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A novel system for collecting longitudinal self-reported dietary consumption information: the internet data logger (iDL).

As diet has been considered as the major exposure pathway for toxic chemicals, such as heavy metals and pesticides, we have developed a web-based questionnaire system, the internet data logger (iDL), in order to facilitate the collection of detailed self-recording of standardized daily dietary consumption. An iDL prototype optimized for hand-held devices was tested in the on-going Children's Pesticide Exposure Study (CPES) in Atlanta, GA in which 15 consecutive days of dietary consumption information were recorded by 11 children or their parents and transmitted to a server via broadband wireless internet connection. Participants spent an average of 6.2 min in day 1 to enter a meal into iDL and approximately 4 min per meal for the remaining 14 study days. Approximately 75% of 446 total meals were entered into iDL on the date of consumption. A within-person comparison revealed that many food items recorded on paper diary were later classified as "unknown" according to iDL standards due to the lack of detailed information provided by the participants. The development of iDL represents a novel and pioneering tool, which integrates dietary data collection, transmission, and management in a real-time and automated manner. iDL provides the needed flexibility and mobility for research focused on collecting not only dietary consumption data but also other time-sensitive behavior data. This study has demonstrated that iDL can be deployed to collect long-term dietary consumption information in a population-based study, though future modifications/enhancements will undoubtedly improve its usability and application.

Child↗

A child with signs of developmental apraxia of speech with whom a palatal lift prosthesis was used to manage palatal dysfunction.

A client is described who exhibited a large number of characteristics consistent with developmental apraxia of speech (DAS). The exhibited symptoms included excessive nasal resonance and nasal emission of air due to velopharyngeal port dysfunction, for which successful management was achieved by use of a palatal lift prosthesis. The results of the client's use of the lift, in conjunction with her speech and language remedial programming, is presented.

Apraxias↗

Brain-computer communication: self-regulation of slow cortical potentials for verbal communication.

OBJECTIVE: To test a training procedure designed to enable severely paralyzed patients to communicate by means of self-regulation of slow cortical potentials. DESIGN: Application of the Thought Translation Device to evaluate the procedure in patients with late-stage amyotrophic lateral sclerosis (ALS). SETTING: Training sessions in the patients' homes. PARTICIPANTS: Two male patients with late-stage ALS. INTERVENTIONS: Patients learned voluntary control of their slow cortical potentials by means of an interface between the brain and a computer. Training was based on visual feedback of slow cortical potentials shifts and operant learning principles. The learning process was divided into small steps of increasing difficulty. MAIN OUTCOME MEASURES: Accuracy of self-control of slow cortical potentials (percentage of correct responses). Learning progress calculated as a function of training session. RESULTS: Within 3 to 8 weeks, both patients learned to self-regulate their slow cortical potentials and to use this skill to select letters or words in the Language Support Program. CONCLUSIONS: This training schedule is the first to enable severely paralyzed patients to communicate without any voluntary muscle control by using self-regulation of an electroencephalogram potential only. The protocol could be a model for training patients in other brain-computer interface techniques.

Adult↗

Design and evaluation of computerized operating procedures in nuclear power plants.

A small-scale virtual system has been developed in this study to enhance operators' understanding and operating performance. For this, a computerized graphical interface based on Dynamic Work Causality Equation (DWCE) has been designed to transform the operating procedure into a flowchart. Furthermore, the Programmable Logic Controller (PLC) was installed to connect the signboard (proposed system) with the computerized graphical interface. An experiment was conducted to verify the effect of computerized graphic interface, indicating that the computerized system significantly decreases learning time and improves operational performance.

Computer Graphics↗

The development of a theoretical framework and design tool for process usability assessment.

The purpose of usability engineering is to facilitate the deployment of new products by decreasing development costs and improving the quality of systems. This paper will discuss the development and delivery of a unique, theoretically based software tool that provides engineers and designers with easy access to the most recent advances in human-machine interface design. This research combines several theoretical views of the interaction process into a hybrid model. Based on this model, a software tool was produced that allows engineers to model the human interaction process within their design. The system then provides feedback on the interaction process through items such as: the amount of mental effort required by a user, the degree to which the system conforms to human capabilities, the expected time to complete the interaction, where potential human error may occur, as well as potential misunderstandings or points of confusion to the users. The designer may then use this information to improve the design of the system. Validation of this technique indicates that the hybrid model produces accurate predictions of usability attributes and that the technique transfers from the laboratory to the real world.

Adult↗

Cerebral organization of verbal and motor functions in left-handed and right-handed adults: effects of concurrent verbal tasks on unimanual tapping performance.

Two experiments were conducted to study the interference effects of different concurrent verbal tasks on unimanual single-finger tapping and unimanual sequential finger tapping. Experiment 1 involved 24 right-handed university students. In the dual-task conditions, right-handers showed a greater right-hand than left-hand performance reduction for single-finger tapping, and an equal right-hand and left-hand reduction for sequential tapping. Experiment 2 involved 60 left-handed university students, divided into four groups according to familial sinistrality and writing hand posture. In the dual-task conditions, left-handers showed a greater left-hand than right-hand performance reduction for single-finger tapping, and an equal left-hand and right-hand reduction for sequential finger tapping. A dichotic listening task revealed a left hemispheric dominance for auditory linguistic functioning in most of the left-handers. Familial sinistrality and hand posture, on the whole, did not influence tapping performances. However, these factors influenced the ear asymmetries on the dichotic listening task. It is speculated that, with single-finger tapping, interference only takes place beyond the point of language motor programming, that is to say, at the motor areas and the supplementary motor areas of the cortex.

Adolescent↗

A study of the usage of a decision-support system for infective endocarditis.

The objective of this study was to examine a design for a World Wide Web-based decision-support system in use by clinically active physicians. A prototype implementation of the design concerned management of infective endocarditis patient cases. The design was based on an integration of hypertext and rule-based knowledge. In the study sessions, physicians in the field of internal medicine worked on managing authentic patient cases in a laboratory setting. Data was collected from interviews with the physicians using video recordings and stimulated recall technique. The qualitative data was analysed according to the constant comparative method in order to develop a model of the physicians' usage of the system. The resulting model describes perceived contributions and criteria for usefulness of the system. The ways the physicians used the system showed that it was able to provide patient-specific support for confirming clinical decisions, for higher-level patient management, and for preparing for and initiating expert consultations. Users also stated that new medical knowledge could be gained as a side effect of using the system.

Attitude to Computers↗

XML-based visualization of design and completeness in medical databases.

PURPOSE: mdplot (medical database plot) visualizes both structure and quality of data in medical databases by means of a summary representation of design and completeness in XML format. The goal is to identify attributes suitable for evaluation and to aid in creating open data models. METHODS: A three-stage visualization approach is applied. First, an overview of all classes in a database, second a detailed view of a specific class and third an analysis of individual attributes. Missing data is identified to enable specific efforts to improve data quality prior to analysis. For each class number of patients, attributes, and records per patient are provided. A condensed bar chart for each category of attributes (categorical, numerical, text and other) visualizes available content: The abscissa corresponds to the sequence of attributes; the ordinate represents completeness per attribute. By selection of a specific class, a detailed description is provided including mean completeness in each category as well as completeness per attribute. To analyse attributes that are collected at several time points per patient, a frequency distribution of records per patient can be generated. RESULTS: The new methodology was applied to two clinical research databases consisting of 292 attributes (955 patients) and 224 attributes (610 patients), respectively, and resulted in major restructuring of the systems. A public website is provided for generation of mdplots.

Data Collection↗

Technical aspects of internet-based knowledge presentation in radiotherapy.

Three-dimensional radiotherapy planning is a complex and time-consuming optimization process which requires much experience. To simplify and to speed up the process of treatment planning as well as to exchange experience and therapeutic knowledge, the department of Medical Physics at the German Cancer Research Centre (DKFZ) in Heidelberg is developing an Internet-based 3D Radiotherapy planning and Information System (IRIS). IRIS designed internet-based client-server application, implemented using Java, CORBA and PVM. The concept of IRIS combines the functionality of an interactive tutorial with a discussion forum, teleconferencing tool and an atlas of dose distributions. Furthermore an integral knowledge-based system provides automatically generated, preoptimized treatment plans. This paper explains the technical design of the system and gives an overview of experiences gained by the technical realization of a first prototype using currently available internet technology. The prototype is currently running for testing in the intranet of DKFZ.

Artificial Intelligence↗

DTDs go XML schema--a tools perspective.

Document Type Definitions (DTDs) are widely used to describe the structure of XML documents. The Clinical Document Architecture (CDA) and the Guideline Element Model (GEM) are examples from the healthcare domain. XML schemas provide another way to describe types of XML documents. In this paper we aim to advocate XML schemas from the perspective of an ANSI standard, the XML based CDA from HL7 (ANSI/HL7 CDA R1.0-2000). It turned out that existing tools do not fully exploit the knowledge contained in DTDs and XML schemas. The result of this study is a set of tools (DTD to XML Schema translator, DTD and XML schema browser, XML editor), which can be downloaded from the official W3C site and which work with any DTD and XML schema.

Ambulatory Care Information Systems↗

Using the Web to aid biochemists and microbiologists: an example of computer-based learning using PCR as an example.

The aim of this study was two-fold: to make available to the medical community a fast, efficient tool for troubleshooting PCR problems, and to demonstrate that hypermedia allow one to approach this kind of problem in a new, more useful way. The Web provides access to an enormous amount of information in the medical area, and in particular enables troubleshooting of new techniques in the medical laboratory. Currently it is possible to find textual information but it is not always easy to find hypermedia information. In many cases authors change only the means of dissemination of a book or paper to the Web, but do not adapt the information to the features of this new medium. The prototype of our hypermedia application was developed using Director and Flash programs (Macromedia), the application was developed from a decision tree built as a result of information compiled from expert PCR users and the existing literature. It was implemented on a website using Dreamweaver (Macromedia). The usefulness and possibilities of this application have been tested with physicians, medical laboratory technicians, and health science students, and have been proven to be more effective than traditional methods, both in education processes and in helping researchers and medical laboratory technicians in their daily work. The advance and popularization of the Internet in the medical profession requires information on the Web to adapt to the advantages offered by hypermedia. This new step must be taken, and the Web must offer medical users not only a different medium of information distribution but also a new way of handling and obtaining information.

Biochemistry↗

Towards personalized Internet health information: the STEPPS architecture.

PRIMARY OBJECTIVE: STEPPS (STructured Evaluated Personalized Patient Support) proposes a strategy for integration of electronic patient records with Internet health-related content and its consequent use in personalized information retrieval for patient education. The application domain is the post-discharge support of burn patients in the Netherlands. MATERIALS AND METHODS: We developed an electronic patient record interface for structured data collection in burn care. The system's thesaurus was projected to UMLS terms and the corresponding codes were incorporated in our software. A list of topics central to burn patient education was identified and a collection of related Web pages was compiled using meta-search software (Copernic2001Pro). The HTML pages were filed into catalogues by the Collexis indexing-matching software, using the UMLS Metathesaurus as indexing vocabulary. RESULTS: The bilingual (English and Dutch) structured data interface is currently used to create a database of retrospective patient data. Each patient's profile, i.e. set of characteristics employed to personalize information retrieval, can be automatically extracted. We have assembled a collection of more than 2500 Internet pages containing relevant information for burn patients. When patient data is available, the Collexis matching engine will accept the patient's profile as input and retrieve the most relevant HTML documents available in the catalogues. DISCUSSION: We have addressed some basic issues around the technical feasibility of linking electronic patient record data to online content. Although the functionality of STEPPS is not yet optimal, it contributes to the efforts towards improved relevance of information retrieval. Electronic patient record applications in conjunction with Internet resources can give a significant boost to the availability of tailored health education material. In this context, quality assurance of online health information is an indispensable element.

Humans↗

A comparison of technologies for database-driven websites for medical education.

Static web pages may be easy to setup using text processors or user-friendly web editing software. However, some basic knowledge of the implementation (HTML) is usually needed for final editing and maintenance. As a result many static web pages are left without appropriate updating. With a database driven, dynamic approach web contents may change through user interaction, the pages are usually easier to maintain, and design elements are separated from contents. Database driven solutions (or content management systems) for larger organizations may be purchased at many different levels of complexity. For smaller systems, such as separate courses or projects, they may, however, be developed locally. The present study compares four alternative technologies for database driven web pages. Each technology offers advantages and disadvantages and many issues need to be considered when selecting platform. The present study demonstrates that database driven web pages may be effectively deployed using free Open Source software. Details may be found at www.intermed.dk/datadriven.

Computer User Training↗