Wasm-iCARE: a portable and privacy-preserving web module to build, validate, and apply absolute risk models

Objective

Absolute risk models estimate an individual's future disease risk over a specified time interval. Applications utilizing server-side risk tooling, such as the R-based iCARE (R-iCARE), to build, validate, and apply absolute risk models, face serious limitations in portability and privacy due to their need for circulating user data in remote servers for operation. Our objective was to overcome these limitations.

Materials and Methods

We refactored R-iCARE into a Python package (Py-iCARE) then compiled it to WebAssembly (Wasm-iCARE): a portable web module, which operates entirely within the privacy of the user's device.

Results

We showcase the portability and privacy of Wasm-iCARE through two applications: for researchers to statistically validate risk models, and to deliver them to end-users. Both applications run entirely on the client-side, requiring no downloads or installations, and keeps user data on-device during risk calculation.

Conclusions

Wasm-iCARE fosters accessible and privacy-preserving risk tools, accelerating their validation and delivery.

Republication of "The Utilization of Internet Resources by Foot and Ankle Patients"

Background

It is critical for patients seeking foot and ankle care to have access to quality online resources, as the treatment of their conditions may involve the use of a variety of diagnostic and therapeutic modalities with which they are unfamiliar. This study was performed to enhance our understanding of if and why patients use Internet-based educational materials, to identify trends in utilization, and to delineate the patient-perceived attributes of quality resources.

Methods

Questionnaires were distributed to 150 adult foot and ankle patients. The questionnaire consisted of demographic and Internet utilization questions. Statistical analysis was performed to determine the frequency of responses for each question and the relationship between demographics and Internet usage.

Results

Younger patients were more likely to use the Internet (P= .006). However, there were no other significant differences in demographic attributes between patients who did (76%) and did not (24%) utilize the Internet (P <.05). Of the participants who didn't search the Internet about their condition, the most commonly cited reason was they preferred to receive information directly from their physician (47%). Among Internet users, most found the quality of resources to be good or very good (75%). However, many patients were unsure of the specific websites they accessed (66%) and if materials were AOFAS sponsored (18%). When asked about the attributes of a reliable website, patients felt that physician and/or medical society endorsement were most important (52% and 46%, respectively).

Conclusion

Although physician and medical society endorsement positively shape patients' opinions of online education materials, patients often struggle in remembering the site they visited and if it was sponsored by a certain society. Despite this, patients are generally satisfied with online foot and ankle education resources. Future works must assess whether patient and physician perceptions of quality Internet resources are correlated.

Level of Evidence

Level IV, case series.

Mobile Health Self-management Support for Spinal Cord Injury: Systematic Literature Review

BACKGROUND

Self-management plays a critical role in maintaining and improving the health of persons with spinal cord injury (SCI). Despite their potential, existing mobile health (mHealth) self-management support (SMS) tools for SCI have not been comprehensively described in terms of their characteristics and approaches. It is important to have an overview of these tools to know how best to select, further develop, and improve them.

OBJECTIVE

The objective of this systematic literature review was to identify mHealth SMS tools for SCI and summarize their characteristics and approaches to offering SMS.

METHODS

A systematic review of the literature published between January 2010 and March 2022 was conducted across 8 bibliographic databases. The data synthesis was guided by the self-management task taxonomy by Corbin and Strauss, the self-management skill taxonomy by Lorig and Holman, and the Practical Reviews in Self-Management Support taxonomy. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) standards guided the reporting.

RESULTS

A total of 24 publications reporting on 19 mHealth SMS tools for SCI were included. These tools were introduced from 2015 onward and used various mHealth technologies and multimedia formats to provide SMS using 9 methods identified by the Practical Reviews in Self-Management Support taxonomy (eg, social support and lifestyle advice and support). The identified tools focused on common SCI self-management areas (eg, bowel, bladder, and pain management) and overlooked areas such as sexual dysfunction problems and environmental problems, including barriers in the built environment. Most tools (12/19, 63%) unexpectedly supported a single self-management task instead of all 3 tasks (ie, medical, role, and emotional management), and emotional management tasks had very little support. All self-management skills (eg, problem-solving, decision-making, and action planning) had coverage, but a single tool addressed resource use. The identified mHealth SMS tools were similar in terms of number, introduction period, geographical distribution, and technical sophistication compared with SMS tools for other chronic conditions.

CONCLUSIONS

This systematic literature review provides one of the first descriptions of mHealth SMS tools for SCI in terms of their characteristics and approaches to offering SMS. This study's findings highlight a need for increased coverage of key SMS for SCI components; adopting comparable usability, user experience, and accessibility evaluation methods; and related research to provide more detailed reporting. Future research should consider other data sources such as app stores and technology-centric bibliographic databases to complement this compilation by identifying other possibly overlooked mHealth SMS tools. A consideration of this study's findings is expected to support the selection, development, and improvement of mHealth SMS tools for SCI.

Towards a World Wide Web without digital inequality

The World Wide Web (WWW) empowers people in developing regions by eradicating illiteracy, supporting women, and generating economic opportunities. However, their reliance on limited bandwidth and low-end phones leaves them with a poorer browsing experience compared to privileged users across the digital divide. To evaluate the extent of this phenomenon, we sent participants to 56 cities to measure the cost of mobile data and the average page load time. We found the cost to be orders of magnitude greater, and the average page load time to be four times slower, in some locations compared to others. Analyzing how popular webpages have changed over the past years suggests that they are increasingly designed with high processing power in mind, effectively leaving the less fortunate users behind. Addressing this digital inequality through new infrastructure takes years to complete and billions of dollars to finance. A more practical solution is to make the webpages more accessible by reducing their size and optimizing their load time. To this end, we developed a solution called Lite-Web and evaluated it in the Gilgit-Baltistan province of Pakistan, demonstrating that it transforms the browsing experience of a Pakistani villager using a low-end phone to almost that of a Dubai resident using a flagship phone. A user study in two high schools in Pakistan confirms that the performance gains come at no expense to the pages' look and functionality. These findings suggest that deploying Lite-Web at scale would constitute a major step toward a WWW without digital inequality.

ImageBox 2 - Efficient and Rapid Access of Image Tiles from Whole-Slide Images Using Serverless HTTP Range Requests

BACKGROUND

Whole-slide images (WSI) are produced by a high-resolution scanning of pathology glass slides. There are a large number of whole-slide imaging scanners, and the resulting images are frequently larger than 100,000 × 100,000 pixels which typically image 100,000 to one million cells, ranging from several hundred megabytes to many gigabytes in size.

AIMS AND OBJECTIVES

Provide HTTP access over the web to Whole Slide Image tiles that do not have localized tiling servers but only basic HTTP access. Move all image decode and tiling functions to calling agent (ImageBox).

METHODS

Current software systems require tiling image servers to be installed on systems providing local disk access to these images. ImageBox2 breaks this requirement by accessing tiles from remote HTTP source via byte-level HTTP range requests. This method does not require changing the client software as the operation is relegated to the ImageBox2 server which is local (or remote) to the client and can access tiles from remote images that have no server of their own such as Amazon S3 hosted images. That is, it provides a data service [on a server that does not need to be managed], the definition of serverless execution model increasingly favored by cloud computing infrastructure.

CONCLUSIONS

The specific methodology described and assessed in this report preserves normal client connection semantics by enabling cloud-friendly tiling, promoting a web of http connected whole-slide images from a wide-ranging number of sources, and providing tiling where local tiling servers would have been otherwise unavailable.

Dataset for WWW landing pages webobject retrieval performance evaluation

This dataset describes data obtained from a multi-day World Wide Web (WWW) measurement campaign distributed internationally across multiple Amazon Web Service (AWS) datacentres. The Chrome web browser was controlled by the Selenium framework to make repetitive requests to several popular websites; the resulting webobjects were captured by a proxy server and details about them stored in the provided SQLite3 databases. A Python script is provided to evaluate the webobjects with respect to their configured as well as their actual expiration times, as part of our more detailed analysis that we provide in [1]. Researchers and practitioners can readily employ this dataset in their own research endeavours with little efforts for avenues of inquiry beyond webobject expiration times we described in [1], as we provide additional information about each webobject and each website visit during the measurement campaign time horizon.

Difficulties Encountered by People With Depression and Anxiety on the Web: Qualitative Study and Web-Based Expert Survey

Background

Depression and anxiety are the most common mental health conditions, and they were identified as leading contributors to global disability in 2016. People with these conditions rely on Web-based resources as a source of accurate health information, convenient and effective treatment, and essential social support. However, a recent systematic review revealed several potentially limiting difficulties that this group experiences online and also suggested that there is a partial understanding of these difficulties as only difficulties associated with neurocognitive, but not sociocognitive, deficits were identified. Therefore, this study fills this knowledge gap and contributes to a more robust and fuller understanding of the difficulties this group experiences online.

Objective

The objective of this study was to identify the difficulties people with depression and anxiety experience when using the Web and the Web activities that are most associated with the experience of difficulties.

Methods

The study employed data triangulation using face-to-face semistructured interviews with 21 participants affected by depression and anxiety and a comparison group (7 participants) without mental disorders (study 1) as well as a persona-based expert online survey with 21 mental health practitioners (MHPs) who treated people with depression and anxiety (study 2). Framework analysis for both studies proceeded through 5 stages: (1) familiarization, (2) identifying a thematic framework, (3) indexing, (4) charting, and (5) mapping and interpretation.

Results

In study 1, 167 difficulties were identified from the experiences of participants in the depression and anxiety group were discussed within the context of 81 Web activities, services, and features. From these, 4 themes and 12 subthemes describing the difficulties people with depression and anxiety experienced online were identified. Difficulties relating to the subtheme lack of control over access and usage were the most common difficulties experienced by participants in the depression and anxiety group (19/21). Sixteen difficulties identified from the experiences of participants in the comparison group were discussed within the context of 11 Web activities, services, and features. Most participants in the comparison group (6/7) contributed to the subtheme describing difficulties with unexpected and irrelevant content. In study 2, researchers identified 3 themes and 10 subthemes that described the perceived difficulties people with depression and anxiety might experience online as reported by MHPs. Practitioners linked these difficulties with 22 common impairments, limitations in activities of daily life, and diagnostic criteria associated with depression and anxiety.

Conclusions

People with depression and anxiety also experience difficulties when using the Web that are related to the sociocognitive deficits associated with their conditions. MHPs have a good awareness of the difficulties that people with depression and anxiety are likely to experience when using the Web. This investigation has contributed to a fuller understanding of these difficulties and provides innovative guidance on how to remove and reduce them for people with depression and anxiety when using the Web.

International Registered Report Identifier (IRRID)

RR2-10.1007/978-3-319-21006-3_3

Lower Neurocognitive Functioning Disrupts the Effective Use of Internet-Based Health Resources in HIV Disease: The Mediating Effects of General Health Literacy Capacity

HIV-associated neurocognitive impairment is an independent predictor of low general health literacy, which can be associated with poor disease outcomes (e.g., viremia). Given the increasing frequency with which health behaviors occur in an online environment (e.g., health information seeking, provider interactions), there is a specific need to understand the predictors of electronic health (eHealth) literacy of persons living with HIV disease. In this study, 90 HIV+ persons completed the eHealth Literacy Scale (eHEALS), which measures one's awareness, skills and evaluation of online health resources. Participants also completed a comprehensive battery of clinical neurocognitive tests and well-validated performance-based measures of general health literacy capacity (e.g., knowledge, numeracy). Results showed that, independent of education, lower neurocognitive function was moderately related to lower eHEALS scores, particularly in the domains of learning and motor skills. Of particular note, general health literacy capacity emerged as a significant mediator of the relationship between neurocognition and eHealth literacy. Thus, the adverse effects of neurocognition on health literacy capacity carries a downstream adverse influence on HIV+ persons' awareness, skills, and evaluation of health-related resources in the online environment.

The neuropsychological aspects of performance-based Internet navigation skills: A brief review of an emerging literature

OBJECTIVE

Over the last 20 years, the Internet has become a fundamental means by which many people with neurocognitive disorders manage their activities of daily living (e.g. shopping) and engage in health behaviors (e.g. appointment scheduling). The aim of this review is to summarize the emerging literature on the neuropsychology of performance-based tasks of Internet navigation skills (INS) as measures of everyday functioning.

METHOD

We performed a structured, qualitative review of the extant literature on INS using PRISMA guidelines.

RESULTS

Seventeen peer-reviewed studies met inclusion criteria and their results suggest that performance-based tests of INS: (1) discriminate healthy adults from some neuropsychological populations [e.g. human immunodeficiency virus (HIV), multiple sclerosis (MS), traumatic brain injury (TBI)]; (2) are associated with performance-based tests of everyday functioning capacity, domain-specific declines in manifest everyday functioning, and self-reported Internet behavior, but not global manifest functional status; (3) correlate with standard clinical neuropsychological tests, particularly executive functions and episodic memory; (4) may relate to demographic factors, most notably age; and (5) have largely unknown psychometric properties (e.g. reliability).

CONCLUSION

This review provided early support for the construct validity of performance-based tasks of INS as modern measures of everyday functioning in neuropsychological populations. Future work is needed to refine these tasks, establish their psychometrics, and evaluate their construct validity in diverse populations, as well as to develop effective remediation and compensatory strategies to improve Internet functionality among persons with neurocognitive disorders.

What defines a good website of a Department of Obstetrics and Gynecology? A user survey

PURPOSE

The Internet has become a widely used source of healthcare information. Many Departments of Obstetrics and Gynecology use their websites for public relations purposes. It is, however, unclear, what relevant stakeholders such as patients, relatives of patients, physicians, and medical students expect of an Obstetrics and Gynecology Department's website. Therefore, we evaluated the opinions and expectations of the various stakeholders using a structured questionnaire.

METHODS

We asked gynecologic patients, obstetric patients, relatives of patients, medical students, and physicians to fill in an anonymous questionnaire consisting of general facts about the informant, one open-ended question on expectations and wishes regarding the website, and 28 rating scale questions (7-step visual analog scale ranging from, not important' to, very important') covering the topics "website navigation" (4 questions), "first contact" (3 questions), "clinic processes" (7 questions), "facts and figures about the Department" (4 questions), "visual impressions" (5 questions), and "obstetrics-specific items" (5 questions). Questionnaires for physicians included four additional questions about the value of Department websites as an information tool for themselves and their patients. We used descriptive statistics to analyze the data.

RESULTS

1458 questionnaires were analyzed (gynecologic patients, n = 615 [42%]; obstetric patients, n = 479 [33%]; relatives of patients, n = 77 [5%]; medical students n = 238 [16%]; physicians, n = 41 [3%]). The number of circulated questionnaires was not recorded and thus, the response rate is unknown. 1304 (89%) respondents used the Internet as a regular source of health care information, 642 (44%) had previously searched an Obstetrics and Gynecology Department website. All respondents rated contact data and information about processes in the clinic highest; whereas, other issues such as medical facts, visual impressions, and website design issues were significantly less important. Pregnant women rated contact information and obstetric facts highest. 90% of physicians regularly used Department websites for patient referrals and rated contact information and medical team details most important.

CONCLUSIONS

When designing a website of an Obstetrics and Gynecology Department, contact information and information about processes in the clinic should be displayed most prominently and be easily accessible. Subsections specifically targeted at obstetric patients and physicians should be provided.

Re-evaluation of websites from burn centers in Austria, Germany and Switzerland

INTRODUCTION

Websites serve as information and communication platforms; hence, they are important tools for the self-promotion of hospitals. In 2010, Selig et al. evaluated the online presence of burn centers in Germany, Austria, and Switzerland based on 37 quality criteria. This study aimed to re-evaluate these websites to assess their development over the past 6.5 years.

MATERIALS AND METHODS

Websites of the German-speaking burn centers were re-evaluated according to criteria previously described by Selig et al. Particular attention was paid to specific information on burns. Additionally, the implementation of social media platforms was investigated.

RESULTS

There was an overall increase in the quality of information published on websites. There was a considerable improvement recorded, especially in the categories of "teaching" and "patient care." However, burn-specific information was found to be still sparse. Over 50% of the hospitals were present on social media.

CONCLUSIONS

Although the quality of information published on German-speaking burn center websites increased, they must be further developed, especially regarding burn-related information. Moreover, a clear structure and design could prevent long searches and facilitate an easier flow of information. The interface from websites and social media platforms appear to be an important tool for up-to-date self-promotion.

A Survey of Web-Based Chemogenomic Data Resources

Chemogenomics is a comparatively nascent branch dealing with the effects of drugs and chemicals on molecular level systems. With the emergence of this new epoch, the quantity of data sources is also unprecedentedly increasing. Despite having a plethora of a databases, the variation in bioactivity measurement as well as bias toward specific protein studies, varied computational procedures and redundant information make data mining tedious, especially for newcomers in the field. In this chapter, we give an overview of hands-on data collection and domains of applicability from some useful Web-based chemogenomic resources that are accessible with nothing more than a Web browser. This overview can help assist users in acquiring chemogenomic datasets for their project at hand.

Defining Information Quality Into Health Websites: A Conceptual Framework of Health Website Information Quality for Educated Young Adults

Background

Today’s health care environment encourages health care consumers to take an active role in managing their health. As digital natives, young educated adults do much of their health information management through the Internet and consider it a valid source of health advice. However, the quality of information on health websites is highly variable and dynamic. Little is known about the understandings and perceptions that young educated adults have garnered on the quality of information on health websites used for health care–related purposes.

Objective

To fill this gap, the aim of this study was to develop a conceptual framework of health website information quality with quality dimensions (ie, criteria) and associated quality drivers (ie, attributes) specified in the context of young educated adults’ use of health websites for health care–related purposes. This aim was achieved by (1) identifying information quality dimensions of health websites from the perspective of young educated adults; (2) identifying the importance ratings of these quality dimensions; and (3) constructing a framework of health website information quality with quality dimensions and associated drivers specified in the context of young educated adults’ use of health websites for health care–related purposes.

Methods

The study employed both qualitative and quantitative methods. Methods included semistructured group interviews and an individual quality assessment exercise grounded in visiting various websites and responding to Likert scale questions regarding the importance ratings of information quality dimensions and open-ended questions with specifying website quality drivers. Study participants included junior and senior undergraduate and graduate students in business, allied health, and public health majors. Qualitative, open-coding procedures were used to develop the conceptual framework reflecting the participants’ means of assessing information quality on health websites.

Results

Five dimensions of information quality for health websites were identified: Completeness of information, Understandability of information, Relevance of information, Depth of information, and Accuracy of information. Completeness of information and Understandability of information were rated as the two most important quality dimensions by the study participants. Results indicated that these five information quality dimensions for health websites were supported by the following main driver themes: Content, Design, Links, Consumer resources, Search functionality, Supporting references, User focus, Content FAQ, Open access, Policy statements, and Site performance.

Conclusions

This study contributes to the literature by developing a health website information quality conceptual framework with quality dimensions and associated drivers specified for a young educated adult population. The detailed quality drivers supporting the corresponding quality dimensions provide a rich picture of young educated adults’ perceptions on health website information quality. This framework can be used to guide the development of health websites, as well as the foundation for a means to evaluate health information from existing health websites with young educated adults as the target audience.

My Hypertension Education and Reaching Target (MyHEART): Development and Dissemination of a Patient-Centered Website for Young Adults with Hypertension

Background

Young adults (18 to 39 years old) with hypertension have the lowest rates of blood pressure control (defined as blood pressure less than 140/90 mmHg) compared to other adult age groups. Approximately 1 in 15 young adults have high blood pressure, increasing their risk of future heart attack, stroke, congestive heart failure, and/or chronic kidney disease. Many young adults reported having few resources to address their needs for health education on managing cardiovascular risk.

Objective

The goal of our study was to develop and disseminate a website with evidence-based, clinical information and health behavior resources tailored to young adults with hypertension.

Methods

In collaboration with young adults, health systems, and community stakeholders, the My Hypertension Education and Reaching Target (MyHEART) website was created. A toolkit was also developed for clinicians and healthcare systems to disseminate the website within their organizations. The dissemination plan was guided by the Dissemination Planning Tool of the Agency for Healthcare Research and Quality (AHRQ).

Results

Google Analytics data were acquired for January 1, 2017 to June 29, 2017. The MyHEART website received 1090 visits with 2130 page views; 18.99% (207/1090) were returning visitors. The majority (55.96%, 610/1090) approached the website through organic searches, 34.95% (381/1090) accessed the MyHEART website directly, and 5.96% (65/1090) approached through referrals from other sites. There was a spike in site visits around times of increased efforts to disseminate the website.

Conclusions

The successfully implemented MyHEART website and toolkit reflect collaborative input from community and healthcare stakeholders to provide evidence-based, portable hypertension education to a hard-to-reach population. The MyHEART website and toolkit can support healthcare providers' education and counseling with young adults and organizations' hypertension population health goals.

Insights From Flutracking: Thirteen Tips to Growing a Web-Based Participatory Surveillance System

Flutracking is a weekly Web-based survey of influenza-like illness (ILI) in Australia that has grown from 400 participants in 2006 to over 26,000 participants every week in 2016. Flutracking monitors both the transmission and severity of ILI across Australia by documenting symptoms (cough, fever, and sore throat), time off work or normal duties, influenza vaccination status, laboratory testing for influenza, and health seeking behavior. Recruitment of Flutrackers commenced via health department and other organizational email systems, and then gradually incorporated social media promotion and invitations from existing Flutrackers to friends to enhance participation. Invitations from existing participants typically contribute to over 1000 new participants each year. The Flutracking survey link was emailed every Monday morning in winter and took less than 10 seconds to complete. To reduce the burden on respondents, we collected only a minimal amount of demographic and weekly data. Additionally, to optimize users' experiences, we maintained a strong focus on "obvious design" and repeated usability testing of naïve and current participants of the survey. In this paper, we share these and other insights on recruitment methods and user experience principles that have enabled Flutracking to become one of the largest online participatory surveillance systems in the world. There is still much that could be enhanced in Flutracking; however, we believe these principles could benefit others developing similar online surveillance systems.

Household Everyday Functioning in the Internet Age: Online Shopping and Banking Skills Are Affected in HIV-Associated Neurocognitive Disorders

OBJECTIVES

The Internet is a fundamental tool for completing many different instrumental activities of daily living (IADL), including shopping and banking. Persons with HIV-associated Neurocognitive Disorders (HAND) are at heightened risk for IADL problems, but the extent to which HAND interferes with the performance of Internet-based household IADLs is not known.

METHODS

Ninety-three individuals with HIV disease, 43 of whom were diagnosed with HAND, and 42 HIV- comparison participants completed Internet-based tests of shopping and banking. Participants used mock credentials to log in to an experimenter-controlled Web site and independently performed a series of typical online shopping (e.g., purchasing household goods) and banking (e.g., transferring funds between accounts) tasks.

RESULTS

Individuals with HAND were significantly more likely to fail the online shopping task than neurocognitively normal HIV+ and HIV- participants. HAND was also associated with poorer overall performance versus HIV+ normals on the online banking task. In the HAND group, Internet-based task scores were correlated with episodic memory, executive functions, motor skills, and numeracy. In the HIV+ sample as a whole, lower Internet-based task scores were uniquely associated with poorer performance-based functional capacity and self-reported declines in shopping and financial management in daily life, but not with global manifest functional status.

CONCLUSIONS

Findings indicate that HAND is associated with difficulties in using the Internet to complete important household everyday functioning tasks. The development and validation of effective Internet training and compensatory strategies may help to improve the household management of persons with HAND. (JINS, 2017, 23, 605-615).

Situating Machine Intelligence Within the Cognitive Ecology of the Internet

The Internet is an important focus of attention for the philosophy of mind and cognitive science communities. This is partly because the Internet serves as an important part of the material environment in which a broad array of human cognitive and epistemic activities are situated. The Internet can thus be seen as an important part of the ‘cognitive ecology’ that helps to shape, support and (on occasion) realize aspects of human cognizing. Much of the previous philosophical work in this area has sought to analyze the cognitive significance of the Internet from the perspective of human cognition. There has, as such, been little effort to assess the cognitive significance of the Internet from the perspective of ‘machine cognition’. This is unfortunate, because the Internet is likely to exert a significant influence on the shape of machine intelligence. The present paper attempts to evaluate the extent to which the Internet serves as a form of cognitive ecology for synthetic (machine-based) forms of intelligence. In particular, the phenomenon of Internet-situated machine intelligence is analyzed from the perspective of a number of approaches that are typically subsumed under the heading of situated cognition. These include extended, embedded, scaffolded and embodied approaches to cognition. For each of these approaches, the Internet is shown to be of potential relevance to the development and operation of machine-based cognitive capabilities. Such insights help us to appreciate the role of the Internet in advancing the current state-of-the-art in machine intelligence.

Fifteen-year trend in information on the World Wide Web for patients with rheumatoid arthritis: evolving, but opportunities for improvement remain

The aim of this study was to assess the changes in the characteristics of rheumatoid arthritis information on the Internet over a 15-year period and the positioning of Web sites posted by universities, hospitals, and medical associations. We replicated the methods of a 2001 study assessing rheumatoid arthritis information on the Internet using WebCrawler. All Web sites and pages were critically assessed for relevance, scope, authorship, type of publication, and financial objectives. Differences between studies were considered significant if 95 % confidence intervals did not overlap. Additionally, we added a Google search with assessments of the quality of content of web pages and of the Web sites posted by medical institutions. There were significant differences between the present study's WebCrawler search and the 2001-referent study. There were increases in information sites (82 vs 36 %) and rheumatoid arthritis-specific discussion pages (59 vs 8 %), and decreases in advertisements (2 vs 48 %) and alternative therapies (27 vs 45 %). The quality of content of web pages is still dispersed; just 37 % were rated as good. Among the first 300 hits, 30 (10 %) were posted by medical institutions, 17 of them in the USA. Regarding readability, 7 % of these 30 web pages required 6 years, 27 % required 7-9 years, 27 % required 10-12 years, and 40 % required 12 or more years of schooling. The Internet has evolved in the last 15 years. Medical institutions are also better positioned. However, there are still areas for improvement, such as the quality of the content, leadership of medical institutions, and readability of information.

Barriers and Facilitation Measures Related to People With Mental Disorders When Using the Web: A Systematic Review

Background

Mental disorders (MDs) affect almost 1 in 4 adults at some point during their lifetime, and coupled with substance use disorders are the fifth leading cause of disability adjusted life years worldwide. People with these disorders often use the Web as an informational resource, platform for convenient self-directed treatment, and a means for many other kinds of support. However, some features of the Web can potentially erect barriers for this group that limit their access to these benefits, and there is a lack of research looking into this eventuality. Therefore, it is important to identify gaps in knowledge about “what” barriers exist and “how” they could be addressed so that this knowledge can inform Web professionals who aim to ensure the Web is inclusive to this population.

Objective

The objective of this study was to provide an overview of existing evidence regarding the barriers people with mental disorders experience when using the Web and the facilitation measures used to address such barriers.

Methods

This study involved a systematic review of studies that have considered the difficulties people with mental disorders experience when using digital technologies. Digital technologies were included because knowledge about any barriers here would likely be also applicable to the Web. A synthesis was performed by categorizing data according to the 4 foundational principles of Web accessibility as proposed by the World Wide Web Consortium, which forms the necessary basis for anyone to gain adequate access to the Web. Facilitation measures recommended by studies were later summarized into a set of minimal recommendations.

Results

A total of 16 publications were included in this review, comprising 13 studies and 3 international guidelines. Findings suggest that people with mental disorders experience barriers that limit how they perceive, understand, and operate websites. Identified facilitation measures target these barriers in addition to ensuring that Web content can be reliably interpreted by a wide range of user applications.

Conclusions

People with mental disorders encounter barriers on the Web, and attempts have been made to remove or reduce these barriers. As forewarned by experts in the area, only a few studies investigating this issue were found. More rigorous research is needed to be exhaustive and to have a larger impact on improving the Web for people with mental disorders.

Assessment of the quality and content of website health information about herbal remedies for menopausal symptoms

OBJECTIVE

To assess the quality, readability and coverage of website information about herbal remedies for menopausal symptoms.

STUDY DESIGN

A purposive sample of commercial and non-commercial websites was assessed for quality (DISCERN), readability (SMOG) and information coverage.

MAIN OUTCOME MEASURES

Non-parametric and parametric tests were used to explain the variability of these factors across types of websites and to assess associations between website quality and information coverage.

RESULTS

39 sites were assessed. Median quality and information coverage scores were 44/80 and 11/30 respectively. The median readability score was 18.7, similar to UK broadsheets. Commercial websites scored significantly lower on quality (p=0.014), but there were no statistical differences for information coverage or readability. There was a significant positive correlation between information quality and coverage scores irrespective of website provider (r=0.69, p<0.001, n=39).

CONCLUSION

Overall website quality and information coverage are poor and the required reading level high.

Effectiveness of Computer Tailoring Versus Peer Support Web-Based Interventions in Promoting Physical Activity Among Insufficiently Active Canadian Adults With Type 2 Diabetes: Protocol for a Randomized Controlled Trial

BACKGROUND

Type 2 diabetes is a major challenge for Canadian public health authorities, and regular physical activity is a key factor in the management of this disease. Given that less than half of people with type 2 diabetes in Canada are sufficiently active to meet the Canadian Diabetes Association's guidelines, effective programs targeting the adoption of regular physical activity are in demand for this population. Many researchers have argued that Web-based interventions targeting physical activity are a promising avenue for insufficiently active populations; however, it remains unclear if this type of intervention is effective among people with type 2 diabetes.

OBJECTIVE

This research project aims to evaluate the effectiveness of two Web-based interventions targeting the adoption of regular aerobic physical activity among insufficiently active adult Canadian Francophones with type 2 diabetes.

METHODS

A 3-arm, parallel randomized controlled trial with 2 experimental groups and 1 control group was conducted in the province of Quebec, Canada. A total of 234 participants were randomized at a 1:1:1 ratio to receive an 8-week, fully automated, computer-tailored, Web-based intervention (experimental group 1); an 8-week peer support (ie, Facebook group) Web-based intervention (experimental group 2); or no intervention (control group) during the study period.

RESULTS

The primary outcome of this study is self-reported physical activity level (total min/week of moderate-intensity aerobic physical activity). Secondary outcomes are attitude, social influence, self-efficacy, type of motivation, and intention. All outcomes are assessed at baseline and 3 and 9 months after baseline with a self-reported questionnaire filled directly on the study websites.

CONCLUSIONS

By evaluating and comparing the effectiveness of 2 Web-based interventions characterized by different behavior change perspectives, findings of this study will contribute to advances in the field of physical activity promotion in adult populations with type 2 diabetes.

TRIAL REGISTRATION

International Standard Randomized Controlled Trial Number (ISRCTN): ISRCTN15747108; http://www.isrctn.com/ISRCTN15747108 (Archived by WebCite at http://www.webcitation.org/6eJTi0m3r).

Crowdsourcing Diagnosis for Patients With Undiagnosed Illnesses: An Evaluation of CrowdMed

Background

Despite visits to multiple physicians, many patients remain undiagnosed. A new online program, CrowdMed, aims to leverage the “wisdom of the crowd” by giving patients an opportunity to submit their cases and interact with case solvers to obtain diagnostic possibilities.

Objective

To describe CrowdMed and provide an independent assessment of its impact.

Methods

Patients submit their cases online to CrowdMed and case solvers sign up to help diagnose patients. Case solvers attempt to solve patients’ diagnostic dilemmas and often have an interactive online discussion with patients, including an exchange of additional diagnostic details. At the end, patients receive detailed reports containing diagnostic suggestions to discuss with their physicians and fill out surveys about their outcomes. We independently analyzed data collected from cases between May 2013 and April 2015 to determine patient and case solver characteristics and case outcomes.

Results

During the study period, 397 cases were completed. These patients previously visited a median of 5 physicians, incurred a median of US $10,000 in medical expenses, spent a median of 50 hours researching their illnesses online, and had symptoms for a median of 2.6 years. During this period, 357 active case solvers participated, of which 37.9% (132/348) were male and 58.3% (208/357) worked or studied in the medical industry. About half (50.9%, 202/397) of patients were likely to recommend CrowdMed to a friend, 59.6% (233/391) reported that the process gave insights that led them closer to the correct diagnoses, 57% (52/92) reported estimated decreases in medical expenses, and 38% (29/77) reported estimated improvement in school or work productivity.

Conclusions

Some patients with undiagnosed illnesses reported receiving helpful guidance from crowdsourcing their diagnoses during their difficult diagnostic journeys. However, further development and use of crowdsourcing methods to facilitate diagnosis requires long-term evaluation as well as validation to account for patients’ ultimate correct diagnoses.

Health-Related Everyday Functioning in the Internet Age: HIV-Associated Neurocognitive Disorders Disrupt Online Pharmacy and Health Chart Navigation Skills

This study evaluated the effects of HIV-associated Neurocognitive Disorders (HAND) on 2 Internet-based tests of healthcare management. Study participants included 46 individuals with HIV infection, 19 of whom were diagnosed with HAND, and 21 seronegatives. Participants were administered Internet-based tests of online pharmacy and health records navigation skills in which they used mock credentials to log in to an experimenter-controlled website and independently perform a series of typical online health-related behaviors (e.g., refill a prescription, read and interpret an electronic chart note). HAND was associated with significantly lower accuracy on both the online pharmacy and health records navigation tasks. Among the HIV+ participants, poorer performance on the online healthcare navigation tasks was associated with fewer years of education, higher plasma viral load, less frequent Internet use, and lower health literacy. Findings indicate that individuals with HAND may have marked difficulties navigating the Internet to complete important health-related behaviors.

Does a Video Improve Knowledge of HIV/AIDS and HIV Testing among a Global Internet Audience?

The objectives of this study were to determine if a video improved HIV/AIDS and HIV testing knowledge among a global sample of Internet users, to discern if this improvement was the same for English and Spanish speakers, and to ascertain if the video was efficacious for those with lower health literacy. A worldwide sample of English- or Spanish-speaking Internet users was solicited. Participants completed a 25-item questionnaire to assess their HIV/AIDS and HIV testing knowledge before and after watching the video. Mean scores on the questionnaire improved after watching the video for both English speakers (after: 19.6 versus before: 16.4; Δ = 3.2; 95% confidence interval [CI]: 2.8-3.5) and Spanish speakers (20.7 versus 17.3; Δ = 3.4; 95% CI: 3.0-3.8). There was no difference in improvement of scores between English and Spanish speakers (Δ = -0.24; 95% CI: -0.79 to 0.31), and this video was equally efficacious for those with lower and higher health literacy skills.

Social media for school nurses: promoting school health in the 21st century

People across the globe use social media to connect with one another, stay in touch with friends and family, and exchange information. Health care has embraced social media, and nursing organizations such as the American Nurses Association (ANA) and NASN have a presence in the social media landscape. The students in our schools today are digital natives who grew up with and are at home in the world of technology. With so many options in the digital world, the question is how can school nurses harness this technology to connect with their students and families? More importantly, how can school nurses use social media in a professional and responsible manner and help to enhance the profession of school nursing overall? This article will outline the planning and implementation of an ongoing social media campaign on wellness and healthy behaviors by one Texas suburban school district.

Development of a fully automated, web-based, tailored intervention promoting regular physical activity among insufficiently active adults with type 2 diabetes: integrating the I-change model, self-determination theory, and motivational interviewing components

Background

Type 2 diabetes is a major challenge for Canadian public health authorities, and regular physical activity is a key factor in the management of this disease. Given that fewer than half of people with type 2 diabetes in Canada are sufficiently active to meet the recommendations, effective programs targeting the adoption of regular physical activity (PA) are in demand for this population. Many researchers argue that Web-based, tailored interventions targeting PA are a promising and effective avenue for sedentary populations like Canadians with type 2 diabetes, but few have described the detailed development of this kind of intervention.

Objective

This paper aims to describe the systematic development of the Web-based, tailored intervention, Diabète en Forme, promoting regular aerobic PA among adult Canadian francophones with type 2 diabetes. This paper can be used as a reference for health professionals interested in developing similar interventions. We also explored the integration of theoretical components derived from the I-Change Model, Self-Determination Theory, and Motivational Interviewing, which is a potential path for enhancing the effectiveness of tailored interventions on PA adoption and maintenance.

Methods

The intervention development was based on the program-planning model for tailored interventions of Kreuter et al. An additional step was added to the model to evaluate the intervention’s usability prior to the implementation phase. An 8-week intervention was developed. The key components of the intervention include a self-monitoring tool for PA behavior, a weekly action planning tool, and eight tailored motivational sessions based on attitude, self-efficacy, intention, type of motivation, PA behavior, and other constructs and techniques. Usability evaluation, a step added to the program-planning model, helped to make several improvements to the intervention prior to the implementation phase.

Results

The intervention development cost was about CDN $59,700 and took approximately 54 full-time weeks. The intervention officially started on September 29, 2014. Out of 2300 potential participants targeted for the tailored intervention, approximately 530 people visited the website, 170 people completed the registration process, and 83 corresponded to the selection criteria and were enrolled in the intervention.

Conclusions

Usability evaluation is an essential step in the development of a Web-based tailored intervention in order to make pre-implementation improvements. The effectiveness and relevance of the theoretical framework used for the intervention will be analyzed following the process and impact evaluation. Implications for future research are discussed.

Visibility and findability of the nursing home compare website

Nursing Home Compare (NHC) is a federal government website providing information for selecting a nursing home. However, not many consumers were aware of or can locate the site. This study analyzed 50 official state and District of Columbia websites from September through December 2013. Using Google "inlink:" operator, this study evaluated the visibility and findability of NHC links in each state-level website. The results show that a link to NHC is available in all states except for Connecticut, Florida, and Michigan. Although it took only 4.7 clicks on average to the page with a NHC link, consumers may still have difficulty to find NHC from a state website. This article provides a snapshot of the visibility and findability of NHC and indicates a need for further investigation of promising website dissemination strategies not yet adequately evaluated.

Geological hazards: from early warning systems to public health toolkits

Extreme geological events, such as earthquakes, are a significant global concern and sometimes their consequences can be devastating. Geographic information plays a critical role in health protection regarding hazards, and there are a range of initiatives using geographic information to communicate risk as well as to support early warning systems operated by geologists. Nevertheless we consider there to remain shortfalls in translating information on extreme geological events into health protection tools, and suggest that social scientists have an important role to play in aiding the development of a new generation of toolkits aimed at public health practitioners. This viewpoint piece reviews the state of the art in this domain and proposes potential contributions different stakeholder groups, including social scientists, could bring to the development of new toolkits.

Evaluation of Autism-Related Health Information on the Web

BACKGROUND

The Internet is a frequently accessed source of information for parents of a child with autism. To help parents make informed decisions about treatment options, websites should contain accurate information. This study aimed to evaluate the quality of information in a sample of autism-relevant websites.

MATERIALS AND METHODS

Autism-related keywords were entered into three widely used search engines in April 2013 and the 20 most frequently appearing sites identified. Website quality was rated, by two independent raters, using the DISCERN tool. Websites were also coded according to the type of references/sources provided to support the intervention content presented.

RESULTS

The mean DISCERN score was 46.5 (range 23-67.5), of a possible 80. Information about treatment risks and no treatment as an option was rarely described. Only six (30%) websites provided research references when describing intervention options.

CONCLUSIONS

Many websites did not meet criteria for quality health information and failed to cite evidence supporting described interventions. Implications of these findings are discussed.

Prospective analysis of the accuracy of diagnosis of carpal tunnel syndrome using a web-based questionnaire

OBJECTIVE

To confirm the accuracy of a diagnostic questionnaire for carpal tunnel syndrome (CTS) when presented via a public website rather than on paper.

DESIGN

Prospective comparison of the probability of CTS as assessed by the web-based questionnaire at http://www.carpal-tunnel.net with the results of nerve conduction studies.

SETTING

Subregional neurophysiology laboratory serving a population of 700,000 in East Kent, UK.

PARTICIPANTS

2821 individuals who were able to complete an online diagnostic questionnaire out of 4899 referred for initial diagnostic testing for new presentations with suspected CTS from April 2011 to March 2013. No exclusions were made on grounds of age, gender or coincident pathology. Main outcome measure--nerve conduction results confirming CTS. The severity of median nerve impairment demonstrated was also assessed using a validated neurophysiological scale.

RESULTS

The web-based questionnaire accurately estimates the probability of CTS being confirmed on nerve conduction studies. Using a website diagnostic score of ≥40% as an example cut-off value the questionnaire achieves 78% sensitivity and 68% specificity in predicting the finding of evidence of CTS on nerve conduction studies. The web-based version of the diagnostic questionnaire was as accurate as the original paper version with an area under the receiver operating characteristic curve of 0.79. There was also a significant correlation between the diagnostic score given by the website and the severity of CTS with higher scores being associated with greater nerve dysfunction (r=0.3, p<0.00001).

CONCLUSIONS

Completion of the symptom questionnaire on the website by patients at home provides a prediction of the likelihood of CTS which is sufficiently accurate to be used in initial planning of investigation and treatment.

A Web-Based Intervention for Users of Amphetamine-Type Stimulants: 3-Month Outcomes of a Randomized Controlled Trial

BACKGROUND

Among illicit drugs, the prevalence of amphetamine-type stimulant (ATS) use is second only to cannabis. Currently, there are no approved pharmacotherapies for ATS problems, but some face-to-face psychotherapies are effective. Web-based interventions have proven to be effective for some substance use problems, but none has specifically targeted ATS users.

OBJECTIVE

The objective of the study was to evaluate the effectiveness of a Web-based intervention for ATS problems on a free-to-access site compared with a waitlist control group.

METHODS

We used a randomized controlled trial design. The primary outcome measure was self-reported ATS use in the past three months assessed using the Alcohol, Smoking, Substance Involvement Screening Test (ASSIST). Other measures included quality of life (EUROHIS score), psychological distress (K-10 score), days out of role, poly-drug use, general help-seeking intentions, actual help-seeking, and "readiness to change". The intervention consisted of three fully automated, self-guided modules based on cognitive behavioral therapy and motivation enhancement. The analysis was an intention-to-treat analysis using generalized estimating equation models, with a group by time interaction as the critical assessment.

RESULTS

We randomized 160 people (intervention n=81, control n=79). At three months, 35/81 (43%) intervention and 45/79 (57%) control participants provided follow-up data. In the intervention group, 51/81 (63%) completed at least one module. The only significant group by time interaction was for days out of role. The pre/post change effect sizes showed small changes (range d=0.14 to 0.40) favoring the intervention group for poly-drug use, distress, actual help-seeking, and days out of role. In contrast, the control group was favored by reductions in ATS use, improvements in quality of life, and increases in help-seeking intentions (range d=0.09 to 0.16).

CONCLUSIONS

This Web-based intervention for ATS use produced few significant changes in outcome measures. There were moderate, but nonsignificant reductions in poly-drug use, distress, days partially out of role, and increases in help-seeking. However, high levels of participant attrition, plus low levels of engagement with the modules, preclude firm conclusions being drawn on the efficacy of the intervention and emphasize the problems of engaging this group of clients in a fully automated program.

TRIAL REGISTRATION

Australian and New Zealand Clinical Trials Registry: ACTRN 12611000947909; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12611000947909 (Archived by WebCite at http://www.webcitation.org/6SHTxEnzP).

How evidence-based is the information on the internet about nausea and vomiting of pregnancy?

BACKGROUND

The Internet has become an important source of information about pregnancy and about health related concerns in general. This study assessed the quality of information available on the Internet for the common problem of nausea and vomiting of pregnancy (NVP).

METHOD

We used three search terms, "nausea and vomiting in pregnancy," "morning sickness," and "hyperemesis gravidarum," to identify the most popular sites as rated by Google. With modifications of previously described tools, the quality of the websites was rated in three categories: accountability using the Silberg criteria, presentation using a modified Abbott's score, and readability using the Flesch-Kincaid grade level score. Subsequently the information on the websites was compared with the SOGC guideline on management of NVP.

RESULTS

We identified 24 unique websites as most popular. The overall scores for accountability indicated poor quality, with only 25% of the websites meeting the required criteria and less than one half of the sites indicating authorship and credentials. Esthetic appeal criteria were met in over 75% of the websites. The readability score of the websites was significantly above the score recommended for the general population, with an average Flesch-Kincaid Grade level score of 10.7 (max = 12). Eighty-seven percent of the websites contained accurate, evidence-based recommendations according to the information provided in the SOGC clinical practice guideline on management of NVP.

CONCLUSION

Overall, the majority of information available online is accurate; however, the web pages demonstrated poor accountability and targeted an audience with a higher reading ability than the general population. Consideration of these findings would help create easy to navigate, credible web pages containing information to help women make informed decisions during pregnancy.

Staging dementia from symptom profiles on a care partner website

BACKGROUND

The World Wide Web allows access to patient/care partner perspectives on the lived experience of dementia. We were interested in how symptoms that care partners target for tracking relate to dementia stage, and whether dementia could be staged using only these online profiles of targeted symptoms.

OBJECTIVES

To use clinical data where the dementia stage is known to develop a model that classifies an individual's stage of dementia based on their symptom profile and to apply this model to classify dementia stages for subjects from a Web-based dataset.

METHODS

An Artificial Neural Network (ANN) was used to identify the relationships between the dementia stages and individualized profiles of people with dementia obtained from the 60-item SymptomGuide (SG). The clinic-based training dataset (n=320), with known dementia stages, was used to create an ANN model for classifying stages in Web-based users (n=1930).

RESULTS

The ANN model was trained in 66% of the 320 Memory Clinic patients, with the remaining 34% used to test its accuracy in classification. Training and testing staging distributions were not significantly different. In the 1930 Web-based profiles, 309 people (16%) were classified as having mild cognitive impairment, 36% as mild dementia, 29% as moderate, and 19% as severe. In both the clinical and Web-based symptom profiles, most symptoms became more common as the stage of dementia worsened (eg, mean 5.6 SD 5.9 symptoms in the MCI group versus 11.9 SD 11.3 in the severe). Overall, Web profiles recorded more symptoms (mean 7.1 SD 8.0) than did clinic ones (mean 5.5 SD 1.8). Even so, symptom profiles were relatively similar between the Web-based and clinical datasets.

CONCLUSION

Symptoms targeted for online tracking by care partners of people with dementia can be used to stage dementia. Even so, caution is needed to assure the validity of data collected online as the current staging algorithm should be seen as an initial step.

Examining the differences in format and characteristics of zoonotic virus surveillance data on state agency websites

Background

Zoonotic viruses are infectious organisms transmittable between animals and humans. Agencies of public health, agriculture, and wildlife conduct surveillance of zoonotic viruses and often report data on their websites. However, the format and characteristics of these data are not known.

Objective

To describe and compare the format and characteristics of statistics of zoonotic viruses on state public health, agriculture, and wildlife agency websites.

Methods

For each state, we considered the websites of that state’s public health, agriculture, and wildlife agency. For each website, we noted the presence of any statistics for zoonotic viruses from 2000-2012. We analyzed the data using numerous categories including type of statistic, temporal and geographic level of detail, and format. We prioritized our analysis within each category based on assumptions of individuals’ preferences for extracting and analyzing data from websites. Thus, if two types of data (such as city and state-level) were present for a given virus in a given year, we counted the one with higher priority (city). External links from agency sites to other websites were not considered.

Results

From 2000-2012, state health departments had the most extensive virus data, followed by agriculture, and then wildlife. We focused on the seven viruses that were common across the three agencies. These included rabies, West Nile virus, eastern equine encephalitis, St. Louis encephalitis, western equine encephalitis, influenza, and dengue fever. Simple numerical totals were most often used to report the data (89% for public health, 81% for agriculture, and 82% for wildlife), and proportions were not different (chi-square P=.15). Public health data were most often presented yearly (66%), while agriculture and wildlife agencies often described cases as they occurred (Fisher’s Exact test P<.001). Regarding format, public health agencies had more downloadable PDF files (68%), while agriculture (61%) and wildlife agencies (46%) presented data directly in the text of the HTML webpage (Fisher’s Exact test P<.001). Demographics and other information including age, gender, and host were limited. Finally, a Fisher’s Exact test showed no association between geography data and agency type (P=.08). However, it was noted that agriculture department data was often at the county level (63%), while public health was mixed between county (38%) and state (35%).

Conclusions

This study focused on the format and characteristics of statistics of zoonotic viruses on websites of state public health, wildlife, and agriculture agencies in the context of population health surveillance. Data on zoonotic viruses varied across agencies presenting challenges for researchers needing to integrate animal and human data from different websites.

"I Found it on the Internet": Preparing for the e-patient in Oman

In the Information Age, the communication patterns between doctor and patient are changing. Using Everett Rogers' theory of Diffusion of Innovations, this paper begins by examining the diffusion of the Internet in the world and in Oman. It then considers the emergence of e-patients. The characteristics of e-patients are described in some detail. The paper ends by describing steps that should be taken when teaching medical students in Oman so that they can be prepared for e-patients.

Teaching undergraduate neuroscience in the digital age

The Internet is enhancing and challenging traditional approaches to teaching undergraduate neuroscience. In addition to the new FUN-supported development of a Society for Neuroscience Portal for higher education, there is a wealth of available teaching resources currently housed on the web. This article discusses the current state of digital libraries and introduces a series of exemplary web-based classroom resources.

A Mixed Learning Technology Approach for Continuing Medical Education

INTRODUCTION

Distance learning technologies have been used for many years to provide CME to rural physicians. The purpose of this study was to evaluate the utility and acceptability of a mixed learning technology approach for providing distance CME. The approach combined audio teleconferencing instruction with a Web-based learning system enabling the live presentation and archiving of instructional material and media, asynchronous computer conferencing discussions, and access to supplemental online learning resources.

METHODOLOGY

The study population was comprised of physicians and nurse practitioners who participated in audio teleconference sessions, but did not access the Web-based learning system (nonusers); learners who participated in audio teleconferences and accessed the Web-based system (online users); and faculty. The evaluation focused upon faculty and learners' experiences and perceptions of the mixed learning technology approach; the level of usage; and the effectiveness of the approach in fostering non-mandatory, computer-mediated discussions.

RESULTS AND DISCUSSION

The users of the Web-based learning system were satisfied with its features, ease of use, and the ability to access online CME instructional material. Learners who accessed the system reported a higher level of computer skill and comfort than those who did not, and the majority of these users accessed the system at times other than the live audio teleconference sessions. The greatest use of the system appeared to be for self-directed learning. The success of a mixed learning technology approach is dependent on Internet connectivity and computer access; learners and faculty having time to access and use the Web; comfort with computers; and faculty development in the area of Web-based teaching.

Video capture and editing as a tool for the storage, distribution, and illustration of morphological characters of nematodes

Morphological identification and detailed observation of nematodes usually requires permanent slides, but these are never truly permanent and often prevent the same specimens to be used for other purposes. To efficiently record the morphology of nematodes in a format that allows easy archiving, editing, and distribution, we have assembled two micrographic video capture and editing (VCE) configurations. These assemblies allow production of short video clips that mimic multifocal observation of nematode specimens through a light microscope. Images so obtained can be used for training, management, and online access of "virtual voucher specimens" in taxonomic collections, routine screening of fixed or unfixed specimens, recording of ephemeral staining patterns, or recording of freshly dissected internal organs prior to their decomposition. We provide an overview of the components and operation of both of our systems and evaluate their efficiency and image quality. We conclude that VCE is a highly versatile approach that is likely to become widely used in nematology research and teaching.

Evaluation of World Wide Web-based Lessons for a First Year Dental Biochemistry Course

First year dental students at The University of Texas Dental Branch at Houston (Dental Branch) are required to take a basic biochemistry course. To facilitate learning and allow student self-assessment of their progress, WWW-based lessons covering intermediary metabolism were developed as a supplement to traditional lectures. Lesson design combined text, graphics, and animations and included learner control, links to other learning resources, and practice exercises and exams with immediate feedback. Results from an on-line questionnaire completed by students in two different classes showed that they completed 50% of the lessons and spent an average of 4 hrs. online. A majority of the students either agreed or strongly agreed that practice exercises were helpful, that the ability to control the pace of the lessons was important, that the lesson structure and presentation was easy to follow, that the illustrations, animations, and hyperlinks were helpful, and that the lessons were effective as a review. The very positive response to the WWW-based lessons indicates the usefulness of this approach as a study aid for dental students.

Tips on searching the internet for medical information

Searching for references is part of everyday life in medicine. Since the arrival of the Internet, it has provided great promise for clinicians because of its ready provision of access to large amounts of knowledge and information. But because of the overload of information, searching for particular information has now become a tedious time-consuming and frustrating task. This article describes effective ways, tips, tools, detailed search techniques and strategies for searching for medical information. It also lists some useful resource and database sites that can help in the search for accurate information.

The internet and the world wide web: applications for family physicians in saudi arabia

The introduction of the World Wide Web has revolutionized the applications of the computer and the Internet in the medical field. The Web provides an easy and cost-effective way of retrieving medical information and a more flexible way of communicating with patients and colleagues. Family practice is a specialty in which care is given to persons as individuals and members of families regardless of their age, gender or specific problems. To provide quality family practice, a family physician should be a good communicator, a critical thinker, a resource and information manager, a life-long learner, a care giver and a community advocate. Providing such high quality care requires that family practice be an information-sensitive specialty. However, the expansion of the new electronic resources on the Internet and the Web poses a real challenge to the family physician. Family physician in Saudi Arabia need to have basic skills and knowledge for easily retrieving and finding reliable Internet information for his professional development and the care of his patients. This article addresses the Web applications for family physicians in Saudi Arabia, giving examples of the most important Websites.

World Wide Web for Crystallography

Some characteristics of the World Wide Web (WWW) and its Virtual Library (W3VL) are described. Aspects of the setting up, maintenance, future development and objectives of the World Wide Web Virtual Library: Crystallography are detailed. An overview of the successful use of WWW in the organisation of two crystallographic conferences and one entirely electronic conference is given. A revolution in scientific publication is under way with the introduction of WWW and CD-ROM technologies and a few of the points important to crystallography are touched upon. An application to distance teaching in crystallography is described. There is no mention of WWW applications to crystallographic databases in this paper as others at the Workshop have adequately described their work.

Electronic Publishing and the Journals of the American Chemical Society

The American Chemical Society is developing a number of initiatives that implement emerging electronic technologies in order to provide a broad range of products and services to members and subscribers. Examples of products currently available, or under development, for access via the World Wide Web include supporting information for journals, electronic ads, color graphics and entire journals. Other activities employ e-mail, CD-ROMs, and softcopy text.