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PubMed2005

An integrated tool for the diagnosis of voice disorders.

A PC-based integrated aid tool has been developed for the analysis and screening of pathological voices. With it the user can simultaneously record speech, electroglottographic (EGG), and videoendoscopic signals, and synchronously edit them to select the most significant segments. These multimedia data are stored on a relational database, together with a patient's personal information, anamnesis, diagnosis, visits, explorations and any other comment the specialist may wish to include. The speech and EGG waveforms are analysed by means of temporal representations and the quantitative measurements of parameters such as spectrograms, frequency and amplitude perturbation measurements, harmonic energy, noise, etc. are calculated using digital signal processing techniques, giving an idea of the degree of hoarseness and quality of the voice register. Within this framework, the system uses a standard protocol to evaluate and build complete databases of voice disorders. The target users of this system are speech and language therapists and ear nose and throat (ENT) clinicians. The application can be easily configured to cover the needs of both groups of professionals. The software has a user-friendly Windows style interface. The PC should be equipped with standard sound and video capture cards. Signals are captured using common transducers: a microphone, an electroglottograph and a fiberscope or telelaryngoscope. The clinical usefulness of the system is addressed in a comprehensive evaluation section.

Computer Graphics↗
PubMed2004

Evaluating the service quality of undergraduate nursing education in Taiwan--using quality function deployment.

This study applies quality function deployment (QFD) techniques to evaluate the quality of service of undergraduate nursing education in Taiwan from the perspective of nursing students. Survey data from 560 undergraduate nursing students at four Taiwanese universities were subjected to QFD analysis in order to identify the quality characteristics most highly valued by students, the elements of educational service they consider most important and least important, and relationships/discrepancies between student quality requirements and institutional service elements. Results show that students value traditional elements of nursing education - clinical practice and lectures - more highly than recent additions such as computer-aided instruction and multimedia teaching. Results also show that students are looking for quality primarily in the area of faculty characteristics. The implication is that institutions which provide nursing education should not neglect the importance of investing in faculty when they are seeking to upgrade the quality of their programs. Further QFD studies are recommended to evaluate the quality of nursing education from the perspective of preceptors and nurses who help to train students in clinical settings.

Attitude of Health Personnel↗
PubMed2005

Evaluating the environmental fate of pharmaceuticals using a level III model based on poly-parameter linear free energy relationships.

We recently proposed how to expand the applicability of multimedia models towards polar organic chemicals by expressing environmental phase partitioning with the help of poly-parameter linear free energy relationships (PP-LFERs). Here we elaborate on this approach by applying it to three pharmaceutical substances. A PP-LFER-based version of a Level III fugacity model calculates overall persistence, concentrations and intermedia fluxes of polar and non-polar organic chemicals between air, water, soil and sediments at steady-state. Illustrative modeling results for the pharmaceuticals within a defined coastal region are presented and discussed. The model results are highly sensitive to the degradation rate in water and the equilibrium partitioning between organic carbon and water, suggesting that an accurate description of this particular partitioning equilibrium is essential in order to obtain reliable predictions of environmental fate. The PP-LFER based modeling approach furthermore illustrates that the greatest mobility in aqueous phases may be experienced by pharmaceuticals that combines a small molecular size with strong H-acceptor properties.

Environmental Monitoring↗
PubMed2005

Risk assessment of "down-the-drain" chemicals: search for a suitable model.

Legal and regulatory authorities around the world generally require that risk assessments are undertaken for the licensing of new and existing substances that present high risk to the environment or the human health. This applies to 'down-the-drain' chemicals that are usually found in household products, such as detergents, that are mainly discharged into rivers via sewer systems. However, the data available for these chemicals is often limited due to cost constraints: in particular, concentration time series for works effluent are generally unavailable, even load data for specific works is often scarce. Although a wide range of models are available, there is a general lack of knowledge on their suitability to model the fate of down-the-drain chemicals at the catchment scale. Several models are presented in this review. The models selected are: the Mackay models, EUSES, Mike 11, QUAL2E, TOMCAT and GREAT-ER. Various applications of these models were investigated to investigate their strength and weaknesses. It appears that, where the availability of data is limited, multimedia fate models such as the Mackay models and EUSES may best be applied to estimate the global risk within each media. However, for site-specific risk assessment the GREAT-ER in-stream water quality model was considered to be more appropriate for modelling down-the-drain chemicals, because it accounts for both spatial and temporal variability, while its data requirements are lower than for models such as Mike 11 and QUAL2E.

Environment↗
PubMed2004

Easy listening to sleep recordings: tools and examples.

BACKGROUND AND PURPOSE: To specify a simple conversion of neurophysiological signals contained in sleep recordings into standard audio files and to illustrate how our cerebral audio processor can then detect specific signal characteristics. METHODS: A software package (freely accessible from the Internet) has been developed that converts signals from standard EDF (or EDF+) format to standard audio (WAV) format, a process usually called audification. The software has been applied to sleep EEG, EOG and ECG. The software is easy to apply. RESULTS: A wide range of audified signals is described, stressing the analogy with familiar sounds. Audio properties of EEG in different sleep stages, EOG, ECG and respiration signals are discussed. Auditive presentation of the signals invokes brain processes that differ essentially from the commonly applied visual interpretation, including physiological frequency analysis. CONCLUSIONS: Such auditive interpretation may complement the visual one. The widespread use of EDF+ and multimedia computers makes such audification simple and straightforward.

Adult↗
PubMed2006

Contraceptive practices in Armenia: Panel evaluation of an Information-Education-Communication Campaign.

Induced abortion remains the major form of birth control among Armenian women, contributing to their excess mortality and preventable morbidity. Reliance on abortion is attributed to limited access to information concerning modern methods of contraception and to widely held misinformation among women regarding family planning and reproductive health. Based on the Steps to Behavior Change model, the Green Path Campaign for Family Health, an information-education-communication (IEC) campaign, was launched in June 2000. This multimedia campaign promoted greater awareness, knowledge, acceptance, and adoption of modern contraception through increased utilization of counseling and related services provided at underutilized family planning centers. A representative panel of 1088 married women aged 18-35 were surveyed on reproductive health/family planning knowledge, attitudes, and practices immediately prior to and immediately following the 6-month national campaign. Exposure to the campaign was associated with significant increases in factors associated with contraceptive behavior change: knowledge, favorable attitudes toward modern methods, favorable attitudes toward family planning services, and information seeking and utilization of family planning services. Women who were more educated, more affluent, and slightly older were more likely to use family planning services as well as modern contraceptive methods. New visits to family planning centers increased by 84%. Despite the usual 25% turnover among those using modern methods at the start of the study, use of modern contraceptive methods increased by 4.6%, significantly exceeding the projected 3% increase. The results document changes in underlying behavioral predictors consistent with the Steps to Behavior Change model and highlight the relatively untapped potential of media-based health promotion efforts in post-Soviet Republics.

Adult↗
PubMed2004

Making a movie on kidney transplantation: a medical school graduation thesis to explain kidney transplantation from students to students.

The aim of this study was to report on the production and the opinions of a video movie on transplantation and organ donation. The video was developed by a medical school student with the help of the students and teachers of a high school for applied arts. For this task, the making of the video was included in the high school program of the participating class. The students were tutored by their photography teacher. The video movie lasts about 50 minutes. Each "scene" lasts no more than 5 minutes, to avoid reducing the attention level. The choice of a nonmedical frame helped to have some moments to digest the technical information and to stress the importance of the patient-physician relationship. The video was employed as a part of small-group lessons in the nephrology course. A semistructured anonymous questionnaire gathered the opinion of 65 students at the end of the lessons. Student satisfaction was high; the median score was the highest (8, range 6 to 10) for the lesson based upon the movie, as compared with the conventional ones on chronic kidney disease or dialysis (7, range 5 to 10). As far as the authors know, this is the first experiment of a multimedia approach, dedicated to medical and nonmedical targets, developed as a graduation thesis in an Italian Medical School. In conclusion, the positive opinions of the students, who highly appreciated the peer-developed message, may suggest implementing such nonconventional educational approaches to support human resources and enthusiasm for kidney transplantation among the new generations.

Adolescent↗
PubMed2004

A tailored multi-media campaign to promote the human papillomavirus cohort study to young women.

BACKGROUND: Human papillomavirus (HPV), a sexually transmitted disease, is now recognized as the major cause of cervical cancer. The Cancer Research Center of Hawaii developed a low-cost and culturally sensitive multimedia campaign to recruit Oahu women to their HPV cohort study, specifically targeting women 18 to 35 years of age. METHODS: Initial promotions and enrollment revealed the highest prevalence of HPV among women ages 18-35. Promotional content was restructured to recruit this age group, based on focus group findings that these women may be motivated by information pertaining to the sexual transmission of HPV rather than its role as a risk factor for cervical cancer. Data obtained during initial triage of participants were used to assess the efficacy of the campaign. RESULTS: The number of women, 18-35, who responded to study promotions increased by 54%. At the conclusion of recruitment, 77% of the 508 HPV-positive women were between 18 and 35 years of age. E-mail and newspaper articles and advertisements generated the biggest response and were cost- and time-efficient. CONCLUSIONS: Although not as effective as personal recruitment during clinic visits, a media campaign which targets the desired demographic can both increase study participation as well as promote cancer prevention and health education.

Adolescent↗
PubMed2005

[Elaboration of an interactive educational CD-R on good laboratory practices for manufacturing and quality control].

cGMPs require that QA systems rely upon qualified personnel in charge of pharmaceutical operations. In order to achieve this legal requirement, the manufacturer must provide initial training and regular re-training along with periodical evaluations of their practical efficiency. This cGMP-learning multimedia CD-R is an interactive and individual training tool, designed for QC laboratory personnel. It contains a final questionnaire allowing an assessment of the course efficiency. Building up a ten-module teaching program entitled "Le médicament en toute confiance", the development of this CD-R was supervised by an European team of experienced industrial pharmacists.

CD-I↗
PubMed2005

Mass community screening for diabetic retinopathy using a nonmydriatic camera with telemedicine.

BACKGROUND: Diabetic retinopathy is a leading cause of blindness. Studies have shown the value of screening and early, timely treatment. Our aim was to measure the effectiveness and degree of acceptance of community screening for diabetic retinopathy using telemedicine. METHODS: In this prospective, population-based cross-sectional study, diabetics recruited through a regional multimedia campaign were surveyed and screened for retinopathy using a nonmydriatic camera and evaluated through telemedical imaging. RESULTS: Of the 291 diabetics recruited over a 3-week period (37% by the regional diabetes association and 30% by the media), 49.4% reported having their most recent eye examination within 1 year, 30.7% between 1 to 2 years, 9.7% over 2 years, and 10.1% had never had an exam. 98.6% found our screening method acceptable, with 95.1% wanting to return for their next screening and 91.2% stating it would increase their compliance to annual screening. INTERPRETATION: Telemedicine provided a reliable and highly acceptable method for diabetic retinopathy screening. It can attract a significant number of people with diabetes and potentially recruit patients who would otherwise be missed by the current methods of vision screening.

Adolescent↗
PubMed1999

Telemedicine: a new dimension in the practice of medicine.

Telemedicine has drawn increasing attention as one of the emerging service delivery vehicles running on the information highway. Until recently, the adoption of telemedicine has been discouraged by the cost of telecommunications and equipment and by the lack of infrastructure, standards, and evidence of cost-effectiveness and cultural acceptance. Although there have been attempts to reduce costs by making use of computer communication networks, they were technically limited by slow network speed and the lack of real-time audio/video compression technology. Ongoing technologic advances in telecommunications, imaging, multimedia computers, and information systems are making interactive telemedicine increasingly possible as high-speed video, voice, and data services are brought to large segments of the general population. The current synergy between health reform initiatives, which are redefining how health care services are accessed and delivered, and advances in technologies that support telemedicine has resulted in a proliferation of telemedicine projects. However, there is still no proof that telemedicine is necessarily cost-effective for a broad set of applications. Each prospective application requires its own business case analysis. Within the current environment, the development of a telemedicine strategy should be based on a sound knowledge of the current and future potential of telemedicine to improve health care access and quality while containing and possibly reducing health care costs.

Humans↗
PubMed1992

Defining lead as the premiere environmental health issue for children in America: criteria and their quantitative application.

The principal environmental health issue for American children is pervasive lead poisoning from the many decades of lead contamination. Available scientific evidence cementing lead's premiere ranking is voluminous, multifaceted, and compelling. This evidence, however, requires organization into a clear and coherent body of science before it can be fully recognized or comprehended by either the scientific community or the general public and its representatives: public health officials, regulators, policy makers, and legislators. An attempt at such organization is presented and begins with the premise that there exist clear, objective criteria by which a premiere environmental health issue can be defined. A second premise is that these criteria sort themselves into three categories which cover the full spectrum of toxic contaminant-population relationships. They are: (1) economic and sociopolitical, (2) scientific and public health, and (3) societal risk assessment criteria. The first set of criteria includes economic and historical centrality, primacy of economic over public health considerations, a relatively narrow decision-making framework, and controlled flow of information on the toxicant, especially its negative impacts. The second set of criteria is also orthodox in scope: the toxicant should be indestructible, should accumulate in both the environment and the body, and should be a multimedia contaminant; it should produce toxicity in numerous organs with little impediment; toxicity should be produced with low/no threshold in huge numbers of the most vulnerable; and finally, effects should persist in the critical target organ(s). There is a third, more globally encompassing, set of criteria important for present-day requirements for risk assessment; e.g., the contaminant should produce full-spectrum population-wide as well as individual toxicity. Evidence for societal harm should be compelling. It should typify the increasing importance of the elements of preventive over clinical medicine and the substance should bring to bear the cost-benefit analysis of macro plus micro health risk. Lead exposure and toxicity is conclusively shown to meet ALL of these criteria and is the premiere environmental health threat to America's children.

Animals↗
PubMed1990

Benzene: environmental partitioning and human exposure.

A multimedia transport model was used to evaluate the environmental partitioning of benzene. Measured and predicted environmental concentrations were used to estimate the accumulation of benzene in the food chain and the subsequent extent of human exposure from inhalation and ingestion. Results show that benzene partitions mainly into air (99.9%) and that inhalation is the dominant pathway of human exposure, accounting for more than 99% of the total daily intake of benzene. Ingestion of contaminated food items represents only a minor pathway of human exposure. The long-term average daily intake of benzene by the general population of the U.S. was estimated using three independent methods. Intake estimates based on measured personal air exposures, measured exhaled air concentrations, and a pharmacokinetically derived adipose tissue concentration (73, 63, and 72 micrograms/day, respectively) are in good agreement. Although inhalation is the primary route of human exposure to background levels of benzene in the environment, smoking was found to be the largest anthropogenic source of background human exposure to benzene.

Air↗
PubMed1998

Integration and communication for the continuity of cardiac care (I4C).

The project I4C (Integration and Communication for the Continuity of Cardiac Care) is carried out for the advancement of cardiac care, from prevention to follow-up. The goals of I4C are: (1) integrated access to patient data, wherever they are stored; (2) support of evidence-based care; (3) consistent recording of patient data (eg, patient history, electrocardiograms IECGs] or cine-angios) in a multimedia patient record; and (4) a documented reference data set for research. In several clinics, workstations are being installed to serve the four goals. Integration with other information systems in clinical care is realized by encapsulation. A computer-based patient record (ORCA) has been developed to support the collection, consultation, and sharing of patient data. In I4C, ORCA is intended for use in a research setting as well as routine patient care. The functionality of ORCA covers the collection of patient history data in a highly structured manner, the recording of drug prescriptions, an overview of laboratory test results, and viewers for ECGs and angiographic images. At present, structured data entry and consultation is supported in six European languages.

Cardiac Care Facilities↗
PubMed1998

Organizational considerations for an electronic curriculum. Part I: A rational nosology for concept management in dentistry.

STATEMENT OF PROBLEM: With the use of multimedia electronic knowledge as a tool in dental education, an overriding concern has centered on how to devise an organizational model that will accommodate the vast and diverse arrays of information involved, yet be sufficiently simple enough to provide students with a rational and consistent means of accessing the information they require. By adopting the natural history of the diseases dentists are called on to address as a common organizing principle, it becomes possible to link all concepts that relate to individual problem areas through a technique of retro-mapping. PURPOSE: The purpose of this article is to introduce learners to a cognitive "scaffolding" that will assist them in achieving a deeper cognitive dimension for problem solving.

Curriculum↗
PubMed1993

The effect of methylene blue-sensitized photodynamic treatment on bladder cancer cells: a further study on flow cytometric basis.

The cytotoxic effect mediated by methylene blue-sensitized photoinactivation on bladder cancer cells has been well known for years, but the actual mechanism is still not clear. Specific fluorescence stains were used in a multiparameter approach. The changes in cellular size, granularity, protein content, RNA and DNA were analyzed by flow cytometry. The results showed that, in addition to cell size, all the other parameters, including cellular granularity, protein, RNA and DNA, diminished following photodynamic therapy. The cytotoxic efficacy is closely related to time of stain and illumination. The DNA and cell cycle were affected simultaneously with decreased DNA content and arrest in the G0/G1 phase. These multistage processes occurred synchronously after the phototherapy. Our results suggest that the methylene blue-sensitized photooxidation of bladder cancer cells is carried out by multimedia reactions through which the intracellular proteins (enzymes in mitochondria), RNA (ribosomes) and DNA (chromatin) decrease with loss of cytoplasmic granularity.

Cell Cycle↗
PubMedDate not supplied

Telemedicine and ophthalmology.

Technology to create and move multimedia medical information is creating alternatives to physically transporting patients and health care professionals. Teletechnology is a physician extender, both supplementing and reinventing traditional health care delivery systems. The potential of comprehensive teleophthalmology is compelling. This article provides a historical perspective of telemedicine, describes various teleophthalmology systems, and surveys teleophthalmology in clinical consultation, research, and education programs around the world. It also discusses basic issues in applying teleophthalmology to public health.

History, 20th Century↗
PubMed2002

Setting information priorities for remediation decisions at a contaminated-groundwater site.

Many sites of contamination due to inappropriate disposal of hazardous materials or wastes have been found. These sites have the potential of damaging the environment and human health and thus need to be evaluated as to whether and what actions should be initiated. In the decision on whether a contaminated site should be subject to management, the knowledge concerning important parameters that would influence the decision will be beneficial to planning of data collection to support the decision. This paper presents a case study of contaminated site located in northern Taiwan, where the groundwater is contaminated by chlorinated hydrocarbons including trichloroethylene (TCE) and tetrachloroethylene (PCE). A site-specific multimedia risk assessment is performed to estimate the total risk resulting from the contamination. In addition, Monte Carlo simulation, rank correlation coefficients, and decision criteria are combined to develop a methodology for assessing the important of parameters in terms of their influence on the decision. It is found that TCE concentration, vegetable yield, deposition interception fraction of vegetables, and plant surface loss constant, are the four parameters important to the decision-making of the case problem.

Algorithms↗