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Video-based computer-assisted learning.

As a relevant exemplar of MPEG-1 and MPEG-2 digital video use, a multimedia computer-assisted learning (CAL) application dealing with Critical Communication Issues in medicine was developed. The application allowed the student to navigate through a series of high-quality digital video and audio clips that were delivered in near real-time from an Intranet server. This paper gives a brief background to the MPEG-2 video compression system and discusses the use of digital video in a CAL environment.

Communication↗

'Ten golden rules' for designing software in medical education: results from a formative evaluation of DIALOG.

Evaluation of educational material has become very important in a climate where there is increasing concern with assessing and maintaining quality. DIALOG (acronym for Distance Interactive Learning in Obstetrics and Gynaecology) is an electronic program on CD-ROM for continuing education. A formative evaluation of DIALOG was carried out to determine whether DIALOG was achieving its educational objectives. The results of the evaluation helped to suggest '10 golden rules' for designing software for the purpose of CPD for medical practitioners. These 'rules' should help in designing future software in medical education. They highlight the importance of content, presentation, design, use of hypermedia and multimedia and reduced cost in order to facilitate appropriate use of such programmes.

CD-ROM↗

Representative survey of dental students about the present state of education, PC equipment and configuration requirements for a net-based dental education system.

A representative survey of 130 dental students revealed that the necessary conditions for using net-based education systems seem to exist, as 99% of all students have access to a PC, of which most (78%) own one. As most of them use the PC at least several times a week, they seem to be adequately skilled to deal with hard- and software. Internet and emailing are the most commonly used features of the PC after text documentation, therefore it can be inferred that almost all computers have Internet access. The students' requirements for the planned net-based dental education system are case documentation, multimedia documented work-flows, checklists related to workflows, a training tool for prosthetic therapy planning, practical advice and films about dental treatment methods, timetables and discussion fora. The net-based dental education system can support private study but may also be used for seminars in small groups.

Attitude of Health Personnel↗

Developing practical criteria for evaluating online patient simulations: a preliminary study.

Online patient simulations are increasingly used in medical education. However, uniform criteria for evaluating simulations don't exist. This study explored expert opinion regarding the essential components of online simulations. Preliminary criteria were examined through a survey of 22 medical educators and follow-up interviews with nine educators. Features involving routine tasks and the teaching of problem solving skills-histories, physicals, labs, and differential diagnoses were highly rated. Features conveying realism such as time constraints and the use of multimedia were ranked lower. Interviewees noted three impediments to wider use of simulations: time required to develop content, limits of current technology and the absence of usable authoring tools.

Computer Communication Networks↗

Web-based, virtual course units as a didactic concept for medical teaching.

The objective was to develop a web-based, virtual series of lectures for evidence-based, standardized knowledge transfer independent of location and time with possibilities for interactive participation and a concluding web-based online examination. Within the framework of a research project, specific Intranet and Internet capable course modules were developed together with a concluding examination. The concept of integrating digital and analogue course units supported by sound was based on FlashCam (Nexus Concepts), Flash MX (Macromedia), HTML and JavaScript. A Web server/SGI Indigo Unix server was used as a platform by the course provider. A variety of independent formats (swf, avi, mpeg, DivX, etc.) were integrated in the individual swf modules. An online examination was developed to monitor the learning effect. The examination papers are automatically forwarded by email after completion. The results are also returned to the user automatically after they have been processed by a key program and an evaluation program. The system requirements for the user PC have deliberately been kept low (Internet Explorer 5.0, Flash-Player 6, 56 kbit/s modem, 200 MHz PC). Navigation is intuitive. Users were provided with a technical online introduction and a FAQ list. Eighty-two students of dentistry in their 3rd to 5th years of study completed a questionnaire to assess the course content and the user friendliness (SPSS V11) with grades 1 to 6 (1 = 'excellent' and 6 = 'unsatisfactory'). The course units can be viewed under the URL: http://giga.rrze.uni-erlangen.de/movies/MKG/trailer and URL: http://giga.rrze.uni-erlangen.de/movies/MKG/demo/index. Some 89% of the students gave grades 1 (excellent) and 2 (good) for accessibility independent of time and 83% for access independent of location. Grades 1 and 2 were allocated for an objectivization of the knowledge transfer by 67% of the students and for the use of video sequences for demonstrating surgical techniques by 91% of the students. The course units were used as an optional method of studying by 87% of the students; 76% of the students made use of this facility from home; 83% of the students used Internet Explorer as a browser; 60% used online streaming and 35% downloading as the preferred method for data transfer. The course units contribute to an evidence-based objectivization of multimedia knowledge transfer independent of time and location. Online examinations permit automatic monitoring and evaluation of the learning effect. The modular structure permits easy updating of course contents. Hyperlinks with literature sources facilitate study.

Computer-Assisted Instruction↗

Q-Pro: a quality control management system for medical equipment.

Q-Pro is an application for quality control (QC) and inspection of medical equipment. The system has been designed on the basis of a broad requirements analysis, contributed by clinical engineers from several European countries and with a focus on current and forthcoming regulatory requirements concerning the quality control and risk management for medical equipment. Q-Pro comprises a generalized application, providing the necessary flexibility to accommodate the different degrees of difficulty and specialization in creating or customizing QC protocols, carrying out inspections and managing collected data. The system incorporates a tool library for QC protocol design, widely used multimedia as well as a local database for protocol and inventory data archiving. The paper presents a detailed account of the system context of use, design and functionality.

Equipment and Supplies↗

Do videotapes improve knowledge and attitudes about AIDS?

Three popular videotapes were assessed for their effectiveness in improving knowledge and attitudes about acquired immune deficiency syndrome (AIDS). One hundred forty-four university students completed knowledge and attitude questionnaires and then watched either an AIDS or a control tape. Half the students completed posttest questionnaires immediately after seeing the tape, and half were tested 1 month later. Students who viewed an AIDS tape showed increased knowledge at immediate and 1-month posttesting (p less than .01); the amount of increase declined over the month, however (p = .012). Students who saw two of the AIDS tapes showed an increase in compassion toward people with AIDS when tested immediately after the tape (p less than .01); but 1 month later, only those students who had viewed a third AIDS tape showed an increase in compassion (p less than .01). The AIDS tapes failed to bring about improvements in attitudes toward preventive behavior. The authors concluded that tapes about AIDS can lead to modest changes in knowledge and perhaps in attitudes; more significant changes, however, probably depend on multimedia interventions that include guided discussions as well as audiovisual and other components.

Acquired Immunodeficiency Syndrome↗

The prevalence of unwanted and unlawful sexual experiences reported by Danish adolescents: results from a national youth survey in 2002.

AIM: To obtain current data about child sexual abuse in Denmark and to assess abused children's own perception of early sexual experiences, which are unlawful according to the Danish Penal Code. METHODS: Multimedia computer-based self-administered questionnaires (CASI) were completed by a national representative sample of 15-16-y-olds. Child sexual abuse was defined according to the penal code and measured by questions defining specific sexual activities, the relationship between the older person and the child, and the youth's own perception of the incident. RESULTS: Among 5829 respondents, 11% reported unlawful sexual experiences, 7% of boys and 16% of girls. Only 1% of boys and 4% of girls felt that they "definitely" or "maybe" had been sexually abused. CONCLUSION: A relatively high percentage of Danish adolescents have early, unlawful sexual experiences. However, young people's own perception of sexual abuse tends to differ from that of the authorities, or their tolerance of abusive incidents is high. Gender differences were found in factors predicting perception of abuse.

Adolescent↗

Technology available in nursing programs: implications for developing virtual end-of-life educational tools.

BACKGROUND: To overcome insufficient attention to end-of-life (EOL) care in nursing education, the authors are developing the "Toolkit for Nursing Excellence at End-of-Life Transition" (TNEEL). METHOD: An evidence-based design process was used to create a computerized (CD-ROM) multimedia toolkit of instructional aides. An online survey of all U.S. undergraduate nursing programs was conducted to identify their current technologic infrastructures available for innovative teaching aides. Expert review process guided pedagogic decisions. RESULTS: Survey findings enabled TNEEL development to be responsive to nurse educators' needs and preferences. CONCLUSION: Educators can use TNEEL to actively engage students in meaningful learning about EOL care.

Clinical Competence↗

Evaluation of Internet-based oncologic teaching for medical students.

BACKGROUND: Electronic tools with substantial educational applications are now widely available. METHODS: In a prospective, randomized study, the value of Web-based educational tools for teaching second-year medical students was evaluated. The 35-hour, image-intensive multifaculty neoplasia course was selected for the experiment, with 103 students assigned to the control group (C) and 61 to the experimental group (E). Representative password-controlled multimedia course modules, accessible via the Internet, were developed. The E cohort was exposed to both classroom and Web-aided materials, whereas the C group had access to the Web modules only after the experiment was concluded (but before the final examination). Pre- and post-exposure questionnaires assessed computer knowledge, familiarity with the Internet, availability of computer access, and the value of Web-based education for both cohorts. Additionally, pre-and post-exposure tests were administered to both cohorts based on educational materials presented in the Web modules. RESULTS: The overall participation rate was 64% (E = 69%; C = 60%). The post-test showed no major performance difference between the two groups. The questionnaires revealed that: less than 1% of the students had not accessed the Internet previously; less than 5% had not used the Internet for medical education before; 34% felt that computer resources on campus were inadequate; and over 75% found Web-based education to be an important additional educational resource. The major negative aspect was the slow pace of data transfer for modem-based home access. Only 1% of students felt that Web-based education could completely replace traditional teaching. CONCLUSION: The potential for incorporating Web-based education in the medical curriculum is considerable.

Computer Literacy↗

Computer-assisted learning: cyberPatient--a step in the future of surgical education.

Computer-assisted learning is a hot topic and is evolving parallel with the rapidly growing computer technology. Today, modern computers with sophisticated software are able to create a new dimension in the application of many important pedagogical principles and philosophies. Modern computers with excellent multimedia applications are capable of simulating a realistic situation that enriches the educational environment, improves the learning process, and brings new challenges to the process of "learning by doing." The use of computers in medical industry and in medical education lags far behind other applications in the industrial world. Although a great many computer-assisted learning programs have been developed in the last decade and patient simulation has been attempted, there are no computer programs in the market that are capable of simulating the realism of the patient-doctor relationship. cyberActive Technology Ltd. has been able to complete this mission. The computer software cyberPatient developed by cyberActive Technology Ltd. is able to realize this long-term dream of medical students and educators. The discrepancy between theoretical and practical medical knowledge in the classical medical education was greater than in any other aspect of science. In classical medical education, diseases were taught beginning with etiology and pathogenesis to signs and symptoms. In practice, the patient comes to the doctor with complaints, and the doctor has to think backward to find out about the etiology and pathogenesis. This discrepancy created enormous difficulties for interns and young doctors with respect to the application of theoretical medicine to medical practice. This was one of the reasons why medical schools turned to a new problem-based learning curriculum. The new curriculum, however, has brought new challenges and problems of its own. Some of the problems include patient availability, increased demands for teachers, and, in turn, significant increases in the costs of medical education. Intensive use of computers may be a solution for problem-based learning. The aim of this article is to give an overview of computer-based learning and its place in the future of medical education.

Computer-Assisted Instruction↗

Can targeted HIV testing campaigns alter health-seeking behaviour?

This paper describes the evaluation of 'gimme 5 minutes' a multimedia HIV testing campaign aimed at gay and bisexual men in London particularly targeting those of Black and South European Origin and those under the age of 25 years old using peer images. The text linked a summary of the key issues of a pre-test discussion with detailed information on how to access testing at a specified testing centre (campaign clinic). The number and demographics of men who reported sex with men (MSM) testing at the campaign clinic were monitored and compared with those testing at two other central London clinics. There was a 4.5-fold rise (p < 0.001) in MSM testing at the campaign clinic. Increases were proportionately greater in the sub-populations targeted with peer images: South European origin, 14-fold rise (p < 0.001), Black origin, 6.5-fold rise (p = 0.003), and MSM under 25 years old, 9.5-fold rise (p < 0.001). There were no significant changes in the number of MSM testing for HIV at the two other central London clinics studied. The results suggest that including detailed information about accessing testing services may be a vital ingredient in the success of media campaigns focusing on HIV testing.

Bisexuality↗

Methyl tertiary hexyl ether and methyl tertiary octyl ether as gasoline oxygenates: assessing risks from atmospheric dispersion and deposition.

Methyl tertiary hexyl ether (MtHxE) and methyl tertiary octyl ether (MtOcE) are currently being developed as replacement oxygenates for methyl tertiary butyl ether (MtBE) in gasoline. As was the case with MtBE, the introduction of these ethers into fuel supplies guarantees their introduction into the environment as well. In this study, a screening-level risk assessment was performed by comparing predicted environmental concentrations (PEC) of these ethers to concentrations that might cause adverse effects to humans or ecosystems. A simple box model that has successfully estimated urban air concentrations of MtBE was adapted to predict atmospheric concentrations of MtHxE and MtOcE. Expected atmospheric concentrations of these ethers were also estimated using the European Union System for the Evaluation of Substances (EUSES) multimedia fate model, which simultaneously calculates PECs in the various environmental compartments of air, water, soil, and sediment. Because little or no data are available on the physicochemical, environmental, and toxicological properties of MtHxE and MtOcE, estimation methods were used in conjunction with EUSES to predict both the PECs and the concentrations at which these ethers might pose a threat. The results suggest that these ethers would contaminate the air of a moderately sized U.S. city (Boston, MA) at levels similar to those found previously for MtBE. The risk assessment module in EUSES predicted risk characterization ratios of 10(-3) and 10(-2) for MtHxE and MtOcE, respectively, in Boston, and 10(-2) and 10(-1) in very large urban centers, suggesting that these ethers pose only a minimal threat to ecosystems at the anticipated environmental concentrations. The assessment also indicates that these compounds are possible human carcinogens and that they may be present in urban air at concentrations that pose an unacceptable cancer risk. Therefore, testing of the toxicological properties of these compounds is recommended before they replace MtBE in gasoline.

Animals↗

Health risk assessment of an industrial site contaminated with polycyclic aromatic hydrocarbons using CalTOX, an environmental fate/exposure model.

This paper presents the results of a risk assessment study made using CalTOX, a multimedia, multiple pathway risk assessment model. The case study is based on the Polycyclic Aromatic Hydrocarbon (PAH) soil contamination resulting from the activities of a natural gas power station over a period of 70 years. It describes model characteristics and input parameters such as physico-chemical properties, landscape description, and human exposure factors. Model simulations and risk estimations corresponding to different remedial scenarios in an industrial zone are also presented. These estimations were based on soil contamination by 16 PAHs in the root-zone and vadose-zone layer. Results show that adult exposure (workers) to contaminated soil will lead to a potential health risk of carcinogenic effects, and to no potential risk of non-carcinogenic effects. On the other hand, the addition of 10 cm of clean soil over the contaminated soil (mitigated scenario) decreases the lifetime cancer risk to an acceptable level. The sensitivity analysis showed that the half-life of benzo[a]pyrene in the root-zone soil is the most sensitive parameter and that it contributes significantly to the variability of the cancer risk estimation. In addition, the cancer risk level of the workers exposed to this substance, as estimated by CalTOX (point estimate) in the mitigated and unmitigated scenario, corresponds approximately to the 95th percentile value obtained by means of Monte-Carlo simulations. Finally, CalTOX has proven to be a valuable tool to predict and elaborate scenarios for the risk management of sites contaminated as a result of industrial activities.

Adult↗

Environmental contamination and human exposure assessment to manganese in the St-Lawrence River ecozone (Quebec, Canada) using an environmental fate/exposure model: GEOTOX.

Methylcyclopentadienyl manganese tricarbonyl (MMT) is an organic derivative of manganese (Mn) used as an additive in unleaded gasoline. The combustion of MMT leads to the formation of oxides of manganese. The objective of the present study is to predict the environmental levels of Mn and the human exposure in the St-Lawrence ecozone (fluvial section, Quebec, Canada) using an environmental fate/exposure model: GEOTOX. The results of our MMT research program on abiotic and biotic components of the ecosystem and on the human exposure were used to validate the model estimations. Air and surface soil were selected as source terms with an annual Mn input rate in each compartment of 0.083-0.113 mol km-2 d-1 and 0.44-0.87 mol km-2 d-1 respectively (Mn3O4 equivalent). The predicted air, soil, plant, surface water and sediment concentrations were similar (+/- 50%) to values measured in the Montreal region. As expected, the ingestion pathway was the main absorption route for adults (> 99%), with vegetables and fruits contributing almost 80% of the dietary intake of Mn. The multimedia exposure doses for adult men predicted by the model ranged between 0.04 and 0.08 mg kg-1 d-1 compared to 0.004 and 0.201 mg kg-1 d-1 (average = 0.05) for workers from the MMT study. Considering the landscape configuration and the source vectors (air and soil) included in the model, GEOTOX estimations were in good agreement with measured values.

Adult↗

Assessment of carcinogenic risk from personal exposure to benzo(a)pyrene in the Total Human Environmental Exposure Study (THEES).

The Total Human Environmental Exposure Study (THEES) was an investigation of multimedia exposure to the ubiquitous environmental carcinogen, benzo(a)pyrene (BaP). The three-phase study was conducted in Phillipsburg, New Jersey and involved the participation of 14-15 individuals (8-10 homes) during each 14-day monitoring period. Microenvironmental sampling of air, food, water and soil indicated that environmental exposure to BaP was primarily through air and food. Exposure and risk estimates were, therefore, based on the results of personal monitoring of breathing zone air and prepared food samples. Based on a comparison of the range and magnitude of inhalation and dietary BaP exposures, food ingestion was clearly the predominant exposure to pathway. The relative contributions of other potential sources of community exposure to BaP (e.g., soil and drinking water ingestion) were also assessed. The excess cancer risk estimates for food ingestion were consistently greater than those for personal air, reflecting both the predominantly higher BaP exposures through the diet and the higher carcinogenic potency value for oral exposure. Overall, the total lifetime risk from personal exposure to BaP for nonsmokers in the community was estimated at 10(-5). In identifying risk reduction options, it is important to account for the observation that personal activities, lifestyle, and diet strongly influenced individual exposures to BaP.

Air Pollutants↗

The development of an Alzheimer's disease channel for the Michigan Interactive Health Kiosk Project.

The overall objective of this article is to describe the development and implementation of an Alzheimer's disease (AD) module for the Michigan Interactive Health Kiosk Project. This project provides access to health information via 100 kiosks located in public places throughout the state (e.g., churches, senior centers, schools, shopping malls, grocery stores, hospitals) using interactive multimedia software. Because the kiosk screen was designed to resemble a television set, program modules are referred to as "channels." The AD channel is designed to increase knowledge and awareness of the disease among the general public. After an overview of the overall project, the steps involved in developing the AD channel and strategies designed to monitor its use are described, including touch-screen usage data and an on-line user survey. Finally, marketing and promotion of the channel and the implications of this initiative for disseminating information about AD are discussed.

Aged↗

Skill improvement during emergency response to terrorism training.

OBJECTIVES: To assess the individual and team skills acquired from an interactive training program to prepare emergency personnel to respond to terrorist acts. METHODS: We developed a 16-hour, two-day, multimedia- and simulation-enhanced course that places learners in realistic situations using the equipment required to respond to various chemical, biologic, radiologic, and explosive acts of terrorism. Small-group sessions and drills were conducted. Errors in skill performance were corrected immediately, and then skills were repeated to achieve mastery. Participants included emergency medical technicians, paramedics, nurses, and physicians. Team performance was assessed over four successive scenarios using a 100-mm visual analog scale. Individual learner skill acquisition was assessed with precourse and postcourse evaluation of selected skills in a randomized sampling of consenting learners. RESULTS: Nearly all teams achieved mastery of the required skills by the second assessment rotation. Individual learners demonstrated significant gains in the ability to emergently don personal protective equipment and administer a nerve agent antidote kit. CONCLUSIONS: An interactive, simulation-enhanced curriculum of terrorism response training for emergency responders can produce significant, quantifiable individual and team skill gain. Future studies should further address performance benchmarks for these newly acquired skills.

Adult↗