19 research outputs found

    Clinical outcomes resulting from telemedicine interventions: a systematic review

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    BACKGROUND: The use of telemedicine is growing, but its efficacy for achieving comparable or improved clinical outcomes has not been established in many medical specialties. The objective of this systematic review was to evaluate the efficacy of telemedicine interventions for health outcomes in two classes of application: home-based and office/hospital-based. METHODS: Data sources for the study included deports of studies from the MEDLINE, EMBASE, CINAHL, and HealthSTAR databases; searching of bibliographies of review and other articles; and consultation of printed resources as well as investigators in the field. We included studies that were relevant to at least one of the two classes of telemedicine and addressed the assessment of efficacy for clinical outcomes with data of reported results. We excluded studies where the service did not historically require face-to-face encounters (e.g., radiology or pathology diagnosis). All included articles were abstracted and graded for quality and direction of the evidence. RESULTS: A total of 25 articles met inclusion criteria and were assessed. The strongest evidence for the efficacy of telemedicine in clinical outcomes comes from home-based telemedicine in the areas of chronic disease management, hypertension, and AIDS. The value of home glucose monitoring in diabetes mellitus is conflicting. There is also reasonable evidence that telemedicine is comparable to face-to-face care in emergency medicine and is beneficial in surgical and neonatal intensive care units as well as patient transfer in neurosurgery. CONCLUSIONS: Despite the widespread use of telemedicine in virtually all major areas of health care, evidence concerning the benefits of its use exists in only a small number of them. Further randomized controlled trials must be done to determine where its use is most effective

    Mercury flux to sediments of Lake Tahoe, California-Nevada

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    Author Posting. © The Author(s), 2009. This is the author's version of the work. It is posted here by permission of Springer for personal use, not for redistribution. The definitive version was published in Water, Air, & Soil Pollution 210 (2010): 399-407, doi:10.1007/s11270-009-0262-y.We report estimates of mercury (Hg) flux to the sediments of Lake Tahoe, California-Nevada: 2 and 15-20 µg/m2/yr in preindustrial and modern sediments, respectively. These values result in a modern to preindustrial flux ratio of 7.5-10, which is similar to flux ratios recently reported for other alpine lakes in California, and greater than the value of 3 typically seen worldwide. We offer plausible hypotheses to explain the high flux ratios, including (1) proportionally less photoreduction and evasion of Hg with the onset of cultural eutrophication and (2) a combination of enhanced regional oxidation of gaseous elemental Hg and transport of the resulting reactive gaseous Hg to the surface with nightly downslope flows of air. If either of these mechanisms is correct, it could lead to local/regional solutions to lessen the impact of globally increasing anthropogenic emissions of Hg on Lake Tahoe and other alpine ecosystems.Funding was provided by Miami University, EPA-STAR, the Postdoctoral Scholar Program at Woods Hole Oceanographic Institution, and the USGS

    Strong sensitivity of the isotopic composition of methane to the plausible range of tropospheric chlorine

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    The 13C isotopic ratio of methane, δ13C of CH4, provides additional constraints on the CH4 budget to complement the constraints from CH4 observations. The interpretation of δ13C observations is complicated, however, by uncertainties in the methane sink. The reaction of CH4 with Cl is highly fractionating, increasing the relative abundance of 13CH4, but there is currently no consensus on the strength of the tropospheric Cl sink. Global model simulations of halogen chemistry differ strongly from one another in terms of both the magnitude of tropospheric Cl and its geographic distribution. This study explores the impact of the intermodel diversity in Cl fields on the simulated δ13C of CH4. We use a set of GEOS global model simulations with different predicted Cl fields to test the sensitivity of the δ13C of CH4 to the diversity of Cl output from chemical transport models. We find that δ13C is highly sensitive to both the amount and geographic distribution of Cl. Simulations with Cl providing 0.28 % or 0.66 % of the total CH4 loss bracket the δ13C observations for a fixed set of emissions. Thus, even when Cl provides only a small fraction of the total CH4 loss and has a small impact on total CH4, it provides a strong lever on δ13C. Consequently, it is possible to achieve a good representation of total CH4 using widely different Cl concentrations, but the partitioning of the CH4 loss between the OH and Cl reactions leads to strong differences in isotopic composition depending on which model's Cl field is used. Comparing multiple simulations, we find that altering the tropospheric Cl field leads to approximately a 0.5 ‰ increase in δ13CH4 for each percent increase in how much CH4 is oxidized by Cl. The geographic distribution and seasonal cycle of Cl also impacts the hemispheric gradient and seasonal cycle of δ13C. The large effect of Cl on δ13C compared to total CH4 broadens the range of CH4 source mixtures that can be reconciled with δ13C observations. Stronger constraints on tropospheric Cl are necessary to improve estimates of CH4 sources from δ13C observations
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