About the Authors

Aixia Sun, M.Sc. (Chemistry)

I was born in China and immigrated to U.S. in 90’s. I received B.S. in physical chemistry & instrumental analysis from Tsinghua University - Beijing, China and M.S. in chemistry from University of Missouri - St. Louis. I have been working in domestic and international organizations, across the fields of diagnostic, environmental, and pharmaceuticals. I currently work as the Principal Scientist at American Clinical Solutions, which is located at Sun City Center, FL. My primary responsibilities are the development, optimization, and validation of robust, high throughput, and CLIA compliant High Performance Liquid Chromatography - Mass Spectrometry (HPLC-MS) mythologies for testing patient samples. In addition, I created and implemented laboratory automation for sample preparation to improve laboratory workflow, efficiency, and cost-effectiveness. I reside in Brandon, FL. I like to work out and travel.

Horace E. Walcott, DVM (Veterinary Medicine, Tuskegee); MSPH (Toxicology and Risk Assessment, School of Public Health and Tropical Medicine, Tulane); MSc (Wild Animal Health, Royal Veterinary College, University of London)

For 15 years, I have been employed by the New York City Department of Education and teach Chemistry at Brooklyn Tech where I am a Weston Research Mentor and conduct pioneering studies in the biomechanics of solar hydrogen electrochemistry.  For more than four years I have been a visiting scientist at the Dynamics Systems Laboratory of Dr. Maurizio Porfiri, Department of Aerospace and Mechanical Engineering at New York University. In addition to my research in the biomechanics of piscine robots at NYU, my other area of research focus is the investigation of neuro-endocrine disruption due to the PCBs in apex predators.  Two years ago I was nominated to be a Fellow of the Royal Society of Arts (FRSA) and have been the recipient of the 2010 Siemens Founders Award and the 2011 STARS Award. 

Health Promotion of Personal Protection of Health Care Workers from the Acute and Chronic Effects of Radiation from Telemedicine

Aixia Sun

Horace E. Walcott

Health Professionals’ Role in Health Promotion

                       DHSC 9000

A course assignment presented to the College of Graduate Health Studies in partial fulfillment of the requirements for the Doctor of Health Science Degree A.T. Still University

March 8, 2015

Appendices

Appendix A. Formulas and Equations

4 X4 P² =  (price +place+ product +promotion) x (plan +perspective+ perseverance +passionate people)­­­­­­­­­­­­­­­­_____________________________________________________ (Equation 1.)

Appendix B. Tables, Graphs, Figures and Charts

Table 2. Permanent RF radiation monitoring systems in Europe

Appendix C. Figures, Charts and Graphs

Figure 2.

http://www.medgadget.com/2010/03/rfid_patient_wristbands_safe for_ct_and_mri.html

Figure 3. 

                                 Children are given an RFID tag brace, and a Nokia phone is used to scan the
tag.  http://telecompk.net/2009/03/20/nokia-and-indus-hospital-

                          implement-electronic-surveillance-system-for-pneumonia/

Figure  4. Examples of electromagnetic interference (EMI) using the Datex-Ohmeda Monitor 3-lead system (A) and the GE MAC 5500 12-lead electrocardiogram machine (B). Note that in (A), EMI was not observed until there was direct contact between the antenna and the subject, whereas with (B), EMI was seen as far as 4 feet away from the subject (Kapa et al., 2011).

Figure  5. The magnetic field strength and signal fidelity were assessed. The magnetic field intensity is shown as a function of distance of the antenna from the medical device (17 feet is direct contact with the device while 1 foot is 16 feet away from the device). Green indicates high signal fidelity and red indicates low signal fidelity (Kapa, Pierce, Hayes, Holmes, & Asirvatham, 2011).

Figure 6. Mobile phone ECG monitor

http://hosting4beginners.com/mobile-phone-ecg-monitor/

Figure 7. Cell phone and the brain. Adapted from “Do Cell Phones Really Cause

Cancer” by M. Merzenich, 2014. http://blog.brainhq.com/2014/11/17/cell-phones-really

cause-brain-cancer/

Figure 8. Cell phones and brain cancer. Adapted from “Cell Phones Linked to Brain Cancer” by

J. Burne, 2007.   http://www.encognitive.com/taxonomy/term/131

Figure 9. SWOT Analysis chart.  Adapted from “” by Creately, 2014.

http://creately.com/SWOT-Analysis-Software#prettyPhoto

Figure 10.  4 x4 P²

Adapted from “ The new 4 Ps of marketing” by Think Tank, 2011.  Retrieved from

       http://vimm.com/the-new-4-ps-of-marketing/

Figure 11. EMF public exposure assessments in the European countries. The size of circles represents the level of activity on the corresponding exposure methods as: i) long term RF radiation monitoring systems, ii) survey by in-situ measurements, iii) personal exposimetry and iv) exposure modeling to RF and/or ELF range.  Adapted from “Report on the level of exposure (frequency, patterns and modulation) in the European Union Part 1:Radiofrequency(RF)radiation” byEFHRAN,2010 http://efhran.polimi.it/docs/D4_Report%20on%20the%20level%20of%20exposure%20in%20th %20European%20Union_Oct2010.pdf

Figure 12.  Three possible upstream regulators were enriched. Direct evidence between two genes from previous literature reports is shown as a solid line and indirect evidence is depicted as a dashed line. Adapted from “Identification of Gene Expression Biomarkers for Predicting Radiation Exposure” by Tzu-Pin Lu, Yi-Yao Hsu,   Liang-Chuan Lai, Mong-Hsun Tsai  & Eric Y.Chuang Scientific Reports 4, Article number: 6293  http://dx.doi.org/ 10.1038/srep06293

Figure 13.   TIPRP Logo.  Medical caduceus: Adapted from “Caduceus with DNA Helix”, by

U.S. Department of Energy Human Genome Program, National Human Genome

Research Institute,

http://freepages.genealogy.rootsweb.ancestry.com/~ncscotts/GG/DNA_Gallery.htm

Figure 14.  The many uses of the cell phone as a hand held and pocket-carrying device by

physicians and veterinarians, who are exposed to the RFR released due to its operation. Adapted

from “A surgeon's review of Google glass in the operating room” by K

Chin Leong, 2015. Retrieved from http://www.fastcompany.com/3022534/internet-of-things/a

surgeons-review-of-google-glass-in-the-operating-room. Other retreivals from http://www.fivebelow.com/cell-phone-microscope.html. 

                                                      Appendix D. Videos

                    Video 1.  WHO Finding Adds to Debate Over Mobile Phones, Brain Cancer

                     https://www.youtube.com/watch?v=wmxhg1uC0V4

Video 2.  Sea World San Diego.  (2010, July). Vets save dolphin are the life. Retrieved from http://www.youtube.com/watch?v=0HpHiwOMQJs

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TIPRP for Animal Health Workers in Zoo Animal Health

TIPRP for Animal Health Workers in Zoo Animal Health

            For the zoo animal health worker, the degree of exposure and risk for RFR-EMI can be higher due to the higher probabilities of overall risks (Lucas, M., Day, L., Shirangi, A., & Fritschi, L. (2009). The cohorts in this group will be 30 zoo animal health workers from the San Diego Zoo, the Woods Hole Animal Health Department, and Disney’s Wild Animal Kingdom (DWAK). A zoo veterinarian from  DWAK may have to travel three to four times per year. The zoo veterinarian will be exposed four times to RFR from airline travel including exposure from the imaging devices at the airports for security checks.  She/he is then exposed to RFR from devices at home including smart meters and computers. In addition, if the clinician is an aquatic veterinarian, she/he may have to conduct scuba dives and can be exposed to RFR from submarine cables and/or extremely low magnetic field (ELF) emissions due to anti-submarine warfare exercises (Maronpot, 2013; National Research Council, 2012). The personal dosimeters will have to be water proof as well as some of the personal protective apparel. The TIPRP for the veterinarians’ patients will be unique with many interesting variations.

Discussions

The wet-suit, diving mask and gloves of the aquatic veterinarian will have to be redesigned to provide protection from surface and sub-aquatic exposure to RFR-EMI.  Health safety guidelines for zoo and wild life veterinarians will have to be radically upgraded to ensure protection from non-ionizing radiation due to TMTH. Many institutions representing many disciplines will have to collaborate to upgrade the protection of specialists in zoological medicine from RFR-EMI. The organizations include the US National Institute for Environmental Health Sciences (US NIEHS), International Association of Aquatic Animal Medicine (IAAAM), National Oceanic and Atmospheric Administration (NOAA), OSHA, the American Association of Zoo Veterinarians (AAZV), and the American Veterinary Medical Association (AVMA).

Recommendation

NIOSH and OSHA in the United States should mandate low exposure levels (LOELs) and no exposure levels (NOELs) for RFR-EMI with respect to zoo and wild life veterinarians. In addition, annual exposure limits to RFR-EMI for zoo veterinarians will have to be established globally.

Conclusion

            TIPRP can be a catalyst for the protection of non-domestic animal health workers from RFR-EMI due to increased applications of TMTH.

TIPRP for Animal Patients

TIPRP for Animal Patients

There are domestic animals and non-domestic animals.  Among the non-domestic species are the free-ranging and captive; for example zoo animals. Dosimeters can be placed in cages of facilities for species in captivity.  For free-ranging animals, dosimeters will have to be miniaturized and micro-miniaturized for micro-vertebrates such as some bats and birds.  For mega-vertebrates such as whales and elephants, dosimeters will have to be injected along with GPS devices by darting the animals with tranquilizing dart rifles. Acutely, many marine mammal strandings have been associated with the use of military sonar.  To effectively promote the radiologic health of humans and animals, there is room for investigating the health effects of RFR on domestic and non-domestic animals.

Both groups of animals can be canaries alerting humanity about the acute and chronic effects of RFR (Hässig et al., 2014).  In the rivers of the Amazon, the electric eel an apex predator (Electrophorus electricus) use electroreception and electro-location for communication, hunting and navigation. The increased use of RFR-MI due to TMTH can disrupt essential parts of the biology of the E. electricus and contribute to the collapse of the fragile Amazonian ecosystem.

Discussions

            Developing dosimeters and other instruments for measuring exposure levels of RFR-EMI in animal patients are challenges that can be overcome with the advancements in biomedical engineering.  Devices for measuring and protection will have to be tailored to suit the anatomy, physiology and behavior of the animal.  The monitoring and protective collar tolerated by a dog or wolf will not be suitable for an anaconda patient.

Recommendation

            United States Department of Agriculture (USDA) mandated guidelines for the protection of animal patients from excessive exposure to RFR-EMI will have to be established (AVMA, 2015).

Conclusion

Uniform international guidelines will have to be formulated to protect animal patients from RFR-EMI due to increased use of TMTH in veterinary practices.

Expected Results

            We expect the one-week conference and the weekend fashion show on TIPRP to be extremely successful.  TIPRP will have a logo (Figure 13 C) and the conference and fashion show will be advertised one year in advance in health journals, science and engineering websites, and magazines.    We do expect to observe initial peak levels of health measures resulting from pre-TIPRP exposures.  These values are expected to decrease temporally as personal protective apparels and devices are used.

            Other data are summarized as equations, tables, graphs, photographs, charts and videos in the appendices.

Major Discussion

            The data from TIPRP activities in the five sectors will be used to design more stringent health promotion on RFR safety and protection (Chung-Feng, Hsin-Ginn, Kuang-Ming, & Won-Fu, 2011).  The data will also be used to design more case-controlled studies on RFR safety and formulate policies to protect health care workers from RFR.  Bioassays with high specificities and high sensitivities will have to be developed. The developing embryos of the zebra fish (Danio rerio) and Japanese medaka (Oryzias latipes) can be excellent animal models for chronic grow-out carcinogenicity and genotoxicity studies (Praskova et al., 2014; Schartl, 2014).  The grow-out exposure studies in non-mammalian species will emulate the chronic, sub-lethal exposure to RFR-EMI in humans.

Major Conclusion

            TIPRP will demonstrate the need to protect and sustain the optimal health of health care workers who are exposed to RFR due to telehealth.  It validates the hypothesis that health care workers increasingly exposed to RFR require immediate personal protection even as the health sciences paradigm is shifting to fully elucidate the acute and chronic health effects of RFR on humans and animals. The increasingly ubiquitous RFR due to telehealth must be carefully monitored to avert a paradoxical pandemic in which humans and animals suffer multi-organ illnesses due to RFR-EMF from TMTH advances.

TIPRP for Animal Health Workers in Private Practice

TIPRP for Animal Health Workers in Private Practice

            The veterinary staff   of Tuskegee University in Alabama and the Animal Medical Center in New York will be used as a model representing the ideals of private practice veterinary medicine. Tuskegee has pioneered bioinformatics and telehealth through its BIMS Center. The AMC is also an academic institution with a 24/7 service that provides postgraduate residency and internship training for veterinarians. It is equipped with state of the art diagnostics that expose veterinarians, animal health technicians, and laboratory technicians to increased levels of RFR.

Needs Assessment

An on-line survey will be part of a need assessment (NA) to quantify the levels of protection currently practiced at TUSVM and the AMC. The NA will also be used in the risk assessment, risk management, and marketing strategy.

Risk Assessment and Epidemiological Studies

            The United States Environmental Protection Agency (USEPA) protocols for risk assessment and risk management will be used for carcinogenicity, genotoxicity, and neurobehavioral health effects.

            In addition, epidemiological studies will be conducted to gather data sets, including morbidity, mortality, and cancer prevalence rates associated with RFR or RFR devices. The epidemiology data will be used in the formulating of marketing strategies.

Marketing

The asset model (AM) derived from change theory will be used.  The AM can facilitate the pooling of currently available resources and collaboration of many parts of communities for the common good of a health initiative. A SWOT analysis (Figure 9 C) will be performed along with a 4 x 4 P square analysis (4 x 4 P²) (“Think Tank”, 2011) (Figure 10 C). In the analysis, a mathematical model is developed in which numerical values of the following variables are combined and examined statistically: (Price + place+ product + promotion) x (Plan + perspective + perseverance + passionate people) (Equation 1).

New York City, the media capital of the world, will be used as a hub for the digital media marketing of the initiative and for the manufacture of personal protective items against RFR. A week-long scientific conference on the health effects of RFR and protection from RFR will be held in NYC to launch the initiative. There will also be a fashion show exhibiting apparel for RFR protection. The success of the conference and fashion show will be used as small wins for future grant applications, consistent with business applications of Sun Zhou’s classic: The Arts of War (Wee, 2002).

Experimental Materials and Methods

            A cohort consisting of 100 individuals from the veterinary staff of TUSVM and the AMC will be issued with personal protective devices for protection from RFR for a five-year period.  Protective devices will also be installed in the homes of the individuals during the study.  Four times per year, blood samples will be collected from the individuals, complete physical examinations will be done on each person, and electroencephalographs (EEG) studies and fMRI brain scans  will also be performed (Regel & Achermann, 2011).  Dosimeter badges for each individual will also be examined and exposure dose recorded.

            Peripheral blood samples will be used for assessing mitochondrial respiratory reserve capacity (MRRC) (Tkalec, Stambuk, Srut, Malarić, & Klobučar, 2013), and the Emulate organ-on-chip platform kits will be used to detect changes is specific organs.  Software provided by LogiNet will be used to record and process the data from the TIPRP.

            The concurrent control for this study will be 100 health care workers at institutions in Alabama and New York City who do not use personal protective devices for RFR.  Similar experimental and non-experimental methodologies will be applied to the other TIPRP groups. The experimental protocols will, however, be unique for the specific group

The Effect of Use of Mobile Phones on Human Health

TIPRP and the Effects of Use of Mobile Phones on Human Health

Purpose

      This promotion will increase awareness of health care organizations and the public about the effect of mobile phone use on human health.

How Do Mobile Phones Communicate?

       Mobile phones communicate with each other by transmitting radio waves through a network of antennas (WHO, 2014) (Figure 11C). Mobile technologies have been increasingly applied in health care and could be excellent tools for providing personal-level support to health care consumers (Free et al., 2013). The mobile phone electrocardiogram (ECG) monitor, is an example (Figures 6 C & 14C).

The Debate Over Mobile Phones and Brain Cancer

      The International Agency for Research on Cancer (IARC) classified the electromagnetic fields produced by mobile phones as possibly carcinogenic to humans (WHO, 2014). Video 1 D shows the debate over the risk of brain cancer from use of cell phones (Youtube, 2011).

Evaluation of Biochemical Parameters in Mobile Phone Users

        Abu Khadra, Khalil, Abu Samak, and Aljaberi (2014) evaluated biochemical parameters in 12 young males’ saliva before and after their use of mobile phones. The authors wrote that super oxide dismutase (SOD) is a specific antioxidant enzyme that dismutates O^●-₂  to form H₂O₂. The increased SOD activity indicates cellular response to oxidative stress to protect cells from nonthermal damage; cytochrome c assay was used to detect extracellular release of superoxide anions (O^●-₂). Uric acid is a major antioxidant in saliva (Abu Khadra et al., 2014). The finding of increased SOD activity in human saliva indicates that mobile phone use increases production of oxidative reactive species (ROS) that could cause potential DNA and other cell damage (Abu Khadra et al. 2014). Table 1 B shows salivary concentration levels of four antioxidant makers at 0, 15, and 30 minutes of talking time. Figure 1 B shows the same four-antioxidant levels in graphs.

Recommendations

Because electromagnetic fields produced by mobile phones increase the risk of carcinogenesis in  many animals and electromagnetic fields are a function of the distance (inverse square law), using hands-free technology, such as Blue tooth, and texting,  can avoid direct contact between the phone and the head (Figures 5C, 7 C, & 8C). Thus, individuals, health care workers included, can have less exposure to magnetic fields (RFR-EMF).

TIPRP and Safe Use of Radio Frequency Identification in the Telemedicine and E-Health

TIPRP and Safe Use of Radio Frequency Identification in the Telemedicine and E-Health

Purpose

     This promotion   ncreases awareness of health care organizations and the public on the safe use of radio frequency identification, especially in the era of telemedicine and E-health.

What is the Radio Frequency Identification (RFID)?

     RFID systems use radio waves to transfer data. They have been used widely in health care industries such as inventory management, equipment tracking, medication monitoring, and in medical devices (Food and Drug Administration, n.d.) (Figure 2C). RFID improves patient safety by quickly retrieving patient information and monitoring patient locations in the hospital (Ajami & Rajabzadeh, 2013). For instance, RFID surveillance systems can help reduce child mortality due to pneumonia (Telecompk.net, n.d.), because it is an automated system for detecting respiratory crises in pediatric patients.

Why Is There a Concern About the Use of RFID?

      RFID generates electromagnetic waves and in health settings there is a concern regarding electromagnetic interference (EMI) with medical devices (Chung-Feng, Hsin-Ginn, Kuang-Ming, & Won-Fu, 2011). Figure 5 C shows that the strength of the magnetic field increases as the distance to antenna decreases.

Examples

    Figure 4 shows examples of the effect of EMI on electrocardiogram machines. Depending on the individual device, the EMI could occur when the device is in direct contact with the antenna or the device is far away from the antenna.

Recommendation

     Health care organizations should take precautionary steps and pre-test all RFID’s with medical devices for EMI assessment to ensure patient and health care worker safety. In addition, the health care industry and RFID venders should work together to develop more mature and safe RFID applications for the health care industry (Kapa et al., 2011).