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PubMed2006

Development of a broadband telehealth system for critical care: process and lessons learned.

A broadband telehealth system has been developed for supporting critical care services between a major referral hospital and a rural hospital by transmitting very high-quality, realtime multimedia information, including images, audio and real-time video, over an Internet Protocol (IP)-based network. The technical design team took an iterative and user-centred approach toward the system design. Usability tests with scenario analysis were incorporated into the development process to produce a system that operates seamlessly in the critical care environment. Careful analysis of the reliability of the system was incorporated into the clinical protocols for integration into existing work practices. The use of high-quality multimedia data, consideration of human factors early in the design process, and incorporation of proper development approaches were critical for the success of the system design.

Critical Care↗
PubMed1978

Evaluation of a gross anatomy program without dissection.

Freshman medical students have been participating in an experimental multimedia gross anatomy program at Emory University for five years. The program includes audiovisuals, computer-assisted instruction, and tutorial sessions using prosected specimens. No lectures are given nor is dissection permitted. Experimental and traditional groups were compared by intramural written and practical examinations and by an extramural written examination prepared by the National Board of Medical Examiners and the Association of Anatomy Chairmen. Study of 35 intramural examinations given to five classes showed students in the traditional course with significantly higher performance in three examinations and students in the experimental course with significantly higher performance in six examinations. Neither group's performance was significantly higher on any extramural examination. It was concluded that, as measured by conventional examinations, students in the multimedia program with prosection tutorials learned human anatomy as well as those in the traditional lecture-dissection program.

Anatomy↗
PubMed2002

MEDICOL: online learning in medicine and dentistry.

OBJECTIVE: MEDICOL (Medicine and Dentistry Integrated Curriculum Online) provides a variety of Web-based resources that act as important adjuncts to all the teaching components of the medical and dental undergraduate curriculum. It uses WebCT, a course-management system, to provide the following educational functions: (1) track students' progress and present course information such as time-tables, learning objectives, handout materials, images, references, course assignments, and evaluations; (2) promote student-to-student and student-to-instructor interactions (through e-mail and bulletin boards); and (3) deliver self-directed learning components, including weekly self-assessment quizzes that provide immediate feedback and multimedia learning modules (clinical skills, radiology, evidence-based medicine, etc.). DESCRIPTION: The University of British Columbia Faculties of Medicine and Dentistry feature a problem-based learning (PBL) curriculum in which students access many of the same tools they will utilize in their professional practice. In the PBL curriculum, students must access the relevant clinical data and educational resources. A MEDICOL site has also been developed for medical students to use during their rural family practice, a four- to six-week experience in the summer after their second year. This site has been designed to be a supplemental learning environment for not only these students, but also for their physician preceptors. It is intended to foster communication among participants, bring new resources to the rural setting, and allow preceptors to develop their Internet skills with the help of students who are already familiar with the electronic environment. The MEDICOL sites enable the exchange of information about the learning issues between, as well as within, tutorial groups. MEDICOL also provides students with faculty-reviewed resources that are listed online; multimedia presentations; and access to histology, radiology, and pathology images through an online image database. Each week, students have access to a new interactive and automatically graded self-assessment quiz for individual study. These quizzes test learning objectives from tutorial, lecture, and lab material for each week of the curriculum and are modeled after summative examinations held twice each year. Question authors provide immediately accessible quality feedback to students. A comprehensive quiz databank of approximately 1,500 questions has been attained. WebCT enables MEDICOL to deliver anonymous, online program-evaluation questionnaires during clinical clerkships (resulting in a 99% response rate after a few e-mail reminders), with easy and timely data collection and reporting methods. Summative assessments have also been delivered through MEDICOL. DISCUSSION: Use statistics indicate that over 90% of students regularly use the MEDICOL sites and have found them helpful. University of British Columbia medical school enrollment will increase because of collaborations with campuses and medical centers across the province. MEDICOL will likely play an increased role in distance learning by continuing to deliver the resources already described, as well as facilitating synchronous communications (e.g., PBL chat rooms) and teaching (e.g., video-streamed lectures) to students located across the province.

Education, Dental↗
PubMed2002

360 degrees: planning a new pediatric clerkship.

OBJECTIVE: Mount Sinai School of Medicine is midway through a major curriculum revision. The immediate goal for the core third-year clerkships was to create a modular schedule with varied and integrated clinical experiences. Some clerkships were lengthened; others, blended. Clerkship directors were asked to find ways to ally with those also in their 12-week module. Content material, only presented at Mount Sinai, was to be delivered at all affiliate sites. Each clerkship had one year to prepare. DESCRIPTION: Core pediatrics faced multiple challenges. Once an eight-week clerkship, pediatrics was condensed into a six-week block and paired with ob-gyn at the same affiliate sites. Material presented during weekly, lecture-based didactic sessions at Mount Sinai was to be delivered at all sites, some of which were considerable distances away. To enable students to have both content and clinical experiences at the same site, new teaching formats and techniques had to be utilized and faculty retrained to implement their new roles. Three approaches met both conditions: (1) interactive case-based learning of clerkship content objectives, (2) use of Web-based instruction to provide resources to all sites, and (3) the identification and training core educators to deliver this new content material. Generalist and specialist pediatricians prepared clinical cases. Each author was given a case-writing template, so that all cases included objectives, references, a case presentation, and guiding questions. Cases were written with extended answers to each of eight standard questions, including key teaching points, to create a teacher's manual. Three faculty members reviewed each case to assure that the content matched the objectives for the module and that cases were written at an appropriate level for third-year medical students. Weekly seminars are now interactive, small-group, and Web-based. Cases use multimedia resources and integrate multiple clinical disciplines. The structure of the seminars, modeled on adult learning theory, include review of the basic approach to patients, organization of data, and generation of a prioritized differential diagnosis. The seminars also review basic management principles for a variety of common pediatric conditions. Core educators were designated to facilitate the cases at each clinical site. They were given instructions for case facilitation, a detailed teacher's manual, and a multimedia CD-ROM. The teacher's manual contains the course syllabus as well as extended case discussions. The accompanying CD-ROM contains photographic images, growth charts, x-rays, microscopy, and sound files. Computers are available at each site and are linked to WEB-CT, the program supporting the Mount Sinai undergraduate online curriculum. DISCUSSION: We have not yet reached 360 degrees in revising our clerkship. Feedback from both students and clinician educators has been extremely positive. Future plans include further enhancement of the cases to incorporate clinical pathology, genetics, laboratory medicine, radiology, and evidence-based medicine. We will also develop and implement a faculty development program to equip our faculty with tools for effective, time-efficient, case facilitation. Starting anew with a few core organizing principles and a multidisciplinary approach has enhanced the learning for both faculty and students.

Child↗
PubMed2003

Development of an undergraduate medical curriculum: the McGill experience.

In 1997 the Faculty of Medicine at McGill University received a grant from the Molson Foundation. The primary project deliverable, which the authors describe, was an online, multimedia-enhanced, undergraduate medical curriculum. The decision to develop an electronic curriculum was predicated on the belief that the integration of educational technology within mainstream material delivered a "value added" component to both students and faculty, which would, in turn, facilitate teaching and learning. Pedagogical values were deemed to include: (1) the ability to use the media to implement adult learning principles such as learner-centered, self-directed and guided learning, (2) the inherent interactivity of the technology, (3) the potential of the technology to provide a powerful means for fostering forms of "termless" learning that students will need to practice medicine, (4) recognition that use of multimedia can address, in part, the variety of learning styles evidenced by students in the lecture hall and classroom, and (5) the provision of opportunities for horizontal and vertical curricular integration. In addition, it was anticipated that an electronic curriculum would permit: (1) easy incorporation of informatics within mainstream curricula, (2) centralization and standardization of curricular material, (3) editorial functionality for revisions and updates, (4) wide accessibility of material irrespective of venue, (5) search functionality for faculty and students, (6) the ability to perform curriculum inventory, and (7) the potential for use to compensate for decreased faculty time. The ongoing experience at McGill has shown that the merging of technology and pedagogy requires a substantial commitment of resources and recognition of faculty time and change-management issues.

Academic Medical Centers↗
PubMed2001

Development of a breast self-examination program for the Internet: health information for Korean women.

Internet-based health information will enable us to interact with many people despite distance and time constraints. Informational media by computer is expected to become an important factor that affects health behavior. This study was done to develop an accessible multimedia program about breast self-examination on the Internet. This study was designed by using the two steps of need assessment and program development. For the need assessment step, a survey was carried out. The sample consisted of the 82 women of Yonsei University selected by convenient random sampling. At the program development step, screen design took into account perspectives of computer engineering. A storyboard for every screen was made via screen design and then ported to computer using the Netscape Navigator program. A breast self-examination program was developed using Netscape 4.0 on the Windows 98 platform. The multimedia program, including text, graphics, animation, and sound, was constructed with HTML language using Memo Sheet in Netscape Navigator. The contents of health information posted on the Internet included general information about breast cancer, the importance of breast self-examination, self-risk appraisal of breast cancer, the diverse methods about breast self-examination, the monthly check list graph, and social network for consultation. It is possible to interact with clients through the Question and Answer function on screen. This Internet-based health information program provides enough information, which can be accessed using search systems on the Internet.

Adult↗
PubMed1999

Information technology applications in biomedical functional imaging.

In parallel with rapid advances in computer technology, biomedical functional imaging is having an ever-increasing impact on healthcare. Functional imaging allows us to see dynamic processes quantitatively in the living human body. However, as we need to deal with four-dimensional time-varying images, space requirements and computational complexity are extremely high. This makes information management, processing, and communication difficult. Using the minimum amount of data to represent the required information, developing fast algorithms to process the data, organizing the data in such a way as to facilitate information management, and extracting the maximum amount of useful information from the recorded data have become important research tasks in biomedical information technology. For the last ten years, the Biomedical and Multimedia Information Technology (BMIT) Group and, recently, the Center for Multimedia Signal Processing have conducted systematic studies on these topics. Some of the results relating to functional imaging data acquisition, compression, storage, management, processing, modeling, and simulation are briefly reported in this paper.

Algorithms↗
PubMed2000

Content-based retrieval of dynamic PET functional images.

The recent information explosion has led to massively increased demand for multimedia data storage in integrated database systems. Content-based retrieval is an important alternative and complement to traditional keyword-based searching for multimedia data and can greatly enhance information management. However, current content-based image retrieval techniques have some deficiencies when applied in the biomedical functional imaging domain. In this paper, we presented a prototype design for a content-based functional image retrieval database system for dynamic positron emission tomography. The system supports efficient content-based retrieval based on physiological kinetic features and reduces image storage requirements. This design makes it possible to maintain a large number of patient data sets online and to rapidly retrieve dynamic functional image sequences for interpretation and generation of physiological parametric images, and offers potential advantages in medical image data management and telemedicine, as well as providing possible opportunities in the statistical and comparative analysis of functional image data.

Computer Graphics↗
PubMed2004

An efficient and anonymous buyer-seller watermarking protocol.

For the purpose of deterring unauthorized duplication and distribution of multimedia contents, a seller may insert a unique digital watermark into each copy of the multimedia contents to be sold. When an illegal replica is found in the market sometime later, the seller can determine the responsible distributor by examining the watermark embedded. However, the accusation against the charged distributor, who was the buyer in some earlier transaction, is objectionable because the seller also has access to the watermarked copies and, hence, is able to release such a replica on her own. In this paper, a watermarking protocol is proposed to avoid such difficulties, known as the customer's right problem, in the phase of arbitration. The proposed watermarking protocol also provides a fix to Memon and Wong's scheme by solving the unbinding problem. In addition, the buyer is no longer required to contact the watermark certification authority during transactions, and the anonymity of the buyer can be retained through a trusted third party. The result is an efficient and anonymous buyer-seller watermarking protocol.

Algorithms↗
PubMed2006

A joint source-channel distortion model for JPEG compressed images.

The need for efficient joint source-channel coding (JSCC) is growing as new multimedia services are introduced in commercial wireless communication systems. An important component of practical JSCC schemes is a distortion model that can predict the quality of compressed digital multimedia such as images and videos. The usual approach in the JSCC literature for quantifying the distortion due to quantization and channel errors is to estimate it for each image using the statistics of the image for a given signal-to-noise ratio (SNR). This is not an efficient approach in the design of real-time systems because of the computational complexity. A more useful and practical approach would be to design JSCC techniques that minimize average distortion for a large set of images based on some distortion model rather than carrying out per-image optimizations. However, models for estimating average distortion due to quantization and channel bit errors in a combined fashion for a large set of images are not available for practical image or video coding standards employing entropy coding and differential coding. This paper presents a statistical model for estimating the distortion introduced in progressive JPEG compressed images due to quantization and channel bit errors in a joint manner. Statistical modeling of important compression techniques such as Huffman coding, differential pulse-coding modulation, and run-length coding are included in the model. Examples show that the distortion in terms of peak signal-to-noise ratio (PSNR) can be predicted within a 2-dB maximum error over a variety of compression ratios and bit-error rates. To illustrate the utility of the proposed model, we present an unequal power allocation scheme as a simple application of our model. Results show that it gives a PSNR gain of around 6.5 dB at low SNRs, as compared to equal power allocation.

Algorithms↗
PubMed2006

Source-optimized irregular repeat accumulate codes with inherent unequal error protection capabilities and their application to scalable image transmission.

The common practice for achieving unequal error protection (UEP) in scalable multimedia communication systems is to design rate-compatible punctured channel codes before computing the UEP rate assignments. This paper proposes a new approach to designing powerful irregular repeat accumulate (IRA) codes that are optimized for the multimedia source and to exploiting the inherent irregularity in IRA codes for UEP. Using the end-to-end distortion due to the first error bit in channel decoding as the cost function, which is readily given by the operational distortion-rate function of embedded source codes, we incorporate this cost function into the channel code design process via density evolution and obtain IRA codes that minimize the average cost function instead of the usual probability of error. Because the resulting IRA codes have inherent UEP capabilities due to irregularity, the new IRA code design effectively integrates channel code optimization and UEP rate assignments, resulting in source-optimized channel coding or joint source-channel coding. We simulate our source-optimized IRA codes for transporting SPIHT-coded images over a binary symmetric channel with crossover probability p. When p = 0.03 and the channel code length is long (e.g., with one codeword for the whole 512 x 512 image), we are able to operate at only 9.38% away from the channel capacity with code length 132380 bits, achieving the best published results in terms of average peak signal-to-noise ratio (PSNR). Compared to conventional IRA code design (that minimizes the probability of error) with the same code rate, the performance gain in average PSNR from using our proposed source-optimized IRA code design is 0.8759 dB when p = 0.1 and the code length is 12800 bits. As predicted by Shannon's separation principle, we observe that this performance gain diminishes as the code length increases.

Algorithms↗
PubMed2000

A systematic uncertainty analysis of an evaluative fate and exposure model.

Multimedia fate and exposure models are widely used to regulate the release of toxic chemicals, to set cleanup standards for contaminated sites, and to evaluate emissions in life-cycle assessment. CalTOX, one of these models, is used to calculate the potential dose, an outcome that is combined with the toxicity of the chemical to determine the Human Toxicity Potential (HTP), used to aggregate and compare emissions. The comprehensive assessment of the uncertainty in the potential dose calculation in this article serves to provide the information necessary to evaluate the reliability of decisions based on the HTP A framework for uncertainty analysis in multimedia risk assessment is proposed and evaluated with four types of uncertainty. Parameter uncertainty is assessed through Monte Carlo analysis. The variability in landscape parameters is assessed through a comparison of potential dose calculations for different regions in the United States. Decision rule uncertainty is explored through a comparison of the HTP values under open and closed system boundaries. Model uncertainty is evaluated through two case studies, one using alternative formulations for calculating the plant concentration and the other testing the steady state assumption for wet deposition. This investigation shows that steady state conditions for the removal of chemicals from the atmosphere are not appropriate and result in an underestimate of the potential dose for 25% of the 336 chemicals evaluated.

Air Pollutants↗
PubMed2006

Student perceptions of a virtual learning environment for a problem-based learning undergraduate medical curriculum.

OBJECTIVE: To investigate the effects of a virtual learning environment (VLE) on group interaction and consultation of information resources during the preliminary phase, self-study phase and reporting phase of the problem-based learning process in an undergraduate medical curriculum. METHODS: A questionnaire was administered to 355 medical students in Years 1 and 2 to ask them about the perceived usefulness of a virtual learning environment that was created with Blackboard for group interaction and the use of learning resources. RESULTS: The students indicated that the VLE supported face-to-face interaction in the preliminary discussion and in the reporting phase but did not stimulate computer-mediated distance interaction during the self-study phase. They perceived that the use of multimedia in case presentations led to a better quality of group discussion than if case presentations were exclusively text-based. They also indicated that the information resources that were hyperlinked in the VLE stimulated the consultation of these resources during self-study, but not during the reporting phase. CONCLUSIONS: Students indicated that the use of a VLE in the tutorial room and the inclusion of multimedia in case presentations supported processes of active learning in the tutorial groups. However, if we want to exploit the full potential of asynchronous computer-mediated communication to initiate in-depth discussion during the self-study phase, its application will have to be selective and deliberate. Students indicated that the links in the VLE to selected information in library repositories supported their learning.

Attitude of Health Personnel↗
PubMed2002

Evaluation of distance interactive learning in obstetrics and gynaecology (DIALOG).

OBJECTIVES: 1. To determine whether DIALOG, a multimedia interactive CD-ROM designed for postgraduate education, was achieving its educational aim; 2. to assess DIALOG as a computer-assisted learning tool by evaluating its design, presentation, usability, effective use of multimedia and interactions and availability; 3. to measure end user satisfaction and the impact of DIALOG in achieving an improvement in clinical practice as an index of educational value. METHODS: Postal questionnaires were sent out to 150 users of DIALOG. A combination of the CIPP model, the CRISIS criteria and Kirkpatrick's model was used to design the evaluation questionnaire. RESULTS: There was a 61.3% response rate to the questionnaire. Overall, 86.9% of respondents were happy with the use of DIALOG, 60.8% had a positive comment on the concept of distance learning using DIALOG and computer-assisted learning, 50% agreed that it had helped sharpen their analytic skills and 45.6% reported an improvement in clinical practice after using DIALOG. CONCLUSION: This assessment proved to be a useful formative assessment of DIALOG. It has provided feedback on the availability and use of DIALOG and has highlighted the potential areas of improvement for future issues.

Education, Distance↗
PubMed2002

A review of medical imaging informatics.

This review of medical imaging informatics is a survey of current developments in an exciting field. The focus is on informatics issues rather than traditional data processing and information systems, such as picture archiving and communications systems (PACS) and image processing and analysis systems. In this review, we address imaging informatics issues within the requirements of an informatics system defined by the American Medical Informatics Association. With these requirements as a framework, we review, in four sections: (1) Methods to present imaging and associated data without causing an overload, including image study summarization, content-based medical image retrieval, and natural language processing of text data. (2) Data modeling techniques to represent clinical data with focus on an image data model, including general-purpose time-based multimedia data models, health-care-specific data models, knowledge models, and problem-centric data models. (3) Methods to integrate medical data information from heterogeneous clinical data sources. Advances in centralized databases and mediated architectures are reviewed along with a discussion on our efforts at data integration based on peer-to-peer networking and shared file systems. (4) Visualization schemas to present imaging and clinical data: the large volume of medical data presents a daunting challenge for an efficient visualization paradigm. In this section we review current multimedia visualization methods including temporal modeling, problem-specific data organization, including our problem-centric, context and user-specific visualization interface.

Databases, Factual↗
PubMedDate not supplied

Image file formats: past, present, and future.

Despite the rapid growth of the Internet for storage and display of World Wide Web-based teaching files, the available image file formats have remained relatively limited. The recently developed portable networks graphics (PNG) format is versatile and offers several advantages over the older Internet standard image file formats that make it an attractive option for digital teaching files. With the PNG format, it is possible to repeatedly open, edit, and save files with lossless compression along with gamma and chromicity correction. The two-dimensional interlacing capabilities of PNG allow an image to fill in from top to bottom and from right to left, making retrieval faster than with other formats. In addition, images can be viewed closer to the original settings, and metadata (ie, information about data) can be incorporated into files. The PNG format provides a network-friendly, patent-free, lossless compression scheme that is truly cross-platform and has many new features that are useful for multimedia and Web-based radiologic teaching. The widespread acceptance of PNG by the World Wide Web Consortium and by the most popular Web browsers and graphic manipulation software companies suggests an expanding role in the future of multimedia teaching file development.

Computer-Assisted Instruction↗
PubMedDate not supplied

Informatics in radiology (infoRAD): HTML and Web site design for the radiologist: a primer.

A Web site has enormous potential as a medium for the radiologist to store, present, and share information in the form of text, images, and video clips. With a modest amount of tutoring and effort, designing a site can be as painless as preparing a Microsoft PowerPoint presentation. The site can then be used as a hub for the development of further offshoots (eg, Web-based tutorials, storage for a teaching library, publication of information about one's practice, and information gathering from a wide variety of sources). By learning the basics of hypertext markup language (HTML), the reader will be able to produce a simple and effective Web page that permits display of text, images, and multimedia files. The process of constructing a Web page can be divided into five steps: (a) creating a basic template with formatted text, (b) adding color, (c) importing images and multimedia files, (d) creating hyperlinks, and (e) uploading one's page to the Internet. This Web page may be used as the basis for a Web-based tutorial comprising text documents and image files already in one's possession. Finally, there are many commercially available packages for Web page design that require no knowledge of HTML.

Hypermedia↗
PubMed1999

The history of science: defending epistemology with new technologies.

The leap in scientific discoveries made with new computer technologies can be compared to the invention of the printing press and expanding scientific thought in the 16th century. Nowadays, new communication technologies offering a multimedia contribution illustrate the fascinating reality of scientific exploration even for individuals who can otherwise not be reached. Since rare books are usually kept in libraries with limited access, the strict safekeeping, however, often overrides the need for academic consultation. Moreover, rare manuscripts are often illustrated with figures that are just as important as the written texts, but which are also unavailable. We combined our expertise in biology, medicine and multimedia to produce a CD-ROM with a hyperlinked text on the scientific revolution of the 16th century, focusing on the early conceptualization of life sciences in Europe. In this paper we show the first page of Malpighi's Epistle II (De pulmonibus - on the Lungs) as it appeared in Opera Omnia published in London (1686) by the Royal Society.

Biological Science Disciplines↗