ObjectivesThe training of physicians, nurse examiners, social workers and other health professional on the evidentiary findings of sexual abuse in children is challenging. Our objective was to develop peer reviewed training cases for medical examiners of child sexual abuse, using a secure web based telehealth application (TeleCAM).MethodsSixty de-identified cases developed by 2 child abuse pediatricians, were stratified by availability of information (minimal, moderate, comprehensive) for both positive and negative child sexual abuse findings. These cases were narrowed to a set of 30 cases through an expert peer review process using pediatricians with extensive expertise in the evaluation of child sexual abuse. A previously studied secure web-based telehealth application TeleCAM which contains a child abuse workflow, was used to develop, disseminate and review cases. A series of Free Margin agreement statistics are used to select those cases with the highest rates of agreement. A final set of 30 cases are stratified equally by availability of information and for both positive and negative findings. Mantel Haenszel Chi-square was used for trend analysis of the ordered categorical variables.ResultsThe highest degrees of inter-rater reliability was found in cases with moderate to comprehensive information. Cases with minimal data had poor kappa agreement indicating that availability of differing levels and types of information contribute to variability in diagnostic findings.ConclusionThese final cases will be further studied with medical examiners in various settings utilizing TeleCAM as the application for dissemination.

Web-based technologies are changing the face of traditional telehealth applications by providing cost-effective clinical data capture and sharing Solutions. Access to medical images in coordination with clinical workflow and face-to-face technologies can integrate clinical service delivery, diagnosis, and treatment across geographic, disciplinary, and organizational boundaries. For example, medical images are used for a variety of put-poses and range in their complexity from a simple digital photograph of it physical mass taken by a primary care provider to a magnetic resonance image (MRI) reviewed by a radiologist that might describe the details of the mass; to a histopathology slide that a pathologist might use to diagnose the malignancy of the mass. Each of these images is managed by separate domain-specific information systems which are often located in technology silos and are constrained by disciplinary, organizational, and geographic barriers.TeleCAM is a telehealth information system that provides a standards-based technological infrastructure for the collection. storage, and display of digital images via the web. Aggregating images across domains, workflow, time, and geographies can greatly enhance clinical collaboration, diagnostic efficiencies, continuity of care, and ultimately patient care outcomes. This chapter will provide a short review of the history of telemedicine and describe in detail the technological specifications, (features, and management strategies of a web-based Solution. Several clinical applications will also be described in order to visualize the full capacity of this web-based solution.

Approximately 1 million children are physically or sexually abused each year in the United States. Accurate diagnosis of these children and subsequent extensive legal intervention requires a thorough clinical assessment as well as legal documentation. A Web-based application developed for the remote sharing of child maltreatment assessment among multiple child protection providers is presented. Usability data was collected from medical personnel at three remote Utah Children's Advocacy Centers (CACs) and one urban tertiary children's hospital. Qualitative findings are summarized and satisfaction differences are reported between remote sites and their referral tertiary center.

The methods for authoring and distributing course content are undergoing substantial changes due to advancement in computer technology. Paper has been the traditional method to author and distribute course content. Paper enables students to personalize content through highlighting and note taking but does not enable the incorporation of multimedia elements. Computers enable multimedia content but lack the capability of the user to personalize the content. Therefore, we investigated TK3 eBooks as a potential solution to incorporate the benefits of both paper and computer technology. The objective of our study was to assess the utility of TK3 eBooks in the context of authoring and distributing dermatology course content for use by second-year medical students at the University of Utah School of Medicine during the spring of 2004. We incorporated all dermatology course content into TK3 eBook format. TK3 eBooks enable students to personalize information through tools such as “notebook,” “hiliter,” “stickies,” mark pages, and keyword search. Students were given the course content in both paper and eBook formats. At the conclusion of the dermatology course, students completed a questionnaire designed to evaluate the effectiveness of the eBooks compared with paper. Students perceived eBooks as an effective way to distribute course content and as a study tool. However, students preferred paper over eBooks to take notes during lecture. In conclusion, the present study demonstrated that eBooks provide a convenient method for authoring, distributing, and using course content but that students preferred paper to take notes during lecture.

It is challenging to remotely share generic medical case information without an agreed upon definition of a medical digital teaching file (DTF). By utilizing an application of the extensible markup language (XML) called web-distributed data exchange (WDDX) along with an agreed upon WDDX structure, it is technically easy to share or syndicate medical case DTFs across computing environments that use different information models and computer languages. Thus, this easily implemented technology offers us an immediately available means to share and increase the value of scientific knowledge.

PURPOSE:To foster a community supported evaluation processes for open-source digital teaching file (DTF) development and maintenance. The mechanisms used to support this process will include standard web browsers, web servers, forum software, and custom additions to the forum software to potentially enable a mediated voting protocol. The web server will also serve as a focal point for beta and release software distribution, which is the desired end-goal of this process.CONCLUSIONS:We foresee that www.mdtf.org will provide for widespread distribution of open source DTF software that will include function and interface design decisions from community participation on the website forums.

The purpose of this study was to investigate more fully the shape and content of ribbons and synapses to second-order neurons in the short-wavelength cone (S-cone, blue cone) pedicle and to learn more concerning the uniqueness of the S-cone system in the primate retina.A piece of well-fixed peripheral human retina (10 mm, 35 degrees nasal to the fovea) was serially thick sectioned in the tangential plane from the level of the outer segments to the tops of the cone pedicles. Then serial electron microscope (EM) sections were collected through the whole depth of the pedicle-occupying region into the neuropil of the outer plexiform layer (OPL). The resultant EM micrograph montages of a large field of cone pedicles were perused, and S-cone pedicles were identified. Serial micrographs of a single S-cone pedicle, picked out of the montages, were digitized and reconstructed by computer three-dimensional methods.The S-cone pedicle arose from a slightly oblique axon and projected 0.5-1 mu m more vitread in the OPL than other cone pedicles. It was bilobed in shape, with synaptic invaginations and ribbons in both lobes. No cone-contacting telodendria projected from the S-cone pedicle itself, but a small number of neighboring cones sent telodendria to its surface to make small gap junctions. Neighboring rod spherules also made small gap junctions. Four robust bipolar cell dendrites, most likely from S-cone-specific bipolar cells, made synapses at ribbons and basal (distal) junctions. A small number of other bipolar cell dendrites made narrow-cleft. basal junction only. The majority of lateral elements were thought to be from HII horizontal cells, and a minority from HI horizontal cells.We conclude that the S-cone pedicle has a unique morphology and connectivity to second-order neurons that makes it quite different from the other two longer wavelength cone systems, and we speculate on the consequences for color processing in the visual system in general. (C) 1997 Wiley-Liss, Inc.

Pseudo-3-dimensional models and surface renderings of a small group of neighboring cone pedicles in the turtle retina, in which the 5 different spectral types are represented, have been made from scanned serial electron micrographs using a Macintosh personal computer, Autocad and Studio Pro software. The resultant computer generated images clarify the morphological differences between the spectral types and show how they are related to each other via telodendrial connections and different levels of ending in the neuropil of the outer plexiform layer (OPL). The double cone pedicles end highest in the neuropil and the single red and green pedicles lie slightly lower into the OPL with the single blue and ultraviolet (UV)-sensitive cone pedicles coming in from obliquely angled axons to assume positions between the others much more vitread in the OPL. Telodendria interconnect the double and single red and green cones but not the blue and UV-sensitive cones.

In this paper we describe the morphology of the different spectral types of photoreceptor pedicles ii the outer plexiform layer (OPL) of the Pseudemys turtle as studied by light (LM) and electron microscopy (EM). Tangential serial thick sections were cut from the oil droplet region to the level where the axons emerge from cell bodies and then serial thin sections through the axons and the entire pedicles were collected and examined. Thus photoreceptor pedicles could be identified by tracing cells from their oil droplets to their synapses in the OPL. Double cone pedicles consisted of closely applied pairs with the principal member's pedicle wrapping around the accessory member's pedicle. Each pedicle was approx. 104 μm2 in area and contained 12 and 8 synaptic ribbons respectively. Rods comprised 8% of the pedicles in the field, were small (84μm2), contained closely packed synaptic vesicles, and on average, 9 long ribbons. Single red and green cone pedicles could not be told apart without following them from their oil droplets, however, both were about the same size (106–127μ2) and contained 10–12 ribbons. Blue cone pedicles were small and round (80/gmm2) and arose from short oblique axons giving off from large, greenish, clear oil droplet-containing cell bodies (13% of the corne population). The least common pedicle types (5% of the cone population) were identified tentatively as UV cones because they originated from small, clear oil droplet-containing cell bodies. UV cones had spherical pedicles, elongated in the vertical axis, that arose from extremely long, angled axons Their very small pedicles (64 μm2) exhibited characteristic “horns” that projected from the top sides of the pedicle. Both putative UV and blue cone pedicles ended more vitread in the OPL than other pedicles and contained only 5–6 and 8–10 ribbons respectively. Understanding the ultrastructural features that distinguish the different types of photoreceptor pedicle will allow us to begin a study of spectral connections to second order neutrons in the turtle OPL in the future.