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PubMed2004

Bioavailability and risk assessment of orally ingested polycyclic aromatic hydrocarbons.

Polycyclic aromatic hydrocarbons (PAHs) are a family of toxicants that are ubiquitous in the environment. These contaminants generate considerable interest, because some of them are highly carcinogenic in laboratory animals and have been implicated in breast, lung, and colon cancers in humans. These chemicals commonly enter the human body through inhalation of cigarette smoke or consumption of contaminated food. Of these two pathways, dietary intake of PAHs constitutes a major source of exposure in humans. Although many reviews and books on PAHs have been published, factors affecting the accumulation of PAHs in the diet, their absorption following ingestion, and strategies to assess risk from exposure to these hydrocarbons following ingestion have received much less attention. This review, therefore, focuses on concentrations of PAHs in widely consumed dietary ingredients along with gastrointestinal absorption rates in humans. Metabolism and bioavailability of PAHs in animal models and the processes, which influence the disposition of these chemicals, are discussed. The utilitarian value of structure and metabolism in predicting PAH toxicity and carcinogenesis is also emphasized. Finally, based on intake, disposition, and tumorigenesis data, the exposure risk to PAHs from diet, and contaminated soil is presented. This information is expected to provide a framework for refinements in risk assessment of PAHs from a multimedia exposure perspective.

Administration, Oral↗
PubMedDate not supplied

Chloroform: exposure estimation, hazard characterization, and exposure-response analysis.

Chloroform has been assessed as a Priority Substance under the Canadian Environmental Protection Act. The general population in Canada is exposed to chloroform principally through inhalation of indoor air, particularly during showering, and through ingestion of tap water. Data on concentrations of chloroform in various media were sufficient to serve as the basis for development of deterministic and probabilistic estimates of exposure for the general population in Canada. On the basis of data acquired principally in studies in experimental animals, chloroform causes hepatic and renal tumors in mice and renal tumors in rats. The weight of evidence indicates that chloroform is likely carcinogenic only at concentrations that induce the obligatory precursor lesions of cytotoxicity and proliferative regenerative response. Since this cytotoxicity is primarily related to rates of formation of reactive, oxidative metabolites, dose response has been characterized in the context of rates of formation of reactive metabolites in the target tissue. Results presented here are from a "hybrid" physiologically based pharmacokinetic (PBPK) animal model that was revised to permit its extension to humans. The relevant measure of exposure response, namely, the mean rate of metabolism in humans associated with a 5% increase in tumor risk (TC05), was estimated on the basis of this PBPK model and compared with tissue dose measures resulting from 24-h multimedia exposure scenarios for Canadians based on midpoint and 95th percentiles for concentrations in outdoor air, indoor air, air in the shower compartment, air in the bathroom after showering, tap water, and food. Nonneoplastic effects observed most consistently at lowest concentrations or doses following repeated exposures of rats and mice to chloroform are cytotoxicity and regenerative proliferation. As for cancer, target organs are the liver and kidney. In addition, chloroform has induced nasal lesions in rats and mice exposed by both inhalation and ingestion at lowest concentrations or doses. The mean rate of metabolism associated with a 5% increase in fatty cysts estimated on the basis of the PBPK model was compared with tissue dose measures resulting from the scenarios already described, and lowest concentrations reported to induce cellular proliferation in the nasal cavities of rats and mice were compared directly with midpoint and 95th percentile estimates of concentrations of chloroform in indoor air in Canada. The degree of confidence in the underlying database and uncertainties in estimates of exposure and in characterization of hazard and dose response are delineated.

Air Pollutants↗
PubMedDate not supplied

From a theoretical framework of human exposure and dose assessment to computational system implementation: the Modeling ENvironment for TOtal Risk Studies (MENTOR).

Georgopoulos and Lioy (1994) presented a theoretical framework for exposure analysis, incorporating multiple levels of empirical and mechanistic information while characterizing/reducing uncertainties. The present review summarizes efforts towards implementing that framework, through the development of a mechanistic source-to-dose Modeling ENvironment for TOtal Risks studies (MENTOR), a computational toolbox that provides various modeling and data analysis tools to facilitate assessment of cumulative and aggregate (multipathway) exposures to contaminant mixtures. MENTOR adopts a "Person Oriented Modeling" (POM) approach that can be applied to either specific individuals or to populations/subpopulations of interest; the latter is accomplished by defining samples of "virtual" individuals that statistically reproduce the physiological, demographic, etc., attributes of the populations studied. MENTOR implementations currently incorporate and expand USEPA's SHEDS (Stochastic Human Exposure and Dose Simulation) approach and consider multiple exposure routes (inhalation, food, drinking water intake; non-dietary ingestion; dermal absorption). Typically, simulations involve: (1) characterizing background levels of contaminants by combining model predictions and measurement studies; (2) characterizing multimedia levels and temporal profiles of contaminants in various residential and occupational microenvironments; (3) selecting sample populations that statistically reproduce essential demographics (age, gender, race, occupation, education) of relevant population units (e.g., census tracts); (4) developing activity event sequences for each member of the sample by matching attributes to entries of USEPA's Consolidated Human Activity Database (CHAD); (5) calculating intake rates for the sample population members, reflecting physiological attributes and activities pursued; (6) combining intake rates from multiple routes to assess exposures; (7) estimating target tissue doses with physiologically based dosimetry/toxicokinetic modeling.

Complex Mixtures↗
PubMed2004

Problem-based learning in public health instruction: a pilot study of an online simulation as a problem-based learning approach.

UNLABELLED: Although increasingly used as a modality in medical education, Problem-Based Learning (PBL) remains somewhat overlooked in the training of public health students (Pham & Blumberg, 2000). This project involved a pilot test of a web-based community simulation as a PBL platform in an undergraduate health behavior course. PURPOSE: To develop and pilot test a web-based computer simulation as an implementation of problem-based learning in an undergraduate public health behavior course. METHOD: Using a web-based simulation platform, a virtual community was designed in which the effects of a mock infectious disease outbreak could be studied and various interventions could be tested. Upon completion of the semester course, 14 undergraduate public health education students completed a survey and participated in a focus group to determine issues related to the simulation. Research focused on whether the simulation was perceived as motivating and which aspects were found to be confusing, ineffective or unrealistic. FINDINGS: Results of the study suggested that a PBL experience based on a community simulation may be effective in providing a motivating and interesting PBL tool for instructing undergraduate public health students. A majority of students agreed that the experience was more motivating and interesting than a more traditional assignment. Design recommendations include an emphasis on incorporating a rich multimedia background, realistic communication and project management tools and the capability for students to submit formatted documents. Further study of attitudinal differences and attainment of learning objectives is recommended between students participating in the simulation experience and those engaging in a traditional assignment.

Adult↗
PubMed2002

Future languages and technologies for advanced medical applications in Internet.

We are living at one of the most exciting moments in the history of healthcare. Technological developments that are beginning to be experienced will, without doubt, produce extraordinary changes in the concept of medicine. This article considers the medical impact of new languages and technologies in wireless Internet, broadband/high speed Internet and virtual reality Internet applications; and analyses their implications for the relationship between patients and physicians in the 21st century. The progressive increase in the speed of transmission of data on the Internet will allow an audiovisual explosion, which will greatly benefit health professionals. Multimedia is extremely important in medicine and, therefore, the Internet will be promoted as an indispensable tool in continuing medical education, telemedicine and healthcare management. The development of wireless devices could be the final piece in this complicated jigsaw puzzle, establishing a bond between the doctor, the patient, the electronic medical record and our daily needs.

Journal Article↗
PubMed2005

Surgical education and Internet-based simulation: The World Virtual University.

The new means and modalities of communication and information technologies have significantly revolutionized access to surgical education. The introduction of the Internet information highway into mainstream clinical practice as an information sharing medium offers a wide range of opportunities to healthcare professionals. High-speed Internet broadcasting allows the display of high-quality full-screen videos. Access to surgical procedures through the Internet already plays a major role in continuing medical education nowadays and will undoubtedly be gaining grounds in the future. WebSurg.com, the World Virtual University, a web-based surgical university, is dedicated to minimally invasive laparoscopic surgery. Using brand-new multimedia data, the electronic university provides thorough descriptions of over 150 procedures in minimal access surgery and 265 videos of surgical interventions. Such a teaching tool recreates all the prerequisites and requirements of a traditional School of Medicine, incorporating the manifold standpoints of world-renowned experts about specific topics and hands-on hints in various surgical specialities. Following the evolution of technologies, recent advances have made it possible to display items of Websurg.com on handheld devices (personal data/digital assistance also known as PDAs, Pocket PCs, and smart phones). Integrating all these elements into a unique World Virtual University, Websurg.com epitomizes the concept of a unified academic center providing teaching and tutorials administered by international experts. The Internet assuredly contributes to the worldwide diffusion of scientific information in an easy and user-friendly way.

Journal Article↗
PubMed2003

Evaluation of an Internet-based smoking cessation program: lessons learned from a pilot study.

The potential contribution of the Internet to smoking cessation seems huge, given that a majority of Americans now have both computers and telephones. Despite the proliferation of Web sites offering smoking cessation support, there is little empirical evidence regarding the efficacy of Internet-delivered cessation programs. We developed a cessation Web site and conducted a short-term evaluation of it, examining recruitment approaches, Web site use patterns, alternative retention incentives and re-contact modes, satisfaction, and cessation rate. The intervention included modules on social support and cognitive-behavioral coping skills configured to take advantage of the interactive and multimedia capabilities of the Internet. Cessation and satisfaction data were obtained from a subsample of 370 subjects followed for 3 months. The program was rated as easy to use, and the social support group component was used most frequently. The cessation rate (abstinence for the previous 7 days) at 3 months was 18%, with nonrespondents (n=161) considered smokers. Among a variety of traditional and Internet-based recruitment strategies, the most successful made use of Internet user groups and search engines. Methodological and procedural issues posed in conducting research on the Internet are discussed.

Adaptation, Psychological↗
PubMedDate not supplied

A semantic-based kernel for advanced health information systems.

This paper reports on the design and development of an infrastructure allowing one to share and exchange multimedia data in the context of a health network. A single technology exploiting a semantic model of the hospital universe provides users with information and data of diverse origins, generated by the various actors or departments of the health organization. Functions provided include act management and patient record management governed by domain semantics. The functionality has been validated through laboratory experiments against the requirements of protocol directed care and health networks. The functionality is integrated into a clinician workstation exploited in the Internet/Intranet environment thanks to a commercial browser. These results have been obtained with the support of several projects in the frame of the Health-Care Telematics Applications Programme of the European Community and of the Eurêka Programme.

Artificial Intelligence↗
PubMed2003

Evaluation methodology for a medical e-education patient-oriented information system.

This paper describes an evaluation methodology designed for the IMSA (Interactive Multimedia System for Auto-medication) system. IMSA stands in the multidisciplinary field of medical informatics and aims at providing a health care Internet tool for the general public. As far as a medical information system is patient-oriented, issues in understanding content and of human - computer interface usability are key factors to achieve success. The team developing IMSA concentrated part of its work on designing an evaluation methodology to ensure that the system is user-friendly and responds in a way that can be easily understood by the general public. This methodology is built on a three-tier architecture with the user, the evaluator and a set of medical case descriptions. The testing protocol is based on a user trying to run scenarios related to mild clinical signs on the IMSA prototype under the passive presence of an evaluator.

Evaluation Studies as Topic↗
PubMed2003

Computer assisted learning in medicine: a long-term evaluation of the 'Practical Training Programme Dermatology 2000'.

In recent years, numerous computer assisted learning (CAL) programmes based on new teaching methods, as for example the principles of cognitive apprenticeship and problem based learning, have euphorically been developed for various medical fields. However, many of these programmes failed due to either low acceptance, economic inefficiency, or, most seriously, problems with the implementation and evaluation in medical curricula. In 1999, the practical training course 'Dermatology 2000', an interactive multimedia programme for dermatological education, was developed and completely integrated into the regular dermatological curriculum of five German medical schools. The formative evaluation of an implemented relational database revealed contemporary information about the programme's quantity of use. So far, 3050 students have participated in 6557 lessons. The evaluation of two online questionnaires showed a high learner acceptance regarding the programme's instructional design, ergonomics, and didactical presentation and, after completion of Dermatology 2000, an increased interest in medical education software. A comparison of the objective learning outcome illustrated that Dermatology 2000 students (n = 31) not only outperformed non-participants (n = 7) but also showed a (10%) lower rate of errors in a conventional knowledge test. Additionally, single-case studies demonstrated the increased ability of participating students to apply the acquired knowledge to diagnostic problems. We conclude that the implementation of CAL in present medical curricula can contribute to reformations of medical education. The instructional design of Dermatology 2000 is well accepted and suitable to provide both theoretic biomedical knowledge and clinical skills.

Computer-Assisted Instruction↗
PubMed2002

Increasing public understanding of transgenic crops through the World Wide Web.

Transgenic crops among the most controversial "science and society" issues of recent years. Because of the complex techniques involved in creating these crops and the polarized debate over their risks and beliefs, a critical need has arisen for accessible and balanced information on this technology. World Wide Web sites offer several advantages for disseminating information on a fast-changing technical topic, including their global accessibility; and their ability to update information frequently, incorporate multimedia formats, and link to networks of other sites. An alliance between two complementary web sites at Colorado State University and the University of Nebraska-Lincoln takes advantage of the web environment to help fill the need for public information on crop genetic engineering. This article describes the objectives and features of each site. Viewership data and other feedback have shown these web sites to be effective means of reaching public audiences on a complex scientific topic.

Food↗
PubMed1997

Synchronous recording and review of oesophageal manometry and video fluoroscopy using a portable manometry recorder and PC with integrated digital video acquisition.

We present the technical details of a new system for the synchronous recording and review of a combined oesophageal manometry and video fluoroscopic barium swallow examination. The system developed uses a portable manometry recorder and personal computer (PC) with an integrated digital video acquisition system. These are controlled using software to enable the real time capture of digital video and manometric data throughout the combined examination. The recorded pressure waveforms can then be synchronously displayed on a screen with the recorded digital video of the fluoroscopic barium swallow. This new tool enables both comparative measurement and detailed analysis of the relationship between visualized bolus transport and pressure measurements. It provides for a deeper understanding and improved clinical assessment of complex motility disorders over those obtained when these two modalities are applied separately. The system is easily incorporated into a clinical radiology suite and it is both user and patient friendly. It uses readily available computer hardware together with multimedia software and is a comparatively economical addition to the radiology suite with the manometry analysis available fulfilling the criteria laid down by the Clinical Associates Group of the British Society of Gastroenterology.

Esophageal Motility Disorders↗
PubMed2001

A comprehensive information resource on traditional, complementary, and alternative medicine: toward an international collaboration.

OBJECTIVES: A prototype for a comprehensive information resource for traditional complementary and alternative medicine (TCAM) has been developed to fill the considerable needs of a broad audience for worldwide access to TCAM information. The proposed resource is to be a comprehensive, vocabulary-controlled, integrated, standardized, multimedia information resource for TCAM. It will facilitate international cooperation, promote synergistic development of individual resources, promote dissemination of TCAM knowledge, and map the interrelationships among the TCAM traditions. METHODS: We organized two workshops for representatives of international databases that contain significant information on various aspects of alternative medicine. For the first workshop, we prepared and demonstrated a prototype named Complementary and Alternative Medicine Digital Library (CAMed) to illustrate the anticipated structure, content, and functionality of the comprehensive resource. We then constructed a second prototype to demonstrate the possibilities of searching across the collaborating databases and presented it to the representatives at the second workshop. OUTCOMES: Representatives of nine international databases attended the two workshops, in Bangalore, India (1998), and in Seoul, Korea (1999). We presented the prototypes at the workshops. Prototype I uses a Web interface, and supports browsing and searching from a variety of access points. Prototype II demonstrates a functional system that provides simultaneous access to selected represented databases by searching thesauri of these databases through our system. The group formalized itself as the International Collaboration for Information on Complementary and Traditional Medicine (IC2TM) with a goal of fully realizing the potential of the project.

Complementary Therapies↗
PubMed2001

Observations from the CDC: CDC's Screen for Life: a National Colorectal Cancer Action Campaign.

Colorectal cancer is the second leading cause of cancer-related deaths in the United States. Despite the availability of several different screening tests for colorectal cancer, screening rates remain low. To raise awareness about colorectal cancer and encourage men and women aged 50 and older to speak with their physicians about being screened for colorectal cancer, the Centers for Disease Control and Prevention and the Health Care Financing Administration launched Screen for Life: A National Colorectal Cancer Action Campaign in 1999. The purpose of this paper is to outline the development of this multiyear, multimedia campaign, from conducting formative research to developing campaign messages and materials. Limited process evaluation results are presented.

Centers for Disease Control and Prevention, U.S.↗
PubMed2000

System of telemedicine services designed for family doctors' practices.

The main goal of the most European telemedicine programs is to increase access to emergency and primary care; however, telemedicine presents both profound opportunities and challenges to general practice/family medicine. The aim of this project is to develop and demonstrate a regional primary care teleconsulting system in Poland linking an academic family medicine center and 10 family doctors' practices (both urban and rural) within a range of 100-200 km, serving a local population of 25,000 individuals. It is designed to support real-time consultations among health care providers via a computer network, provide secure access to multimedia patient records, and facilitate an innovative home monitoring and remote care from doctors to their patients. The entire process (planned for 3 years) includes: selecting the best technology (i.e., teletransmission system, communication protocols, etc.) and equipment; preparing the assumptions and conditions for formats and transmission rates; analysis of the existing techniques of compression and preparing own specific solution; finding an optimal infrastructure (i.e., equipment and communication configuration); implementing the system; evaluation of the medical, economic, organizational, and sociological aspects of the system (i.e., accessibility to primary health care, cost feasibility and cost-effectiveness of telemedicine services, quality of care assessment, etc.). The project offers the potential to improve: access to high-quality primary health care; the patient-physician bond and the attending physician's level of confidence; education of family doctors; use of expensive resources; and a convenient mode of delivering medical services to the patient.

Academic Medical Centers↗
PubMed2004

A shockwave approach for web-based clinical motion analysis.

Advances in Internet connectivity and personal multimedia computing have created opportunities for integrating simple motion analysis into clinical practice. The Macromedia Shockwave environment provides tools for creating media-rich software that runs within a Web browser. For this project, clinical motion analysis software was created using Shockwave that can load digital video clips of a client's motion, step/shuttle/play through the clip, superimpose a grid over the video image, measure relative joint angles, scale to a linear factor, measure distances, and measure average velocities. After installing the Shockwave and Quicktime video plug-ins, the Motion Analysis Tools-Shockwave program runs directly from a Web page hyperlink. Program testing involved comparing angle measurements, linear distances, stride length, and walking speed among six video clips. The first three clips were of a transtibial prosthesis being carried through the field of view (640 x 480, 320 x 240, 320 x 240 enlarged to 640 x 480). The second set of three clips was of a metal square carried through the field of view. Average root mean square errors were 2.0 degrees for angle measures and 1.2 cm for length measures. Stride length standard deviation was 4.6 cm (mean length = 212.1 cm). Average walking speed standard deviation was 0.015 m/s (mean speed = 1.15 m/s). The test results were consistent with video motion analysis results and within an acceptable range for clinical design-making. This Web-based motion analysis approach provides a useful tool for ubiquitous, quantitative, clinical gait analysis.

Decision Support Techniques↗
PubMed1996

Opportunities on the Internet for child and adolescent psychopharmacologists: net access and mailing lists.

The Internet, a system linking computers around the world, provides clinical and research psychopharmacologists with a convenient and efficient way to exchange information and offers a growing number of services to facilitate patient care. These opportunities are not theoretical, not in the future, and not for a select few. Many patients are already benefitting from practitioners who have sought guidance for their clinical work on the Internet. This article describes, for the novice user, how to begin the Internet journey. It also discusses psychopharmacology-related mailing lists, including a site that specializes in child and adolescent psychopharmacology. Subsequent articles will (1) show how to use Medlines to conduct literature searches and retrieve abstracts and articles from the computer screen, (2) describe ways to enter and traverse the World Wide Web (the "multimedia" portion of Internet), and (3) survey the use of "Web browsers" to find specialized psychopharmacology resources and databases, electronic journals, pertinent bulletin boards, and support services for patients and families-all with an emphasis on direct benefits to the practicing psychopharmacologist.

Computer Communication Networks↗
PubMed2004

Adaptive user displays for intelligent tutoring software.

Intelligent tutoring software (ITS) holds great promise for K-12 instruction. Yet it is difficult to obtain rich information about users that can be used in realistic educational delivery settings--public school classrooms--in which eye tracking and other user sensing technologies are not suitable. We are pursuing three "cheap and cheerful" strategies to meet this challenge in the context of an ITS for high school math instruction. First, we use detailed representations of student cognitive skills, including tasks to assess individual users' proficiency with abstract reasoning, proficiency with simple math facts and computational skill, and spatial ability. Second, we are using data mining and machine learning algorithms to identify instructional sequences that have been effective with previous students, and to use these patterns to make decisions about current students. Third, we are integrating a simple focus-of-attention tracking system into the software, using inexpensive, web cameras. This coarse-grained information can be used to time the display of multimedia hints, explanations, and examples when the user is actually looking at the screen, and to diagnose causes of problem-solving errors. The ultimate goal is to create non-intrusive software that can adapt the display of instructional information in real time to the user's cognitive strengths, motivation, and attention.

Algorithms↗