The eClinical Care Pathway Framework: A novel structure for creation of online complex clinical care pathways and its application in the management of sexually transmitted infections.

Despite considerable international eHealth impetus, there is no guidance on the development of online clinical care pathways. Advances in diagnostics now enable self-testing with home diagnosis, to which comprehensive online clinical care could be linked, facilitating completely self-directed, remote care. We describe a new framework for developing complex online clinical care pathways and its application to clinical management of people with genital chlamydia infection, the commonest sexually transmitted infection (STI) in England.Using the existing evidence-base, guidelines and examples from contemporary clinical practice, we developed the eClinical Care Pathway Framework, a nine-step iterative process. Step 1: define the aims of the online pathway; Step 2: define the functional units; Step 3: draft the clinical consultation; Step 4: expert review; Step 5: cognitive testing; Step 6: user-centred interface testing; Step 7: specification development; Step 8: software testing, usability testing and further comprehension testing; Step 9: piloting. We then applied the Framework to create a chlamydia online clinical care pathway (Online Chlamydia Pathway).Use of the Framework elucidated content and structure of the care pathway and identified the need for significant changes in sequences of care (Traditional: history, diagnosis, information versus Online: diagnosis, information, history) and prescribing safety assessment. The Framework met the needs of complex STI management and enabled development of a multi-faceted, fully-automated consultation.The Framework provides a comprehensive structure on which complex online care pathways such as those needed for STI management, which involve clinical services, public health surveillance functions and third party (sexual partner) management, can be developed to meet national clinical and public health standards. The Online Chlamydia Pathway's standardised method of collecting data on demographics and sexual behaviour, with potential for interoperability with surveillance systems, could be a powerful tool for public health and clinical management.UKCRC Translational Infection Research (TIR) Initiative supported by the Medical Research Council, eSTI2 Consortium (Grant Number G0901608)

Interpreting ethics: public relations and strong hermeneutics

This article suggests that public relations’ inadequate engagement with the complexities of ethical theory has contributed to public loss of trust in its activities. Instead of blaming this on publics, communicators could take more responsibility for their professional ethics. The author suggests that a hermeneutic approach to ethics opens up a new area for debate in the field. Public relations ethics have traditionally drawn on the major approaches of deontology (Kant) and consequentialism (Bentham and Mill), with marginal reference to the more recent revival of Aristotelian virtue ethics (MacIntyre, 1984), an approach that shifts attention from ethical action to ethical agent. Thus discussion of ethics in public relations literature (Fitzpatrick and Bronstein, 2006; S. A. Bowen, 2007; McElreath, 1996) concentrates on rational approaches to ethical decision making, based (respectively) in marketplace theory, Kantian approaches or systems theory. In these and other writings, there is an emphasis, as is common in approaches to professional ethics, on external rule-based ethics rather than attempts to focus on inner processes to assess ethical implications of practice. This article argues that as concepts of professionalism shift and buckle under global economic and social pressures, it might be timely to look less to systems and more to human experience for ethical guidance. A hermeneutic approach, drawing on the philosophy of interpretation developed in recent decades by thinkers such as Gadamer, Habermas and Riceour, offers an alternative, inner, path to an ethics drawn from the search for shared meaning. The article starts with a brief overview of the current state of public relations ethics, suggesting a reliance on somewhat superficial codes for guidance and the absence of reflexivity in ethical debates; it then introduces concepts from hermeneutics and its main schools or approaches, with a particular focus on hermeneutic ethics. Finally, the article links the two topics to show how ‘strong’ hermeneutic ethics might contribute to greater reflexivity in public relations ethics. It aims to shift the ethical debate away from notional reliance on codes and external guidance towards a deeper ethic. The approach taken is broadly critical (Hall, 1980; Heath, 1992) and is itself interpretative, making the article doubly-hermeneutic (Giddens, 1984) in both form and content

Biogeochemical mechanisms controlling trophic state and micropollutant concentrations in a tropical artificial lake

Universidade de Brasília. Instituto de Geociências. Brasília, DF, Brazil.Universidade de Brasília. Instituto de Geociências. Brasília, DF, Brazil.Universidade Federal de Tocantins. Departamento de Química Ambiental. Tocantins, TO, Brazil.Universidade de Brasília. Instituto de Geociências. Brasília, DF, Brazil.Companhia de Saneamento do Distrito Federal. Brasília, Df, Brazil.Ministério da Saúde. Secretaria de Vigilância em Saúde. Instituto Evandro Chagas. Ananindeua, PA, Brasil.Universidade de Brasília. Instituto de Geociências. Brasília, DF, Brazil.Lake Paranoá is a human-made water reservoir created in 1959 together with the new capital of Brazil (Brasilia). With the demands of urban development, population growth, and land use changes, the lake presented severe deterioration of water quality due to the disposal of wastewater with a high concentration of nutrients. To better elucidate the natural and anthropogenic sources controlling the water quality from Lake Paranoá, this study aimed to (1) investigate the main geochemical processes controlling water quality of the lake and its tributaries; (2) evaluate Lake Paranoá’s trophic state; and (3) determine the occurrence and fate of organic micropollutants in Lake Paranoá waters and WWTPs effluents. The waters from Lake Paranoá tributaries are naturally acidic due to the nature of the extremely weathered ferralsols and the crustal material composition. The main processes linked with anthropogenic activities that affect the water quality from the tributaries are the input of untreated domestic wastewater and the dissolution of carbonate minerals arising from construction material residues. Generally, the waters of Lake Paranoá presented low nutrient and chlorophyll-a concentrations, indicating a low trophic state (oligo-mesotrophic). A significant increase in the trophic state (super-eutrophic) was observed at specific regions of the lake that have high nutrient input from tributaries, caused by the continuous disposal of untreated domestic sewage. In Lake Paranoá waters, the organic micropollutants that were identified and quantified (caffeine, bezafibrate, bisphenol A, diethyl phthalate, and nonylphenol) presented concentrations consistent with previous studies and within the threshold of toxicity, except bisphenol A