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iMPACT3: Internet-based development and administration of utility elicitation protocols.

iMPACT3 (Internet Multimedia Preference Assessment Instrument Construction Tool, version 3) is a software development environment that helps researchers build Internet-capable multimedia utility elicitation software programs. The program is a free, openly accessible Web site (http.// preferences.ucsd.edu/impact3/asp). To develop a utility elicitation software program using iMPACT3, a researcher selects modular protocol components from a library and custom tailors the components to the details of his or her research protocol. iMPACT3 builds a Web site implementing the protocol and downloads it to the researcher's computer. In a study of 75 HIV-infected patients, an iMPACT3-generated protocol showed substantial evidence of construct validity and good internal consistency (logic error rates of 4% to 10% and procedural invariance error rates of 10% to 28%, depending on the elicitation method) but only fair 3- to 6-week test-retest reliability (intraclass correlation coefficient= 0.42 to 0.55). Further work may be needed on specific utility assessment procedures, but this study's results confirm iMPACT3's feasibility in facilitating the collection of health state utility data.

Adult↗

GeneNotes--a novel information management software for biologists.

BACKGROUND: Collecting and managing information is a challenging task in a genome-wide profiling research project. Most databases and online computational tools require a direct human involvement. Information and computational results are presented in various multimedia formats (e.g., text, image, PDF, word files, etc.), many of which cannot be automatically processed by computers in biologically meaningful ways. In addition, the quality of computational results is far from perfect and requires nontrivial manual examination. The timely selection, integration and interpretation of heterogeneous biological information still heavily rely on the sensibility of biologists. Biologists often feel overwhelmed by the huge amount of and the great diversity of distributed heterogeneous biological information. DESCRIPTION: We developed an information management application called GeneNotes. GeneNotes is the first application that allows users to collect and manage multimedia biological information about genes/ESTs. GeneNotes provides an integrated environment for users to surf the Internet, collect notes for genes/ESTs, and retrieve notes. GeneNotes is supported by a server that integrates gene annotations from many major databases (e.g., HGNC, MGI, etc.). GeneNotes uses the integrated gene annotations to (a) identify genes given various types of gene IDs (e.g., RefSeq ID, GenBank ID, etc.), and (b) provide quick views of genes. GeneNotes is free for academic usage. The program and the tutorials are available at: http://bayes.fas.harvard.edu/genenotes/. CONCLUSIONS: GeneNotes provides a novel human-computer interface to assist researchers to collect and manage biological information. It also provides a platform for studying how users behave when they manipulate biological information. The results of such study can lead to innovation of more intelligent human-computer interfaces that greatly shorten the cycle of biology research.

Biology↗

An overview of human exposure modeling activities at the USEPA's National Exposure Research Laboratory.

The computational modeling of human exposure to environmental pollutants is one of the primary activities of the US Environmental Protection Agency (USEPA)s National Exposure Research Laboratory (NERL). Assessment of human exposures is a critical part of the overall risk assessment paradigm. In exposure assessment, we analyze the source-to-dose sequence of processes, in which pollutants are released from sources into the environment, where they may move through multiple environmental media, and to human receptors via multiple pathways. Exposure occurs at the environment-human interface, where pollutants are contacted in the course of human activities. Exposure may result in a dose, by which chemicals enter the body through multiple portals of entry, primarily inhalation, ingestion, and dermal absorption. Within the body, absorbed pollutants are distributed to, metabolized within, and eliminated from various organs and tissues, where they may cause toxicologic responses or adverse health effects. The NERL's modeling efforts are directed at improving our understanding of this sequence of processes, by characterizing the various factors influencing exposures and dose, and their associated variabilities and uncertainties. Modeling at the NERL is one of three essential programmatic elements, along with measurements and methods development. These are pursued interactively to advance our understanding of exposure-related processes. Exposure models are developed and run using the best currently available measurement data to simulate and predict population exposure and dose distributions, and to identify the most important factors and their variabilities and uncertainties. This knowledge is then used to guide the development of improved methods and measurements needed to obtain better data to improve the assessment and reduce critical uncertainties. These models and measurement results are tools that can be used in risk assessments and in risk management decisions in order to reduce harmful exposures. Current areas of the NERL's exposure modeling emphasis include: Pollutant concentrations in ambient (outdoor) air using the Third Generation Air Quality Modeling System's Community Multiscale Air Quality model (Models-3/CMAQ); Air flow and pollutant concentrations at local and microenvironmental scales using computational fluid dynamics (CFD); Human inhalation exposure to airborne particulate matter, air toxics, and multipathway exposure to pesticides, using the Stochastic Human Exposure and Dose Simulation (SHEDS) model; Human and ecological exposure and risk assessments of hazardous waste sites using Framework for Risk Analysis in Multimedia Environmental Systems--Multimedia, Multipathway, Multireceptor Risk Assessment (FRAMES-3MRA), one of many software programs available from the NERL's Center for Exposure Assessment Modeling (CEAM); Physiologically based pharmacokinetic (PBPK) modeling of pesticides and volatile organic compounds (VOCs) in the Exposure-Related Dose-Estimating Model (ERDEM). A brief historical overview of the NERL's evolution of human exposure models is presented, with examples of the present state-of-the-science represented by SHEDS and FRAMES-3MRA.

Air Pollutants↗

Performance tests of a satellite-based asymmetric communication network for the 'hyper hospital'.

The Hyper Hospital is a prototype networked telemedicine system which uses virtual reality. We measured the performance of a novel multimedia network based on satellite communications. The network was a hybrid system consisting of a satellite channel in one direction and a terrestrial channel in the other. Each user was equipped with a standard satellite communication receiver and a telephone connection. Requests from the users were sent by modern and telephone line and responses were received by satellite. The user requests were initiated by clicking buttons on a World Wide Web browser screen. The transmission rates of satellite and normal telephone-line communications were compared for standardized text data. Satellite communication was three to five times faster. The transmission rate was also measured for standardized graphical data (GIF format). With a file size of about 400 kByte, satellite-mediated communication was 10 times faster than telephone lines. The effect of simultaneous access on performance was also explored. For simultaneous access of nine users to a single graphics file, 78% of the transmission speed was obtained in comparison with that of a single user. The satellite-based system showed excellent high-speed communication performance, particularly for multimedia data.

Hospitals↗

Internet electronic mail: a tool for low-cost telemedicine.

Electronic mail, in addition to the sending of text messages, may be used to transfer multimedia and privacy-enhanced messages. Email can be used for so-called store-and-forward telemedicine, which can be particularly useful for remote consultations. This paper reviews the standards used in Internet email, from communication protocols to the message formats, and pays special attention to multimedia and confidential messages; it then describes some email-based telemedicine applications. The problems of the Internet are principally the lack of any guarantee of quality of service and the low bandwidth; intranets can guarantee appropriate performance.

Computer Communication Networks↗

A web-based federated neuroinformatics model for surgical planning and clinical research applications in epilepsy.

There is an increasing need to efficiently share diverse clinical and image data among different clinics, labs, and departments of a medical center enterprise to facilitate better quality care and more effective clinical research. In this paper, we describe a web-based, federated information model as a viable technical solution with applications in medical refractory epilepsy and other neurological disorders. We describe four such online applications developed in a federated system prototype: surgical planning, image analysis, statistical data analysis, and dynamic extraction, transforming, and loading (ETL) of data from a heterogeneous collection of data sources into an epilepsy multimedia data warehouse (EMDW). The federated information system adopts a three-tiered architecture, consisting of a user-interface layer, an application logic layer, and a data service layer. We implemented two complementary federated information technologies, i.e., XML (eXtensible Markup Language) and CORBA (Common Object Request Broker Architecture), in the prototype to enable multimedia data exchange and brain images transmission. The preliminary results show that the federated prototype system provides a uniform interface, heterogeneous information integration and efficient data sharing for users in our institution who are concerned with the care of patients with epilepsy and who pursue research in this area.

Animals↗

Social and cognitive processes in interpersonal communication: implications for advanced telecommunications technologies.

Interactive multimedia conferencing systems, in which two or more remotely located people can work on cooperative tasks through shared audio, video, and data, appear to be the wave of the future. However, because of great advances in the underlying technology of multimedia conferencing systems, many design decisions have been driven by what is technically feasible as opposed to what will best suit the needs of the users. In this paper we provide a framework for the design and evaluation of features in advanced telecommunications products and services which is derived from empirical research on interpersonal communication. We also discuss implications of this research for the development and use of advanced telecommunications technologies.

Cognition↗

Teaching Acute Coronary Syndrome High-Risk ECG Interpretation and Clinical Decision-Making Through FOAMed Videos and Podcast Versus Print-Based Materials Among Emergency Care Providers: Randomized Controlled Mixed Methods Trial.

BACKGROUND: Accurate interpretation of high-risk acute coronary syndrome (ACS) electrocardiograms (ECGs) is essential for early diagnosis and timely reperfusion, yet substantial deficits persist across health care professions. Digital self-learning formats such as FOAMed (Free Open Access Medical Education) are widely used, but their effectiveness has rarely been evaluated for complex, high-risk ACS ECG patterns. Existing ECG education studies often focus on students or single professional groups and established ST-segment elevation myocardial infarction (STEMI) criteria, leaving newer guideline-recognized STEMI equivalents, selected emerging occlusion myocardial infarction (OMI)-related patterns, and interprofessional emergency care underrepresented. OBJECTIVE: This study aimed to compare the effectiveness of FOAMed podcast and videos versus traditional print-based materials for teaching high-risk ACS ECG patterns and related clinical decision-making in emergency providers. METHODS: We conducted a prospective, interprofessional, controlled mixed methods trial across 5 training sites in Germany. Paramedics, prehospital emergency physicians, and emergency department clinicians received either a FOAMed multimedia module or print-based materials through concealed allocation; deviations from the intended 1:1 ratio resulted from participant no-shows. The intervention consisted of a 30-minute supervised self-learning session. In total, 103 participants were allocated to FOAMed (n=45) or print-based materials (n=58). Two coprimary outcomes were assessed: ECG interpretation accuracy and text-based ACS clinical decision-making. Secondary outcomes included subjective confidence, learning experience, and exploratory qualitative free-text responses. Outcome assessment was automated and blinded; mixed ANOVA was the primary analysis. The study was not prospectively registered because it assessed educational outcomes in health care professionals rather than patient health outcomes. RESULTS: All 103 participants completed the study. Both groups improved, with greater gains in the FOAMed group: ECG interpretation increased from 55% to 65.5% and text-based ACS clinical decision-making from 45% to 68%, versus 57% to 60% and from 47% to 63%, respectively, in the print-based group. Effect sizes were η²=0.055 for ECG interpretation and η²=0.044 for clinical decision-making. Exploratory subgroup analyses provided no evidence of differential effects across age, gender, or professional background and were likely underpowered. Qualitative responses (46 and 37 entries) provided contextual insights into perceived clarity, engagement, and practical relevance supporting the quantitative findings. CONCLUSIONS: This study is innovative in directly comparing a curated FOAMed multimedia module with selected print-based materials in an interprofessional emergency care population. It differs from existing research by focusing on subtle, emerging ischemic patterns and evaluating realistic, time-limited self-learning formats. The findings provide evidence that curated FOAMed resources can produce greater short-term improvements in ECG interpretation and text-based ACS clinical decision-making than traditional print-based materials in this setting. Although implications for clinical performance remain hypothetical, concise, high-quality digital modules may represent a practical supplement to structured continuing education in emergency care.

Humans↗

Interactive stereoscopic virtual reality: a new tool for neurosurgical education. Technical note.

The goal of this study was to develop a new method for neurosurgical education based on interactive stereoscopic virtual reality (ISVR). Interactive stereoscopic virtual reality can be used to recreate the three-dimensional (3D) experience of neurosurgical approaches much more realistically than standard educational methods. The demonstration of complex 3D relationships is unrivaled and easily combined with interactive learning and multimedia capabilities. Interactive stereoscopic virtual reality permits the accurate recreation of neurosurgical approaches through integration of several forms of stereoscopic multimedia (video, interactive anatomy, and computer-rendered animations). The content explored using ISVR is obtained through a combination of approach-based cadaver dissections, live surgical images and videos, and computer-rendered animations. These media are combined through an interactive software interface to demonstrate key aspects of a neurosurgical approach (for example, patient positioning, draping, incision, individual surgical steps, alternative steps, relevant anatomy). The ISVR platform is designed for use on a desktop personal computer with newly developed, inexpensive, platform-independent shutter glasses. Interactive stereoscopic virtual reality has been used to capture the anatomy and methods of several neurosurgical approaches. In this paper the authors report their experience with ISVR and describe its potential advantages. The success of a neurosurgical approach is contingent on the mastery of complex, 3D anatomy. A new technology for neurosurgical education, ISVR can improve understanding and speed the learning process. It is an effective tool for neurosurgical education, bridging the substantial gap between textbooks and intraoperative training.

Computer-Assisted Instruction↗

Real-time emergency telemedicine system: prototype design and functional evaluation.

In this paper, an emergency telemedicine system was designed for the transmission of real-time multimedia for remote consultation, including radiological images, patient records, video-conferencing, full-quality video, ECG, BP, respiration, temperature, SpO(2), systolic and diastolic pressures and heart rate. The standardized, modular, software-based design architecture, without resorting to external hardware compression boards, enables the low-cost implementation of the telemedicine system, using the unified, systematic and compact integration of multimedia on general personal computers. Experimental tests on local networks analyze the technical aspects of designed systems, and inter-hospital experiments demonstrate its clinical usefulness.

Computer Systems↗

The Observer Video-Pro: new software for the collection, management, and presentation of time-structured data from videotapes and digital media files.

The Observer Video-Pro is a system for collecting, managing, analyzing, and presenting observational data. It integrates The Observer software with time code and multimedia hardware components. It extends the functionality of a conventional real-time event recording program in various ways. Observational data can be collected, reviewed, and edited with synchronized display of the corresponding video images. For optimal visual feedback during coding, one can display the video image in a window on the computer screen. Video playback from either a VCR or a digital media file can be controlled by the computer, allowing software-controlled jog, shuttle, and search functions. Besides a wide range of VCRs, The Observer Video-Pro supports all major digital video file formats. The software allows the user to summarize research findings in numerical, graphical, or multimedia format. One can create a time--event plot for a quick glance at the temporal structure of the observed process, or run specific analysis procedures and generate reports with statistics. An Event Summary function is available for exploratory and qualitative analysis. Video material can be summarized in a Video Play List, which allows on-screen summary presentations or the creation of highlight compilations on tape, CD, or other media. Video images can be captured and saved as disk files, for use as illustrations in documents, slides for presentations, and so forth. In this paper we describe the design and operation of the system, illustrated with a case study from research on Repetitive Strain Injury (RSI).

Electronic Data Processing↗

Learning with technology: use of case-based physical and computer simulations in professional education.

This paper describes a multimedia technology project in midwifery education and how it is being developed to improve student learning experiences and outcomes. The role of the university providing quality education relevant to today's world and professional practice is emphasised. A collaborative (Royal Melbourne Institute of Technology and Australian Catholic University) interdisciplinary project 'Pregnancy Simulator: Developing and Enhancing Student Learning of Pregnancy Assessment Skills' was developed with university and direct Commonwealth support. This project consists of a physical simulation of a pregnant woman at term and case-based multimedia computer simulations designed to develop and enhance student learning of abdominal assessment skills. A key feature of the development has been to design a learning experience explicitly on an authoritative theory-based view of teaching, in this case Diana Laurillard's 'Conversational Framework'.

Computer Simulation↗

Use of a computerized digital camera in podiatric medical practice.

Multimedia technology was once rarely found outside the realm of commercial production studios or in elaborate computer games. However, with the addition of only a few simple accessories, recent advances have made this technology readily available to the podiatric medical practitioner on a desktop office computer. The role that the application of multimedia technology using a computerized digital camera can play in a podiatric medical practice--including in such areas as record keeping, outcome measurement, patient education, interdisciplinary communications, and practice-management tools--is discussed.

Computers↗

Functional and control integration of an ICU, LIS and PACS information system.

The need for collaboration and data sharing among systems dedicated to individual functional areas and user groups has initiated major efforts towards the development of an integrated hospital information system. Major issues in the development of any integrated architecture that incorporates autonomous departmental systems include the development of commonly accepted interaction mechanisms, standardisation, the structure of the computerised patient record, its extensibility, as well as limitations multimedia data impose. This paper presents work done within project IHIS, a nationally funded project for the development of an integrated hospital information system that provides ICU staff with access to both the ICU assisting laboratory information system's data as well as radiological multimedia data.

Clinical Laboratory Information Systems↗

Continuing medical education and the anesthesiologist.

There are a large variety of scheduled activities and courses available to meet the continuing medical education (CME) needs of anesthesiologists. The presentation of CME material varies in format and delivery style. The reasons for attending CME activities include licensure requirements, participation in state and national societies, keeping current with technology, review of old subject material, participation as a lecturer, and other personal reasons. Funding occurs via personal funds, employer support, commercial support, or by research grants. External bodies, such as the American Council of Continuing Medical Education and the American Medical Association, have imposed guidelines in these areas. Methods to evaluate CME activities include retrospective needs analysis based on exit interviews, prospective needs assessment, focus groups, and complex systems such as the CRISIS criteria. Self-directed CME can be evaluated by data collection that identifies how quickly information is received and by the effect of this data on measurable outcome. In the future, CME will increasingly utilize simulators and multimedia computers. Multimedia can bring CME to the physician as opposed to the physician traveling to a CME site. Virtual reality and artificial intelligence are on the horizon and may interface well with the field of anesthesiology due to the technical nature of the discipline and the increasing use of computers and electronic data collection already occurring in clinical practice.

Anesthesiology↗

CathSim: an intravascular catheterization simulator on a PC.

The development of a medical simulator that incorporates substantial training value and realism into an affordable product has been a huge challenge for the simulation community. A large hurdle to making an inexpensive simulator has been the high cost of the computers needed for adequate realism. We have met this challenge by developing CathSim, a low-cost medical simulator that integrates force feedback, multimedia, and 3D graphics simulation technology on an industry standard PC. This product is commercially available and is currently being used by numerous training institutions and hospitals. The CathSim system includes software and a force feedback interface device. The platform and device can be used to train health care providers to perform needle-stick medical procedures. Our first module teaches users the techniques of peripheral intravenous (i.v.) catheterization. Other training modules that will be added to the CathSim platform include central venous catheter (CVC) insertion and peripherally inserted central catheter (PICC) placement. This paper discusses the challenges of this project and the trade-offs and solutions that we developed to overcome them. We describe our process of analyzing and prioritizing the medical tasks necessary to correctly perform peripheral intravenous catheterization. This analysis and prioritization was used to decide which tasks would be included in the simulator and how the included tasks would be replicated. We discuss the method by which we obtained the needed realism in the 3D graphics rendering and in the tactile feedback of the input device. We illustrate how we blended together simulation and multimedia technology to ensure adequate immersion and training efficacy, while keeping the system cost to a minimum.

Computer Simulation↗

PreOp endoscopic simulator: a PC-based immersive training system for bronchoscopy.

The high cost of simulators that offer adequate realism for training has been a major challenge for the simulation community. The cost of the computers alone has been too high for most training institutions to afford. We have met this challenge by developing the PreOp Endoscopic Simulator, our second generation of low-cost medical simulators. The PreOp system integrates multimedia, 3D graphics simulation, and force feedback technology on a PC. This paper discusses the challenges of this project and the trade-offs and solutions that we developed to overcome them. We discuss our process of analyzing and prioritizing the medical tasks necessary to correctly perform flexible bronchoscopy. In addition, we illustrate how we blended together simulation and multimedia technology to ensure adequate immersion and training efficacy, while keeping the system cost to a minimum.

Biopsy↗

Telemedicine technology and applications for home hemodialysis.

Home hemodialysis (HD) for the treatment of patients with end-stage renal disease (ESRD) was first put into practice about 30 years ago. In this paper we describe the application of telematics monitoring services (TMS) for supporting patients who need home or satellite HD (SHD). For the clinical trials two modified HD machines were located in the renal unit and a central control station (UNIX workstation with multimedia PC-terminal) was located in another room of the hospital. Bi-directional communication between modified HD machines and central control station was managed via ISDN (Integrated Services Digital Network) links. Using these HD-machines 150 HD sessions were performed in nine patients over a period of five months. This system enabled on-line remote supervision of the HD machine-related functions (air in the blood, leak of blood, low conductivity etc.) and the clinical condition of patients through measurement of blood pressure (BP), pulse rate, PO2 (pulse oxymetry) and electrocardiogram (ECG) from the central control station (CCS). The user checked the type of alarm/warning, its appearance on HD machines and multimedia terminal units (MTU), the action of the protective system and the appearance of consultative messages from CCS on the remote terminal unit RTU. According to the data collected, the disturbances of HD machine function were visible and audible in the CCS and the user messages were always observed on the RTU. No unusual dialysis-associated complications were observed, all data and alarms/warnings were transmitted correctly and patients had adequate HD treatment.

Female↗