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The MPEG-4 standard and electronic reporting for mobile, multimedia patient records.

Electronic reporting and transfer of confidential patient data to the electronic patient record using Internet-related and wireless technologies can pose threats to the security and integrity of data. The MPEG-4 (Moving Pictures Experts Group-Version 4) standard can enable the seamless integration of text, digitized images and video sequences, and the necessary data security protocols for mobile access to and transfer of patient information. This standard will improve the quality of the electronic patient record as well as the reliability of authentication of reports. Applying the standard for patient reporting will also improve ways for authorized users to interact with patient records. Easier access to mobile multimedia patient records will assist clinicians in documenting patient episodes in a more timely and synchronous manner. This will result in better communication between health-care team members by allowing them to stay linked and interactive even when separated by distances in a telemedicine environment.

Computer Security↗

The effectiveness of a multimedia program to prevent fetal alcohol syndrome.

Fetal alcohol syndrome (FAS) continues to be the leading preventable cause of mental retardation in the United States. Because abstaining from alcohol prior to and throughout pregnancy is the only way to prevent FAS, some prevention programs try to target women before they become pregnant. The Fetal Alcohol Spectrum Teaching and Research Awareness Campaign (FASTRAC) is a multimedia, peer-delivered educational presentation designed to reduce the incidence of FAS. Results from an ethnically diverse sample of high school students indicate that the program increased participants' knowledge regarding FAS but had no significant effect on participants' attitudes, beliefs about the dangers of FAS or intention to use alcohol during pregnancy. The FASTRAC program failed partly because of its didactic approach and the lack of health education principles that have been shown to be effective in changing other substance use behaviors. Suggestions for improving FAS prevention education programs are offered.

Adolescent↗

The Multimedia Activity Recall for Children and Adolescents (MARCA): development and evaluation.

BACKGROUND: Self-report recall questionnaires are commonly used to measure physical activity, energy expenditure and time use in children and adolescents. However, self-report questionnaires show low to moderate validity, mainly due to inaccuracies in recalling activity in terms of duration and intensity. Aside from recall errors, inaccuracies in estimating energy expenditure from self-report questionnaires are compounded by a lack of data on the energy cost of everyday activities in children and adolescents. This article describes the development of the Multimedia Activity Recall for Children and Adolescents (MARCA), a computer-delivered use-of-time instrument designed to address both the limitations of self-report recall questionnaires in children, and the lack of energy cost data in children. METHODS: The test-retest reliability of the MARCA was assessed using a sample of 32 children (aged 11.8 +/- 0.7 y) who undertook the MARCA twice within 24-h. Criterion validity was assessed by comparing self-reports with accelerometer counts collected on a sample of 66 children (aged 11.6 +/- 0.8 y). Content and construct validity were assessed by establishing whether data collected using the MARCA on 1429 children (aged 11.9 +/- 0.8 y) exhibited relationships and trends in children's physical activity consistent with established findings from a number of previous research studies. RESULTS: Test-retest reliability was high with intra-class coefficients ranging from 0.88 to 0.94. The MARCA demonstrated criterion validity comparable to other self-report instruments with Spearman coefficients ranging from rho = 0.36 to 0.45, and provided evidence of good content and construct validity. CONCLUSION: The MARCA is a valid and reliable self-report questionnaire, capable of a wide variety of flexible use-of-time analyses related to both physical activity and sedentary behaviour, and offers advantages over existing pen-and-paper questionnaires.

Journal Article↗

Supporting family carers using interative multimedia.

ACTION (Assisting Carers using Telematic Interventions to meet Older persons' Needs) is a nursing led Pan-European project (1997-2000). Its primary aim is to maintain the autonomy, independence and quality of life of frail older and disabled persons and their family carers by the application of telematic technology. This article describes the development of two multimedia programmes created as part of the ACTION project. Programme 1 'Planning ahead' helps family carers and frail older people to think about and plan for the future. Programme 2 'Break from caring' assists carers and older people to explore the range of respite care options available. Both programmes have been developed using a multimethod, user-centred approach. Preliminary evaluation data have indicated that frail older people and their carers have used the programmes to assist them when making difficult decisions such as selecting a nursing home, or exploring the use of respite care facilities.

Adult↗

Multimedia bootcamp: encouraging faculty to integrate technology in teaching.

As students entering college, graduate, and professional schools have increased needs and preferences for multimedia in instruction, faculty need to learn appropriate techniques for integrating technology into their educational duties. Instructional designers at the Claude Moore Health Sciences Library at the University of Virginia developed and implemented aMultimedia Bootcamp to help faculty and their support staff develop the skills necessary to integrate technology into teaching.

Communications Media↗

A comparison between the multimedia fate and exposure models CalTOX and uniform system for evaluation of substances adapted for life-cycle assessment based on the population intake fraction of toxic pollutants.

In life-cycle assessment (LCA) and comparative risk assessment, potential human exposure to toxic pollutants can be expressed as the population intake fraction (iF), which represents the fraction of the quantity emitted that enters the human population. To assess the influence of model differences in the calculation of the population iF ingestion and inhalation iFs of 365 substances emitted to air, freshwater, and soil were calculated with two commonly applied multimedia fate and exposure models, CalTOX and the uniform system for evaluation of substances adapted for life-cycle assessment (USES-LCA). The model comparison showed that differences in the iFs due to model choices were the lowest after emission to air and the highest after emission to soil. Inhalation iFs were more sensitive to model differences compared to ingestion iFs. The choice for a continental seawater compartment, vertical stratification of the soil compartment, rain and no-rain scenarios, and drinking water purification mainly clarify the relevant model differences found in population iFs. Furthermore, pH correction of chemical properties and aerosol-associated deposition on plants appeared to be important for dissociative organics and metals emitted to air, respectively. Finally, it was found that quantitative structure-activity relationship estimates for superhydrophobics may introduce considerable uncertainty in the calculation of population intake fractions.

Animals↗

Imagix: multimedia software for evaluating the vividness of movement-imagery.

This article presents a new software, Imagix, designed for the evaluation of the vividness of movement-imagery. This multimedia test is comprised of 18 movements in six different psychomotor categories whose vividness of imagery is to be appraised. Imagix has the advantage of offering an evaluation of the vividness of imagery in a normative way. The participant chooses among four films displaying a vividness gradient, which includes contrast and luminosity. The participant is first asked to visualize a movement verbally suggested. The participant is then asked to evaluate the vividness of this mental image by choosing on a computer screen the movie that best corresponds to the vividness of the movement-imagery. The first versions of this freeware (in English and French) are currently being validated.

Contrast Sensitivity↗

Formative evaluation of a multimedia CAL program in an ophthalmology clerkship.

The use of computer-aided learning (CAL) in medical education has grown considerably in recent years. CAL has a number of attractive educational features, and computer simulations have been shown to improve learning in health professions education. This paper describes the formative evaluation of a multimedia CAL simulation used in a third year ophthalmology clerkship. The CAL program combines the use of a Macintosh computer with a mannequin head, housing two motor driven camera diaphragms which simulate pupil response. This allows students to practice the "swinging flashlight test", an important clinical exam commonly used to detect visual dysfunction. Five questions are addressed in this study and the formative evaluation process is described. The highly positive results are then presented, with suggestions given for improvement followed by implications for future development.

Clinical Clerkship↗

Incorporation of potential for multimedia exposure into chemical hazard scores for pollution prevention.

We are reporting a chemical hazard score for pollution prevention, called the Purdue score. The Purdue score provides a relative quantitative measure combining a variety of chemical hazards into a single quantitative hazard weighting factor for the non-expert to use. The main expected uses are to design safer products, assist in implementing and measuring achievement in pollution prevention, and as an adjunct for reporting Toxic Release Inventory data to the U.S. Government. Scoring results are presented for 200 Superfund chemicals, rank ordered by the worker hazard part of the score, by the environmental hazard part, and by combined worker and environmental hazard scores. We have reviewed the extent to which the Purdue score presently incorporates potential for multimedia pathway and multiroute absorption exposure. Until other possible uses have been carefully tested, peer-reviewed and published, users are advised to limit use of this system to planning, implementing and measuring pollution prevention and to enhancing the interpretation of Toxic Release Inventory data. The objective of this report is to look at how the structure of this score handles exposure to chemicals, both via multi-compartment pathways and multi-routes for contact or absorption health damage, as well as how it handles habitat degradation by chemicals. For all of these, the approach is built on inherent properties of each chemical, which are true for all sites and scenarios. The biggest obstacle to scoring is lack of measured chemical property data needed for scoring. We handle missing data by regression, quantitative structure activity relationship estimations, and a missing data default rule. The limitations of chemical hazard scoring are reviewed. At present, there is no widely accepted single measure of relative chemical hazard, against which to calibrate this hazard score for accuracy, except experience from industrial use. However, despite limitations, we suggest there is a strong value added for industry and society in availability of a concise, simple-to-use measure of relative chemical hazard. The Purdue score enables separate or combined consideration of chemical hazard to workers and to the natural environment. The Purdue score has potential for major cost savings in relative hazard ranking and business decision making regarding little-studied organic chemicals, because of the extensive use of advanced property estimation software. We conclude that there is societal need to warrant advanced development of this risk management tool, which is now ready for pilot use by industry. The Purdue score is mainly intended to assist and encourage businesses to implement and measure pollution prevention-especially small businesses--in a cost-effective way. The Purdue score relies strongly on sublethal toxicity, and there is practical potential for it to be used with thousands of chemicals.

Animals↗

PATSy: a distributed multimedia approach to client assessment skills training.

This paper describes the development of an interactive distributed multimedia system (PATSy). When completed, it will serve as a repository of brain-injured clients and their test data for use by speech and language therapy students and researchers. In education, PATSy will be a resource which is flexible enough to accommodate various teaching pedagogies as well as support student learning in clinical assessment and diagnosis of various disorders.

Clinical Competence↗

An Expert PArasite IdentificatiON (EPAION) system with multimedia support.

Until now computer-assisted parasite identification was based on database applications requiring data specification on an individual basis, thus limiting the ability of the system to handle rule-based knowledge as humans are used to do. A new Expert PArasite IdentificatiON (EPAION: Greek term for expert) system was developed to serve as an interface between the database and the user, where the database is a repository for bionomic and morphological facts about the parasites for the expert system. The system was developed by using a logic-based computer language which allows the definition of rules and facts to assist the creation of queries to the database. The components of the system are the knowledge base, the multimedia data base, the inference mechanism, and the graphical user interface. The operational modules of the system are the Parasite Identifier and the system Utilities. This expert system facilitates knowledge incorporation in a manner simulating the natural mental process, thus allowing the checking of the accuracy of the information that the user feeds to the computer and the creation of intelligent queries to the database. These characteristics accelerate focusing and optimize the parasite identification scheme regardless of the user's profile of competency.

Animals↗

Educational technology transfer in newly independent states: developing a medical multimedia laboratory in Lithuania.

This paper discusses the development of an interactive multimedia computer laboratory within the Vilnius University Medical Faculty involving transfer of hardware and courseware developed in the USA. The contexts in which the laboratory was developed are described and factors helping and hindering successful technology transfer are identified. The future of the laboratory and its potential role in international distance education and information access are discussed. While this paper does not focus on international distance education in the traditional sense of offering courses or training from one or more source institutions to individuals off-site, it has implications for providing education internationally, especially in the Baltic and other newly independent states of the former USSR.

Databases, Bibliographic↗

Developing a virtual reality-multimedia system for anatomy training.

The University of California, San Diego, School of Medicine's Learning Resources Center is developing a prototype next-generation application for anatomy education which combines virtual reality and multimedia curricular resources. The anatomy lesson utilizes polygon-based 3-D models of the hepatobiliary system created by BioGraphics Inc. of Fort Collins, Colorado which were derived from the National Library of Medicine's Visible Human Project Dataset. This article describes the needs assessment, learning objectives, and preliminary design of the current prototype. The multivariate design, the development strategy for implementing functionalities, and the engineering of critical software interface components are also outlined.

Anatomy↗

Disseminating multimedia protocols over Internet for emergency and catastrophe management.

Over the last years we have developed various computing methods to assist specialized personnel on various aspects of catastrophe and emergency management. New models can address tasks such as patient triage; stabilization, resource coordination and hospital alertness and techniques based on information technologies. In this paper we present various tools (written on Java and C+2) that we created to store, represent, and disseminate practice guidelines and protocols over the World Wide Web. Guidelines and protocols are stored using a standard database program (e.g., Microsoft Access), and represented in a flowchart format linked to multimedia information such as text, pictures, sound, video or external sources of data. Using our JAVA tool, protocols can be disseminated over the Web and viewed with any browser with JAVA compliance. We have implemented 15 emergency protocols that we developed in collaboration with specialized military personnel from the Ministry of Defense, Spain. Users can access remotely those electronic protocols comparing their procedures and methods. Our goal is to enhance agreement and consensus among remote medical centers regarding emergency and catastrophe management, establishing discussions over the network. Our tools have also a potential for training medical and paramedical personnel for emergency situations.

Clinical Protocols↗

An evaluation of an innovative multimedia educational software program for asthma management: report of a randomized, controlled trial.

BACKGROUND: Asthma continues to be a substantial cause of morbidity in pediatric populations. New strategies are needed to provide cost-effective educational interventions for children with asthma, particularly those in the inner city. OBJECTIVE: To assess the effectiveness of a multimedia educational software program about asthma. SETTING: A hospital-based primary care clinic and an affiliated neighborhood health center. DESIGN: Randomized, controlled trial. POPULATION: Children 3 to 12 years old with physician-diagnosed asthma. INTERVENTION: An interactive educational computer program, Asthma Control, designed to teach children about asthma and its management. Using a graphic display of a child going through simulated daily events, the game emphasizes: 1) monitoring; 2) allergen identification; 3) use of medications; 4) use of health services; and 5) maintenance of normal activity. Control group participants reviewed printed educational materials with a research assistant. OUTCOMES: Acute health care use (emergency department and outpatient) was the primary outcome. Secondary outcome measures included maternal report of asthma symptom severity, child functional status and school absences, satisfaction with care, and parental and child knowledge of asthma. RESULTS: A total of 137 families were enrolled in the study (76 intervention, 61 control). Both intervention and control groups showed substantial improvement in all outcomes during the 12-month follow-up period. Aside from improvement in knowledge after use of the computer program, no differences were demonstrated between the 2 groups in primary or secondary outcome measures. Children reported enjoyment of program use. CONCLUSIONS: This trial of an educational software program found that it did not produce greater improvement than occurred with review of traditional written materials. Because both groups showed substantial improvement over baseline, computer-based education may be more cost-effective. Alternatively, improvements in illness severity over time may overshadow the effects of such interventions. Rigorous comprehensive evaluations such as this are necessary to assess new interventions intended to improve management and outcomes of asthma.

Asthma↗

[Professional licensing examination. Innovative experience: the Integrated Multimedia Pilot Project of the Chieti University].

The Medical Licensing Examination (MLE) is governed, in Italy, by a law enacted in 1956. An ideal clinical competence assessment tool should effectively, reliably and objectively measure all the components of clinical competence: basic knowledge and clinical skills as history-taking, performing a physical examination, formulating the most likely diagnosis, establishing a management plan, communication and interpersonal relations. Since 1998 first session of the MLE, Chieti University implemented computer-based case simulations and standardized patients in the Multimedia Integrated Pilot Project (MIPP) administration. At the present time, we have examined 370 subjects during five sessions of MLE. This preliminary work shows results regarding the examinees in the first examination session of 1998 and 1999. The two groups of examinees are relatively homogeneous for number, age, gender, length of curriculum and country of University degree. In both groups the curriculum scores (preclinical, clinical and total) and the MIPP final score are reported for all subjects, first ten and last ten examinees. The MIPP final score is moderately correlated with the preclinical, clinical and total curriculum scores. Recently, the Federation of State Medical Boards and the National Board of Medical Examiners, sponsoring organisations of the United States Medical Licensing Examination (USMLE), have been planning the implementation of computer-based testing for the USMLE. It is important to point out that our MIPP-based MLE is not a mere didactic experiment, but a legal certifying examination valid for licensure.

Adult↗

Performance on a Spanish picture-identification task using a multimedia format.

An option for estimating the word-recognition performance of patients who do not speak English as a first language involves using auditory materials, presented in the patient's native language, in conjunction with a closed-set response mode incorporating pictures or written words. The advantage of this auditory/visual paradigm is that the audiologist is not required to know the foreign language and is therefore not required to judge the accuracy of an oral response to speech stimuli in a foreign language. Spanish auditory/visual materials, known as the Spanish Picture-Identification Task, were developed to be used in a computer-driven multimedia administration and scoring format. Performance data, both in open- (word-recognition) and closed-set (word-identification) response modes, were established for the Spanish Picture-Identification Task using subjects whose first language was Spanish. The results from the open-set paradigm indicate that the Spanish Picture-Identification Task word lists are essentially equivalent to conventional Spanish and English materials used for word recognition. Findings from the closed-set conditions indicate that the Spanish Picture-Identification Task materials are appropriate for estimating the word-identification abilities of Spanish-speaking adult listeners.

Adult↗

[Multimedia environmental behavior of herbicide atrazine].

In the paper, taking the Baiyangdiang Lake area as a study field, on the basis of soil characterization, environmental monitoring, and studies of adsorption, biodegradation, hydrolysis and photolysis, the atrazine concentrations in soil, groundwater and corn plant during 30 years were predicted by multimedia environmental fugacity model.

Adsorption↗