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Integrating DXplain into a clinical information system using the World Wide Web.

The World Wide Web(WWW) offers a cross-platform environment and standard protocols that enable integration of various applications available on the Internet. The authors use the Web to facilitate interaction between their Web-based Clinical Information System and a decision-support system-DXplain, at the Massachusetts General Hospital-using local architecture and Common Gateway Interface programs. The current application translates patients laboratory test results into DXplain's terms to generate diagnostic hypotheses. Two different access methods are utilized for this model; Hypertext Transfer Protocol (HTTP) and TCP/IP function calls. While clinical aspects cannot be evaluated as yet, the model demonstrates the potential of Web-based applications for interaction and integration and how local architecture, with a controlled vocabulary server, can further facilitate such integration. This model serves to demonstrate some of the limitations of the current WWW technology and identifies issues such as control over Web resources and their utilization and liability issues as possible obstacles for further integration.

Computer Communication Networks↗

Automated grading of homework assignments and tests in introductory and intermediate statistics courses using active server pages.

Active server pages permit a software developer to customize the Web experience for users by inserting server-side script and database access into Web pages. This paper describes applications of these techniques and provides a primer on the use of these methods. Applications include a system that generates and grades individualized homework assignments and tests for statistics students. The student accesses the system as a Web page, prints out the assignment, does the assignment, and enters the answers on the Web page. The server, running on NT Server 4.0, grades the assignment, updates the grade book (on a database), and returns the answer key to the student.

Automation↗

Users' information-seeking behavior on a medical library Website.

The Central Medical Library (CMK) at the Faculty of Medicine, University of Ljubljana, Slovenia, started to build a library Website that included a guide to library services and resources in 1997. The evaluation of Website usage plays an important role in its maintenance and development. Analyzing and exploring regularities in the visitors' behavior can be used to enhance the quality and facilitate delivery of information services, identify visitors' interests, and improve the server's performance. The analysis of the CMK Website users' navigational behavior was carried out by analyzing the Web server log files. These files contained information on all user accesses to the Website and provided a great opportunity to learn more about the behavior of visitors to the Website. The majority of the available tools for Web log file analysis provide a predefined set of reports showing the access count and the transferred bytes grouped along several dimensions. In addition to the reports mentioned above, the authors wanted to be able to perform interactive exploration and ad hoc analysis and discover trends in a user-friendly way. Because of that, we developed our own solution for exploring and analyzing the Web logs based on data warehousing and online analytical processing technologies. The analytical solution we developed proved successful, so it may find further application in the field of Web log file analysis. We will apply the findings of the analysis to restructuring the CMK Website.

Consumer Behavior↗

Past, present, and future of computer-tailored nutrition education.

Computer-tailored nutrition education is an innovative and promising tool to motivate people to make healthy dietary changes. It provides respondents with individualized feedback about their dietary behaviors, motivations, attitudes, norms, and skills and mimics the process of "person-to-person" dietary counseling. The available evidence indicates that computer-tailored nutrition education is more effective in motivating people to make dietary changes than general nutrition information, especially for reduction of dietary fat. The effectiveness of computer tailoring has been attributed to the fact that individualized feedback commands greater attention, is processed more intensively, contains less redundant information, and is appreciated better than more general intervention materials. Interactive technology (eg, the Internet, the World Wide Web) offers good opportunities for the application of computer-tailored nutrition education, and a first controlled study of Web-based computer tailoring shows promising results. However, using the Web for interactive personalized nutrition education also presents new challenges.

Computer-Assisted Instruction↗

Blind persons navigate in virtual reality (VR); hearing and feeling communicates "reality".

Can Virtual Reality (VR) developments in audio navigation for blind persons support therapies for all? Working with Crystal River Engineering we are developing navigable Virtual Reality worlds for blind users, using spatialized audio [1], [2]. All persons, however, use specialized channels, such as: visual, aural, and kinetic learning senses. Predominantly visual VR worlds and health informatics models from World Wide Webs, may be downloaded, tailored, augmented, and delivered to each of these learning senses using VR. We are also testing a proof of concept system with Boston Dynamics which downloads 3-dimensional, satellite-derived map models from the World Wide Web, and makes them navigable by "feeling" the terrain using haptic (tactual or force feedback to your hand) robotic interfaces. Ultimately, these multi-sensory VR access methods: sight, localization by audio, and "feeling" of data sets could open up the World Wide Web to individuals with sight impairments. This could also, however, benefit government, businesses, universities, and (elementary) education. It could contribute more powerful communications, education, and medical simulation applications on the World Wide Web. This work is part of government technology transfer to telemedicine, (elementary) education, disabilities access to the Web, and new Internet access and productivity efforts under Vice President Gore's National Performance Review.

Adult↗

Capillary electrophoresis - mass spectrometry: survey on developments and applications 2003-2004.

The major developments and applications related to CE-MS over the last two years (2003-2004) and most of the reviews and applications found in the ISI Web of Science and publisher data bases are presented in a tabulated way. This article complements our previous review "Capillary electrophoresis - mass spectrometry: 15 years of developments and applications", Electrophoresis, 2003, 24, 3837-3867 for the last two years 2003-2004. All cited articles were analyzed in a way to illustrate (i) in which journals CE-MS-related papers were mostly found over the last decades and (ii) which commercial CE-, MS-instrumentations or CE-MS combinations were mostly used in the European, Asian, and American continent. Additionally, like it was done in our last review, the reader will rapidly find applications classified as forensics, environment, bioanalytics, pharmaceutics, and metabolites.

Electrophoresis, Capillary↗

Evaluation of hearing handicaps and presbyacusis using World Wide Web-based calculators.

This article is a clinical report on the applicability of computer software in determining hearing handicaps and presbyacusis. The software is now World Wide Web based and can be implemented in a clinical setting by using JavaScript calculators housed on the World Wide Web at . Added features consist of calculating the maximum recommended allowable noise exposure using the National Institute of Occupational Safety and Health 1997 frequencies in handicap determination and the projection of future audiometric thresholds using the International Standards Organization 1999 compression factor. A review of the literature and the theoretical and clinical applications of these new features are discussed. A guide in the selection of Web-based development software is also presented in the hope of encouraging other researchers to develop Web-based versions of their software applications.

Audiometry↗

Dynamic XML-based exchange of relational data: application to the Human Brain Project.

This paper discusses an approach to exporting relational data in XML format for data exchange over the web. We describe the first real-world application of SilkRoute, a middleware program that dynamically converts existing relational data to a user-defined XML DTD. The application, called XBrain, wraps SilkRoute in a Java Server Pages framework, thus permitting a web-based XQuery interface to a legacy relational database. The application is demonstrated as a query interface to the University of Washington Brain Project's Language Map Experiment Management System, which is used to manage data about language organization in the brain.

Brain↗

Evaluation of Web-based computer-aided instruction in a basic science course.

PURPOSE: To demonstrate the applicability of server statistics, in combination with user surveys, to evaluate utilization of Web-based computer-aided instruction (CAI) in the undergraduate medical curriculum. METHOD: Individual user surveys with students' names provided information about computer literacy prior to the course and use of CAI during the course. Utilization of specific web-based CAI developed for the course was recorded by server software and the daily logs correlated with course content. Regression analyses were used to measure correlation of server access logs of individual students versus information from user surveys and performances in the course based on in-course examinations. RESULTS: There was no correlation between computer literacy of students at matriculation and their subsequent levels of use of CAI in the curriculum. Utilization of CAI developed for specific course objectives coincided closely with course content, which is an indication of the effectiveness of the applications in achieving their curricular objectives. In contrast, student use of tutorials coincided most closely with in-course examinations. Students' responses to surveys were generally substantiated by server statistics, but discrepancies were sufficiently large (10% to 20%) to call into question the validity of these surveys. Significant differences in CAI utilization correlated with the performances of students in the course. CONCLUSIONS: This study demonstrates an important advantage of web-based applications to collect and evaluate CAI utilization efficiently and objectively at both the level of the class and the level of the individual student.

Computer Literacy↗

Participation in the International Classification for Nursing Practice (ICNP) programme.

The International Council of Nurses (ICN) is a federation of 129 national nurses associations. The International Classification for Nursing Practice (ICNP) is a programme of the ICN. The purpose of this paper is to describe the development and maintenance processes of the ICNP Programme that are used to increase participation. These include processes by which the ICNP was and continues to be developed, tested, distributed and implemented worldwide, with emphasis on the current version, ICNP Version 1.0. The ICNP is a unified nursing language that facilitates cross-mapping among local terms and existing terminologies. ICNP conforms to current terminology standards and criteria, for example, ISO standards and HL7. The ICNP Alpha and Beta Versions documented the progress of concept validation and classification of nursing phenomena and interventions. The ICNP Beta 2 Version was a combinatorial terminology organized in two multi-axial structures representing nursing phenomena and nursing actions. The ICNP Version 1.0, launched in 2005, changed the relatively straight-forward multi-axial structure into a compositional terminology through the application of description logics using Web Ontology Language (OWL) within Protégé, an ontology development environment. ICNP Version 1.0 is also represented in a multiaxial model (7-Axis) for nurses to compose nursing diagnosis, intervention and outcome statements. Language translations and clinical information systems applications are required to make the ICNP Version 1.0 available to nurses at the point of healthcare delivery. ICNP data collected in healthcare environments provide standardized terminology for nursing that allows comparison of nursing practice across health care settings, specialties and countries; facilitate data-based clinical and management decision making; and contribute to the development of guidelines and standards for best practices and optimal outcomes for patients, families and communities.

Nursing Informatics↗

A web-based tutorial to enhance student learning of activity analysis.

BACKGROUND: This paper describes the impact on learning of a web-based tutorial for the application of activity analysis, with occupational therapy students, at McGill University, Montreal, Quebec. This tutorial offers unique, interactive instructional strategies allowing for self-directed higher cognitive and reflective learning, which has not been possible, to date, in current web-based technology. SCOPE: Through repeated practice, students collaboratively (in dyads) apply concepts of activity analysis, and receive immediate feedback by comparing their answers to a standard. METHODS AND RESULTS: Comparisons of performance outcomes on summative exams before and after implementation of the tutorial are made, suggesting a decrease in variance scores indicating fewer students are falling below the class average. These results are attributed to opportunities to practice activity analysis and to receive immediate feedback. PRACTICE IMPLICATIONS: Web-based instruction can impact student learning if the instructional strategies ensure coherence with all other instructional components, match the learning outcomes, facilitate self-directed and collaborative learning, and allow for practice and feedback.

Canada↗

Open courseware and shared knowledge in higher education.

Most college and university campuses in the United States and much of the developed world today maintain one, two, or several learning management systems (LMSs), which are courseware products that provide students and faculty with Web-based tools to manage course-related applications. Since the mid-1990s, two predominant models of Web courseware management systems have emerged: commercial and noncommercial. Some of the commercial products available today were created in academia as noncommercial but have since become commercially encumbered. Other products remain noncommercial but are struggling to survive in a world of fierce commercial competition. This article argues for an ethics of pedagogy in higher education that would be based on the guiding assumptions of the non-proprietary, peer-to-peer, open-source software movement.

Internet↗

USAGE: a web-based approach towards the analysis of SAGE data. Serial Analysis of Gene Expression.

MOTIVATION: SAGE enables the determination of genome-wide mRNA expression profiles. A comprehensive analysis of SAGE data requires software, which integrates (statistical) data analysis methods with a database system. Furthermore, to facilitate data sharing between users, the application should reside on a central server and be accessed via the internet. Since such an application was not available we developed the USAGE package. RESULTS: USAGE is a web-based application that comprises an integrated set of tools, which offers many functions for analysing and comparing SAGE data. Additionally, USAGE includes a statistical method for the planning of new SAGE experiments. USAGE is available in a multi-user environment giving users the option of sharing data. USAGE is interfaced to a relational database to store data and analysis results. The USAGE query editor allows the composition of queries for searching this database. Several database functions have been included which enable the selection and combination of data. USAGE provides the biologist increased functionality and flexibility for analysing SAGE data. AVAILABILITY: USAGE is freely accessible for academic institutions at http://www.cmbi.kun.nl/usage/. The source code of USAGE is freely available for academic institutions on request from the first author.

Databases, Factual↗

Web servicing the biological office.

UNLABELLED: Biologists routinely use Microsoft Office applications for standard analysis tasks. Despite ubiquitous internet resources, information needed for everyday work is often not directly and seamlessly available. Here we describe a very simple and easily extendable mechanism using Web Services to enrich standard MS Office applications with internet resources. We demonstrate its capabilities by providing a Web-based thesaurus for biological objects, which maps names to database identifiers and vice versa via an appropriate synonym list. The client application ProTag makes these features available in MS Office applications using Smart Tags and Add-Ins. AVAILABILITY: http://services.bio.ifi.lmu.de/prothesaurus/

Computational Biology↗

Pharmacologic activity of bepafant (WEB 2170), a new and selective hetrazepinoic antagonist of platelet activating factor.

The hetrazepine WEB 2170 (international nonproprietary name: bepafant), a thieno-triazolodiazepine that is structurally related to the recently described platelet activating factor (PAF) antagonist WEB 2086, is a potent and selective PAF antagonist both in vitro and in vivo. WEB 2170 inhibited PAF-induced human platelet and neutrophil aggregation in vitro (IC50 values: 0.3 and 0.83 microM, respectively) but had little or no inhibitory action against aggregation induced by other agonists. The potency in vitro was comparable to that described recently for WEB 2086 (Casals-Stenzel, J., Muacevic, G. and Weber, K.H.: J. Pharmacol. Exp. Ther. 241: 974-981, 1987). When guinea pigs were given i.v. infusions of PAF at 30 ng x kg-1 x min-1, oral (0.005-0.5 mg/kg) as well as intravenous (0.005-0.05 mg/kg) treatment with WEB 2170 abrogated the intrathoracic accumulation of 111In-labeled platelets, the bronchoconstriction and the hypotension as well as the finally occurring death in a dose-dependent fashion. Oral (0.01-1 mg/kg) and intravenous (0.005-0.1 mg/kg) WEB 2170 shared with the beta 2 agonist fenoterol and the steroid dexamethasone the property of protecting elderly NMRI mice from the lethal effect of PAF. In anesthetized rats, intravenous (0.001-0.1 mg/kg) and oral (0.05-1 mg/kg) WEB 2170 inhibited PAF-induced hypotension in a dose-related manner. Coadministration of WEB 2170 inhibited PAF-induced increase of vascular permeability in rat skin very effectively. The half-time of duration of action in the rat was estimated to be about 5 to 6 h after oral administration and about 1.1 to 2.3 h after intravenous application. In conclusion, the hetrazepine WEB 2170 is a strong and selective PAF antagonist, which is in vitro more or less equipotent to WEB 2086. In contrast, in vivo oral WEB 2170 is--depending on the species and considered parameter--about 5 to 40 times more potent against exogenous PAF-induced alterations than the recently described hetrazepine WEB 2086. Particularly in mice and rats, oral WEB 2170 is by far superior to WEB 2086.

Administration, Oral↗

Optimization of a research web environment for academic internal medicine faculty.

Usability evaluations are a powerful tool that can assist developers in their efforts to optimize the quality of their web environment. This underutilized, experimental method can serve to move applications toward true user-centered design. This article describes the usability methodology and illustrates its importance and application by describing a usability study undertaken at the Mayo Clinic for the purpose of improving an academic research web environment. Academic institutions struggling in an era of declining reimbursements are finding it difficult to maintain academic enterprises on the back of clinical revenues. This may result in declining amounts of time that clinical investigators have to spend in non-patient-related activities. For this reason, we have undertaken to design a web environment, which can minimize the time that a clinician-investigator needs to spend to accomplish academic instrumental activities of daily living. Usability evaluation is a powerful application of human factors engineering, which can improve the utility of web-based Informatics applications.

Computer Simulation↗

Evaluation of physical activity web sites for use of behavior change theories.

Physical activity (PA) Web sites were assessed for their use of behavior change theories, including constructs of the health belief model, Transtheoretical Model, social cognitive theory, and the theory of reasoned action and planned behavior. An evaluation template for assessing PA Web sites was developed, and content validity and interrater reliability were demonstrated. Two independent raters evaluated 24 PA Web sites. Web sites varied widely in application of theory-based constructs, ranging from 5 to 48 on a 100-point scale. The most common intervention strategies were general information, social support, and realistic goal areas. Coverage of theory-based strategies was low, varying from 26% for social cognitive theory to 39% for health belief model. Overall, PA Web sites provided little assessment, feedback, or individually tailored assistance for users. They were unable to substantially tailor the on-line experience for users at different stages of change or different demographic characteristics.

Behavior Therapy↗