Elena A. Wood

Region-of-interest video coding for enabling surgical telementoring in low-bandwidth scenarios

Surgical telementoring can prove very effective in a military surgical paradigm where less experienced surgeons deployed at forward sites can be mentored by more experienced specialists from a rearward remote site, thus enhancing in-theater surgical options by bringing scarce expertise into play. However, lack of sufficient bandwidth in active military theaters limit the ability to implement real-time video communication capability, and hence render such clinically beneficial programs undeliverable. Region-of-interest (ROI) video-coding presents a possible solution to this problem. By allocating more bits to the ROI as compared to the rest of the frame (also known as background (BG)), ROI encoding of surgical videos can increase the bandwidth perceived by the telementoring application. In this paper, we introduce a flexible and interactive ROI in a low-complexity, H.264-compliant and diagnostically lossless (DL) fashion to enable remote mentoring of surgical procedures in very low-bandwidth scenarios. Further, subjective evaluations by surgeons indicate that ROI-encoded videos are preferred over the uniformly-encoded videos for the purpose of surgical evaluation and telementoring.

Assessment of Insulin Administration Methods: Perceptions by Patients and Significant Others Instrument Development.

Background and Purpose: To develop, test, and establish the validity and reliability of 4 instruments to evaluate perceptions of paired patients and patient-identified significant others to assess the impact of continuous subcutaneous insulin infusion (CSII) and multiple daily insulin injections (MDII) on diabetes management and lifestyle. Methods: Sociotechnical systems theory and the life patterns model framed the study. Four parallel survey instruments (patient CSII and MDII and significant other CSII and MDII) were developed to elicit demographic information and perceptions concerning CSII and MDII. Results: Validity and reliability were established. Conclusions: The instruments developed for this study could be adapted or used as templates in management approach impact studies of other chronic diseases. The study should be replicated with a different geographic sample.

Partnering to Analyze Selection of Resources by Medical Students for Case-Based Small Group Learning: A Collaboration between Librarians and Medical Educators

Abstract Librarians and medical educators analyzed the quality of information resources used by first- and second-year medical students in their case-based small group learning summaries. Librarians provided instruction on using library resources and gave formal feedback to students about appropriate resources for basic science and clinical questions. The team found that students used a high number of clinical and basic science journal articles and textbooks with a number of factors influencing their resource choices. The study demonstrates numerous areas where librarians can play a key role in assisting students to find and assess information to answer clinical questions.

The impact of an Emergency Medical Technician basic course prior to medical school on medical students

ABSTRACT Background: Previous research on Emergency Medical Technician (EMT) programs as an early clinical experience indicates that medical students’ confidence in patient care and team-building skills increases with participation. However, very little is known about the unplanned, long-term effects of EMT courses on medical students once they enter medical school. Objectives: This study examined the immediate outcomes produced by the month-long summer EMT course and the unplanned outcomes that students reported 1 year later. Methods: Pre/postsurveys were collected on all 25 students who graduated from the EMT course offered before their first year. These survey data were analyzed using a paired-samples t test. A subset of students (N = 14) consented to taking a survey and be interviewed on the lasting impact of their EMT experience. Interviews were conducted 10 months after the 2016 cohort completed the EMT course and at 22 months for the 2015 cohort. They were audio-recorded, transcribed, and analyzed using inductive content analysis. Results: Survey results indicated that students’ confidence in patient care and team-building skills increased significantly for all identified skills at the P < 0.05 level. Overall confidence in patient care increased 1.5 points (P = 0.001) on 1–4 Likert-type scale. Overall confidence in team-building skills increased at 0.7 points (P = 0.01). Qualitative analysis of interviews discovered four themes, including the retention and transferability of practical skills, a developed understanding of team communication, comfort with patient interactions, and the development of a framework for assessing patients’ needs. Students applied the EMT skills in various extracurricular volunteering experiences and in clinical skills courses. Conclusions: This study concludes that EMT programs have both immediate and lasting effects that seem to assist students with making sense of and navigating other learning opportunities. Specifically, EMT courses offered to students prior to their entry into medical school may help orient them to team-based health care and triaging patient care.

An application of interdependence theory to military medical research teams: Cultural noise, tradeoffs, and meaning

ABSTRACT To better manage costs and effectiveness of a team or enterprise, the organizational sciences, social sciences and medical field are seeking new theory to transform teams and enterprises with computational models of complex social behavior that create “smart” systems. We have proposed to fulfill these calls with new theory, but ours is still under development. In a field application, we studied an electronic Institutional Review Board (eIRB) operating across a large complex of military medical scientists and researchers in Department of Defense (DoD) hospitals and clinics. As part of a field study of how the eIRB has transformed processes for DoD, we completed three comparable focus groups at a small and three focus groups at a large research site, one focus group of the eIRBs system managers, and one focus group of a competing eIRB operating in DoD (the latter group results are not reviewed at this time). We found tentative support for our theory: more noise (entropy) is being generated at the small site along with less research performed; cultural noise at both sites reflected an intransigence by sites to be transformed by adopting standardized forms; and the meaning of the findings differed between the small and large sites.

Sleep and activity monitoring for Returning Soldier Adjustment Assessment

This paper describes the development of unobtrusive room sensors to discover relationships between sleep quality and the clinical assessments of combat soldiers suffering from post-traumatic stress disorder (PTSD) and mild traumatic brain injury (TBI). We consider the use of a remote room sensor unit composed of a Doppler radar, light, sound and other room environment sensors. We also employ an actigraphy watch. We discuss sensor implementation, radar data analytics and preliminary results using real data from a Warrior Transition Battalion located in Fort Gordon, GA. Two radar analytical approaches are developed and compared against the actigraphy watch estimates - one, emphasizing system knowledge; and the other, clustering on several radar signal features. The radar analytic algorithms are able to estimate sleep periods, signal absence and restlessness in the bed. In our test cases, the radar estimates are shown to agree with the actigraphy watch. PTSD and mild-TBI soldiers do often show signs of sporadic and restless sleep. Ongoing research results are expected to provide further insight.