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PubMed1998

The current and future role of the Internet in patient education.

The Internet technology known as the World Wide Web is rapidly emerging as the most powerful medium of mass communication this century and it can be harnessed to dispense global, cost-effective, high-quality, multimedia patient education material. This paper reviews how the Internet has progressed from delivering simple static, text-based material to sophisticated interactive Web sites based on CGI Technology. Interactive Web sites can be used to deliver health assessment questionnaires and Web-based decision-support systems can give patients advice on the emergency management of acute medical problems. The advantages and drawbacks of this new technology, including information regulation and quality are discussed. The role of the Hospital Intranet as a patient education resource is described. The paper concludes by illustrating how patients can appreciate the 3-D structure of bones and organs using virtual reality in a VRML Web environment.

Decision Support Techniques↗
PubMedDate not supplied

Medical emergency aid through telematics: design, implementation guidelines and analysis of user requirements for the MERMAID project.

MERMAID is an EU financed telemedicine project with global reach and 24-h, multilingual capability. It aspires to provide a model for the provision of health care services based on the electronic transmission of medical information, via ISDN based videoconferencing. This model will not be limited to medical diagnostics but it will encompass all cases where the actual delivery of health care services involves a patient who is not located where the provider is. Its implementation requires the commissioning of an expensive telecommunications infrastructure and the exploration of a number of solutions. In fact, all categories of telemedical applications (audio and video conferencing, multimedia communications, flat file and image transfer with low, medium and high bandwidth data requirements) are considered while the full range of network choices (digital land lines, cellular/wireless, satellite and broadband) are being tested in terms of cost/performance tradeoffs that are inherent to them and the developmental stage each of these options occupies in their in its life cycle. Finally, out that MERMAID utilises advanced land based line transmission technologies to aid the remote patient by making available the specialist care that is best suited in the particular case.

Computers↗
PubMedDate not supplied

Current and future models for nursing e-journals: making the most of the Web's potential.

We are presently witnessing an increasing number of nursing, medical and health-related electronic journals (e-journals) being made available on the World Wide Web, a minority of which are specifically devoted to informatics. We would expect, given the potential of interacting multimedia and computer-mediated communications (i.e. telematics), to also see an increasing diversity of models, but this is not currently the case. Following a brief discussion of some of the issues relevant to electronic publications, the authors present a taxonomy of current nursing e-journal models, including discussion of some examples from around the world that fall into categories within this taxonomy. We describe the model and levels of usage of one particular e-journal, Nursing Standard Online. Some of the issues presented may account for the current relative paucity of high quality content and innovative models in the development of Web-based e-journals for nurses and other health professionals. We believe it likely that nursing e-journals using current models will need to be specialist rather than generalist if they are to attract a larger audience. In concluding our paper, we advocate the development of innovative and increasingly interactive nursing e-journals as the way forward, discussing one particular model which holds promise.

Classification↗
PubMed1999

Curriculum for building medical resources on the Internet--experience in Taiwan.

This paper describes our experience with a one-semester course on how to build a medically-related homepage on the Internet, designed for fourth-year medical students. Based on the assumption of limited technical knowledge of the Internet, this class taught students Internet-exploring skills, multimedia authoring and HTML (Hypertext Markup Language) in the first eight-week period. Students were then divided into four-person teams and asked to select a topic for a homepage. These teams were then asked to collect the necessary resources for the development of the homepage both through individual work and, consultation with an advisor. Each group project for building medically-related homepage was accomplished and presented in the remaining four-week period. The resultant projects of these fourth-year medical students were of surprisingly good content and high quality. Medical students rapidly learned to use the software tools, and through proper instruction and provision of equipment, they were able to build significant medical resources on the Internet that can potentially be useful in education, clinical applications and research.

Curriculum↗
PubMedDate not supplied

Use of a computerized kiosk in an assessment of food safety knowledge of high school students and science teachers.

A multimedia touch-screen kiosk was used to assess food safety knowledge and convey food safety principles to 93 high school science teachers and 165 students. The kiosk program based on the FightBAC messages informed users of correct responses and reasons for the response. Teachers correctly answered more questions than students; however, for the areas of hand washing, sources of foodborne illness, and handling of leftover foods, at least 40% of both students and teachers provided incorrect answers.

Adolescent↗
PubMed2005

Lehigh Valley Hospital: engaging patients and families.

BACKGROUND: Lehigh Valley Hospital (LVH), a 623-bed tertiary care referral center, is one of two hospitals of the Lehigh Valley Hospital and Health Network. PATIENT AND FAMILY INVOLVEMENT: Improving patient safety requires active engagement. Many units have collaborative rounds, which family members may join. Family meetings often include multimedia sources to review patient conditions, results, and plans of care. LVH's advanced intensive care unit program allows virtual meetings with an off-site intensivist. USE OF INFORMATION TO SET AND EVALUATE QUALITY GOALS AND PRIORITIZE INITIATIVES: The Institute of Medicine (IOM) aims of care are addressed in terms of Donabedian's clinical outcomes (safety, effectiveness, and timeliness), financial outcomes (efficiency), and service outcomes (patient-centeredness and equity). APPROACH TO ADDRESSING THE SIX IOM AIMS: Two strategies to address the IOM's six aims have been employed--patient engagement and an emphasis on technology. More than $30 million has been invested, thereby creating a digital hospital, which, in combination with evidence-based practice, uses advanced computerized and wireless systems to improve patient care and safety. CHALLENGES AND LESSONS LEARNED: New problems evident once process improvements are made are quickly addressed. Technology cannot fix bad processes; rather, process improvements should come first, with technology then added to enhance those improvements.

Family↗
PubMedDate not supplied

Evaluation of an experimental chemistry preprint server.

A preprint is a research article made publicly available prior to formal publication. A preprint server is a freely available archive and distribution medium for preprints, allowing rapid dissemination and use of multimedia and supporting files. Electronic eprints have been widely adopted in certain fields (notably high energy physics), but, until recently, the preprint concept has not been received with enthusiasm by most chemists. Despite the fact that preprints have the advantage of rapid publication, chemists have been reluctant to produce them because they could be viewed as "unallowable" for research assessment or tenure exercises or for publication in certain prestigious journals. In theory, preprints, together with version control and online discussion, could be a useful compromise: rapid prepublication followed by open peer review, before publication in a traditional journal. This paper constitutes a preliminary evaluation of a Chemistry Preprint Server in its second year of operation and summarizes the lessons that can be learned from the experiment to date.

Journal Article↗
PubMed2002

The air-sea equilibrium and time trend of hexachlorocyclohexanes in the Atlantic Ocean between the Arctic and Antarctica.

Hexachlorocyclohexanes (HCHs) were determined simultaneously in air and seawater during two cruises across the Atlantic Ocean between the Arctic Ocean (Ny-Alesund/ Svalbard, 79 degrees N; 12 degrees E) and the Antarctic Continent (Neumayer Station/ Ekstroem Ice Shelf, 70 degrees S; 8.2 degrees W) in 1999/ 2000. The concentrations of alpha-HCH and gamma-HCH in air and surface waters of the Arctic exceeded those in Antarctica by 1-2 orders of magnitude. The gaseous concentrations of gamma-HCH were highest above the North Sea and between 20 degrees N and 30 degrees S. Fugacity fractions were used to estimate the direction of the air-sea gas exchange. These showed for alpha-HCH thatthe measured concentrations in both phases were close to equilibrium in the North Atlantic (78 degrees N-40 degrees N), slightly undersaturated between 30 degrees N and 10 degrees S and again close to equilibrium between 20 degrees S and 50 degrees S. Y-HCH has reached phase equilibrium in the North Atlantic as alpha-HCH, but the surface waters of the tropical and southern Atlantic were strongly undersaturated with y-HCH, especially between 30 degrees N and 20 degrees S. These findings are significantly different from two earlier estimates around 1990 as a result of global emission changes within the past decade. Therefore, we investigated the time trend of the HCHs in the surface waters of the Atlantic between 50 degrees N and 60 degrees S on the basis of archived samples taken in 1987-1997 and those from 1999. A decrease of alpha-HCH by a factor of approximately 4 is observed at all sampling locations. No decrease of gamma-HCH occurred between 30 degrees N and 30 degrees S, but there was a decrease in the North Atlantic, North Sea, and in the South Atlantic south of 40 degrees S. The constant level of gamma-HCH in the tropical Atlantic confirms the conclusion that the tropical Atlantic acts as a sink for y-HCH at present time. The measured alpha-HCH seawater concentrations were compared with results from a global multimedia fate and transport model. Whereas the time trend over 13 years and the latitudinal gradient were well reproduced by the model, the absolute levels were too high by a factor of 4.5. This may be explained by the zonal averaging employed in the model as well as uncertain emissions and degradation rates.

Air Pollutants↗
PubMed2002

Including transformation products into the risk assessment for chemicals: the case of nonylphenol ethoxylate usage in Switzerland.

A method for applying the risk assessment approach using ratios of predicted environmental concentrations (PECs) and predicted no-effect concentrations (PNECs) to mixtures of parent compounds and their environmental transformation products is presented. Nonylphenol ethoxylates (NPnEOs) and a selection of their most relevant transformation products are investigated as a case study illustrating the method. The PEC values of NPnEO and its transformation products are calculated with a regional multimedia fate model including the transformation kinetics of the NPnEO degradation cascade. PNEC values are derived from a selection of toxicity data on NPnEO and its transformation products. The toxicity of the emerging mixture of NPnEO and its transformation products is then estimated under the assumption of concentration addition (similar mode of action). On this basis, PEC-to-PNEC ratios for the aquatic environment and the sediment are calculated for the individual components of the mixture and the mixture itself. For this purpose, average release rates of NPnEO and its transformation products from Swiss sewage treatment plants were used. While the PEC values of the individual components do not exceed the corresponding PNEC values, the risk quotient of the mixture in water is greater than 1. In sediment, the mixture does not exceed a risk quotient of 1. A combination of sensitivity and scenario analyses is employed to identify the upper and lower bounds of the results.

Animals↗
PubMed2003

Fate modeling of phenanthrene with regional variation in Tianjin, China.

A multimedia fate model with spatially resolved air and soil phases was developed and evaluated. The model was used for calculation of phenanthrene concentrations in air, water, soil, and sediment in Tianjin area and transport fluxes between the adjacent bulk phases under steady-state assumption. Both air and soil phases were divided into 3113 individual compartments of 4 km2 each to assess the spatial variation of phenanthrene concentrations and fluxes. Independently measured phenanthrene concentrations in air, water, and soil were used for model validation. The spatial variation in soil was validated using a set of measured phenanthrene concentrations of 188 surface soil samples collected from the area. Most data used either for model calculation or for model validation were collected during the last 5 years. As the results of the model validation, the calculated mean values for phenanthrene concentrations in various bulk phases are in fair agreement with those independently observed and are very close to those calculated using the model without spatial variation. The absolute difference between the calculated and the measured mean concentrations are 0.14, 0.48, and 0.13 log-units (mol/m3) for air, water, and soil, respectively. The spatial distribution patterns of phenanthrene in both air and soil were well modeled. Spatially, however, the model overestimated the soil phenanthrene level at low concentration range and underestimated it at high concentration range. The calculated distribution of phenanthrene in the air matches well with the emission from fossil fuel combustion, while the calculated distribution pattern in the soil is similar to that observed.

China↗
PubMed2002

The influence of vertical sorbed phase transport on the fate of organic chemicals in surface soils.

Gaseous exchange between surface soil and the atmosphere is an important process in the environmental fate of many chemicals. It was hypothesized that this process is influenced by vertical transport of chemicals sorbed to soil particles. Vertical sorbed phase transport in surface soils occurs by many processes such as bioturbation, cryoturbation, and erosion into cracks formed by soil drying. The solution of the advection/diffusion equation proposed by Jury et al. to describe organic chemical fate in a uniformly contaminated surface soil was modified to include vertical sorbed phase transport This process was modeled using a sorbed phase diffusion coefficient, the value of which was derived from soil carbon mass balances in the literature. The effective diffusivity of the chemical in a typical soil was greater in the modified model than in the model without sorbed phase transport for compounds with log K(OW) > 2 and log K(OA) > 6. Within this chemical partitioning space, the rate of volatilization from the surface soil was larger in the modified model than in the original model by up to a factor of 65. The volatilization rate was insensitive to the value of the sorbed phase diffusion coefficient throughout much of this chemical partitioning space, indicating that the surface soil layer was essentially well-mixed and that the mass transfer coefficient was determined by diffusion through the atmospheric boundary layer only. When this process was included in a non-steady-state regional multimedia chemical fate model running with a generic emissions scenario to air, the predicted soil concentrations increased by upto a factor of 25,whilethe air concentrations decreased by as much as a factor of approximately 3. Vertical sorbed phase transport in the soil thus has a major impact on predicted air and soil concentrations, the state of equilibrium, and the direction and magnitude of the chemical flux between air and soil. It is a key process influencing the environmental fate of persistent organic pollutants (POPs).

Adsorption↗
PubMed2003

Temperature dependence of the characteristic travel distance.

The effect of temperature variation on the environmental fate of organic chemicals can be evaluated in steady-state multimedia box models by expressing chemical partitioning data and reaction rate coefficients as functions of temperature. Using such a modelthetemperature dependence of the characteristic travel distance in air L(A), which is a measure for the atmospheric long-range transport potential of organic chemicals, is calculated. Simulations are reported for a set of 40 chemicals of environmental interest. Increasing temperature is shown to have two opposing effects on L(A). Rates of chemical transformations in the atmosphere (k(air)) and surface media are increased, which reduces L(A). Rates of atmospheric deposition (k(dep)) are reduced leading to increased mobility and L(A). Accordingly, L(A) can monotonically increase or decrease with increasing temperature, or it can have a maximum in the modeled temperature range, but it cannot have a minimum. For chemicals with a strong temperature dependence of k(air) relative to k(dep), L(A) will increase with increasing temperature. Results for selected polychlorinated biphenyls are compared to monitoring data yielding qualitative agreement when chemical properties are adjusted to mean temperatures for the measurement period. The results demonstrate that the temperature dependence of the characteristic travel distance is highly dependent on chemical characteristics and can be counterintuitive. The use of mass balance models is thus essential. The difference between the L(A) values at 5 degrees C and 30 degrees C can be up to a factor of 6. Accordingly, chemical ranking with respect to L(A) can change significantly if performed at different temperatures. Implications of the different temperature dependencies on long-range transport to polar regions are discussed.

Air Movements↗
PubMed2004

Simulating the influence of snow on the fate of organic compounds.

Snow scavenging, a seasonal snowpack, and a dynamic water balance are incorporated in a non-steady-state generic multimedia fate model in order to investigate the effect of snow on the magnitude and temporal variability of organic contaminant concentrations in various environmental media. Efficient scavenging of large nonpolar organic vapors and particle-bound organic chemicals by snow can lead to reduced wintertime air concentrations and incorporation in the snowpack. The snow cover functions as a temporary storage reservoir that releases contaminants accumulating over the winter during a short melt period, resulting in temporarily elevated concentrations in air, water, and soil. The intensity of these peaks increases with the length of the snow accumulation period. Organic chemicals of sufficient volatility (log KOA < 9; e.g., light polychlorinated biphenyls) can volatilize from the snowpack, resulting in springtime concentration maxima in the atmosphere. The behavior of fairly water-soluble chemicals during snowmelt depends on their relative affinity for the newly formed liquid water phase and the rapidly diminishing ice surface-quantitatively expressed by their interface-water partition coefficient (KIW). Chemicals with a preference for the dissolved phase (low KIW; e.g., pentachlorophenol) can become enriched in the first meltwater fractions and experience a temporary concentration peak in lakes and rivers. Organic chemicals that are neither volatile enough to evaporate from the snowpack nor sufficiently water soluble to dissolve in the meltwater (e.g., polybrominated diphenyl ethers) sorb to the particles in the snowpack. These particles may be sufficiently contaminated to constitute the major input route to the terrestrial environment upon release during snowmelt. Because wintertime deposition to the snowpack may be higher than to a non-snow covered surface, this can result in higher soil concentrations of persistent organic contaminants in the long term. The potential ecotoxicological significance of peak exposures demands a better understanding of the role of snow in the fate of organic contaminants.

Environmental Monitoring↗
PubMed2004

Measures of overall persistence and the temporal remote state.

The overall persistence, Pov, has been suggested as an indicator that integrates single media half-lives and phase partitioning. However, the application of this indicator is hindered by the fact that there are different definitions of Pov and that the most common measure of Pov, the residence time at steady state, depends heavily on the release pattern. Here, different measures are compared that can be used to compute Pov from the mass of a chemical in the environment as a function of time in a dynamic multimedia model. These measures include the equivalence width, which corresponds to the residence time at steady state, the mean value of the function of mass vs time ("mean time"), and the clearance time. The temporal remote state is defined as the state of the model system long after the stop of emissions; it is independent of the release pattern of a chemical. The mean time in the temporal remote state reflects the long-term removal rate of a chemical and is used as a persistence benchmark. Correlations of the three measures of Pov to the persistence benchmark are analyzed. The maximum equivalence width, which is obtained with release to one of the media air, water, or soil, is a good approximation of the mean time in the temporal remote state. Because the maximum equivalence width is identical to the maximum residence time at steady state, the mean time in the temporal remote state can be estimated with existing steady-state models.

Environmental Monitoring↗
PubMed2004

European-scale modeling of concentrations and distribution of polybrominated diphenyl ethers in the pentabromodiphenyl ether product.

The results from a modeling exercise utilizing the European variant (EVn) BETR multimedia environmental fate model are presented for selected polybrominated diphenyl ethers (PBDEs) of the technical penta- (Pe-) bromodiphenyl ether (BDE) product. The objectives of this study were to test PeBDE emission estimates from the literature for Europe by investigating the consistency between model predictions and ambient measurements to address the ability of the model to predict spatial variability and differences between congeners. Concurrently sampled and analyzed passive sampling air data, together with soil and grass data, were used as key model validation tools. The model steady-state simulations gave generally good agreement with measured data for BDE-47 and -99 with greater discrepancies for heavier congeners (e.g., BDE-153). To predict future atmospheric concentration trends, the model was used in its fully dynamic mode over the period 1970--2010. It was predicted that atmospheric concentrations peaked around 1997, declining with an overall "disappearance" half-life of 4.8 years. Soil and grass levels were underestimated by the model; possible reasons for differences with measurement data are further explored. Finally, the importance of temporally and spatially resolved environmental data sets is highlighted, while improved quantification of degradation half-lives is essential to better understand and predict the behavior of BDE congeners in PeBDE.

Air Pollutants↗
PubMed2004

Adaptation of fugacity models to treat speciating chemicals with constant species concentration ratios.

A "multiplier" method is developed by which multimedia mass balance fugacity models designed to describe the fate of a single chemical species can be applied to chemicals that exist as several interconverting species. The method is applicable only when observed ratios of species concentrations in each phase are relatively constant and there is thus no need to define interspecies conversion rates. It involves the compilation of conventional transformation and intermedia transport rate expressions for a single, selected key species, and then a multiplier, Ri, is deduced for each of the other species. The total rate applicable to all species is calculated as the product of the rate for the single key species and a combined multiplier (1 + R2 + R3 + etc.). The theory is developed and illustrated by two examples. Limitations of the method are discussed, especially under conditions when conversion rates are uncertain. The advantage of this approach is that existing fugacity and concentration-based models that describe the fate of single-species chemicals can be readily adapted to estimate the fate of multispecies substances such as mercury which display relatively constant species proportions in each medium.

Environmental Pollutants↗
PubMed2006

Estimating the impact of high-production-volume chemicals on remote ecosystems by toxic pressure calculation.

Although many chemicals are in use, the environmental impacts of only a few have been established, usually on per-chemical basis. Uncertainty remains about the overall impact of chemicals. This paper estimates combined toxic pressure on coastal North Sea ecosystems from 343 high-production-volume chemicals used within the catchment of rivers Rhine, Meuse, and Scheldt. Multimedia fate modeling and species sensitivity distribution-based effects estimation are applied. Calculations start from production volumes and emission rates and use physicochemical substance properties and aquatic ecotoxicity data. Parameter uncertainty is addressed by Monte Carlo simulations. Results suggest that the procedure is technically feasible. Combined toxic pressure of all 343 chemicals in coastal North Seawater is 0.025 (2.5% of the species are exposed to concentration levels above EC50 values), with a wide confidence interval of nearly 0-1. This uncertainty appears to be largely due to uncertainties in interspecies variances of aquatic toxicities and, to a lesser extent, to uncertainties in emissions and degradation rates. Due to these uncertainties, the results support gross ranking of chemicals in categories: negligible and possibly relevant contributions only. With 95% confidence, 283 of the 343 chemicals (83%) contribute negligibly (less than 0.1%) to overall toxic pressure, and only 60 (17%) need further consideration.

Ecosystem↗
PubMed2006

Empirical and modeling evidence of the long-range atmospheric transport of decabromodiphenyl ether.

Understanding of the long-range atmospheric transport (LRT) behavior of decabromodiphenyl ether (BDE-209) is still limited. Most existing model-based approaches to assessing an organic chemical's potential for LRT have assumed invariant environmental conditions, even though many factors impacting on the atmospheric residence time are known to vary considerably over a variety of time scales. Model estimates of LRT also suffer from limited evaluation against observational evidence. Such evidence was sought from dated sediment cores taken from lakes along a latitudinal transect in North America. BDE-209 was generally detected only in recent sediment horizons, and sedimentation fluxes were found to decline exponentially with latitude. The empirical half-distance (EHD) for BDE-209 derived from surface flux data is approximately half that of the sigmaPCBs. A dynamic multimedia fate and transport model provides further insight into the temporal variability of processes that control LRT for BDE-209 and PCBs. The variability of precipitation, and in particular, the occurrence of time periods without precipitation coinciding with strong winds, influences the LRT potential of chemicals that combine a sufficiently long atmospheric half-life with very low volatility. Likewise, the forest filter effect may be important for a wider range of chemicals than believed previously, because models assuming constant precipitation fail to account for the impact of differences in dry deposition on days without rain. Chemicals that are both sorbed to particles and potentially persistent in the atmosphere, such as BDE-209, may have a larger potential for LRT than anticipated on the basis of earlier model evaluations. Still, the EHDs illustrate that the model seems to underestimate atmospheric loss processes of potential significance to BDE-209, illustrating the need to critically compare predictions of LRT against observations. Processes that need to be understood better in order to improve predictions of LRT for BDE-209 include particle dry deposition, precipitation scavenging, and photolysis in the sorbed state.

Air Movements↗