Severely damaged human lungs can now be successfully recovered

Columbia Engineering and Vanderbilt researchers demonstrate that human lungs rejected for transplant can be recovered using cross-circulation, to provide much larger number of donor lungs to critically ill patients

COLUMBIA UNIVERSITY SCHOOL OF ENGINEERING AND APPLIED SCIENCE

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VIDEO: VIDEO SHOWING THE SEQUENCE OF LUNG RECOVERY ON CROSS-CIRCULATION SYSTEM view more 

CREDIT: AHMED HOZAIN AND JOHN O'NEILL/COLUMBIA ENGINEERING

New York, NY--July 10, 2020--Respiratory disease is the third leading cause of death worldwide, and lung transplantation is still the only cure for patients with end-stage lung disease. Despite advances in the field, lung transplantation remains limited by the low availability of healthy donor organs, and most donor lungs cannot be used due to severe but potentially reversible injuries. Currently, a method known as ex vivo lung perfusion (EVLP) is used to provide lung support outside the body and recover marginal quality donor lungs before transplantation. However, EVLP provides only a limited duration of six to eight hours of support--a time that is too short to recover the majority of severely damaged donor lungs.

A multidisciplinary team from Columbia Engineering and Vanderbilt University has now demonstrated that severely injured donor lungs that have been declined for transplant can be recovered outside the body by a system that uses cross-circulation of whole blood between the donor lung and an animal host. For the first time, a severely injured human lung that failed to recover using the standard clinical EVLP was successfully recovered during 24 hours on the team's cross-circulation platform. The study is published today in Nature Medicine.

The investigators, led by Gordana Vunjak-Novakovic, University Professor and The Mikati Foundation Professor of Biomedical Engineering and Medical Sciences at Columbia Engineering, and Matthew Bacchetta, Surgical Director of the Vanderbilt Lung Institute, attributed the accomplishment of their major milestone to the physiologic milieu and systemic regulation that their unique platform provides to explanted human lungs.

"It is the provision of intrinsic biological repair mechanisms over long-enough periods of time that enabled us to recover severely damaged lungs that cannot otherwise be saved," said the study's lead authors, Ahmed Hozain (surgical research fellow at Columbia Engineering) and John O'Neill (adjunct associate research scientist at Columbia Engineering).

Human lung that failed on EVLP (left) and then recovered on cross-circulation (right)

Over the past eight years, the researchers have been developing their radically new method to provide more lungs for patients in dire need of organ transplantation. In 2017, they demonstrated the feasibility of cross-circulation support of whole lungs outside the body. In 2019, they demonstrated the efficacy of cross-circulation by regenerating severely damaged swine lungs, and in 2020, they successfully extended the duration of cross-circulation support to an unprecedented four days.

Now, in this new paper, the team shows that explanted human lungs, already declined for transplantation, can be recovered on their cross-circulation platform, which successfully maintained lung integrity and resulted in functional lung recovery. Throughout the 24 hours of cross-circulation, the team saw substantial improvements of cell viability, tissue quality, inflammatory responses and--most importantly--respiratory function.

"We were able to recover a donor lung that failed to recover on the clinical ex vivo lung perfusion system, which is the current standard of care. This was the most rigorous validation of our cross-circulation platform to date, showing great promise for its clinical utility," Vunjak-Novakovic said.

This particular donor lung demonstrated persistent swelling and fluid buildup that could not be resolved, and it was declined for transplantation by multiple transplant centers and eventually offered for research. By the time the team received this lung, it had experienced two periods of cold ischemia that totaled 22.5 hours, plus five hours of clinical EVLP treatment. Remarkably, after 24 hours on cross-circulation, the lung showed functional recovery.

Vunjak-Novakovic noted that the size and profile of their multi-institutional research team--25 investigators with expertise in bioengineering, surgery, immunology, stem cells, and various clinical disciplines--reflects the complexity of this translational project.

Zachary Kon, Director of Lung Transplantation Program, NYU Langone Health, who was not involved in the study, commented: "As a lung transplant surgeon, I have seen many patients not receive lung transplants they desperately needed. I find this work intriguing and hope this technology will make more donor lungs available."

The investigators emphasize that more work needs to be done before cross-circulation can become a clinical reality. For clinical application of the cross-circulation platform, they envision two clinical scenarios for application of the cross-circulation platform, which they are planning to pursue. One approach is to directly translate the method demonstrated in this new study, with the human donor lung recovered by "xenogeneic" cross-circulation with a medical-grade, pathogen-free animal host. To this end, the safety, feasibility, risk profiles, and outcomes of xenogeneic cross-circulation will need to be evaluated in large numbers of lungs.

Another approach is that critically ill patients already awaiting transplantation on artificial lung support could serve as the cross-circulation host to recover an injured donor lung, which they would receive for transplant as soon as the organ recovers. As described in the paper, the xenogeneic cross-circulation platform may also serve as a research tool to investigate organ regeneration, transplant immunology, and the development of novel therapeutics.

Looking ahead, the researchers hope to extend the benefits of their cross-circulation platform to the recovery of other human organs, including livers, hearts, kidneys, and limbs.




About the Study

The study is titled "Xenogeneic cross-circulation for extracorporeal recovery of injured human lungs."

Authors are: Ahmed E. Hozain,1,2, John D. O'Neill1, Meghan R. Pinezich1, Yuliya Tipograf2, Rachel Donocoff3, Katherine M. Cunningham1, Andrew Tumen4, Kenmond Fung5, Rei Ukita4, Michael Simpson2, Jonathan A. Reimer1,2, Edward C. Ruiz1, Dawn Queen6, John W. Stokes4, Nancy L. Cardwell4, Jennifer Talackine4, Jinho Kim7, Hans-Willem Snoeck8,9, Ya-Wen Chen8,10, Alexander Romanov3, Charles C. Marboe11, Adam D. Griesmer9, Brandon A. Guenthart1,12, Matthew Bacchetta1,4,16,17 and Gordana Vunjak-Novakovic1,8

1 Department of Biomedical Engineering, Columbia University

2 Department of Surgery, Columbia University Medical Center

3 Institute of Comparative Medicine, Columbia University Medical Center

4 Department of Thoracic Surgery, Vanderbilt University

5 Department of Clinical Perfusion, Columbia University Medical Center

6 Vagelos College of Physicians and Surgeons, Columbia University Medical Center

7 Department of Biomedical Engineering, Stevens Institute of Technology

8 Department of Medicine, Columbia University Medical Center

9 Department of Microbiology and Immunology, Columbia University Medical Center

10 Columbia Center for Human Development, Columbia University Medical Center

11 Department of Medicine, University of Southern California

12 Department of Stem Cell Biology and Regenerative Medicine, University of Southern California

13 Department of Pathology and Cell Biology, Columbia University Medical Center

14 Center for Translational Immunology, Columbia University Medical Center

15 Department of Cardiothoracic Surgery, Stanford University

16 Department of Cardiac Surgery, Vanderbilt University

17 Department of Biomedical Engineering, Vanderbilt University

The study was supported by grants from the National Institutes of Health (HL134760, EB27062, HL120046, HL007854), Blavatnik Foundation, and the Mikati Foundation.

The authors declare no competing financial interests.

LINKS:

Paper: http://dx.doi.org/10.1038/s41591-020-0971-8

DOI: 10.1038/s41591-020-0971-8

Visuals: https://www.dropbox.com/sh/7m2yioy1os5y1s8/AAD5zY039z9a84f4CCPTV9wva?dl=0

https://engineering.columbia.edu/

https://bme.columbia.edu/gordana-vunjak-novakovic

https://bme.columbia.edu/

https://bme.columbia.edu/

https://www.vanderbilt.edu/vise/visepeople/matthew-bacchetta/

https://www.nature.com/articles/s41551-017-0037

https://www.nature.com/articles/s41467-019-09908-1

https://www.jtcvs.org/article/S0022-5223(19)32146-4/fulltext

Columbia Engineering

Columbia Engineering, based in New York City, is one of the top engineering schools in the U.S. and one of the oldest in the nation. Also known as The Fu Foundation School of Engineering and Applied Science, the School expands knowledge and advances technology through the pioneering research of its more than 220 faculty, while educating undergraduate and graduate students in a collaborative environment to become leaders informed by a firm foundation in engineering. The School's faculty are at the center of the University's cross-disciplinary research, contributing to the Data Science Institute, Earth Institute, Zuckerman Mind Brain Behavior Institute, Precision Medicine Initiative, and the Columbia Nano Initiative. Guided by its strategic vision, "Columbia Engineering for Humanity," the School aims to translate ideas into innovations that foster a sustainable, healthy, secure, connected, and creative humanity.

Jumping course 

New models detail how major rivers will respond to changing environmental conditions

UNIVERSITY OF CALIFORNIA - SANTA BARBARA

From the Nile to the Mississippi and from the Amazon to the Yangzi, human civilization is inextricably linked to the great rivers along which our societies developed. But rivers are mutable, and the benefits they bestow can quickly become disasters when these waterways change course.

Scientists are working to understand how environmental changes alter river dynamics. A new study in the Proceedings of the National Academy of Sciences coauthored by UC Santa Barbara geomorphologist Vamsi Ganti has outlined the factors that dictate how often rivers jump course, or avulse, and the effects this will have on river deltas. The results promise to help scientists and planners prepare for a future of sea-level rise and changing land use.

Deltas counteract sea level rise by building up sediment, which mostly occurs near a river channel itself. Every once in a while, the river will switch course through an avulsion and begin building up the delta somewhere else. "So avulsions are the way that the river spreads its sediment out over the whole landscape," said first author Austin Chadwick, a postdoctoral scholar at University of Minnesota.

"The questions we're asking are how often do rivers naturally change their course," he continued, "and how is that going to change with climate change and human interference."

Unfortunately, there has previously been no consensus on how rivers responded to climactic shift. Some scientists thought avulsion rates would increase as sea level rises, while others predicted they'd decrease. "There simply was no unifying theory to explain how river avulsion frequency is dependent on sea level," Ganti said.

To straighten out the situation, Ganti, Chadwick and their coauthor Michael Lamb of Caltech, combined observations from the geologic and historical records with a mathematical model of river dynamics. By focusing on this specific issue, they aimed to finally get definitive answers and useful predictions.

Large rivers tend to flatten out and decelerate as they approach the ocean. After a certain point, the downstream conditions of the sea level begin to influence the river's behavior in what scientists call backwater hydrodynamics. "This is a dynamic zone where deposition and erosion occurs in coastal rivers," Ganti explained.

In a previous paper, the team had shown that avulsions occur within this backwater region, which can extend quite far inland. For instance, the backwater zone of the Mississippi River reaches 500 kilometers from the coast. Deeper, flatter rivers like the Mississippi, which have larger backwater regions, therefore have larger deltas.

The researchers goal with this study was to apply their newfound understanding of the impact of backwater hydrodynamics to learn about the frequency of avulsions themselves.

Using the model, and comparing their results to field data, the team discovered that there are three ways that deltas can respond to sea level rise, which depend on the balance between the rate of sea-level change and the sediment supplied by the river.

The first: when a river has a lot of sediment and sea-level rise is relatively slow. According to the model, these rivers are resilient to sea-level rise, and their avulsion rates remain stable. China's Yellow River is one example.

The second case occurs when a river has less sediment or the sea level rises more quickly. In this scenario, avulsions become more frequent. The rising ocean promotes sedimentation, and once a channel fills to a certain depth, the river will jump its course.

And representing the extreme, in which sea level rise outpaces a river's ability to deposit sediment, is the third case. As the ocean infiltrates the delta, the river will reach its maximum avulsion rate, and the whole system will begin migrating inland. Scientists hadn't known about this case before, and the discovery of the three regimes together explains the previous inconsistencies in the scientific literature.

The researchers inputted observations and data into their model to see whether various river deltas would behave differently under predicted climate conditions. "The answer is yes, for most of them," Chadwick said. "Many rivers will experience more frequent avulsions and some rivers will also have avulsions farther inland."

River avulsions have huge societal implications, with the potential to cause economic and civil unrest. Archaeologists believe that a course change of the Indus River in western India directly contributed to the decline of the Bronze Age Harappan civilization. More recently, avulsions led to the 1877 Yellow River flood and 1931 China floods, two of the deadliest natural disasters in modern history.

An avulsion could have dire consequences for rivers like the Mississippi, where a system called the Old River Control Structure has prevented the river from jumping course since 1963. If the backwater region migrated inland, the river could change course upstream from the facility and bypass it altogether. Millions of gallons of water per minute would course through previously dry land, while the downstream portion of the channel would go completely dry.

The authors have made their model available and accessible to anyone who might want to use it. They were even able to reduce several formulas into a single equation by implementing a few basic assumptions about river conditions and dynamics.

"Groups like the Army Corps of Engineers and the Department of the Interior can use this tool to apply to any delta," said Chadwick. "And hopefully it will help inform our decisions in these places as we cope with climate change."

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Well-off countries need trade to cut environmental woes

MICHIGAN STATE UNIVERSITY

 

IMAGE: A NEW STUDY SHOWS INTERNATIONAL TRADE CAN IMPROVE A DEVELOPED NATION'S SUSTAINABLE DEVELOPMENT GOALS, BUT SOMETIMES AT THE EXPENSE OF LESS DEVELOPED COUNTRIES. THIS SHIP MOVES THROUGH THE PANAMA CANAL.... view more 

CREDIT: SUE NICHOLS, MICHIGAN STATE UNIVERSITY

International trade wins and losses don't just show up in the stock market, but also on a nation's environmental sustainability scores, a new study in Nature Sustainability shows.

In a first analysis of its kind, scientists at Michigan State University's Center for Systems Integration and Sustainability (CSIS) and in China examine how international trade affected seven of the 17 United Nations Sustainable Development Goals (SDGs) in countries trading both with other countries at a distance, as well as countries with which they shared borders.

Their study shows these environmental measures reflect a common problem between haves and have-nots. Trading internationally was generally good developed countries like the United States, Canada and most of Europe, but resulted in environmental losses for developing countries such as Russia and part of East Asia struggling to make gains in their SDGs scores.

It also showed not only was international trade an environmental plus for developed countries - it's an environmental savior. Using an innovative analysis, the researchers found the SDGs scores of developed countries would sink lower than those of developed countries after excluding the function of international trade in the current world.

"A nation's sustainability progress is not only dependent on deliberate actions within the nation, it also can become a victim of unintended, and often hard-to-see consequences," said Jianguo "Jack" Liu, MSU Rachel Carson Chair in Sustainability and CSIS director. "Clearly, everyone wants to make positive economic progress, but we can only make crucial environmental improvements by being very clear-eyed about how one action affects another, even if these actions take place over hundreds or thousands of miles. Sustainability is a complicated business."

The group assessed the impacts of international trade starting in 1995 on nine environment-related SDG target likely affected by trade and for which there are clear quantitative metrics - goals that address sustainable water use, energy, economic growth, industrialization, forest management, and consumption and production; and combating climate change. They compared these impacts with a scenario of what each country would be like were there no international trade in today's world.

It's been known that trading goods and services can help save local resources that are essential for production but can also transfer production burdens to the countries that become exporters. For example, if the United States decides to buy wooden furniture from southeast Asia that saves forests in the States but can cause biodiversity loss and deforestation in southeast Asia.

But the extent of impact on environmental sustainability has not been fully revealed. At the national level, international trade improved the SDG scores of 70% of the evaluated developed countries but reduced the SDG scores of over 60% of the evaluated developing countries.

An example can be carbon emissions. International trade has displaced 16 Gt of carbon dioxide from developed to developing countries from 1990 to 2008, which largely stabilized the carbon emissions of developed countries but doubled the carbon emissions of developing countries, the paper notes.

Using the framework of metacoupling (human-nature interactions within as well as between adjacent and distant places), the researchers also found that distant trade offered more environmental benefit, partly because there was more trading to customers further away, and partly because close neighbors likely also shared the same constraints that spurred distant trade in the first place.

"Many critics of trade have raised the concerns that trade can generate negative spillover effects such as enlarging the social and environmental inequality between developed and developing countries," said Yingjie Li, a PhD student at MSU CSIS and a lead author. "But national policymakers may not be aware that international trade can play a big role in their efforts towards achieving the UN SDGs."

Findings in "Impacts of International Trade on Global Sustainable Development" offer an opportunity for policymakers to view international trade beyond financial balance sheets.

"This is the first study about how international trade affects SDG targets," said co-lead author Zhenci Xu, a former MSU-CSIS PhD student and now research associate at University of Michigan. "As the countries connected with each other more in the globalization era, understanding how trade shapes progress toward national and global sustainable development can provide useful information for policy making aiming at achieving SDGs together."

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In addition to Li, Xu and Liu, authors are Sophia Chau, Thomas Dietz, Canbing Li, Luwen Wan, Yunkai Li, Liwei Zhang, Jindong Zhang and Min Gon Chung.

The work was supported by the National Science Foundation, MSU, Michigan AgBioResearch, the Environmental Science and Policy Program Doctoral Recruiting Fellowships, and the China Scholarship Council.

How to strengthen New Zealand's proposed cannabis legalization and control bill

SOCIETY FOR THE STUDY OF ADDICTION MEANS THEY ARE ANTI DRUGS

 

Two drug policy experts have identified gaps and challenges in New Zealand's proposal for legalizing recreational cannabis. In advance of a widely-watched national referendum vote to be held this September, Associate Professor Chris Wilkins and Dr. Marta Rychert of Massey University argue in the pages of Addiction that New Zealand's Cannabis Legislation and Control Bill (CLCB) needs to be strengthened in two critical areas:

Set a formal minimum price for cannabis: The legalization of cannabis in other jurisdictions has resulted in significant declines in the legal price of cannabis. Minimum unit pricing has been shown to be effective at reducing alcohol consumption levels and related harms. The CLCB includes a discretionary power to raise the excise tax for cannabis for a maximum of 12 months if the price of cannabis drops below the level consistent with purposes of the Act. This discretionary power lacks clear criteria for activation and thus falls short of a clear minimum price provision.

Lower the potency cap for cannabis products: High potency cannabis is associated with increasing first-time cannabis treatment admissions, transition to daily use, cannabis dependence and higher risk of psychosis and psychosis relapse. The CLCB's maximum potency levels for cannabis plant (15% THC) appears to be at the higher end of those currently found in the black market in New Zealand. Potency levels for edibles and extracts are expressed as milligrams "per unit" and "per package" without defining what constitutes a unit or package. (Edibles and concentrates will not initially be sold but they are included in the CLCB for future approval.)

Wilkins and Rychert also identify two public health objectives of the CLCB that will be difficult to achieve:

Difficulties reducing cannabis use over time via a commercial market: The CLCB largely proposes a commercial cannabis market with provisions for non-commercial and not-for-profit supply. The CLCB objective of lowering cannabis use over time appears at odds with the proposed commercial cannabis sector, which will focus on expanding sales. Non-commercial or not-for-profit operators can provide legal access to cannabis while avoiding profit driven commercial companies.

Difficulties taxing products by THC potency: The CLCB proposes a progressive product excise tax based on THC potency and weight. Considerable work will be required to implement a potency-based tax, including consistent sampling procedures, certified testing facilities, and effective auditing to prevent producers gaming the system. Also, the reliability and replicability of testing THC is problematic. A weight-based tax (similar to the taxation of tobacco) may be a more practical alternative for now.

Dr Wilkins says: "The New Zealand referendum vote will be the first time a country will have the opportunity to vote on a comprehensive regulatory framework to legalise cannabis rather than a general question asking whether cannabis should be legal or not. It's therefore important that New Zealand voters clearly understand the strengths and weaknesses of the proposed CLCB."

Wilkins and Rychert provided feedback on the first draft of the CLCB to the New Zealand Ministry of Justice Cannabis Referendum Team, along with a number of other anonymous experts and public commentators. The authors received no financial or non-financial remuneration for these comments.

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For editors:

Peer reviewed: Yes
Type of study: Policy analysis
Subject of study: People
Funding: Government/research council

This paper is free to download for one month from the Wiley Online Library: https://onlinelibrary.wiley.com/doi/abs/10.1111/add.15144 or by contacting Jean O'Reilly, Editorial Manager, Addiction, jean@addictionjournal.org.

To speak with lead author Dr Chris Wilkins: contact him at Massey University (New Zealand) by email (c.wilkins@massey.ac.nz) or telephone (+64 (09) 414 0800 ext. 41330).

Full citation for article: Wilkins C and Rychert M (2020) Assessing New Zealand's Cannabis Legalisation and Control Bill: Prospects and Challenges. Addiction 115: doi: 10.1111/add.15144.

Funding: The work in this paper was supported by external research funding from the New Zealand Royal Society Marsden Grant (MFP_MAU1813).

Addiction is a monthly international scientific journal publishing peer-reviewed research reports on alcohol, substances, tobacco, and gambling as well as editorials and other debate pieces. Owned by the Society for the Study of Addiction, it has been in continuous publication since 1884. Addiction is the number two journal in the 2019 ISI Journal Citation Reports ranking in the substance abuse category (science and social science editions).

Social media inspired models show winter warming hits fish stocks

UNIVERSITY OF QUEENSLAND

 

IMAGE: MATHEMATICAL MODELLING INSPIRED BY SOCIAL MEDIA IS IDENTIFYING THE SIGNIFICANT IMPACTS OF WARMING SEAS ON THE WORLD'S FISHERIES. view more 

CREDIT: THE UNIVERSITY OF QUEENSLAND

Mathematical modelling inspired by social media is identifying the significant impacts of warming seas on the world's fisheries.

University of Queensland School of Veterinary Science researcher Dr Nicholas Clark and colleagues from the University of Otago and James Cook University have assembled a holistic picture of climate change's impacts on fish stocks in the Mediterranean Sea.

"Usually, when modelling ecosystems to understand how nature is changing, we build models that only focus on the effects of the environment," Dr Clark said.

"But it's just not accurate enough.

"Newer models - commonly used in social media to document people's social interactions - offer an exciting way to address this gap in scientific knowledge.

"These innovative network models give us a more accurate picture of reality by incorporating biology, allowing us to ask how one species responds to both environmental change and to the presence of other species, including humans."

The team used this technique to analyse fish populations in the Mediterranean Sea, a fisheries-based biodiversity hotspot with its future under threat from rapidly warming seas.

"Experts from fisheries, ecology and the geographical sciences have compiled decades of research to describe the geographical ranges for more than 600 Mediterranean fish species," Dr Clark said.

"We put this information, along with data from the Intergovernmental Panel on Climate Change's sophisticated climate models into our network model.

"We found that warming seas - particularly in winter - have widespread effects on fish biodiversity."

The University of Otago's Associate Professor Ceridwen Fraser said winter warming was often overlooked when people thought about the impacts of climate change.

"A great deal of research and media attention has been on the impacts of extreme summer temperatures on people and nature, but winters are getting warmer too," Dr Fraser said.

"Interestingly, coastal water temperatures are expected to increase at a faster rate in winter than in summer.

"Even though winter warming might not reach the extreme high temperatures of summer heatwaves, this research shows that warmer winters could also lead to ecosystem disruption, in some cases more than hotter summer warming will.

"Our results suggest that winter warming will cause fish species to hang out together in different ways, and some species will disappear from some areas entirely."

The researchers hope the study will emphasise the need to understand and address climate change.

"If fish communities are more strongly regulated by winter temperatures as our model suggests, this means that fish diversity may change more quickly than we previously thought," Dr Clark said.

"Catches for many bottom-dwelling and open-ocean fishery species in the Mediterranean Sea have been steadily declining, so any changes to fish communities may have widespread economic impacts.

"For the sake of marine ecosystems and the people whose livelihoods depend on them, we need to gain a better understanding of how ocean warming will influence both species and economies."

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The research has been published in Nature Climate Change (DOI: 10.1038/s41558-020-0838-5) and included contributions from James Cook University's Dr James Kerry.

Women, newborns, young children and adolescents lose 20 percent of health and social services to COVID-19

'COVID-19 is making a bad situation worse'

UN SECRETARY-GENERAL'S INDEPENDENT ACCOUNTABILITY PANEL FOR EVERY WOMAN, EVERY CHILD, EVERY ADOLESCENT

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IMAGE: MOTHERS, NEWBORNS, YOUNG CHILDREN AND ADOLESCENTS ARE LOSING 20 PERCENT OF THEIR HEALTH AND SOCIAL SERVICES DUE TO THE COVID-19 PANDEMIC SAYS A PANEL OF SENIOR GLOBAL HEALTH EXPERTS ADVISING... view more 

CREDIT: SOURCE: IAPEWEC

Women, newborns, young children and adolescents are losing 20 percent of their health and social services due to the COVID-19 pandemic says a Panel of senior global health experts.

"Health systems in both rich and poor nations are massively struggling and the services for mothers, newborns, young children and adolescents are crumbling," says Elizabeth Mason, M.D, co-chair of the UN Secretary-General's Independent Accountability Panel (IAP) for Every Woman, Every Child, Every Adolescent reviewing the impact of COVID-19 on these groups.

"Especially worrisome are declines in access to life-saving vaccines for children and maternal health services due to closures and movement restrictions. Immunization campaigns are being halted and health workers are being diverted from maternity to COVID-19 units," Dr. Mason adds.

The Panel provides an overview of estimated impacts from COVID-19 pandemic on women, newborns, young children and adolescents since its start in January.

• 5.3 million deaths in children under 5 by pre-pandemic estimates, and over 400,000 additional deaths due to COVID-19-related disruptions in services.
• 2.5 million newborn deaths pre-pandemic, with a minimum of 168,000 additional deaths estimated.
• 295,000 maternal deaths pre-pandemic, with an additional 24,400 additional deaths estimated.
• 13.5 million children missed vaccinations against life-threatening diseases.
• More than 20 countries reported vaccine shortages caused by the pandemic.
• Disruption to contraceptive supplies leading to 15 million unintended pregnancies among women and adolescent girls in low- and middle-income countries.
• 'Backdoor' legislation being pushed through that adversely affects the sexual and reproductive health and rights of women and adolescents
• Around 42-66 million children risk falling into extreme poverty.
• Some 370 million children are missing school meals.
• Adolescents facing increasing social isolation and mental health challenges
• Women disproportionally suffering increased depression, anxiety and uncertainty.
• 15 million additional acts of violence against women and girls every three months of lockdown. In some countries, emergency calls increased by 30 percent.
  "These new findings show how weak our health systems are at protecting mothers, newborns, young children and adolescents," says Joy Phumaphi, co-chair of the Panel and former WHO Assistant Director-General. "We are at a point where decades of progress for this group could be easily reversed."
  The COVID-19 pandemic has interrupted steady progress and has led to increased poverty and unemployment. Early data finds women experience not only loss of various categories of support and social safety nets, but also an inability to access increased support, compared to men.
  "COVID-19 is making a bad situation worse," says Ms. Phumaphi, reflecting the conclusion of the Panel's report (at https://bit.ly/2ZPuTfH).
  "The lives' of every mother, newborn, child and adolescent matter," says Giorgi Pkhakadze, a professor of Epidemiology and Public Health, David Tvildiani Medical University, Georgia. "Quality healthcare is not a luxury, but a life-saving resource."
  Since 2000, maternal and children under 5 deaths have been cut by 40 percent, because of focused leadership and investment, even in the poorest nations. Also, in the last decade, more than $50 billion has been raised through the Every Woman Every Child movement to meet the health and medical needs of this vulnerable group. Even the poorest countries have shown progress, especially in reducing under 5 mortality.
  The Scorecard
  To understand and analyze the basic needs and gaps for mothers, newborns, young children and adolescents by country, the Panel has created a Scorecard for 193 nations, by income category, of seven key indicators (see the full Scorecard at https://bit.ly/38xi4KJ):
• Maternal mortality ratio (per 100,000 live births)
• Stillbirth rate (per 1,000 total births)
• Neonatal mortality rate (per 1,000 live births)
• Under-5 mortality rate (per 1,000 live births)
• Adolescent mortality rate (per 100, 000 population)
• Birth registration (proportion of children under 5 years with civil authority registered births)
• Death registration (completeness of cause-of-death data)
  Each indicator for the 193 countries is colour-coded to depict a country's current status relative to global/country targets: dark green for surpassed, light green for advanced, yellow for intermediate, and red for catching-up countries.
  "The colour-coding makes it easy to pick out the countries where mothers, newborns, young children and adolescents are thriving and countries where they need help," says Dr. Nicholas Alipui, M.D., a visiting scholar at Yale University and former UNICEF Director of Programmes.
  Countries with all dark green surpassed in all seven categories are Finland, Iceland, Slovenia, Luxembourg, Japan, Norway, Estonia Sweden, Italy, Spain, Czechia, Austria, Belgium, Ireland, Germany, Australia, Israel, Portugal, Netherlands, France, Switzerland, Denmark, United Kingdom, Hungary, Poland, Greece, Croatia, Canada, Slovakia, Malta, Bahrain, Belarus, Cuba, Republic of North Macedonia.
  Countries that are all dark green, surpassed global targets - except for a light green, advanced ranking for adolescent deaths are: Latvia, Lithuania, New Zealand, United States, Uruguay, Seychelles, Bulgaria, Russian Federation, Romania, Costa Rica, Georgia, Kazakhstan
  Countries that are mainly red, catching up are Mauritania, Cameroon, Angola, Lesotho, Côte d'Ivoire, Nigeria, Guinea Bissau, the Democratic Republic of the Congo, South Sudan, Sierra Leone, Central African Republic, Chad, Somalia.
  The gap between rich and poor countries is huge. For example: Under 5 mortality rate (per 1,000 live births): Finland -1.7, Iceland and San Marino -2, Slovenia 2.1, Cyprus and Luxembourg -2.4, and Japan -2.5. That compares to the Central African Republic -116.5, Chad -119, Nigeria -119.9, and Somalia -121.5.
  On maternal mortality ratio (per 100,000 live births): Norway, Italy, Poland and Belarus - 2, Finland, Czechia, Greece and United Arab Emirates -3. That compares to Nigeria - 917, Sierra Leone -1,120, Chad -1,140 and South Sudan -1,150.
  Ethnic minority communities even in the wealthiest countries have large disparities of both morbidity and mortality. A number of factors create disparities: racism, low wages, limited opportunities, and poor education. This exacerbates poor health, lack of access to health, water and sanitation.
  Women, children and adolescents in countries with access to similar economic resources sometimes experience different health outcomes. For example, the United States spends more than twice as much on health than either Japan or France, yet children in the US are more likely to die before their 5th birthday and women are more than twice as likely to die in childbirth.
  Another example: Nigeria spends around 74 USD per capita on health, compared to 34 USD in Tanzania. However, Nigeria has more than double the child mortality rate compared to Tanzania, 120 and 53 deaths per 1,000 live births, respectively. This reflects significant inequalities and other disparities.
  "Critical gaps in quality health service delivery and financial protection require urgent remedy and action," says Dr. Alipui. "These gaps are found between countries and within countries."
  Losing ground
  Besides the loss of services due to the pandemic, IAP has found that globally implementation is 20 percent behind on the UN's 2030 goals (Every Woman Every Child - the Global Strategy for Women's, Children's and Adolescent's Health 2016-2030) to reduce preventable deaths for mothers, newborns, young children and adolescents.
  The UN goals include:
  •   Maternal deaths- a global decline to less than 70 deaths per 100,000 live births.
  • Newborn deaths- each country reduces to at least as low as 12 deaths per 1000 live births.
  • Children under 5 deaths - each country reduces to at least as low as 25 deaths per 1000 births.
  More than 190 countries have agreed to these targets.
  The IAP's 2020 report, published this week, calls for leaders to fulfill their commitments and lays out the action needed to get back on track. Commitments to universal health coverage, primary health care, International Health Regulations and sustainable development, were urgently needed before the pandemic. Now with COVID-19, they are even more important.
  About 2 USD trillion a year lost due to inefficiencies, corruption and waste
  Besides the 20 percent deficit, the Panel found that 2 trillion USD a year is lost to health expenditures, due to inefficiencies, corruption and waste.
  "How money is spent is every bit as important as how much is spent to improve health and socioeconomic benefits," points out Ms. Phumaphi. "The key is full accountability which connects commitment to progress."
  "A key element to sustainable progress is strong citizen voices which advocate for full accountability at all levels, community, state and national," says Dr. Alipui.
  "Mass protests clamouring for racial justice in both health and policing in the United States and around the globe have laid bare how central accountability is to achieving justice and a fairer world," explains Alicia Ely Yamin, LLD and a senior fellow in global health and rights at Harvard Law School. 
  The seven big "Lacks"
  There are still a host of basic problems blocking advancement of the health of mothers, newborns, young children and adolescents. These "lacks" relate to commitments that world leaders have made at the highest level. The UN's Sustainable Development Goals, High-level Political Declaration on Universal Health Coverage and the Every Woman Every Child Global Strategy are examples of commitments at the highest level, and yet these gaps persist.
  1. Health workers. The world needs an additional 18 million health workers.
  2. Health Data. Data emerging from countries on COVID-19 has been incomplete.
  Estimates and projections based on modeling to assess country risks and progress on COVID-19 and the health of mothers, newborns, young children and adolescents vary widely. Thus, outcomes end up patchy. The lack of relevant and accurate data constrains governments' abilities to make informed decisions to ensure people's health and wellbeing of this vulnerable group.
  Often, simple information has not been collected. Globally, one in 4 births of children under five are not registered with a civil authority; only 93 out of 193 countries are currently able to register more than 80 percent of adult deaths.
  3. Accountability. Accountability is a must-have, not a nice-to-have. It must be permanently embedded so that every leader and every government is obliged to do what they have committed to do. Private sector and development partners should 'do no harm' and provide assistance and technical cooperation to help countries make progress on health targets. Citizens need to participate fully and voice their experiences.
  "Accountability connects commitments to progress in a justifiable and constructive way," says Shyama Kuruvilla, Ph.D. who directs the Panel's secretariat. "As the Panel's report shows, accountability is critical to accelerate improvement."
  For the accountability cycle to work, a formal, institutionalized relationship is needed between the monitoring, review and recommendations, and the remedy and action that follows.
  By investing in institutionalizing accountability processes, countries can increase their capacity to apply lessons rapidly and effectively during and after events such as the COVID-19 pandemic and to rectify and remedy problems.
  4. Underinvestment in common goods for health. Common goods for health (such as for legislation and regulation, health surveillance and information, population services, and communication) form the foundation for strong health systems that are resilient and responsive, not only to population health needs but also to emergencies. The lack of these critical investments in public goods for health, both national and international, have shown up in the fault lines of the COVID-19 response with millions of people's lives, health and livelihoods put at risk, especially mothers, newborns, young child and adolescents.
  5. Universal Health Coverage and Primary Health Care. On the path to universal health coverage (quality health services and financial protection), only between one-third and one-half of the world's population were covered by the essential health services they need, including interventions for women, children and adolescents. More than 900 million people experienced catastrophic health expenditure last year. One of the smartest investments that countries can make is in primary health care. Investing an additional 200 billion USD a year on scaling up primary health care across low- and middle-income countries could save 60 million lives and increase average life expectancy by 3.7 years by 2030 and contribute significantly to socio-economic development.
  6. Progress across other sectors, e.g. water, sanitation and hygiene. From 2000 to 2017, the population using safely managed sanitation services increased from 28 percent to 45 percent. Though 60 percent of the global population has basic hand-washing facilities with soap and water available at home, 3 billion people still lack such facilities and 1.4 billion had no facilities at all. The United Nations warns that the risk of disruption to these services from lockdowns endangers health, especially from waterborne diseases, and the containment of COVID-19.
  7. Inequities are a critical concern. There are gaping gaps between rich and poor, and racial discrimination, geographical and other factors limit access to services. Capital regions often have higher coverage of basic health and multisectoral services than other sub-regions demonstrating sub-national inequalities. Inequities will worsen from the COVID-19 pandemic, compounded by lack of financial and social protection, and the most vulnerable, including women, children and adolescents would be hardest hit.
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  Accountability: Connecting commitment to progress -in a justifiable and constructive way
  The IAP sets out an accountability framework with four pillars: Commit, Justify, Implement, Progress. Every single one of these pillars must be present for effective accountability -if just one of them is missing, the whole structure falls:
  Commit: all those who have commitments and a responsibility to act should be clear on and commit to their roles and obligations towards achieving agreed goals and rights. 
  Justify: decisions and actions related to commitments must be supported and explained on the basis of evidence, rights and the rule of law. 
  Implement: core accountability functions of Monitor-Review-Remedy-Act should be institutionalized and implemented. 
  Progress: continuous progress towards agreed goals and rights should be ensured, justifying any reversals - this is the human rights principle of 'progressive realization.'

COVID-19: Considering meditation and yoga as adjunctive treatment

MARY ANN LIEBERT, INC./GENETIC ENGINEERING NEWS

 

IMAGE: DEDICATED TO RESEARCH ON PARADIGM, PRACTICE, AND POLICY ADVANCING INTEGRATIVE HEALTH view more 

CREDIT: MARY ANN LIEBERT, INC., PUBLISHERS

New Rochelle, NY, July 13, 2020--The anti-inflammatory and other beneficial effects of meditation and yoga practices make them potential adjunctive treatments of COVID-19, according to the peer-reviewed journal JACM, The Journal of Alternative and Complementary Medicine. Click here to read the article.

Deepak Chopra, University of California, San Diego and William Bushell of Massachusetts Institute of Technology and co-authors from Harvard University and Harvard T.H. Chan School of Public Health describe the anti-inflammatory effects associated with meditation and yoga.

The "brief overview of key subjects" found "there is evidence of stress and inflammation modulation, and also preliminary evidence for possible forms of immune system enhancement, accompanying the practice of certain forms of meditation, yoga, and pranayama, along with potential implications for counteracting some forms of infectious challenges." The authors also "readily acknowledge that in the context of the SARS-CoV-2 pandemic, the ideas put forth in this article must be put to further rigorous scientific investigation."

JACM Editor-in-Chief John Weeks, johnweeks-integrator.com, Seattle, WA, states: "The paper is another in a series in JACM and in other integrative medicine journals suggesting that research agencies in the United States and Europe would serve their citizens by upping their exploration of the potential contributions of natural health practices, especially amidst the present dearth of conventional treatments."

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About the Journal

About the Journal JACM, The Journal of Alternative and Complementary Medicine is a monthly peer-reviewed journal published online with open access options and in print that is dedicated to research on paradigm, practice, and policy advancing integrative health. Led by John Weeks (johnweeks-integrator.com), the co-founder and past Executive Director of the Academic Collaborative for Integrative Health, JACM publishes human clinical trials, observational studies, systematic reviews and commentary intended to help healthcare professionals, delivery organization leaders, policy-makers and scientists evaluate and integrate therapies into patient care protocols, payment strategies and appropriate protocols. Complete tables of content and a sample issue may be viewed on the JACM website.

About the Publisher

Mary Ann Liebert, Inc., publishers known for establishing authoritative peer-reviewed journals in many promising areas of science and biomedical research. A complete list of the firm's 90 journals, books, and newsmagazines is available on the Mary Ann Liebert, Inc., publishers website.