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PubMed2001

U.S. environmental law statutes in coastal zone protection.

U.S. federal legislation relevant to the coastal zone and adjacent ocean was reviewed and included the Coastal Zone Management Act, Clean Water Act, Marine Protection Research and Sanctuaries Act, and Oil Pollution Act. Problems affecting these waters involve complex activities/issues related to multimedia sources of pollution and coastal land use planning. Effective pollution control requires state-local-federal interaction with a better understanding of scientific as well as social and economic issues.

Environmental Monitoring↗
PubMed2001

Does computer-assisted instruction really help to improve the learning process?

OBJECTIVES: We have developed both a computer-assisted instruction (CAI) multimedia program and a textbook on arterial blood gas interpretation with the same content as formal didactic instruction. A prospective, randomized study was designed to compare the outcomes of self-learning using the software and using the textbook. METHODS: 80 third-year medical students were randomly allocated to two groups: the CAI (n=40) and text group (n=40). A 30-item, type-K examination was administered as the pre-test. After the pre-test, the volunteers in the CAI group studied the software program, whereas those in the text group spent their time reading the textbook covering the same material. The post-test was held immediately at the end of a full day of study, and 3 weeks later, the final test was performed without prior notice. A P value of <0.05 was considered to be a statistically significant difference. RESULTS: Students in the text group seemed to fulfil their assignments and improved their scores post-test better than those in the CAI group. After 3 weeks, the final test scores of both groups demonstrated a significant decrease, but showed an insignificant difference between the two groups. CONCLUSION: Text-based learning seems to be a convenient method of education where time is limited. However, with more time available, use of software may be as good as the conventional learning method and can be an alternative tool. The computer-assisted instruction program seems to enhance the learning process.

Computer-Assisted Instruction↗
PubMedDate not supplied

A computer expert system prototype for mechanically ventilated neonates development and impact on clinical judgment and information access capability of nurses.

A computer expert system is an alternative method of training and providing real-time clinical decision support for nurses to advance their practices from a novice to a proficient level. The purpose of this study was twofold: (1) to develop a prototype of a computer expert system for mechanically ventilated neonates (ES-MVN) and (2) to assess the impact of the ES-MVN on the clinical judgment and information access capability of nurses. Five steps used in developing the prototype are described in this article. The ES-MVN is a multimedia interactive consultation-based program that contains 2 major parts: the nursing diagnosis and the knowledge base on nursing care of mechanically ventilated neonates. A rule-based (Boolean frame) was chosen for the nursing diagnosis decision model. The prototype was developed on the Web server and a combination of computer applications operated in a Microsoft Windows environment. A quasi-experimental, 1-group pretest-posttest design was used to measure the efficacy of the ES-MVN in 16 neonatal intensive care unit registered nurses. Case simulations were used to test the nurses' clinical judgment performance. The results showed a significant increase in the nurses' performance scores of diagnoses and managed care after using the ES-MVN (t[15] = 17.21, P = .0001). The nurses' scores for perceptions of their information access capability and clinical judgment ability after receiving the ES-MVN were significantly higher than before installing the ES-MVN in the neonatal intensive care unit (ts[15] = 6.91 and = 17.53, Ps = .0001, respectively). The findings suggest the usefulness of the computer expert system as an effective tool to support nurses' clinical judgment in critical care situations and to provide access to information at the practice site.

Adult↗
PubMedDate not supplied

Navigation in medical Internet image databases.

The world wide web (WWW) changes common ideas of database access. Hypertext Markup Language allows the simultaneous presentation of information from different sources such as static pages, results of queries from) databases or dynamically generated pages. 'Therefore, the metaphor of the WWW itself as a database was proposed by Mendelzon and Nlilo in 1998. Against this background the techniques of navigation within WWW-databases and the semantic types of their queries has e been analysed. Forty eight image repositories of different types and content, but all concerning medical essence, have been found by search-engines. Many different techniques are offered to enable navigation ranging from simple HTML-link-lists to complex applets. The applets in particular promise an improvement for navigation. Within the meta-information for querying, only ACR- and UMLS-encoding were found, but not standardized vocabularies like ICD10 or Terminologia Anatomica. UMLS especially shows that a well defined thesaurus can improve navigation. However, of the analysed databases only the UMLS 'metathesaurus' is currently implemented without providing additional navigation support based on the UMLS 'semantic network'. Including the information about relationships between the concepts of the metathesaurus or using the UMLS semantic network could provide a much easier navigation within a network of concepts pointing to multimedia files stored somewhere in the WWW.

Anatomy, Cross-Sectional↗
PubMed2001

HONselect: multilingual assistant search engine operated by a concept-based interface system to decentralized heterogeneous sources.

Any new user to the Internet will think that to retrieve the relevant document is an easy task especially with the wealth of sources available on this medium, but this is not the case. Even experienced users have difficulty formulating the right query for making the most of a search tool in order to efficiently obtain an accurate result. The goal of this work is to reduce the time and the energy necessary in searching and locating medical and health information. To reach this goal we have developed HONselect [1]. The aim of HONselect is not only to improve efficiency in retrieving documents but to respond to an increased need for obtaining a selection of relevant and accurate documents from a breadth of various knowledge databases including scientific bibliographical references, clinical trials, daily news, multimedia illustrations, conferences, forum, Web sites, clinical cases, and others. The authors based their approach on the knowledge representation using the National Library of Medicine's Medical Subject Headings (NLM, MeSH) vocabulary and classification [2,3]. The innovation is to propose a multilingual "one-stop searching" (one Web interface to databases currently in English, French and German) with full navigational and connectivity capabilities. The user may choose from a given selection of related terms the one that best suit his search, navigate in the term's hierarchical tree, and access directly to a selection of documents from high quality knowledge suppliers such as the MEDLINE database, the NLM's ClinicalTrials.gov server, the NewsPage's daily news, the HON's media gallery, conference listings and MedHunt's Web sites [4, 5, 6, 7, 8, 9]. HONselect, developed by HON, a non-profit organisation [10], is a free online available multilingual tool based on the MeSH thesaurus to index, select, retrieve and display accurate, up to date, high-level and quality documents.

Databases, Bibliographic↗
PubMed2001

XML transcription method for biomedical acoustic signals.

We have proposed applying MIDI technology to coding of biomedical acoustic signals such as heart sounds used in medical diagnosis for constructing medical audio databases. According to our several experiments, we could correspond encoded MIDI event data or musical notes with heart sound components used for clinical diagnosis. However, precise discrimination among abnormal heart sounds and murmurs was difficult owing to insufficiency of analysis precision in our proposed method. Then we have improved its coding precision and supported harmonic or formant analysis in order to extend our application to multimedia low bit-rate audio coding, especially representation of vocal sounds by MIDI codes. In these efforts, we can describe precisely heart-sound components with MIDI codes and segment converted MIDI codes into heart sound components; about 80% automatically in 55 cases. In this paper, we are going to describe our novel heart sound automatic XML transcription method. This XML document includes MIDI data reflecting numerical detailed information for each segmented heart sound component and can reproduce heart sound signals by a browser and MIDI sequencer plug-in.

Acoustics↗
PubMed2001

Patient empowerment via 'pushed' delivery of Personalised Healthcare educational content over the internet.

We present an Internet-based Personalised Healthcare Information (PHI) dissemination system. Information personalisation is guided by the individual's current health profile as recorded in his/her EMR. A PHI package is composed by intelligently selecting and synthesizing various topic-specific documents, each corresponding to some health parameter noted in the EMR. To ensure medical consistency, constraint satisfaction techniques are employed during the information selection phase. The resultant PHI package--covering both long-term and immediate health-maintenance requirements--can be pro-actively pushed to the individual via email, thereby ensuring the timely availability of situation-specific health maintenance information. The featured work is in line with the Malaysian Multimedia Super Corridor Telemedicine initiative and can serve as a test-bed to evaluate the effectiveness of PHI, system design and operational considerations for larger-scale deployment.

Health Status↗
PubMed2001

The Otsego-Schoharie healthy heart program: prevention of cardiovascular disease in the rural US.

OBJECTIVES: To describe a rural, hospital-based public health intervention program and to evaluate its effectiveness in cardiovascular disease (CVD) risk reduction using cross-sectional studies and a panel study. METHODS: A rural population of 158,000 located in New York state comprised the intervention population. A similar but separate population was used for reference. A multifaceted, multimedia 5-year program provided health promotion and education initiatives to increase physical activity, decrease smoking, improve nutrition, and identify hypercholesterolemia and hypertension. To evaluate the effectiveness of the intervention, surveys were conducted at baseline in 1989 (cross-sectional) and at follow-up in 1994-95 (cross-sectional and panel). For cross-sectional studies, a random sample of adults was obtained using a three-stage cluster design. Self-reported and objective risk factor measurements were obtained. Comparison of pre- to post- changes in intervention versus reference populations was done using 2 x 2 randomized block ANOVA, 2 x 2 mixed ANOVA. and extension of the McNemar test. RESULTS: Smoking prevalence declined (from 27.9% to 17.6%) in the intervention population. Significant adverse trends were observed for high-density lipoprotein cholesterol and triglycerides. Systolic blood pressure was reduced while diastolic blood pressure remained stable. Body mass index increased significantly in both populations. CONCLUSIONS: This rural. 5-year CVD community intervention program decreased smoking. The risk reduction may be attributable to tailoring of a multifaceted approach (multiple risk factors, multiple messages, and multiple population subgroups) to a target rural population. The study period was too short to identify changes in CVD morbidity and mortality.

Adult↗
PubMed2001

Impact evaluation of a folate education campaign with and without the use of a health claim.

OBJECTIVE: To measure the impact of a Kellogg/Northcott Society multimedia folate education campaign, run nationally from July 1998 to June 1999, with and without the use of health claims. METHOD: Three national telephone surveys of more than 500 Australian women aged 18-44 in July and November 1998 and May 1999. RESULTS: Awareness of the role of folate in the prevention of birth defects rose from 21% at baseline to 29% in November 1998 and 44% in May 1999. Awareness of the recommendation to take folate before pregnancy rose by 8% in the first six months of the campaign (without health claims) and by 22% in the second half (when health claims were incorporated). At the end of the campaign, the foods most commonly cited as sources of folate were leafy green vegetables (72%), breakfast cereals (70%), fruit (41%) and bread (40%). CONCLUSION: Inclusion of a specific health claim explaining the role of folate in preventing birth defects appeared to increase the impact of the folate education campaign. IMPLICATIONS: Changing food regulations to permit health claims may increase the impact of health promotion campaigns involving industry partnerships. Future folate programs should target young women (aged 18-24), those in rural areas and those on lower incomes.

Adolescent↗
PubMed1998

[Relationship between anatomic variations of nasal sinus and chronic sinusitis].

OBJECTIVE: To understand the etiology of chronic sinusitis. METHODS: Ninety-one coronal CT scans of chronic sinusitis were analysed with mutimedia software developed by the authors. Sinus CT images were scanned into multimedia computer and the subtle anatomic structures such as pneumatization of the middle turbinate, agger nasi cell, Haller's cell, septal deformity, maxillary sinus hypoplasia, abnormality of uncinate process and ethmoid bulla and so on were measured. The results were analysed by the statistical software SPSS. RESULTS: The penumatization rate of total or inferior part of middle turbinate correlated positively to the inflammation of anterior ethmoid and maxillary sinuses. Compared with patients with normal frontal sinuses, the vertical diameters of agger nasi cells of patients with frontal sinusitis were larger(11.70 +/- 5.50 mm and 8.54 +/- 3.67 mm respectively, P < 0.01). Compared with patients with normal maxillary sinuses, the Haller's cells of patients with maxillary sinusitis were larger (77.8% and 33.3%, P < 0.05) and the amount of inflammatory Haller's cells of the latter was more abundant than that of the former(91.6 +/- 17.8 mm2 and 41.6 +/- 12.6 mm2, respectively, P < 0.05). The deviation of uncinate process was one of the factors of maxillary sinusitis. The sizes of ethmoid bullae increased with the soft tissue thickening in anterior ethmoid sinus, the large ethmoid bulla may cause anterior ethmoid sinusitis. CONCLUSION: Some anatomic variations may play a role in chronic sinusitis.

Adolescent↗
PubMed2001

Enabling clinicians, researchers, and educators to build custom web-based biomedical information systems.

We describe an open-source toolkit that enables clinicians, researchers, and educators to build their own web-based biomedical information systems. The Web Interfacing Repository Manager (Wirm) is a high-level application server aimed at medical professionals, allowing them to create individually tailored systems for managing their multimedia data and knowledge. We provide an overview of the features of Wirm, explaining how they meet the requirements for supporting biomedical information management, and describe four applications that are currently being developed with Wirm: MyPACS, a teaching file authoring system for radiologists, Fathom, an experiment management system for natural language processing, the Digital Anatomist Repository, an image archiving tool for medical schools, and Ontolog, a browser for medical vocabularies.

Anatomy↗
PubMed2001

Marketing your dental practice using microsoft powerpoint.

Educating the parents of my patients about the techniques and specialized care pediatric dentists provide has always been a challenge. When I began my dental practice in 1974, the materials and audiovisual programs that were available for parental and patient education were of poor quality and often did not reflect my office philosophy. The multimedia material for pediatric dentistry was limited in scope and of little value in conveying to the parents and patients pediatric restorative procedures, causes of dental disease, caries prevention and patient management. Effective communication to the public can be divided into two areas: in-office marketing; and outside advertising. The primary focus of this discussion will be on in-house marketing of your dental practice using Microsoft PowerPoint.

Computers↗
PubMed2002

[Continuing medical education as an "event"--innovative use of satellite technology during information transfer].

While it is true that satellite technology has for some time allowed experts that are physically far apart to congregate through their telepresences in--as a rule--one auditorium, nevertheless, the expenditure of effort involved is rarely worth the attention generated by the medium. Therefore by using innovative and appropriately timed satellite technology a multimedia concept with both the character of an "event" and the lasting quality of an "experience" was developed. This concept is based among other things on the complex interconnecting of four experts in four separate halls delivering four lectures (with ensuing discussions) as well as technically speaking on a live television outside broadcast standard including professional presentation and direction. The implementation of the concept was tested and optimised in the course of two information transfer events. Besides confirming the exceptional quality and motivational benefit of the concept the participants' evaluation also underscored the importance of the professional production with its use of specific forms of presentation (such as interviews).

Education, Medical, Continuing↗
PubMedDate not supplied

[Integration of the Internet into medical education].

The Internet promises dramatic changes in the way we learn and teach, the way we interact as a society. Networked technologies introduce interactivity and multimedia into the educational process. The student of the 21st century will use his/her PC as a learning station, as a tutoring system, as an information provider and as a communication center. Therefore the passive classroom (teacher-centered teaching) will evolve into active studio learning (student-centered learning). This will be achieved by new teaching techniques and standards of quality. The role of the new generation of educators is to create exploratory learning environments that offer a wide range of views on many subject areas and encourage active lifelong learning. This will be achieved by 1) placing courseware on the web where it can be accessed by remote students and by 2) finding and reviewing teaching materials obtained from www for possible integration into the local lecture material. The paper suggests strategies for introducing medical educators to networked teaching.

Education, Medical↗
PubMed2002

[The fight over water fluoridation in Israel].

Water fluoridation in Israel was initially introduced on a municipal level in 1981. Legislation in favor of national water fluoridation was approved in 1998. Over the last year an increasing campaign against the fluoridation project has become more and more evident. The material published by the opponents to fluoridation, distributed in pamphlets, daily journals and mass media resources, illustrate as in the USA, an endless and unrestrained "duel" between opponents and supporters of fluoridation. In Israel, in contrast to the USA, referenda are unprecedented, therefore, the political "battle field" is transferred to the municipal authorities and the Knesset. The pivotal component of the Israeli opponents to fluoridation regards the public's health and safety. Unscientific publications appear regularly in the daily journals and electronic mass media with no reference of supporting studies ever mentioned. The inevitable question addressed in this article is what are the best ways of action to be taken by the supporters of fluoridation is Israel. The main and most important mode of action against this campaign is, undoubtedly, continuous persuasion. Nevertheless, the continuous daily struggle of the supporters must be in a world-wide frame and be adjusted to the different target groups of the public. An effective confrontation should include nation-wide available publications (internet, daily papers and multimedia) with special emphasis on the important subjects (e.g. evidence based care, significance of toxic doses and the value of social justice), in a format comprehensible to the public and its leaders. The American experience helps us to understand that the opposition to water fluoridation will not diminished but, on the contrary, is expected to strengthen. We must look forward with no illusions and establish ways of action and cooperation by learning from past experience and from that of our collaborators. This will serve as the basis for the ongoing frank and persuasive efforts, derived from a deep and honest belief in the justice of our way.

Attitude to Health↗
PubMedDate not supplied

Dramatic print ads raise awareness. NorthEast Medical Center's breast health campaign.

NorthEast Medical Center, a 457-bed independent hospital in Concord, N.C., found itself increasingly in competition with hospitals in neighboring Charlottesville. It changed from an emphasis on media relations and public relations to an advertising mode, beginning with a multimedia breast health campaign last October for Breast Health Month. The attention-grabbing visuals were adapted from the print ads and used as in-house posters to encourage employee participation in the breast screening program.

Adult↗
PubMed2002

A dynamic mass budget for toxaphene in North America.

A continental-scale dynamic mass budget for toxaphene in North America is presented, based on available information on physicochemical properties, usage patterns, and reported environmental concentrations and using the Berkeley-Trent North American mass balance contaminant fate model (BETR North America). The model describes contaminant fate in 24 ecological regions of North America, including advective transport between regions in the atmosphere, freshwater, and near-shore coastal water. The dynamic mass budget accounts for environmental partitioning, transport, and degradation of the estimated 534 million kg of toxaphene that were used in North America as an insecticide and piscicide between 1945 and 2000. Satisfactory agreement exists between model results and current and historically reported concentrations of toxaphene in air, water, soil, and sediments throughout North America. An estimated 15 million kg of toxaphene are believed to remain in active circulation in the North American environment in the year 2000, with the majority in soils in the southern United States and Mexico, where historic usage was highest. Approximately 70% of total toxaphene deposition from the atmosphere to the Great Lakes is attributed to sources outside the Great Lakes Basin, and an estimated total of 3.9 million kg of toxaphene have been transported to this region from other parts of the continent. The toxaphene mass budget presented here is believed to be the first reported continental-scale multimedia mass budget for any contaminant.

Agriculture↗
PubMed2002

Reconstructing source polybrominated diphenyl ether congener patterns from semipermeable membrane devices in the Fraser River, British Columbia, Canada: comparison to commercial mixtures.

Semipermeable membrane devices (SPMDs) were placed in the Fraser River near Vancouver, British Columbia, Canada, between August 6 and September 30, 1996. This location is near a large urban and industrial region (population 2,000,000) and is expected to be representative of other large, modern cities. After exposure to the ambient water column, SPMD samples were analyzed for a suite of 36 polybrominated diphenyl ether (PBDE) congeners plus all homologue groups from mono- through hexa-brominated. Observed congener patterns differed significantly from that of the commercial penta- and octa-BDE mixtures. A reconstruction approach was developed based on an aquatic transport model and utilizing published octanol-water partition coefficients, calculated SPMD uptake rates, and predicted water concentrations by using the EcoFate multimedia mass balance aquatic simulation model for the 13 major PBDE congeners. In combination, composite technical mixtures were created by combining commercial penta-BDE mixtures (Bromkal 70-SDE and Great Lakes Chemicals DE-71) with commercial octa-BDE mixtures (Bromkal 79-8DE and Great Lakes Chemicals DE-79) in their relative 2000 North American production volumes. The reconstructed SPMD patterns more closely approximated the composite technical mixtures and suggest that PBDEs in such an industrial region arise primarily from penta- and octa-BDE source mixtures.

British Columbia↗