Internetquestion and answer (iQ&A): a web-based ... - IEEE Xplore

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InternetQuestion and Answer (iQ&A): A Web-Based Survey Technology Robert A. Dennis and Sanjiv S. Gambhir

Abstract—This paper presents InternetQuestion and Answer, a Web-based survey development and implementation technology, which has been designed for constructing on-line surveys for educational, medical, or administrative purposes. The system, called iQ&A, is a three-tiered database-backed Web system that has been developed to support a wide range of applications. Surveys are considered as general data collection instruments and include a wide field of application. iQ&A facilitates rapid survey construction and administration which is ideally suited for biomedical research as well as other research and educational activities. Full report management capabilities provide the survey publisher on-line access to current information on survey responses. Current implementations of this technology in the areas of biomedical applications of clinical trials, longitudinal research, and other research-related systems are presented. Further refinement of the current system should lead to a powerful general survey technology for broadbased applications. Index Terms—Database systems, research systems, survey technology, Web software.

I. INTRODUCTION HE Interactive Media Group of the Crump Institute for Biological Imaging began to utilize the World Wide Web (WWW) to deliver instructional content shortly after the hypertext transmission protocol (http) supplanted gopher as the primary Internet technology. In early 1996, we began to take advantage of database-backed Web technology to add interactivity, and particularly online assessments, to the instructional units we had been developing for undergraduate and medical education and delivering via the WWW. It quickly became apparent to us that we needed a general mechanism for building online selected-response tests and questionnaires, as these were a common request from the original information providers that we were supporting. We therefore began to design and program a test-building component for a Web-based authoring suite called the Interdisciplinary Collaborative Environment for the Development of Training and Educational Applications (Iced_Tea).1 At about the same time, we began work on developing a prostate cancer patient/physician decision support system for helping patients and physicians better understand patient options in the management of newly diagnosed prostate cancer.2

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Manuscript received May 14, 1999; revised November 7, 1999. This work was supported in part by the Ahmanson Foundation and the Association for the Cure of Cancer of the Prostate (CaP Cure). The authors are with the Crump Institute for Biological Imaging, UCLA School of Medicine, Los Angeles, CA 90095-1770 USA. Publisher Item Identifier S 1089-7771(00)03953-4. 1[Online]. 2[Online].

Available: http://laxmi.nuc.ucla.edu:8888 Available: http://prostate.crump.ucla.edu:8008

It was clear to us that what we were calling a test builder should be generalized to support the business (transaction) logic and the kind of question sets that made up the Prostate Cancer Decision Support system. The key capability missing from our early versions of a test builder was support for dynamic branching, or contingency. The term “contingency” is used in the context of a survey or a questionnaire to refer to dynamic ordering of questions that are presented to respondents. The set of questions that are presented to a respondent can be dynamically determined based upon responses to previous questions. By incorporating contingency into the authoring and back-end portions of the system, we found we could accommodate the operational requirements of decision support systems and also take simple online tests to a more sophisticated “interactive” level, sometimes referred to as adaptive testing [1], [2]. Since each set of answered questions is submitted back to a server, and the server communicates with a relational database management system (RDBMS), the basic architecture with which to accommodate our goal of adding support for contingency was available. The list of possible applications of Web-based surveys is extremely broad. This is partially due to a loose interpretation looking over or upon with a purpose of of a survey as “ reporting the results” (Webster New International Dictionary 2nd Edition). In this broad sense of the notion of a “survey,” any hypertext markup language (HTML) form that solicits input from respondents can be considered a survey. Assuming this definition, some examples of Web-based surveys include: employer/employee satisfaction questionnaires, student applications and application-tracking reports, end of chapter tests, product registrations, personnel performance reviews, patient demographic information forms, product order forms, compatibility and profile matching (dating services), patient satisfaction forms, etc. The list of the purposes to which html forms can be put is very large. The capability to interactively branch through a set of questions contingent upon each respondent’s replies brings new and exciting potential to a basic capability. However, taking advantage of this potential has been difficult and costly. In this paper, we present an overview of our work in developing a general and flexible database-backed Web system that manages the construction, data collection, and reporting of HTML form-based surveys. The paper begins with a short review of currently available survey products and their limitations. We then look at the current state of Web-based survey technologies and their limitations. We briefly present the architecture and design of our system and its advantages over existing systems. We present several specific examples of the application of

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DENNIS AND GAMBHIR: INTERNETQUESTION AND ANSWER (iQ&A): A WEB-BASED SURVEY TECHNOLOGY

iQ&A, and we conclude with a discussion of our current work, goals, and the directions we anticipate taking in the near future. Computer-based surveys are not new. There have been many different products that allow one to develop a survey and then print it out, conduct a phone interview, or send it to respondents via email (for example, see [3], [4]). Most recent efforts have been to move survey-building software applications toward the WWW. The extent to which these products take advantage of the Internet varies from simple exporting to HTML format [5], [6], to more sophisticated applications that address complexities like skip patterns based on survey responses [7]. However, most of these products lack tight integration with a back-end relational database and they are awkward fits at best with the Web. There are several Web-based survey systems that currently exist [8], [9]. The 2WAY system3 is a combination of a Windows 32-bit client executable program that handles survey authoring and a three-tiered Web-based system for the deployment of surveys [8], [10]. A respondent of 2WAY surveys uses a web browser. On the client side, 2WAY makes use of JavaScript to accomplish navigation and limited error-checking. On the server side of a 2WAY system are an http server and Microsoft’s SQL Server version 6.5. Between these two components sits the 2WAY server that incorporates all the business logic and report management. The 2WAY server is written in C/C++ and interoperates with any http server using the common gateway interface (CGI). Communications between the 2WAY server and MS-SQL is through an Open Database Connectivity (ODBC) connection. A complete 2WAY system requires Windows NT, and it is not available for UNIX platforms. Another new system that attempts to take advantage of the Web is Quiz Studio [11]. Quiz Studio is a Java-based client–server system.4 Tests and surveys are authored using a Java application. A separate application is used to manage users and groups and other administration policies. Tests are taken using a Java-enabled web browser. The test or surveys appear in an applet window. The test taking Applet supports a wide range of question types, and it allows for some interesting drag-and-drop capabilities. The Applet uses Java 1.1 and therefore does not run on all platforms. For example, it will not run on a Macintosh system using Netscape Navigator. Additionally, the performance of the Applet is slow, and the response time is sluggish. There is an initial delay at the beginning while the Applet downloads. On slower connections, this becomes a limiting issue. A future version is promised that supports contingency, but at the time of our review the most current version did not appear to have this powerful capability. An additional drawback to Quiz Studios is its lack of support for offline use. Since all tests are administered using applets, a network connection is a requirement. II. iQ&A GENERAL ARCHITECTURE iQ&A is a client–server system that is best described as a database-backed web application (see Fig. 1). The basic architectural model of iQ&A is a three-tiered client–server system. On the client side are forms expressed in HTML and rendered by 3[Online]. 4[Online].

Available: http://www.2way.tm Available: http://www.quizstudio.com

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Fig. 1. The client–server architecture of iQ&A. A survey author uses a Web browser to set up and publish a survey. Others respond to the survey using a Web browser. Also depicted is the architecture of the iQ&A server. Requests for an HTML page come in to the server from clients. The server answers the request. If the page has embedded TCL scripting code in it, the server parses the code before sending the document back to the client. A page may also request information from the database or post information into the database.

a web browser running on a respondent’s computer (the client). On the back-end are the http server, the database server, and a TCL interpreter and application programming interface (API) that executes all the business logic as well as brokers communication between the two servers. The database and the http server can reside on the same physical computer, or they can be run on separate computers. The web (http) server at the heart of iQ&A is the freely available AOLserver. America Online (AOL) bought the original company, NaviSoft, which was the developer of a software product called NaviServer in 1996. AOL currently uses AOLserver as the heart of its online web hosting business, as well as for www.aol.com, one of the highest traffic sites on the Internet today. The AOLserver is a fast multithreaded web server. It has C and Tcl API’s that allow for rapid application development and the construction of dynamic pages that can query a database. An additional advantage of the AOLserver is the availability of source code. The source has been released to the public domain and is available at aolserver.lcs.mit.edu. III. RELATIONAL DATABASE LINKAGE The most powerful aspect of the AOLserver is its tightly integrated database capabilities. Connections to databases are pooled and managed by AOLserver, so that setup and takedown of connections are fast and efficient. In addition, the proxy daemon (for a nonthread-safe RDBMS like Sybase) and the Tcl API allow for development of the business logic of a web-based application to be abstracted from the specifics of a particular RDBMS. Many of the most popular RDBMS’s are supported, for example, Oracle, Sybase, Informix, MS-SQL, Postgres, and Borland’s Interbase. The AOLserver is one of the most flexible, powerful, and extensible web application development environments available on any platform [12], [13]. The iQ&A system has evolved from a functional proof-of-concept system first developed in the fall of 1996. As work on iQ&A has progressed, we have had to face different

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Fig. 2. The basic user interface of iQ&A as viewed in Netscape. Across the top are the controls. Shown along the left is a listing of the user’s private collection of questions. The user browses the collection and then “adds” an item to the currently active section. In this figure, the user is working on a survey called “Lung Cancer” and the visible question is being added to the “demographics” section.

limitations and constraints with the various database products we have used, for example, reliability and cost. With the growth of interest in the free UNIX-like Linux operating system, many database companies have released free or inexpensive versions of their products. Sybase has made available for free the Adaptive Server version 11.03.3 for Linux. We have ported iQ&A to Sybase. However, since the free version of Sybase for Linux does not include management tools, we have had to turn to third party applications. We use DBArtisan from Embarcadero Software.5 iQ&A is entirely web-based. All interactions are conducted using a web browser. Authors set up, publish, manage, and view reports of surveys using a web browser (see Fig. 1). A survey in our system consists of one or more sections (pages) with one or more items (questions) in each section. Work within iQ&A normally begins with setting up a databank of questions. Questions are stored in the database and organized in author-specified collections. The iQ&A system was designed to allow questions to be easily reused and, in certain cases, shared across authors. Many question types are supported: radio buttons, check boxes, select lists, text boxes, and text areas. There are also several special purpose item types (e.g., a date item and file upload item). Additionally, each question in an author’s collection can be associated with an image, animation, or any object that a browser can display. 5[Online].

Available: http://www.embarcadero.com

Once a set of questions with possible responses has been authored, preparation of a survey is trivial. A new survey is created with a click of a button and a specification of a unique title for the survey. By default, the author is provided with an empty section (a blank page) to which to add questions. Questions are “added” to a section, and a survey author can add new sections at any time (see Fig. 2). The order of questions within a section, and the order or sections within a survey can easily be sorted using a graphical sorting tool (see Fig. 3). When the content and structure of the survey are determined, it is “published” to the web. Publishing a survey requires that the author select a template that will specify the look and format of the final survey. Once a survey is published, it exists as HTML pages. A survey can be published so that respondents are required to login before proceeding, or it can be an anonymous survey with no login requirements. Once a survey is published and data are associated with it, it cannot be altered. If changes are required, the survey must be duplicated, modified, and then published again. We are adding supports in iQ&A for carrying forward data that are common across altered forms of a survey. Any published survey can have one or more reports associated with it. Reports are active HTML pages. When a report is accessed, the current state of the data are reported. A report can present any combination of the questions presented in a survey. When a report is set up, the author can select from a number of different graphic representations (e.g., bar charts,

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Fig. 3. The iQ&A item sorting interface. This is a dynamic HTML page. The user can move a question with a click-and-drop motion. A question can be moved around within a section, or it can be moved to a different section. Sections can also be reordered. In this example, the demographics section has been expanded, revealing the question items that make up this section.

column charts, pie charts, line charts, or numeric tables). Charts are dynamically generated images. On the iQ&A back-end, a Java servlet is passed data and parameters for labels and legends, and it returns a gif-encoded image which is sent back to the client’s browser. Reports are treated like all iQ&A objects. Reports are stored in the author’s reports directory. An iQ&A author can create new subdirectories and move reports around according to any filing schema. When a report is viewed, it is presented in a new browser window (see Fig. 4). An advanced feature of iQ&A is support for contingent branching between pages in a survey. Contingency allows our system to support an additional class of applications, such as adaptive testing, interactive performance-based instruction, and decision support systems, etc. This one feature represents the defining capability that distinguishes online database-backed systems from static paper-based data collections and simple HTML forms that merely accept data and return a fixed reply. Dynamic branching in a survey is authored using a custom set of interfaces. Fig. 5 shows the iQ&A dynamic branching authoring interfaces. Each page within a survey has a default“next” page. In a survey with no dynamic branching, this default next section determines the ordering of pages. However, when the next page of a survey is contingent upon a respondent’s answers to one or more questions in the current (or previous) pages(s), then the default next section is only invoked when none of the

defined response patterns are encountered. We call the key questions that determine the flow of pages “branching items.” The first step in authoring a dynamic branching survey is specifying the branching questions. Branching points can be either within an item or between item combinations. For example, a survey author can specify that a respondent who indicates she is a woman and has an immediate relative who has had breast cancer should be taken to a specific set of questions and information (i.e., a different section than other respondents). In this example, the branching item would actually be a combination of two actual survey questions. The survey author must identify all the response patterns of interest using the interfaces depicted in Fig. 5. One additional feature we support is the delay of a branching event. By specifying that a branching event is to occur after some subsequent section, a survey author can build a survey where the branching is tied to some response pattern to some question in the front part of a survey but is delayed until further into the survey. In this way, a branching item can be made up of questions from several different sections in a survey. This capability allows for the authoring of a great many different branching and skip patterns. In addition to the capabilities outlined above, iQ&A has considerable support for and control over the management of surveys. Management of surveys refers to control over the programmatic uses to which surveys are put. A number of these

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Fig. 4. An iQ&A generated report page. The author can select which questions from a survey are to be included in a report, as well as the representation (i.e., bar chart, line graphs, etc.).

features are presented below in the context of real systems developed using iQ&A, but it is worth noting the more general ones here. For the purpose of administering and managing the context (i.e., the project) in which surveys are taken, iQ&A has a general mechanism for specifying a sequence of surveys that are to be presented to a group of users. There is a users and groups manager that handles users’ login names and passwords. iQ&A has a general scheduling manager that monitors when each member of a group is due to respond to a survey. There is also a messaging manager that handles automated email reminders that are sent out to users who are due to respond to a particular survey. Various standard reports are maintained concerning the status of each respondent who is part of the project. There is also a general field notes component for use in research settings. Field notes are miscellaneous text that is related to members of a project. Some examples of the way in which field notes can be used in iQ&A-based systems are to record patient–researcher contacts or teacher notes regarding student performance. IV. PLATFORM REQUIREMENTS The iQ&A system relies upon the freely available AOLserver version 2.3. The capabilities upon which iQ&A depends are the AOLserver’s Tcl API and database proxy daemons. Beginning with version 2.2, the AOLserver is only available for UNIX platforms, and the popular Linux OS is supported. We run the AOLserver on Sun Sparc, Dec Alpha, and Intel-based Linux

computers, but other platforms are supported as well. We also run a number of databases on NT and connect to these using database proxy daemons. This allows us to use AOLserver on UNIX but still take advantage of certain RDBMS’s that are only available for Windows, such as MS-SQL 6.5. Setup of the system is straightforward. The AOLserver comes with an installation script. Once the install is complete, a bootstrap program will launch a startup server that is used to configure and create all virtual servers. The AOLserver allows multiple virtual web servers to run on a single computer, each listening on different network interfaces or port addresses. All administration of the http server and the iQ&A system is accomplished via web pages. The database server can be a process running on the same physical computer or on a completely different platform. With the database server up and running, feeding the iQ&A data model to the server either directly or via the AOLserver will generate the iQ&A table structure. Finally, the iQ&A interface and business logic are all contained in special active HTML pages and a package of registered procedures. These files need to be copied over to an appropriate directory. For someone with a little experience with UNIX administration, the entire setup can be accomplished in about an hour. If both the http server and the database server are run on the same computer, the amount of RAM installed in the computer should be increased. Since the density/price ratio of RAM continues to improve, adding more memory is a cost-effective solution to improving performance. Depending upon the amount

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Fig. 5. The dynamic branching section of the sorter. Using these interfaces, a survey author can specify the branching that will occur based upon a survey respondent’s answers to key questions, called branching items. In this example, there are two branches, one in section 1 and one in section 2. Based upon a person’s answers to the branching item in section 1, he will be taken to either section 2a or 2b.

of stored data, it has often been possible for us to hold an entire database in RAM allowing for very fast read access. In general, we have come to prefer running both the AOLserver and the database server on Intel-based computers using the Linux OS. This allows us to assemble very high-performance systems very inexpensively. We still run a couple of databases on Windows NT; however, we see little reason to prefer this situation. In the future, we will most probably run all our servers on computers running Linux OS. V. iQ&A INTERFACE ISSUES All users of the iQ&A system, both authors and respondents, work entirely within a web browser. Certain functionality of iQ&A is achieved with dynamic HTML (DHTML), and thus

a minimum requirement is a 4.x version of either Microsoft’s Internet Explorer (IE) or Netscape’s Communicator. The implementation of DHTML is different in these two browsers, but the capabilities are roughly equal. We conduct our development and testing with Netscape’s Communicator and then go back and redo programs to work under IE. The iQ&A system is essentially a database-backed web service that relies upon client–server communications. However, we have encountered research situations where Internet connectivity has not been available. There are times when information must be collected from subjects in settings where connectivity is not available, for example, in consultation rooms at hospitals. To accommodate these situations, we have added some limited “offline” options to published surveys. We refer to these situations as off-line data collections. When a survey is published for

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offline use, we prepare for download to the client’s computer client-side JavaScript programs that allow for data to be temporarily stored on the client’s hard drive. When network access becomes available, all collected data are uploaded to the iQ&A server in batch. All issues of unique ID’s are appropriately handled such that data collection of the online version of the survey can occur simultaneously with offline collections without worry of ID conflicts or data loss. VI. EDUCATIONAL APPLICATIONS iQ&A began as a test builder for use in instructional settings and as part of a more general authoring suite (Iced_Tea). Much of the design decisions and requirements come from this foundation. For example, in educational environments, questions are very often reused in alternative forms of tests. Teachers often prepare several versions of a test that may have a number of common questions. The emphasis in iQ&A is on reuse of questions and ordered sets of questions across many tests. The iQ&A interface is built around the concept of a collection of questions that become associated with a survey. Some general questions that get reused often in educational settings are the course and instructor evaluation questions. These questions are available to all authoring users of iQ&A. The course and instructor evaluation questions are stored in a “public” library of questions. Since iQ&A began as a simple test builder, it is quite well suited for the assembling, administering, and reporting of tests and questionnaires. However, the system has grown in capability and is now a very sophisticated web-based application development environment. It has implications beyond its early beginnings. One immediate implication for education is adaptive testing. VII. ADMINISTRATIVE APPLICATIONS We consider any HTML form to be a survey. The iQ&A system is indifferent to the purpose of the survey and the meaning of the data it collects, manages, and reports. In our own department, we have used iQ&A in administrative settings. One example is our faculty search survey. Our department was accepting applications for a junior-level faculty position in Medical Imaging. In order to facilitate internal reviews by current faculty members, a survey was set up and published allowing an administrative assistant to input all information received from applicants. Once all the resumes, letters of recommendation, and application forms were input into an iQ&A survey, it was easy for reviewers to visit a report and supply feedback regarding their choices of the best candidates. More recently, we have begun to shift the application procedure for the graduate degree programs in molecular and medical pharmacology over to an iQ&A-based system. In the future, applicants will apply online by filling out a set of iQ&A-generated “surveys.” VIII. DETAILS OF SPECIFIC IMPLEMENTATIONS With each application of iQ&A beyond simple questionnaires, opinion polls, and administrative uses, we have

discovered new opportunities to enhance and extend the system. We present two special purpose systems that we have developed around iQ&A. Development of these systems has brought new capabilities to the iQ&A system. What was accomplished through considerable custom coding for these special purpose systems is now part of the standard features and authoring options of iQ&A.

IX. LONGITUDINAL RESEARCH One example of the application of iQ&A comes from a medical research setting. The Quality-of-Life (QoL) study is an ongoing longitudinal study that seeks to fill a gap in knowledge of cancer patients’ quality of life following treatment for prostate [14]–[16]. This study examines how the treatment of prostate cancer affects patients’ self-reported perceptions of the quality of life of themselves and their families using a repeated measures research design [14]. The most important physical effects of prostate cancer treatment are on urinary, sexual, and bowel functions. However, prostate cancer and its various treatments also have a tremendous effect on a patient’s emotions, stress level, family relationships, and social interactions. In order to uncover this important information, patients treated for early stage prostate cancer are invited to participate in the study. Once a patient has consented to participant, and they have chosen (in consultation with their doctors) their treatment, they are asked to fill out a questionnaire. This is done on a computer, with the help of a research assistant (RA), using an offline-published version of an iQ&A survey. The same questionnaire is then presented to participants at specific time intervals over a two-year period to see how their quality of life changes, and how quickly they return to their pretreatment baseline quality of life. Patients are encouraged to participate by completing the questionnaires online. Those who agree to participate online are sent automated email reminders each time they are due to respond to a questionnaire. Most patients participate using coded paper copies of the questionnaire, and then one of the RA’s enters the data into the QoL research management system. There are currently 182 patients participating, and 18 patients are replying online. iQ&A was modified to meet the needs of this research effort. Specifically, we added a general mechanism to create a longitudinal study by specifying a string of published surveys. A string of surveys can be either repeated administrations of a single questionnaire or it can be any arbitrary sequence of different tests or surveys. In this way, iQ&A can be used to manage the administration of a formal course of study as well as many different kinds of research projects. In addition to general support for longitudinal data collection, we added a host of management features for tracking compliance and scheduling administration. We added an alert manager to handle automated email reminders. To support the RA’s role in research, we added a field notes component that manages all study-related notes and events, such as phone conversations, and relates these events to both the patient and the RA. Fig. 6 shows the RA’s administration page. Each of these links is a function or a report to which RA’s have direct one-click access.

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Fig. 6. Shown are several pages of the adminstrator side of the QoL research system. The Survey Status report page (center) lists all active patients’ schedules and whether they have responded to each of the nine surveys that make up this study.

X. MEDICAL TECHNOLOGY ASSESSMENT A second example of the use of iQ&A is a system developed for conducting biomedical research related to new technology assessment. In this application of iQ&A, we have worked with nuclear medicine physicians to design surveys that help to understand the utilization of positron emission tomography (PET) in the management of various cancer patients [17], [18]. This technology is rapidly expanding as an imaging tool that helps to diagnose and manage cancer patients. In this application of iQ&A, it is desirable to understand the referral patterns for PET and the impact this new technology has on better managing patients. The survey is a set of questions which helps to delineate: 1) why the PET scan is being ordered; 2) the disease state of

the individual patient; 3) the results of the PET scan; 4) results of other tests performed on the patient; 5) the surgical or medical management of the patient; and 6) the final outcome(s) for the patient. The survey in this case is in part taken by the physician(s) referring the patient for the PET study and in part by the physician(s) performing the PET study. The patient is not directly involved in this survey. Through ongoing use of this system over the last 6 months, it has been possible to understand the significant impact that PET is having on the management of various cancers. Online reporting allows continued tracking of the impact of PET in cancer management. Further refinement of this particular application of iQ&A should lead to flexibility for applications in which several individuals fill out portions of the same survey.

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XI. SOLUTIONS OFFERED BY iQ&A There are a growing number of survey-service providers on the Internet. It is clear that more people and enterprises are taking advantage of the WWW as a medium in which to conduct inquiry and research. General-purpose products that support such work have begun to appear. However, the field is still young and the few commercially available products all have limitations and drawbacks. To our knowledge, contingency remains a challenge to most systems. Commercial products, like 2WAY, have an appealing polish and are excellent solutions for simple questionnaires and surveys, but for more sophisticated applications the only answer is custom programming. Another limitation is platform support. For example, 2WAY has chosen to support the PC platform exclusively for survey authoring and management. While the PC is the predominant platform, a significant number of people use Macintosh or Unix computers. Quiz Studio holds cross-platform promise, but Java is still unevenly supported within browsers. Quiz Studio, for example, does not run on a Macintosh using the latest Netscape browser. Clearly, the safest approach is to stay within the capabilities of a web browser. iQ&A does not have the same weaknesses as those cited above. iQ&A was designed and engineered to support sophisticated branching through a multipage survey. We have developed a flexible and powerful set of interfaces for specifying branching patterns. To accomplish the authoring of dynamic branching, we have stayed within straight HTML. iQ&A is an HTML-based application. iQ&A works on any platform that can run a 4.0.x version web browser. Another important strength of iQ&A is its emphasis on reuse of questions and sets of questions. One does not need to setup every question with each new survey. Many questions in a typical survey are common items that can be reused, such as name and email address. Since setting up questions does take some additional effort, this can be a true timesaving aspect. All questions that each iQ&A author creates and uses in a survey are stored for reuse in a private collection. In addition to each author’s private collection, all authors have access to a public collection of questions and sections. This aspect of the system provides an element of collaboration and sharing between members. An additional aspect of iQ&A that is an area of important strength is the architecture and software upon which it is built. The core of iQ&A is a freely available web application development environment. This makes iQ&A easy to extend, modify, and improve. The iQ&A relational data model can be implemented in many different RDBMS’s. Although all our current work is with Sybase and Oracle8i, iQ&A could be set up and run using a free relational database such as Postgres.6 XII. DISCUSSION AND FUTURE WORK The bulk of our current work with iQ&A surrounds organized and programmatic uses to which surveys are put: for example, longitudinal research, and other clinical trials. iQ&A has grown from being an easy-to-use survey and test builder into a full-featured research project authoring and management system. We 6[Online].

Available: http://db.cs.berkeley.edu

are concentrating on robustness, ease of use, and thoughtful integration of the various enhancements derived from the various applications we have developed. With each application of iQ&A to a project environment like the two cases presented above, we have improved and enhanced the system. The area of iQ&A that remains in need of further development attention is reporting. iQ&A lacks sophisticated interactive reporting capabilities. We have been reluctant to pursue complex statistical analysis capabilities. We have, however, added data exporting support for both SAS and SPSS data file formats. The need for more flexible online reporting is clear. One example of where iQ&A is lacking is the capability to define a variable for reporting purposes that is a composite of several questions from a survey. One area of work we see ourselves actively pursuing in the near future is adaptive testing. The uniquely simple contingency authoring support feature of iQ&A will allow us to quickly assemble adaptive tests [2]. We currently do not store item difficulty or item response theory parameters, but this would be a simple addition to the iQ&A data model. In addition, we will continue to develop decision support systems like the Prostate Cancer Decision Support system. XIII. CONCLUSIONS We have developed and tested an Internet-based survey technology with potential for wide-based applications in education, administration, and bio-medical research. iQ&A is a flexible software system capable of running on many different UNIX server platforms with various different back-end databases. The simplicity of survey construction and publishing, WWW access to published surveys with an Internet browser, and powerful online report capabilities provide a unique environment in which to construct, administer, and analyze surveys for various applications. Continued refinement of iQ&A should lead to an even more powerful system with a large array of applications. ACKNOWLEDGMENT The authors wish to thank members of the Interactive Media Lab of the Crump Institute for Biological Imaging for their contributions to this work. They thank T. Hong and K. Huang for their programming efforts and G. Lacson and P. Zaslov for their design and graphic contributions. They also thank Dr. M. Litwin, Dr. J. Banderis, and I. Chand for their support and contributions to the Quality of Life system. The authors are especially grateful to Dr. M. E. Phelps for his support and guidance. REFERENCES [1] H. Wainer, Computerized Adaptive Testing: A Primer. Hillsdale, NJ: Erlbaum Associates, 1990. [2] N. S. Petersen, Computerized Adaptive Testing: From Inquiry to Operation , 1st ed, W. A. Sands, B. K. Waters, and J. R. McBride, Eds. Washington, DC: Amer. Psycholog. Assoc., 1999. [3] J. P. Mello, “Survey software automates electronic polling,” PC World, vol. 14, p. 78, 1996. [4] T. Powell, “Do-it-yourself survey software,” Marketing Computers, vol. 16, p. 30, 1996. [5] B. Simon, “Two ways to take stock,” PC Magazine, vol. 17, p. 73, 1998. [6] S. Borden, “Poll your customers the easy way,” Computer Shopper, vol. 17, p. 452, 1997.

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[7] M. Kramer, “These results just in,” PC Week, vol. 14, p. 39, 1997. [8] M. Hammond, “2Way enables Web customer feedback,” PC Week, p. 26, Nov. 15, 1998. [9] M. Heck, “Survey package gives polling flexibility; decisive software establishes dialogue via e-mail, Web site,” InfoWorld, vol. 19, p. IW2, 1997. [10] D. Drucker, “Software enables interactive surveys (Mazda North America uses 2Way’s 2Way Enterprise Suite,” InternetWeek, p. 22, Nov. 1, 1999. [11] M. Heck, “Quiz studio conducts distance test taking and polls,” InfoWorld, vol. 20, p. 78, 1998. [12] P. Greenspun, Philip and Alex’s Guide to Web Publishing. San Francisco, CA: Morgan Kaufmann, 1999. , Database Backed Web Sites: The Thinking Person’s Guide to Web [13] Publishing. Emeryville, CA: Ziff-Davis, 1997. [14] M. S. Litwin, A. I. Shpall, F. Dorey, and T. H. Nguyen, “Quality-of-life outcomes in long-term survivors of advanced prostate cancer,” Amer. J. Clin. Oncol., vol. 21, pp. 327–332, 1998. [15] M. S. Litwin, R. D. Hays, A. Fink, P. A. Ganz, B. Leake, G. E. Leach, and R. H. Brook, “Quality-of-life outcomes in men treated for localized prostate cancer [see comments],” J. Amer. Med. Assoc., vol. 273, pp. 129–135, 1995. [16] M. S. Litwin, J. T. Fine, F. Dorey, R. A. Figlin, and A. S. Belldegrun, “Health related quality of life outcomes in patients treated for metastatic kidney cancer: A pilot study,” J. Urol., vol. 157, pp. 1608–1612, 1997. [17] M. E. Phelps, “PET: A biological imaging technique,” Neurochem. Res., vol. 16, pp. 929–940, 1991. [18] C. K. Hoh, C. Schiepers, M. A. Seltzer, S. S. Gambhir, D. H. Silverman, J. Czernin, J. Maddahi, and M. E. Phelps, “PET in oncology: Will it replace the other modalities?,” Seminars in Nuclear Medicine, vol. 27, no. 2, pp. 94–106, Apr. 1997.

Robert A. Dennis was born in Hollywood, CA. He received the B.S. degree in philosophy from the University of California at Santa Cruz and the M.A. and Ph.D. degrees in educational psychology from the University of California Los Angeles (UCLA). He is currently the Co-Director of the Interactive Media Group at the Crump Institute for Biological Imaging in the Department of Molecular and Medical Pharmacology at the UCLA School of Medicine. His research interests center around interactive educational technology. He has conducted research in mathematical modeling of cognitive structures for the purpose of driving online instruction; and other approaches to computerized scoring of various online performance assessments. Furthermore, he has research interests in database design and development to support online research systems and Internet-based decision support tools. Prior to joining the Crump Institute, he was a Project Director at the National Center for Research on Evaluation, Standards, and Student Testing (CRESST), a research and development center funded by the Office of Educational Research and Improvement of the Department of Education.

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Sanjiv S. Gambhir was born in Ambala, India. He received the B.S. degree in physics from Arizona State University, the Ph.D. degree in biomathematics, and the M.D. degree from the Medical Scientist Training Program at the University of California Los Angeles (UCLA). He is currently an Assistant Professor in the Department of Molecular and Medical Pharmacology at the UCLA School of Medicine. He is Co-Director of the Communication/Computational Sciences Division of the Crump Institute for Biological Imaging. He also has a joint appointment in Biomathematics and is a clinical attending in Nuclear Medicine. His research interests center around mathematical modeling in positron emission tomography (PET) and functional magnetic resonance imaging. He is developing new assays for imaging gene expression in vivo using PET. Furthermore, he has research interests in multimedia educational tool development including Internet-based decision support tools. Dr. Gambhir has received numerous honors including Summa Cum Laude in Physics, Phi Beta Kappa, The UCLA Alumni Association Gold Medal Outstanding Graduate Student Award, UCLA Graduate Distinguished Scholar Award, Mary Lenora Schulte Award, Dr. Ursula Mandel Award, Edith & Carl Lasky Memorial Award, National Institutes of Health (NIH) Medical Scientist Fellowship, NIH Systems & Integrative Biomathematics Training Grant, and the Alexander Hollaender Fellowship from the Department of Energy.