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The Eindhoven laparoscopic cholecystectomy training course--improving operating room performance using virtual reality training: results from the first E.A.E.S. accredited virtual reality trainings curriculum.

BACKGROUND: This study was undertaken to investigate operating room performance of surgical residents, after participating in the Eindhoven virtual reality laparoscopic cholecystectomy training course. This course is the first formal surgical resident trainings course, using a variety of complementary virtual reality (VR) skills training simulation in order to prepare surgical residents for their first laparoscopic cholecystectomy. The course was granted EAES certification. METHODS: The four-day course is based on multimedia and multimodality approach. A variety of increasingly difficult simulation training sessions, next to intimate focus-group "knowledge sessions" are included. Both basic and procedural VR simulation is featured, using MIST-VR and the Xitacts' LapChol simulation software. The operating room performance of twelve surgical residents who participated in the course and twelve case-control counterparts were compared. The case-control group was matched for clinical number laparoscopic cholecystectomy performance (maximum of 4 procedures). Two observers analyzed a randomly mixed videotape, featuring the part of the "clip-and-cut" procedure of the laparoscopic cholecystectomy, and were blinded for participants' group status. Structured questionnaires including multiple observation scales were used to assess performance. RESULTS: Residents of both the experimental and control group did not differ in demographic parameters, except for number of laparoscopic cholecystectomies in favor of the control group (p-value 0.008). Both observers judge the experimental group to perform significantly better (p-value 0.004 and 0.013). Experimental group residents valued their course highly in terms of their laparoscopic surgical skills improvement and the use of VR simulators in the surgical curriculum. CONCLUSIONS: The Eindhoven Virtual Reality laparoscopic cholecystectomy training course improves surgical skill in the operating room above the level of residents trained by a variety of other training methods.

Adult↗

Computer-based desktop system for surgical videotape editing.

BACKGROUND: The educational role of surgical video presentations should be optimized by linking surgical images to graphic evaluation of indications, techniques, and results. We describe a PC-based video production system for personal editing of surgical tapes, according to the objectives of each presentation. METHODS: The hardware requirement is a personal computer (100 MHz processor, 1-Gb hard disk, 16 Mb RAM) with a PC-to-TV/video transfer card plugged into a slot. Computer-generated numerical data, texts, and graphics are transformed into analog signals displayed on TV/video. A Genlock interface (a special interface card) synchronizes digital and analog signals, to overlay surgical images to electronic illustrations. The presentation is stored as digital information or recorded on a tape. RESULTS: The proliferation of multimedia tools is leading us to adapt presentations to the objectives of lectures and to integrate conceptual analyses with dynamic image-based information. We describe a system that handles both digital and analog signals, production being recorded on a tape. Movies may be managed in a digital environment, with either an "on-line" or "off-line" approach. System requirements are high, but handling a single device optimizes editing without incurring such complexity that management becomes impractical to surgeons. CONCLUSIONS: Our experience suggests that computerized editing allows linking surgical scientific and didactic messages on a single communication medium, either a videotape or a CD-ROM.

Analog-Digital Conversion↗

Implementing a MIRC query interface for a database driven teaching file.

This paper describes the authors' experience with integrating an existing database-driven teaching file with the RSNA (Radiological Society of North America) Medical Imaging Resource Center (MIRC). MIRC is the product of an RSNA-sponsored initiative to enable medical institutions to share their electronic medical content (images, text, and multimedia) by creating a distributed repository accessible from the Internet. An existing database-driven teaching file, developed by the authors and used extensively by the University of California San Francisco (UCSF) Department of Radiology since 1998, was retrofitted to include an interface for handling broadcast queries initiated by a MIRC query service. These queries take place through the exchange of XML documents via HTTP. After all the storage services have responded, the results are collated by the query service and presented to the user. The teaching file and MIRC interface were developed using the 4th Dimension Relational Database Management System (RDBMS). The integration process primarily involved mapping the "MIRCdocument" schema to the teaching file's schema, translating the actual MIRC query into the internal query language of the database and extending the access control mechanisms of the teaching file to allow public access. A working implementation of the interface required only 3 days of development time, with refinements taking place over several months. Interface development was greatly aided by MIRC's use of well-established Internet standards. This project has demonstrated the feasibility of implementing a MIRC interface on an existing teaching file server.

Computer-Assisted Instruction↗

Review of technology: planning for the development of telesonography.

Teleradiology allows contemporaneous interpretation of imaging exams performed at some distance from the interpreting radiologist. The transmitted images are usually static. However, there is benefit to real-time review of full-motion ultrasound (US) exams as they are performed. Telesonography is transmission of full-motion sonographic data to a remote site. We hypothesize that US exams, read after having been compressed utilizing Motion Picture Experts Group version 4 (MPEG-4) compression scheme, transmitted over the Internet as streaming multimedia, decompressed, and displayed, are equivalent in diagnostic accuracy to reading the examinations locally. MPEG-4 uses variable compression on each image frame to achieve a constant output bit rate. With less compression, the bit rate rises, and the only way the encoder can contain bit rate within the set bandwidth is by lowering frame rate or reducing image quality. We review the relevant technologies and industry standard components that will enable low-cost telesonography.

Biomedical Technology↗

Visual interaction: models, systems, prototypes. The Pictorial Computing Laboratory at the University of Rome La Sapienza.

This paper reports on the research activities performed by the Pictorial Computing Laboratory at the University of Rome, La Sapienza, during the last 5 years. Such work, essentially is based on the study of humancomputer interaction, spans from metamodels of interaction down to prototypes of interactive systems for both synchronous multimedia communication and groupwork, annotation systems for web pages, also encompassing theoretical and practical issues of visual languages and environments also including pattern recognition algorithms. Some applications are also considered like e-learning and collaborative work.

Academies and Institutes↗

Computer-assisted instruction in clinical education: a roadmap to increasing CAI implementation.

This reflection is based on the premise that clinical education can be improved by more widespread use of computer-assisted instruction (CAI) and that a roadmap will enable more medical educators to begin using CAI. The rationale for CAI use includes many of its inherent features such as incorporation of multimedia and interactivity yet the use of CAI remains limited, apparently because educators are not convinced about the role for CAI. Barriers to CAI use are discussed including misinterpretation of the literature for CAI effectiveness; a disconnect between CAI developers and the educators who make decisions about CAI use; and the paucity of knowledge regarding how to integrate CAI effectively into clinical education. Specific roles for CAI in undergraduate and graduate medical education can include improving uniformity of instruction, providing documentation of exposure or competence, improving the learners' educational experience or outcomes, and assessment that is matched to learning. Funding for CAI remains an important barrier but the authors believe that this will be overcome when use of CAI becomes more widespread.

Computer-Assisted Instruction↗

Development of a computer-based risk-reduction counseling intervention: acceptability and preferences among low-income patients at an urban sexually transmitted infection clinic.

In preparation for the development of an individually tailored, multimedia, computerized sexually transmitted infection (STI)/HIV-risk reduction intervention software application for use in publicly funded STI clinics, we conducted a waiting-room survey among 583 inner-city patients (67% male; 79% African American; mean age = 30.3) at an STI clinic in Milwaukee, Wisconsin regarding their computer experience and opinions related to a computerized approach to HIV/STI-risk reduction counseling. A substantial minority of respondents indicated they would prefer having either a combined computerized and human counseling intervention (30%) or preferred a computerized intervention alone (13%). Perceived benefits of computerized counseling included impartiality of the response, privacy, accuracy of the information, convenience, and being able to control the dissemination of information. Perceived disadvantages included lack of human contact, inability to obtain necessary information, technical problems, threats to privacy, and failure to take information from a computer seriously. Despite their limited economic resources, participants reported relatively high levels of computer experience overall and a willingness to use an individually tailored computerized risk-reduction counseling approach. We discuss how participants' responses were used to inform the development of such an intervention.

Adolescent↗

Stimulation of cortisol during mental task performance in a provocative virtual environment.

Fully immersive and stereoscopic Virtual Environments (VE) represent a powerful multimedia tool for laboratory-based simulations of distinct scenarios including scenarios for evaluating stressful situations resembling reality. Thus far, cortisol secretion as a neuroendocrine parameter of stress has not been evaluated within a Virtual Reality (VR)-based paradigm. In this study 94 healthy volunteers were subjected to a provocative VR-paradigm and a cognitive stress task. Provocative in this context means the VE was designed to provoke physiological reactions (cortisol secretion) within the respective users by purpose. It was tested (a) if a fully dynamic VE as opposed to a static VE can be regarded as a stressor and (b) if such a fully dynamic VE can modify an additional response to a cognitive stressor presented within the VE additionally. Furthermore, possible gender-related impacts on cortisol responses were assessed. A significant cortisol increase was observed only after the combined application of the fully dynamic VE and the cognitive stressor, but not after application of the dynamic VE or the cognitive stressor alone. Cortisol reactivity was greater for men than for women. We conclude that a fully dynamic VE does not affect cortisol secretion per se, but increases cortisol responses to a dual task paradigm that includes performance of a stressful mental task. This provides the basis for the application of VR-based technologies in neuroscientific research, including the assessment of the human Hypothalamus-Pituitary-Adrenal (HPA) axis regulation.

Adult↗

A fMRI study of age-related differential cortical patterns during cued motor movement.

Healthy adults of three age groups (young, middle-age and older) were cued by a multimedia projector to perform a series of simple (making a fist, opening/closing of the mouth) and complex (opposition of index finger and thumb, chewing gum) motor tasks while being scanned by functional magnetic resonance imaging. Our results showed that in unilateral hand movements, the premotor/motor cortex in the contralateral hemisphere was most strongly activated. Supplementary motor cortex involvement was usually present in the young and not in the old, except in precision movement when supplementary motor cortex was also involved in the old. For movements of the face (chewing, opening and closing of mouth), the prefrontal cortex was activated in the old age group but finger and hand movements never activated the prefrontal cortex in any age. Furthermore, areas like insula and cingulate gyrus might be activated in motor tasks. We conclude that different motor activities triggered diverse activation patterns which differed in different age groups.

Adult↗

Mercury in northeastern North America: a synthesis of existing databases.

A large number of datasets representing mercury (Hg) levels in northeastern North America were assembled in a standardized format between 2000 and 2003. Based on support from the Northeastern States Research Cooperative, scientists annually gathered and developed an operational template to collaboratively analyze and interpret these data for a series of peer-reviewed publications. The diverse group covered Hg policy connections, Hg in air, sediment and surface water, Hg in biota, and Hg collection, assessment and monitoring tools. A site-specific application of these Hg data is provided to demonstrate the importance of well-placed air monitoring stations, the need for integrative multimedia data sets, and the complexity of linking abiotic and biotic Hg compartments. Demonstrated is the ubiquitous nature of Hg and methylmercury availability and how its heterogeneous distribution is now relatively well understood for northeastern North America.

Animals↗

Scientific Grid activities and PKI deployment in the Cybermedia Center, Osaka University.

The Cybermedia Center (CMC), Osaka University, is a research institution that offers knowledge and technology resources obtained from advanced researches in the areas of large-scale computation, information and communication, multimedia content and education. Currently, CMC is involved in Japanese national Grid projects such as JGN II (Japan Gigabit Network), NAREGI and BioGrid. Not limited to Japan, CMC also actively takes part in international activities such as PRAGMA. In these projects and international collaborations, CMC has developed a Grid system that allows scientists to perform their analysis by remote-controlling the world's largest ultra-high voltage electron microscope located in Osaka University. In another undertaking, CMC has assumed a leadership role in BioGrid by sharing its experiences and knowledge on the system development for the area of biology. In this paper, we will give an overview of the BioGrid project and introduce the progress of the Telescience unit, which collaborates with the Telescience Project led by the National Center for Microscopy and Imaging Research (NCMIR). Furthermore, CMC collaborates with seven Computing Centers in Japan, NAREGI and National Institute of Informatics to deploy PKI base authentication infrastructure. The current status of this project and future collaboration with Grid Projects will be delineated in this paper.

Computational Biology↗

Wavelet transformation based watermarking technique for human electrocardiogram (ECG).

Nowadays, watermarking has become a technology of choice for a broad range of multimedia copyright protection applications. Watermarks have also been used to embed prespecified data in biomedical signals. Thus, the watermarked biomedical signals being transmitted through communication are resistant to some attacks. This paper investigates discrete wavelet transform based watermarking technique for signal integrity verification in an Electrocardiogram (ECG) coming from four ECG classes for monitoring application of cardiovascular diseases. The proposed technique is evaluated under different noisy conditions for different wavelet functions. Daubechies (db2) wavelet function based technique performs better than those of Biorthogonal (bior5.5) wavelet function. For the beat-to-beat applications, all performance results belonging to four ECG classes are highly moderate.

Algorithms↗

The impact of a media campaign in the reduction of risk-taking behavior on the part of drivers.

As part of an ongoing media educational campaign to enhance pedestrian safety in the Victoria (Canada) metropolitan area, multimedia campaigns have been targeted at drivers. This paper evaluates the campaign that focused on encouraging left-turning drivers to yield. Observers monitored five signalized intersections during five separate weeks. Logistic regression analyses indicate that this media campaign produced a long-term effect of increasing drivers' yielding behaviors.

Accidents, Traffic↗

The responsive workbench: a virtual working environment for physicians.

The paper describes the concept of the Responsive Workbench (RW). This virtual environment was designed to support end users working on desks, workbenches, and tables as physicians, architects and scientists with an adequate human-machine interface. We attempt to construct a task-driven interface for this class of users by working in an interdisciplinary team from the beginning. The system is explained and evaluated along three medical applications: medical education, a cardiological tutorial with a simulation system for ultrasonographic examinations of the heart and surgery planning. Virtual objects are located on a real "workbench". The objects, displayed as computer generated stereoscopic images are projected onto the surface of a table. The participants operate within a non-immersive virtual environment. A "guide" uses the virtual environment while several observers can also watch events by using shutter glasses. Depending on the application, various input and output modules can be integrated, such as motion, gesture and speech recognition systems which characterize the general trend away from the classical multimedia desktop interface. The RW is compared with other common virtual reality systems as head mounted displays. First experiences of the collaborators are drawn and future enhancements are proposed.

Computer Graphics↗

Morphing as a means of generating variation in visual medical teaching materials.

In computer-based medical education, there is frequently a need to present students with pictorial data representative of the natural variation associated with disease presentations as well as the progression of disease within an individual. Because of the difficulty in acquiring such data, image acquisition is often the most resource-intensive phase of multimedia courseware development. In light of the resource demands associated with image content, many courseware designers do not make opportune use of image data, but rely instead upon text descriptions to provide variation in content. The resulting lack of adequate pictorial content often lessens the overall impact of the courseware. To overcome constraints imposed by the difficulty in acquiring pictorial content of sufficient richness, a methodology of generating variation in visual teaching materials has been developed through the use of morphing. These techniques have general applicability in creating variation in pictorial teaching materials in a variety of image-intensive domains.

Ascites↗

The rural and global medical informatics consortium and network for radiology services.

Telemedicine systems that provide health delivery services to rural clinics and hospitals are being demonstrated in clinical settings. This paper summarizes the research and consortia projects at the University of Arizona Medical Center. The paper describes the Rural and Global Picture Archiving and Communications (PACS) environment developed under a National Science Foundation grant. The Rural and Global PACS environment includes many workstations, database, and networking components and is treated as a large distributed system. These components are described in this paper. The multimedia services for radiology provided by the Rural and Global PACS are described and their performance is measured. Finally, the current research work using the Open Software Foundation's distributed computing environment (OSF DCE) services is described. An OSF DCE testbed for the Rural and Global PACS is described and the rationale of using OSF DCE in the project is presented.

Arizona↗

An integrated framework to identify significant human exposures (SHELs).

Typically, health risk assessment methodologies have been designed to assess risks associated with exposure to individual chemicals through one specific medium, such as air, water, or food. This is partly because classical experimental methodology is used to study pure chemicals, and partly because a majority of early promulgated environmental laws (e.g., Clean Air Act, Clean Water Act) regulated chemicals in a given matrix via a specific route. Often, however, exposures in the ambient environment are through multiple routes, multiple media and to multiple chemicals. Presented here is a multimedia framework that health risk assessors can use to identify significant human exposure levels (SHELs) on a site-specific basis. This framework is presented in the context of a decision tree that links health guidance values such as minimal risk levels (MRLs) with site-specific data, using a range of decision-support models. It includes a provision to estimate a level of concern by comparing the estimated total dose (exposures) with guidance values established by the Agency, by other federal organizations, and by basket-survey results. If a SHEL has been identified, a range of follow-up public health actions may be indicated (i.e., surveillance, health education, or other preventive interventions). This framework serves to (1) integrate the overall health assessment process, (2) evaluate the need for public health interventions, (3) incorporate innovative decision-support methods/models, and (4) demonstrate utility of such methods in public health practice and the pursuit of the Agency's mission.

Air Pollutants↗

The impact of a media campaign on public action to help maltreated children in addictive families.

Developed because of the need to promote public understanding of the link between addictions and child maltreatment, a multimedia campaign helped to increase by 62% the average monthly number of people who called a telephone service for information about how to aid abused and neglected children. The campaign was supported by market research and professional experience that indicated the campaign should focus on easy action a citizen could take, avoid inducing fear or blame, and target third party helpers and younger families-at-risk. Campaign exposure was promoted through the support of corporate partners. A random household survey found that 61% of the general population had seen or heard the campaign slogan. The average monthly calls to the child maltreatment information service regarding alcohol and other drug abuse tripled and the requests regarding at-risk children almost doubled. An auxiliary project provided interprofessional education to increase the probability that people seeking help would get it when referrals were made. The project yielded several lessons for future public awareness campaigns: focus on helping action rather than the problem; use of client-based market research; a strategic plan to assure necessary exposure; reliance on public-private-nonprofit sector partnerships; preparation of the service system; promotion of personal ways of helping.

Alcoholism↗