In the battle to address Europe’s biodiversity crisis, fixing its implementation gap—the gap between EU nature law on the books, and on the ground—is vital. Europe’s private nature governance revolution, underpinned by the UNECE Aarhus Convention, is a core part of its response. This article breaks new empirical ground in understanding how those mechanisms have been working in practice, and their knock-on effects for traditional enforcement by the State. We develop an innovative methodological tool, the Nature Governance Effectiveness Indicators (“NGEIs”), enabling the first quantitative measurement of the effectiveness of public and private nature governance in practice. In collecting data on these indicators, we create a novel dataset spanning three jurisdictions and 23 years, giving a unique insight into Europe’s “environmental democracy in action”. We regress the NGEIs against the Nature Governance Index, an original longitudinal index measuring the evolution in nature governance laws over this period. Our results provide the first systematic empirical evidence that, despite the widespread embrace of private nature governance laws on the books across our studied jurisdictions from 1992 to 2015, the enhanced citizens’ rights conferred by these laws are not being consistently used in practice. They also reveal that, despite these inconsistencies in usage of the Aarhus mechanisms in practice, passing private governance laws can in fact improve levels of State enforcement of EU nature law in practice. For policymakers seeking to increase enforcement of EU nature law on the ground, harnessing what we term the shadow of heterarchy, by strengthening private governance rights, may therefore be a more effective means of doing so than simply ratcheting up existing traditional governance mechanisms such as levels of maximum criminal penalties or civil fines.

In 1998, the American Medical Informatics Association (AMIA) published a white paper entitled "Guidelines for the Clinical Use of Electronic Mail with Patients," which outlined a practical framework for this interaction. Interest in the use of other Internet-based tools, such as the World Wide Web, to enhance clinical communication is increasing. In such systems, static information can be made centrally available to patients and interactive tools such as messaging systems, schedules, and individualized care regimens can be integrated within the site. Site-specific guidelines are needed to address potential problems inherent in the particular services being offered. This article presents advice on developing site-specific guidelines, with examples, based on experience gained in developing and refining guidelines for the use of PatientWeb at the Massachusetts General Hospital Department of Neurology.

The Partners Healthcare Epilepsy Service hosts an epilepsy 'Webforum'. In this paper, we describe our observations regarding who uses it, what kind of information is exchanged, how much misinformation is present and how we can better serve our patients. We examined a sample of 155 posts to the forum and 342 responses to those posts. The individual making the post and the type of questions were categorized. We also determined whether any information was objectively inaccurate. The principal users were care-givers (49%) and patients (34%). Eighty percent of the primary posts were questions. Answers were given largely by patients (38%) and care-givers (34%). The most commonly asked questions were about treatment options (31%) and the natural history of the illness (28%). In 20% of the questions, the user incidentally remarked that a health-care provider had not met their information needs. Six percent of the information was objectively inaccurate. The Web can serve as an effective means for the exchange of information between individuals with a common medical condition. We found that a small amount of misinformation is exchanged and that health-care providers are sometimes perceived as unable or unwilling to supply important health-related information.

Traditional medical care relies on face-to-face encounters in which patient and physician work collaboratively. However, many patients have limited mobility, want additional medical information and wish to share experiences with others in similar medical circumstances. This poster illustrates how the Web can be used as a computer-based tool to augment the physician-patient encounter at the Epilepsy referral center at Massachusettts General Hospital using our “PatientWeb” system. Patients are given access to a library, discussion groups, chatrooms, and the opportunity to communicate privately with healthcare providers. Patients were included in the design process and are involved in the evolution of the site. Monitoring of the project is performed by Epilepsy care providers. We are in the process of examining the impact of this technology on patient satisfaction, quality of life and comparing/contrasting its use to traditional face-to-face encounters. For more information please see www.patientweb.net.