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Researchers, instructional designers and consumers of ALNs must be cautious when interpreting results of media comparison studies. Much of the literature purports to have found no significant difference in learning effectiveness between technology-based and conventional delivery media. This research, though, is largely flawed. In this paper, we first outline the philosophical positions of the opposing sides of an intense debate in the literature as to whether delivery media alone influence learning outcomes. We then select at random several representative media comparison studies to illustrate the inadequacy of their methodologies and conclusions. More important, we derive critical design considerations for those who evaluate or conduct media comparison research. ALN practitioners should not assume that students would learn better from technology delivery systems. Rather, ALN practitioners should adhere to time-tested instructional design strategies, regardless of the medium they choose. Learning effectiveness is a function of effective pedagogical practices. Accordingly, the question for ALN practitioners ought to be: "What combination of instructional strategies and delivery media will best produce the desired learning outcome for the intended audience?"

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If telemedicine were available to the fleet, ship medical staffs would initiate nearly 19, 000 consults in a year-7% of all patient visits. Telemedicine would enhance quality of care in two-thirds of these consults. Seventeen percent of the MEDEVACs would be preventable with telemedicine (representing 155,000 travel miles), with a savings of $4400 per MEDEVAC. If the ship's communication capabilities were available, e-mail and Internet and telephone and fax would be cost-effective on all ships (including small ships and submarines). Video teleconferencing would be cost-effective on large ships (aircraft carriers and amphibious) only. Teleradiology would be cost-effective on carriers only. Telemedicine's bandwidth requirement is small-1% of a month's time. However, if the ships' medical departments need to resort to a commercial satellite, E-mail and Internet would be the only telemedicine modality generating enough monetary benefits to offset the costs.