Pruning chemicals from the green building landscape.

Green building design has substantially minimized environmental impacts by reducing energy consumption compared with traditional buildings. Yet, it is not uncommon for a green building to meet the highest criteria for energy efficiency and be built with materials that contain chemicals hazardous to occupant health. Because of this discrepancy in achieving holistic sustainability, the architecture/engineering/construction (AEC) industry has never been more interested in occupant health and well-being than it is today. At the same time, numerous scientific studies have documented exposures to and associated health effects of chemicals used in building materials. Opportunities to translate environmental health research so that it is useful to the AEC community exist across the landscape of healthier buildings. For example, research can be conducted to prioritize building material and chemical combinations to demonstrate how green building certification systems, government building codes, and the building products marketplace can increase energy performance while also addressing the greatest chemical exposures and health impacts. In order for scientific research to be used to create and support healthier environments, researchers should design and translate their research with this landscape in mind and should consider experts in the AEC industry as ambassadors for change. We provide key examples of how scientists have promoted healthy building practices and highlight additional research opportunities.

Barriers to Adherence in Juvenile Idiopathic Arthritis: A Multicenter Collaborative Experience and Preliminary Results.

OBJECTIVE: Nonadherence is currently an underrecognized and potentially modifiable obstacle to care in juvenile idiopathic arthritis (JIA). The purpose of our study was to design and implement a standardized approach to identifying adherence barriers for youth with JIA across 7 pediatric rheumatology clinics through the Pediatric Rheumatology Care and Outcomes Improvement Network (PR-COIN) and to assess the frequency of adherence barriers in patients and their caregivers across treatment modalities. METHODS: An iterative process using coproduction among parents and providers of patients with JIA was used to design the Barriers Assessment Tool to screen for adherence barriers across 4 treatment modalities (i.e., oral medications, injectable medications, infusions, and physical/occupational therapy). This tool was implemented in 7 rheumatology clinics across the United States and patient responses were collected for analysis. RESULTS: Data were collected from 578 parents and 99 patients (n = 44 parent-child dyads). Seventy-seven percent (n = 444) of caregivers and 70% (n = 69) of patients reported at least 1 adherence barrier across all treatment components. The most commonly reported adherence barriers included worry about future consequences of therapy, pain, forgetting, side effects, and embarrassment related to the therapy. There was no significant difference between endorsement of barriers between parents and adolescents. CONCLUSION: Implementing a standardized tool assessing adherence barriers in the JIA population across multiple clinical settings is feasible. Systematic screening sheds light on the factors that make adherence difficult in JIA and identifies targets for future adherence interventions in clinical practice.

Viral Lysis of Photosynthesizing Microbes As a Mechanism for Calcium Carbonate Nucleation in Seawater.

Removal of carbon through the precipitation and burial of calcium carbonate in marine sediments constitutes over 70% of the total carbon on Earth and is partitioned between coastal and pelagic zones. The precipitation of authigenic calcium carbonate in seawater, however, has been hotly debated because despite being in a supersaturated state, there is an absence of persistent precipitation. One of the explanations for this paradox is the geochemical conditions in seawater cannot overcome the activation energy barrier for the first step in any precipitation reaction; nucleation. Here we show that virally induced rupturing of photosynthetic cyanobacterial cells releases cytoplasmic-associated bicarbonate at concentrations ~23-fold greater than in the surrounding seawater, thereby shifting the carbonate chemistry toward the homogenous nucleation of one or more of the calcium carbonate polymorphs. Using geochemical reaction energetics, we show the saturation states (Ω) in typical seawater for calcite (Ω = 4.3), aragonite (Ω = 3.1), and vaterite (Ω = 1.2) are significantly elevated following the release and diffusion of the cytoplasmic bicarbonate (Ωcalcite = 95.7; Ωaragonite = 68.5; Ωvaterite = 25.9). These increases in Ω significantly reduce the activation energy for nuclei formation thresholds for all three polymorphs, but only vaterite nucleation is energetically favored. In the post-lysis seawater, vaterite's nuclei formation activation energy is significantly reduced from 1.85 × 10-17 J to 3.85 × 10-20 J, which increases the nuclei formation rate from highly improbable (<<1.0 nuclei cm-3 s-1) to instantaneous (8.60 × 1025 nuclei cm-3 s-1). The proposed model for homogenous nucleation of calcium carbonate in seawater describes a mechanism through which the initial step in the production of carbonate sediments may proceed. It also presents an additional role of photosynthesizing microbes and their viruses in marine carbon cycles and reveals these microorganisms are a collective repository for concentrated and reactive dissolved inorganic carbon (DIC) that is currently not accounted for in global carbon budgets and carbonate sediment diagenesis models.

Baseline monitoring of the western Arctic Ocean estimates 20% of Canadian basin surface waters are undersaturated with respect to aragonite.

Marine surface waters are being acidified due to uptake of anthropogenic carbon dioxide, resulting in surface ocean areas of undersaturation with respect to carbonate minerals, including aragonite. In the Arctic Ocean, acidification is expected to occur at an accelerated rate with respect to the global oceans, but a paucity of baseline data has limited our understanding of the extent of Arctic undersaturation and of regional variations in rates and causes. The lack of data has also hindered refinement of models aimed at projecting future trends of ocean acidification. Here, based on more than 34,000 data records collected in 2010 and 2011, we establish a baseline of inorganic carbon data (pH, total alkalinity, dissolved inorganic carbon, partial pressure of carbon dioxide, and aragonite saturation index) for the western Arctic Ocean. This data set documents aragonite undersaturation in ≈ 20% of the surface waters of the combined Canada and Makarov basins, an area characterized by recent acceleration of sea ice loss. Conservative tracer studies using stable oxygen isotopic data from 307 sites show that while the entire surface of this area receives abundant freshwater from meteoric sources, freshwater from sea ice melt is most closely linked to the areas of carbonate mineral undersaturation. These data link the Arctic Ocean's largest area of aragonite undersaturation to sea ice melt and atmospheric CO2 absorption in areas of low buffering capacity. Some relatively supersaturated areas can be linked to localized biological activity. Collectively, these observations can be used to project trends of ocean acidification in higher latitude marine surface waters where inorganic carbon chemistry is largely influenced by sea ice meltwater.

Online resources for assessment and evaluation.

OBJECTIVE: The Accreditation Council for Graduate Medical Education and the Liaison Committee on Medical Education have mandated the transition from written global evaluation methods to competency-based assessments in resident and medical student training. Assessment of competency requires analysis of performance data from numerous sources. This article reviews characteristics of Web-based evaluation and assessment systems and recommends areas for further development. METHOD: The authors review functions common to a variety of online evaluation and curriculum management systems with attention to their adaptation for competency documentation and assessment. Details of online global assessments, examination methods, electronic portfolios, procedure/case logs, and survey systems are provided along with a list of Internet resources. RESULTS: Online evaluation and assessment systems not only provide data on trainee competence but can provide valuable feedback on faculty teaching, curriculum quality, and the learning environment. Suggestions for future development, legal ambiguities that could become obstacles, and the need to clarify the responsibility for funding this work are discussed. Web-based performance assessment and evaluation are seen in the larger context of moving toward competency assessment of practicing physicians. CONCLUSIONS: Online assessment systems offer advantages over paper systems in allowing robust data analysis, reporting, and flexibility. A national online procedure/case log tracking system would facilitate gathering data that could provide one type of experiential benchmark for determining competency.

E-Learning systems: promises and pitfalls.

OBJECTIVE: This review examines the use of e-learning systems in psychiatric education. METHOD: The authors review the Instructional System Design process, focusing on ADDIE (Analysis, Design, Development, Implementation, and Evaluation). The authors also report on two representative teaching projects, discussing the planning, work, and assessment required. RESULTS: The basic operations of these education software systems are relatively easy to learn. The real work is the project preparation which precedes software use and final implementation. CONCLUSIONS: Internet-based learning software is another tool in the educator's armamentarium. Educators must still utilize sound educational pedagogy to create effective learning instruments.