Total-body digital X-ray in trauma. An experience report on the first operational full body scanner in Europe and its possible role in ATLS

When patients enter our emergency room with suspected multiple injuries, Statscan provides a full body anterior and lateral image for initial diagnosis, and then zooms in on specific smaller areas for a more detailed evaluation. In order to examine the possible role of Statscan in the management of multiply injured patients we implemented a modified ATLS((R)) algorithm, where X-ray of C-spine, chest and pelvis have been replaced by single-total a.p./lat. body radiograph. Between 15 October 2006 and 1 February 2007 143 trauma patients (mean ISS 15+/-14 (3-75)) were included. We compared the time in resuscitation room to 650 patients (mean ISS 14+/-14 (3-75)) which were treated between 1 January 2002 and 1 January 2004 according to conventional ATLS protocol. The total-body scanning time was 3.5 min (3-6 min) compared to 25.7 (8-48 min) for conventional X-rays, The total ER time was unchanged 28.7 min (13-58 min) compared to 29.1 min (15-65 min) using conventional plain radiography. In 116/143 patients additional CT scans were necessary. In 98/116 full body trauma CT scans were performed. In 18/116 patients selective CT scans were ordered based on Statscan findings. In 43/143 additional conventional X-rays had to be performed, mainly due to inadequate a.p. views of fractured bones. All radiographs were transmitted over the hospital network (Picture Archiving and Communication System, PACS) for immediate simultaneous viewing at different places. The rapid availability of images for interpretation because of their digital nature and the reduced need for repeat exposures because of faulty radiography are also felt to be strengths.

Inverse thermodilution with conventional pulmonary artery catheters for the assessment of cerebral, hepatic, renal, and femoral blood flow

Assessment of regional blood flow changes is difficult in the clinical setting. We tested whether conventional pulmonary artery catheters (PACs) can be used to measure regional venous blood flows by inverse thermodilution (ITD). Inverse thermodilution was tested in vitro and in vivo using perivascular ultrasound Doppler (USD) flow probes as a reference. In anesthetized pigs, PACs were inserted in jugular, hepatic, renal, and femoral veins, and their measurements were compared with simultaneous USD flow measurements from carotid, hepatic, renal, and femoral arteries and from portal vein. Fluid boluses were injected through the PAC's distal port, and temperature changes were recorded from the proximally located thermistor. Injectates of 2 and 5 mL at 22 degrees C and 4 degrees C were used. Flows were altered by using a roller pump (in vitro), and infusion of dobutamine and induction of cardiac tamponade, respectively. In vitro: At blood flows between 400 mL . min-1 and 700 mL . min-1 (n = 50), ITD and USD correlated well (r = 0.86, P < 0.0001), with bias and limits of agreement of 3 +/- 101 mL . min-1. In vivo: 514 pairs of measurements had to be excluded from analysis for technical reasons, and 976 were analyzed. Best correlations were r = 0.87 (P < 0.0001) for renal flow and r = 0.46 (P < 0.0001) for hepatic flow. No significant correlation was found for cerebral and femoral flows. Inverse thermodilution using conventional PAC compared moderately well with USD for renal but not for other flows despite good in vitro correlation in various conditions. In addition, this method has significant technical limitations.

Kostenorientiertes Controlling von E-Learning-Plattformen mit dem TCO-Konzept

Zur administrativen Unterstützung von Lehr- und Lernprozessen werden E-Learning-Plattformen eingesetzt, die auf der Grundlage des Internet Funktionen zur Distribution von Lehr- und Lernmaterialien und zur Kommunikation zwischen Lehrenden und Lernenden anbieten. Zahlreiche wissenschaftliche Beiträge und Marktstudien beschäftigen sich mit der multikriteriellen Evaluation dieser Softwareprodukte zur informatorischen Fundierung strategischer Investitionsentscheidungen. Demgegenüber werden Instrumente zum kostenorientierten Controlling von E-Learning-Plattformen allenfalls marginal thematisiert. Dieser Beitrag greift daher das Konzept der Total Cost of Ownership (TCO) auf, das einen methodischen Ansatzpunkt zur Schaffung von Kostentransparenz von E-Learning-Plattformen bildet. Aufbauend auf den konzeptionellen Grundlagen werden Problembereiche und Anwendungspotenziale für das kostenorientierte Controlling von LMS identifiziert. Zur softwaregestützten Konstruktion und Analyse von TCO-Modellen wird das Open Source-Werkzeug TCO-Tool eingeführt und seine Anwendung anhand eines synthetischen Fallbeispiels erörtert. Abschließend erfolgt die Identifikation weiterführender Entwicklungsperspektiven des TCO-Konzepts im Kontext des E-Learning. Die dargestellte Thematik ist nicht nur von theoretischem Interesse, sondern adressiert auch den steigenden Bedarf von Akteuren aus der Bildungspraxis nach Instrumenten zur informatorischen Fundierung von Investitions- und Desinvestitionsentscheidungen im Umfeld des E-Learning.

Changing the Face of Traditional Education

At large, research universities, a common approach for teaching hundreds of undergraduate students at one time is the traditional, large, lecture-based course. Trends indicate that over the next decade there will be an increase in the number of large, campus courses being offered as well as larger enrollments in courses currently offered. As universities investigate alternative means to accommodate more students and their learning needs, Web-based instruction provides an attractive delivery mode for teaching large, on-campus courses. This article explores a theoretical approach regarding how Web-based instruction can be designed and developed to provide quality education for traditional, on-campus, undergraduate students. The academic debate over the merit of Web-based instruction for traditional, on-campus students has not been resolved. This study identifies and discusses instructional design theory for adapting a large, lecture-based course to the Web.

E-Learning 2.0 in hydraulic engineering education

In this contribution the experiences with e-Learning 2.0 applications by using a Wiki for the education in hydraulic engineering are shown. Up to now important information for the students has been prepared by the instructor. For this project the students were asked to collaborate and search on their own for the information they needed. Therefore a Wiki-system was used. For the engineering practice a self dependent realisation of tasks is an important requirement which students should be prepared for. With the help of online communication there should be shown the possibilities for students for working together in an interdisciplinary team. The positive experiences as well as the results of the evaluation of this project plead for a continuation of the application of e-Learning 2.0 for education. The comparison of results of tests without using Wiki and with using Wiki shows a qualitative tendency of better marks. In this contribution we present the application of Wiki in hydraulic engineering but the results can also be used for other engineering disciplines.

Integriertes Informationsmanagement für Bildungseinrichtungen

Der CampusSource Workshop fand vom 10. bis 12. Oktober 2006 an der Westfälischen Wilhelms Universität (WWU) in Münster statt. Kernpunkte der Veranstaltung waren die Entwicklung einer Engine zur Verknüpfung von e-Learning Anwendungen mit Systemen der HIS GmbH und die Erstellung von Lehr- und Lerninhalten mit dem Ziel der Wiederverwendung. Im zweiten Kapitel sind Vorträge der Veranstaltung im Adobe Flash Format zusammengetragen. Zur Betrachtung der Vorträge ist der Adobe Flash Player, mindestens in der Version 6 erforderlich

aXess: an authoring tool for XML content management

The use of XML for representation of eLearning-content and for automatic generation of different kinds of teaching media from this material is with all its advantages nowadays stateof-the-art. In the last years there have been numerous projects that leveraged XML-based production environments. At the end of the financial advancement the created materials have to be maintained with limited (human) resources. In the majority of cases this is only possible, if the authors care for their teaching material without extensive IT-support. From our point of view there has so far been a lack of intuitive usable XML editors. The prototype of such an XML editor “aXess” is introduced with the intention to encourage a broad discussion about the required features to manage the content of eLearning-materials.

Accessible e-learning

People with disabilities often encounter difficulties while trying to learn something, because teaching material is for example not accessible to blind people or rooms, where courses take place, are not accessible to people using a wheelchair. E-learning provides an opportunity to disabled people. With the new German law on the equalisation of opportunities for people with disabilities for the first time access to information technology was explicitly taken up in German legislation. As a consequence of this law the framework law on universities (Hochschulrahmengesetz) was changed. The law now commit universities not to discriminate disabled students in their studies. For references on how universities can design accessible e-learning contents and provide accessible information online see http://wob11.de/links/anleitungen.html#elearning.

MetaCampus REAL – ein europäischer Marktplatz für E-Learning Leistungen

This article addresses the discussion about open source solutions in the e-learning business. In contrast to critics by commercial suppliers this article comes to different conclusions. On the one hand such a discussion seems to be useless in this early state of the e-learning market. On the other hand solutions without costs might have a strong influence of which commercial suppliers could profit as well.

MetaCampus REAL – a European Marketplace for Lifelong Learning

This article addresses the discussion about open source solutions in the e-learning business. In contrast to critics by commercial suppliers this article comes to different conclusions. On the one hand such a discussion seems to be useless in this early state of the e-learning market. On the other hand solutions without costs might have a strong influence of which commercial suppliers could profit as well.

Multi-Channel-Learning (MCL)

Lerneinheiten müssen stark variierenden Anforderungen gerecht werden. Neben unterschiedlichen Lerntypen spielen vor allem auch die Umfeldbedingungen eine wesentliche Rolle, in denen Lernprozesse stattfinden. Faktoren wie z. B. die Tagesform führen letztlich dazu, dass nicht einmal für eine einzelne Person konstante Lernpräferenzen herrschen. Mit diesem Beitrag wird vorgeschlagen, zur Lösung des Problems einer Mehrkanalstrategie zu folgen. Allerdings sind spezifische Eigenschaften von Learning-Content-Systemen (LCS) notwendig, um ein sog. Multi-Channel-Learning (MCL) zu ermöglichen. Diese Eigenschaften werden im Beitrag anhand von Informationsmodellen beschrieben werden. Sie sollen als Referenzmodell dienen, das sowohl bei der Entwicklung als auch bei der Auswahl und Anpassung von LCS hilfreich sein kann. Das Referenzmodell wird deduktiv abgeleitet und anhand praktischer Anwendungen geprüft. Vorgestellt werden sowohl Anwendungs- als auch Organisationssysteme, die nach dem Modell realisiert worden sind. Auf dieser Grundlage kann schließlich eine Nutzenabschätzung des Modells für das Multi-Channel-Learnings vorgenommen werden.