php
Web‐Based Learning Center, University of Oklahoma, USA	http://www.oumedicine.com/body.cfm?id=2511
WebPath, University of Utah, USA	http://library.med.utah.edu/WebPath/webpath.html
Ophthalmic pathology website
EyePathologist, Duke University, USA	http://www.eyepathologist.com
Ophthalmic Pathology Atlas, University of Wisconsin, USA	http://wieyemd.ophth.wisc.edu/ocupath/main.html
Neuropathology blog
Neuropathology Blog, Brian E. Moore, MD, USA	http://neuropathologyblog.blogspot.com/

Archival websites are the first category and contain an organized body of original, usually educational information. The Case of the Month series of the International Society of Neuropathology is an example that provides study cases (28). NeuroLearn (20) is an integrated website provided by the University of Oklahoma Health Sciences Center (OUHSC) that includes study cases, quizzes, didactic text and a separate program for nonpathology trainees (Figure 1). Substantial neuropathology content can also be found in some general pathology websites such as the University of Utah “Webpath”(30) and the “PathologyOutlines”(42). Some of the professional neuropathology websites in this category also include an educational component. For example, the American Association of Neuropathologists provides online educational resources (4).

Figure 1.

NeuroLearn of the University of Oklahoma Health Sciences Center. This site is exclusively for neuropathology and provides quizzes, study cases, text and links. (http://moon.ouhsc.edu/kfung/JTY1/index.htm).

The second category (broker) consists of websites that serve as information brokers. These websites provide links to other websites or online resources with relevant content. These websites do not provide a substantial amount of original material, but rather seek out and organize other sources of relevant information available on the Web. Not unlike a peer review process, the owners of these websites play a valuable role in assessing the content and quality of the new material constantly being added to the Web. Websites such as Rule Out Cancer (49) are invaluable starting points for learning about new internet‐based neuropathology resources. PubMed (44) provided by the United States National Library of Medicine and the National Institute of Health is a search engine that provides exhaustive links to abstracts on all health‐related publications.

The third category (news) comprises websites that disseminate news or information around a specific topic. In medicine, such sites are typically hosted by a professional society. The main purpose of these websites is to serve as a communication port for its members and to post news related to the society. These websites often have other functions and offer services such as membership application or collection of dues. Some of them also have an archival section for educational material and news. The websites of the American Association of Neuropathologists (3) and The International Society of Neuropathology (28) are good examples. Temporary websites for meetings or symposia also fall under this category.

The fourth general category (blog) is the weblog or blog for short. Typically, these sites are in the form of a logbook or diary with a particular theme. The format and content are the most variable and can include information, commentary, descriptive records or events. The majority of blogs are owned and maintained by an individual or a group that shares the same interest. Many blogs welcome contributions and function as discussion forums. Blogs are new to the internet family and are unique in providing venue to foster the exchange of ideas. Blogs are useful for providing rapid communication about specialized topics. Blogs can be a very effective way for an individual or a small group to disseminate news or information. However, because of the limited authorship and lack of peer review, they have typically been a more effective tool for publicity and advocacy than in the dissemination of scientific information. Neuropathology Blog by Dr Brian Moore (38) is devoted to neuropathology news and information. The Daily Scan (13) is a website sponsored by Aperio that is devoted to WSI. Lab Soft News by Dr Bruce Friedman (19), sponsored by the nonprofit Pathology Education Consortium, is a blog devoted to pathology informatics and clinical laboratory.

NEUROPATHOLOGY INFORMATION ON THE WEBSITES FOR THE GENERAL PUBLIC

Many large, general purpose health websites designed for the public include pathology and sometimes neuropathology information. Understanding Brain Tumors created by the University of Virginia Health System (40) is an example that includes both clinical and pathological information. MyBiopsy.org, provided by the College of American Pathologists (39), and Oncolink (41) are examples that provide dynamic content aimed at the specific needs of a particular group of patients. These websites are examples of resources with easy to understand and relevant information, such as specific procedures in pathology and the role of pathologists. MyBiopsy.org is designed for patients and their families, and provides answers to frequently asked questions about diseases, treatment options and other common problems. The site includes definition of key terms and pictures of both normal and diseased tissues. It is interesting to note that currently, there is no neuropathology content on this site. Similarly, Oncolink is a website first designed at the University of Pennsylvania to help cancer patients and their caregivers with basic information about their disease, clinical trials and links to educational material. Neuropathology websites designed exclusively for the general public are rare. The Center for Neurodegenerative Disease Research at the University of Pennsylvania (10) is one example. This website provides information on neurodegenerative diseases for health‐care professionals as well as for the general public.

EDUCATION AND TRAINING

Some of the major applications of computer and the Internet are education, training and assessment. Some of the most sophisticated computer‐based clinical simulators can anticipate and alert users to potential errors (9). Many websites aim to provide content that can educate, motivate and enlighten their students. Digitally recorded lectures and conferences are widely used in online medical education. Depending on institutional policies and personal consent, such material may be posted on the websites or made available through resources such as Apple's iTunes U, a clearing house for free or inexpensive educational material. Online resources for education and assessment offer desirable features that are applicable to neuropathology education at a slightly more sophisticated level. These include WSI of classic lesions that can be used for training and/or assessment, or collections of test questions with known performance characteristics. These questions can be used in a dynamic assessment setting to test student performance. Many of these features have been or are being incorporated into education assessment, such as board exams, but have yet to find their way into training of residents and fellows, or continuing medical education of practitioners.

The Internet and the www have greatly improved the efficiency of academic education programs. It is possible to better match the student with the appropriate learning methods using web tools, and this can be done at the convenience of the learner. Motivated students may also find computers less intimidating than human instructors. Residency and fellowship training programs can allow each trainee to learn the assigned material well and to improve themselves regardless of their level of competence. Computers and the Internet are important supplements to a training program, but their role cannot be over emphasized.

Residency and fellowship training programs must allow all residents to benefit from the learning experience, motivate and enlighten the participants with interactive and practice‐relevant content. Such a system has the following advantages:

• (i) The computer can repeat the same job endlessly at any odd hour of the day at several locations simultaneously. This affords trainees the ability to learn at a time that fits their schedule and to learn at their own pace.
• (ii) The instructor can take additional time to prepare more comprehensive and insightful material. Instructors can spend more time discovering the weaknesses and strengths of their trainees. They are now better equipped to improve individual trainees rather than to recite the information.
• (iii) The learning materials, particularly the images, can be easily modified and recycled for use at a level appropriate for the particular learner group.
• (iv) Trainees often feel less intimidated when they make a mistake with a computer than before a human instructor. While such educational experience cannot substitute practical training and interpersonal skills, it provides a less stressful venue for learning basic concepts.
• (v) Recognizing that there are certain types of information and skills that need to be taught through face‐to‐face interactions, one can design complementary information that can be effectively conveyed online. This is particularly true for content that requires repetition to learn where the perceived risk of annoying or offending an instructor is eliminated by working through tutorials to help develop a desired skill or knowledge.
• (vi) Computer systems provide both high‐quality visual and auditory information simultaneously or separately. As most trainees would find one form more desirable than the other, the simultaneous access to both text and voice would improve the training efficiency.
• (vii) The program can be tailored for every level of proficiency to explore the subject through presenting appropriate links and appropriate amount of material. This is particularly important in neuropathology as mastering of clinicopathological correlations is critical for the understanding of the disease process.
• (viii) 

  Although some technical hurdles still exist, WSI may eventually offer a better environment for discussion than projected still images. WSI technology has an unprecedented ability to display high‐quality images at very low magnifications, a feature greatly appreciated by neuropathologists. WSI can be extensively annotated so that trainees can be guided through WSI to focus on particular fields that illustrate key findings.

• (ix) It is easier to perform statistics and quantitative assessment of the learning experience over time.
• (x) By participating in the preparation of online materials, trainees can develop a more critical mind in diagnostic neuropathology.

Ideally, neuropathology education should integrate seamlessly into the anatomic pathology training program. It should incorporate lectures, unknown slide sessions, hands‐on experiences and other educational activities. Implementation of computer and web‐assisted training poses technological, logistic and psychological challenges to the program. Thus, a flexible training model is needed to satisfy the requirements of a diverse group of learners. The Department of Pathology of the OUHSC is one of the institutes that hosts a comprehensive web‐based program to meet the needs of different groups of trainees. Most of the online educational materials are free for access through the OU Web‐Based Learning Center (21). The architecture of this program is outlined in Figure 2.

Figure 2.

Architecture of the Web‐Based Learning Center of the University of Oklahoma Health Sciences Center. This program provides self‐studying material including cases and quizzes as well as evaluation programs. Residents are actively engaged in the preparation of material. Complementary lectures are also created to maximize learning efficiency. Abbreviation: OU = University of Oklahoma.

CONSULTATIONS, SELF‐ASSESSMENT MODULES AND CONTINUED EDUCATION

There have been radical advances in information sharing over the Internet, which have resulted in a significant expansion of the scale and nature of internet‐based consultations in diagnostic pathology. WSI technology promises a significant expansion in the scale and nature of internet‐based consultations as discussed above and by Guzman and Judkins in this symposium. WSI files can be shared within a health‐care center, between centers and even across continents to aid working groups and consensus conferences. Depending on the software and the architecture of the system, several slides can be viewed simultaneously from different computers around the world through the Internet 14, 16, 32, 36, 45, 48). With proper organization, the consultation process can easily benefit users at different levels of expertise. Once the educational materials are made available on the Web, trainees at remote locations can access these materials freely. WSI technology also allows sharing of historic archival collections online. They are likely to raise trainees' interests in neuropathology and could help to recruit talented individuals to our discipline.

Diagnostic or clinical utilities brought about by the advances in the Internet and the www are not just limited to consultations. Virtually all functions of a surgical pathology or neuropathology division can be improved by the use of shared documents, online assessment tools, quality assurance aids and items for specialized assessment. Sharing of standards, norms and experience across laboratories can significantly improve the functions of all pathology departments, large or small. The experience with immunohistochemical antibodies and special diagnostic tests of one institution can greatly aid in the decision making of other laboratories. Websites that accumulate and archive diagnostic experience can be a great help for pathologists in deciding whether a positive result for an antibody staining should alter the diagnosis. Immunoquery is a very practical commercial website that began as a free web service and is currently available for use by all pathologists and neuropathologists (27). Immunoquery is an example of a pathology website that has successfully converted into a subscription‐based pay site from a free web service suggesting that the potential exists for commercial success of diagnostic pathology‐related websites. Undoubtedly, more content will be made available to practicing surgical pathologists and neuropathologists to aid their day‐to‐day endeavors.

NEUROPATHOLOGY RESEARCH

In addition to the sharing of static images and WSI through the Internet, the Internet and the www have made additional contributions to research. Fundamentally, the Internet provides a backbone for transmission of very large files with images through e‐mail and direct server upload. Building upon this foundation, researchers have been greatly aided through the creation and sharing of datasets and information to provide easy access to large research database and search engines for scientific use. Searches and comparisons of nucleic acid sequences and protein sequences using the National Center for Biotechnology Information's Entrez portal have made major impacts on molecular biology and biochemistry. An example that is relevant to neuropathogy is the Allen Brain Atlas, an online resource that utilized WSI to show temporal and spatial distribution of a large number of genes in the developing mouse brain (2). The development of such resources has greatly facilitated both the exchange of ideas and research data among investigators. The Internet also allows the upload and sharing of manuscripts. This has significantly simplified and accelerated the publication of research papers. Many scientific articles are now published online well ahead of the printed version. While still in its infancy, there is an emerging trend to combine the technical features of blogs, described above, with a peer review process to develop online journals. The leading example of this is the Public Library of Science, which publishes several online journals related to science and medicine (43).

FUTURE DIRECTIONS

The Internet and the www have changed many aspects of neuropathology practice, research and education. These novel communication technologies have helped to organize, transmit and disseminate a huge body of information. For neuropathologists, it is essential to master these technological advances and to utilize these resources to keep neuropathology a vibrant and progressive subspecialty in the 21st century. Furthermore, active engagement with the Internet and web‐based resources is essential for the continued relevance and advancement of neuropathology. Opportunities exist for partnership with high‐quality resources that serve as outreach for the general public and to develop novel neuropathology content through professional and research communities. One way to nurture this development would be through the establishment of central networks that would publicize websites of all types with substantial neuropathology content. This will greatly facilitate the search and exchange of information. In addition, guidelines for sound information and quality assurance should be developed and adopted. Creation of a related neuropathology blog with WSI technology would provide an additional level of communication opportunity for the pathology community. Developing internet‐based education and assessment tools would be greatly facilitated by an active exchange of information. Finally, consideration should be given to the development of standards for the use of WSI for educational and consultation purposes without curtailing creativity or freedom of the use of the Internet and the www.

CONFLICT OF INTEREST DISCLOSURE

The authors have no financial ties with any of the websites, products or companies being mentioned in this article. Both authors have made significant contributions to several websites discussed in this article. Dr Fung has contributed to the websites sponsored by the OUHSC, the American Association of Neuropathologists and the International Association of Chinese Pathologists. Dr Tihan has significant contributions to the University of California, San Francisco Pathology Continuing Medical Education and the American Association of Neuropathologists websites.