MEDICINE

Home blood pressure monitoring saves lives, cuts costs, and reduces healthcare disparities

New research in the American Journal of Preventive Medicine confirms that regular self-testing better controls hypertension, especially among underserved patients

Peer-Reviewed Publication

ELSEVIER

Ann Arbor, July 13, 2023 – Expanding home blood pressure monitoring among US adults with hypertension could substantially reduce the burden of cardiovascular disease and save healthcare costs in the long term, according to a new study in the American Journal of Preventive Medicine, published by Elsevier. The results of the study show that expanding home monitoring has the potential to address pervasive health disparities facing racial and ethnic minorities and rural residents because it would reduce cardiovascular events among US adults.

Co-lead investigator Yan Li, PhD, Professor, School of Public Health, Shanghai Jiao Tong University School of Medicine, explained, “Our study is among the first to assess the potential health and economic impact of adopting home blood pressure monitoring among American adults with hypertension. We found that it facilitates early detection, timely intervention, and prevention of complications, leading to improved control and better health outcomes.”

Analyzing data from the 2019 Behavioral Risk Factor Surveillance System (BRFSS), investigators projected that implementing home blood pressure monitoring, as opposed to traditional clinic-based care, could result in a reduction of myocardial infarction (MI) cases by 4.9% and stroke cases by 3.8% over 20 years.

Non-Hispanic Blacks, women, and rural residents had more averted cardiovascular events and greater cost savings related to adopting home blood pressure monitoring compared to non-Hispanic Whites, men, and urban residents. Adopting home blood pressure monitoring in rural areas would lead to a potential reduction of 21,278 MI cases per one million people compared to 11,012 MI cases per one million people in urban areas. Rural residents tend to have a higher prevalence of hypertension and uncontrolled hypertension than urban residents and often face additional barriers in accessing primary care services.

Estimating healthcare cost parameters based on actual healthcare payment data from the Medical Expenditure Panel Survey (MEPS), researchers projected an average of 4.4% per person annual savings and an average of $7,794 in healthcare costs per person over a span of 20 years in this population due to home blood pressure monitoring adoption and the subsequent reduced cardiovascular disease cases. Previous economic evaluations of home blood pressure monitoring have primarily focused on local health systems or conducted short-term, small-scale randomized controlled trials.

Hypertension -- systolic blood pressure (BP) greater than 130 mmHg or a diastolic BP greater than 80 mmHg or being on medication for it -- is a pressing public health challenge in the US, with significant implications for the development of heart disease and stroke and leads to substantial healthcare costs. Traditional clinic monitoring, the common method for BP measurement and hypertension diagnosis, has a number of drawbacks: Patients may not visit clinics often enough to pick up the problem, and when they do, accuracy may be compromised by the “white coat” (high office BP but normal BP on home measurements) or “masked” (normal/high normal BP in the office but elevated at home) effects.

Home blood pressure monitoring eliminates these impediments and provides more comprehensive and accurate data compared to sporadic measurements obtained during clinic visits. Yet, the highly effective practice has not been widely adopted in the US because of inadequate health insurance coverage, lack of investment in preventive services, and limited health promotion efforts provided by primary care physicians. However, the landscape has changed between 2020 and 2022 when home blood pressure monitoring attracted increasing attention due to healthcare disruptions caused by the COVID-19 pandemic.

Co-lead investigator Donglan Zhang, PhD, Associate Professor, Center for Population Health and Health Services Research, New York University Long Island School of Medicine, commented, “Given that almost half of all adults in the US (47%) are affected by high blood pressure, and considering the persistent health disparities in cardiovascular health, it is very important to advocate for the widespread adoption of effective and cost-saving strategies. Home blood pressure monitoring empowers patients to take a more active role in managing their chronic conditions. Our findings provide compelling evidence for healthcare systems and payers supporting the broader implementation of this intervention.”

 

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JOURNAL

American Journal of Preventive Medicine

DOI

10.1016/j.amepre.2023.05.010 

METHOD OF RESEARCH

Data/statistical analysis

SUBJECT OF RESEARCH

People

ARTICLE TITLE

The Health and Economic Impact of Expanding Home Blood Pressure Monitoring

New guidance: Bridging the gap between what we know and what we do

Medical organizations publish approaches for implementing infection prevention

Peer-Reviewed Publication

SOCIETY FOR HEALTHCARE EPIDEMIOLOGY OF AMERICA

ARLINGTON, Va. (July 11, 2023) — Five medical societies have published a set of recommendations for operationalizing strategies for infection prevention in acute care settings that account for conditions within the facility, including the culture and communications style of teams, hospital policies, resources available, leadership support and staff buy-in.

“There is no best way to implement a practice, but implementation need not be overly complex,” said Joshua Schaffzin, MD, a pediatric infectious disease physician and a senior author of Implementing Strategies to Prevent Infections in Acute Care Settings published as a new section of the Compendium, a set of guidelines for infection prevention. “This new section is a compilation of a number of options and practical tools you can use to find your best way to implement successfully. It’s a way to take the Compendium from paper to bedside to improve practices for patient safety.”

The new chapter summarizes seven models for implementing other Compendium recommendations for preventing common healthcare-associated infections. It is meant to help bridge the “knowing-doing” gap, a term that describes why healthcare practices often diverge from published evidence to prevent infections that harm patients.

The complexity of healthcare systems makes it difficult for healthcare teams to implement best practices in infection prevention. Understanding factors that promote and hinder adoption within a given setting is an important step to identifying the best framework to deploy in that setting.

“Spending time listening and exploring your context, including local factors such as operational support, informatics resources, familiarity and experience, willingness to change, and safety, is of tremendous value and will guide you to success,” Schaffzin said. “People are rarely eager to change. It’s ok to be discouraged, but don’t give up.”

Schaffzin compared establishing new infection prevention strategies to convincing a young child to try a new food. Sometimes it’s easy, and other times you have to try different tactics, but you can’t force new behaviors.

“Studies in implementation science make it clear that identifying effective interventions is a necessary first step before transferring them into real-world settings in an intentional process,” said Kavita Trivedi, M.D., Director of Clinical Guidance and Communicable Disease Controller at the Alameda County Public Health Department in California and the lead author of the chapter. “Here we provide the reader with the resources to think about implementation and evaluate the contextual determinants of behavior in order to design more successful, customized interventions.”

Implementing Strategies to Prevent Infections in Acute Care Settings is a new section to the Compendium, first published in 2008. The Compendium is sponsored by the Society for Healthcare Epidemiology (SHEA) and is the product of a collaborative effort led by SHEA, with the Infectious Diseases Society of America, the Association for Professionals in Infection Control and Epidemiology, the American Hospital Association, and The Joint Commission, with major contributions from representatives of several organizations and societies with content expertise. It is a multiyear, highly collaborative guidance-writing effort by over 100 experts from around the world.

An update of strategies to prevent catheter-associated urinary tract infections will be published in coming weeks. The societies also recently updated strategies for preventing methicillin-resistant Staphylococcus aureus infections, Clostridioides difficile infections, surgical site infections, central line-associated bloodstream infections, ventilator and non-ventilator associated pneumonia and events, and strategies to prevent healthcare-associated infections through hand hygiene.

Each Compendium article contains infection prevention strategies, performance measures, and approaches to implementation. Compendium recommendations are derived from a synthesis of systematic literature review, evaluation of the evidence, practical and implementation-based considerations, and expert consensus.

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About Infection Control & Hospital Epidemiology
Published through a partnership between the Society for Healthcare Epidemiology of America and Cambridge University Press, Infection Control & Hospital Epidemiology provides original, peer-reviewed scientific articles for anyone involved with an infection control or epidemiology program in a hospital or healthcare facility. ICHE is ranked 24th out of 94 Infectious Disease Journals in the latest Web of Knowledge Journal Citation Reports from Thomson Reuters.

About the Society for Healthcare Epidemiology of America (SHEA) 

The Society for Healthcare Epidemiology of America (SHEA) is a professional society representing more than 2,000 physicians and other healthcare professionals around the world who possess expertise and passion for healthcare epidemiology, infection prevention, and antimicrobial stewardship. The society’s work improves public health by establishing infection-prevention measures and supporting antibiotic stewardship among healthcare providers, hospitals, and health systems. This is accomplished by leading research studies, translating research into clinical practice, developing evidence-based policies, optimizing antibiotic stewardship, and advancing the field of healthcare epidemiology. SHEA and its members strive to improve patient outcomes and create a safer, healthier future for all. Visit SHEA online at shea-online.org, facebook.com/SHEApreventingHAIs and twitter.com/SHEA_Epi.

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JOURNAL

Infection Control and Hospital Epidemiology

METHOD OF RESEARCH

Literature review

SUBJECT OF RESEARCH

Not applicable

ARTICLE TITLE

Implementing Strategies to Prevent Infections in Acute Care Settings

ARTICLE PUBLICATION DATE

11-Jul-2023

Caesarean birth injury rates have risen for mums and babies but training and a new device could change that

Peer-Reviewed Publication

FLINDERS UNIVERSITY

 

IMAGE: FETAL PILLOW. IMAGE REPRODUCED COURTESY OF COOPER SURGICAL, INC. view more 

CREDIT: BJOG: AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY

Over 34% of women in Australia have a caesarean birth, and a significant proportion of these happen in late labour when the fetal head is deep in the mother’s pelvis and can be impacted which makes delivering a baby challenging and poses serious risks to both the mother and the baby.

It’s estimated the baby’s head is wedged, known as impacted fetal head (IFH) in around 10% of all emergency caesarean births (CB). This makes it difficult for the doctor to get their hand below the baby’s head to deliver it, which leads to longer delivery times.

Recent statistics show that while the majority of babies born following IFH sustain minor damage, 2% of these infants die or suffer serious injuries with lifelong consequences.The NHS Resolution report in the UK states that 9% of avoidable brain injuries at birth are caused by impacted fetal head (IFH).

Complications for the mother include increased blood loss, an increased risk of infection, bladder and urinary tract damage, uterine tears that require repair and may cause issues in subsequent pregnancies, or even a hysterectomy.  While complications for the baby include lacerations and bruising to the head and face, skull fractures, and haemorrhages,  there have also been reports of eye injuries.

A Scientific Impact Paper published in BJOG: an International Journal of Obstetrics & Gynaecology by the Royal College of Obtsetricians & Gynaecologists in the UK and Professor Annette Briley at Flinders University has reported a significant rise in cases of IFH injuries in recent years, with maternity staff implementing varied approaches and no consensus regarding the definition or training regarding management to help deliver the baby during CB.

Approaches to managing this obstetric emergency include having an assistant push the baby's head up during birth, delivering the baby feet first, using an inflatable balloon device (Fetal Pillow) designed to elevate the baby’s head, and administering medication to relax the mother’s womb. 

However, this scientific impact paper reviewed the available evidence, concluding there is currently no consensus on the best approach for these risky cases.

Various manoeuvres and some devices have been introduced to help with the delivery of the baby in this situation, but to date there is no consensus on which is best for mothers and babies or the training required for staff managing this emergency situation. 

Most commonly, an assistant is asked to push up from below, although some evidence suggests reverse breech extraction may be associated with better outcomes. A UK-wide survey reported that more than half of obstetric registrars did not feel confident performing reverse breech extraction, and fewer than one in 10 are familiar with the Patwardhan technique.

"The aim of this scientific impact paper was to examine all the current available evidence regarding different manoeuvres and devices currently in use to manage IFH, with the results integrated into the findings of a systematic review commissioned by the National Guideline Alliance (UK)," says research co-author and midwife at Flinders University, Dr. Annette Briley.

The researchers say key steps need to be taken to improve standards:

•    High-quality adequately powered RCTs comparing techniques to manage and prevent IFH are required. (Those currently available have significant weaknesses.)
•    A universally accepted definition of IFH would facilitate future research and education.
•    Women and their partners need to inform research around the language and management of IFH.
•    The development and implementation of an evidence-based multi-professional educational package would lead to consistent management of this obstetric emergency.
•    More research is required around the efficacy and cost-effectiveness of the Fetal Pillow

Dr Briley says the data clearly shows that there has been a significant rise in caesarean sections in late labour and associated cases of IFH-related injuries in recent years, and further education is needed to develop consistent management of this obstetric emergency.

"We’ve reviewed the existing evidence on strategies to identify, prevent, and manage the IFH during births to provide guidance and recommendations that improve outcomes for mothers and babies when this potentially serious complication occurs. It’s essential that clinicians use the best evidence to inform care for women and babies, including the optimal techniques to reduce the potentially devastating complications associated with IFH."

Dr Briley is also part of a research team developing and evaluating the Tydeman tube, an innovative single-use, hollow silicone tube inserted to elevate the baby’s head. Its designed to minimise applied pressure to the head and reduce any suction effect once access has been achieved.  

"A minimal number of Tydeman Tubes have been used clinically; further research in a clinical setting, compared with appropriately trained and executed manual disimpaction, is required to investigate its efficacy and safety before use."

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JOURNAL

International Journal of Obstetrics and Gynaecology

DOI

10.1111/1471-0528.17534 

METHOD OF RESEARCH

Systematic review

SUBJECT OF RESEARCH

People

ARTICLE TITLE

Management of Impacted Fetal Head at Caesarean Birth

Chagas Disease is also 

underdiagnosed in Spain

A new study of nearly 3,000 Latin Americans who visited the Hospital Clinic over 17 years shows that 47% were infected with the parasite that causes the disease, and more than 10% had heart lesions

Peer-Reviewed Publication

BARCELONA INSTITUTE FOR GLOBAL HEALTH (ISGLOBAL)

A high percentage of people from Latin America are infected with the parasite that causes Chagas disease. This is the conclusion of an analysis of nearly 3,000 people from countries where the disease is endemic and who attended the International Health Service at Barcelona’s Hospital Clinic, over a 17-year period. The study, published in PLOS Neglected Tropical Diseases, was led by the Barcelona Institute for Global Health (ISGlobal), an institution supported by "la Caixa" Foundation.

Nearly 7 million people in the world are estimated to be infected with Trypanosoma cruzi, the parasite that causes Chagas disease. Although the vector that transmits the parasite (the kissing bug) is endemic in 21 Latin American countries, the parasite has spread globally due to migratory flows. In non-endemic countries, the parasite can be transmitted vertically, from mother to child or, less commonly, through blood or organ donations. In 30-40% of cases, the infection ends up damaging the heart and digestive system, causing Chagas disease. 

"It is therefore recommended that Latin Americans arriving in the country be tested in order to treat them if they are infected and, in the case of women of childbearing age, to prevent the vertical transmission of the parasite," explains Irene Losada, coordinator of the Chagas Initiative and first co-author of the study, along with Pedro Laynez-Roldán, ISGlobal researcher and physician at the Clínic’s International Health Service.

This retrospective study describes one of the largest samples of people at risk of infection in a non-endemic country: 2,820 Latin Americans, the vast majority from Bolivia, who attended the International Health Service of the Hospital Clinic of Barcelona between 2002 and 2019. Of the total number of people analysed, almost half (47%) were infected with T. cruzi and 17% had heart lesions typical of the disease. Although in most cases an electrocardiogram was sufficient to detect the lesions, an echocardiogram was needed in 10% of cases. "These results reinforce the importance of echocardiograms in the initial assessment of patients with T. cruzi infection," says Laynez-Roldán.

An underdiagnosis problem

The authors note that many people arriving from highly endemic regions of Latin America, such as Bolivia, had never been tested before. "The infection is clearly under-diagnosed even in Spain, one of the European countries with the highest diagnostic coverage," warns Maria Jesús Pinazo, last author of the study, former researcher at ISGlobal and currently at DNDi.

The majority of the cases are women of working age, reflecting the migratory flows of recent years, which allows for better targeting of screening and prevention programmes.

 

Reference

Laynez-Roldán P, Losada-Galván I, Posada E et al. Characterization of Latin American migrants at risk for Trypanosoma cruzi infection in a non-endemic setting. Insights into initial evaluation of cardiac and digestive involvement. Plos NTD. 2023.

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JOURNAL

PLoS Neglected Tropical Diseases

DOI

10.1371/journal.pntd.0011330 

METHOD OF RESEARCH

Observational study

SUBJECT OF RESEARCH

People

ARTICLE TITLE

Characterization of Latin American migrants at risk for Trypanosoma cruzi infection in a non-endemic setting. Insights into initial evaluation of cardiac and digestive involvement

ARTICLE PUBLICATION DATE

13-Jul-2023

U$ FOR PROFIT MEDICINE

New UCF study examines insurance barriers to access opioid addiction medication

While insurance coverage of some forms of buprenorphine has improved over the years, researchers say coverage of new, more effective forms of the medication is lacking

Peer-Reviewed Publication

UNIVERSITY OF CENTRAL FLORIDA

 

IMAGE: BARBARA “BASIA” ANDRAKA-CHRISTOU IS AN EXPERT IN HEALTH SERVICES, HEALTH POLICY AND SUBSTANCE-USE DISORDER TREATMENT. PHOTO CREDIT: BLAKE OSTING view more 

CREDIT: PHOTO CREDIT: BLAKE OSTING, UNIVERSITY OF CENTRAL FLORIDA

By Danielle Hendrix ’15

ORLANDO, July 13, 2023 – In 2021, more people died from opioid overdoses in the U.S. than any other year in history, according to data from the U.S. Centers for Disease Control and Prevention.

However, a new University of Central Florida study recently published in Health Affairs shows that one of the most effective medications for treating opioid addiction is one of the least covered by insurance plans often used by patients with substance use disorder.

Researchers found that although most plans covered the immediate-release sublingual form of buprenorphine, extended-release buprenorphine injections were covered by less than half of commercial plans and less than a fifth of Medicare Advantage Plans. Furthermore, while most Medicaid plans did cover it, more than a third presented a barrier by requiring prior authorization before prescription.

The study’s lead author, Barbara “Basia” Andraka-Christou, says her key passion in research is trying to understand how to expand access to these life-saving treatments.

"Approximately 20% of people actually use buprenorphine or another similar medication called methadone for treatment of opioid-use disorder,” she says. “Most people don't get any treatment, or if they do get treatment, they're getting something that's less effective. Unfortunately, there have been a lot of barriers to accessing it, and some of those have been either lack of insurance coverage or various prior-authorization requirements.”

Buprenorphine can be prescribed by any clinician licensed by the Drug Enforcement Administration and comes in two overall forms: an oral immediate release version that is taken daily or a monthly extended-release intramuscular injection. Since some of the oral versions of the medication are available in generic form, they tend to be the cheaper option. The injection is newer and still under patent, making it the more expensive option.

How the Research Was Performed

Andraka-Christou, an associate professor in the School of Global Health Management and Informatics at UCF, teamed up with Thuy Nguyen from the University of Michigan, W. David Bradford from the University of Georgia and Kosali Simon from Indiana University to examine Medicaid, Medicare Advantage and commercial insurance formulary files to compare insurance-imposed restrictions for buprenorphine from 2017-21.

They studied factors like insurance coverage, prior-authorization requirements, and other potential access barriers like step therapy and quantitative limits across commercial providers, Medicaid, and Medicare.

“Medicaid covers about a third of people in the U.S. with opioid-use disorder and Medicare covers both the elderly and disabled populations,” she says. “That’s important because among older Americans, the rates of opioid overdoses have also been increasing. Because people flow in and out of different types of insurance, it’s very important to look at all insurance sectors.”

What Andraka-Christou and her team found were stark differences in coverage and prior authorization barriers depending on the form of buprenorphine requested. Nearly all plans covered at least one form of immediate-release buprenorphine in 2021, and prior-authorization requirements and quantity limits gradually decreased for immediate-release buprenorphine.

The intramuscular, extended-release injection was subject to the most variance by insurer type. Their research determined that Medicare and commercial insurance were less likely to cover the cost of the buprenorphine injection — with only 46% of commercial plans and 19% of Medicare Advantage plans covering it — as compared to Medicaid. On the other hand, most Medicaid plans covered the extended-release version in 2021, although 37% still required prior authorization.

Despite the oral version now being largely covered by insurers, Andraka-Christou says there is a downside in that it’s easier for opioid-use disorder patients to relapse if they skip doses. With the monthly intramuscular injection, that is less likely to happen.

“The reason prior-authorization requirements are a problem is that someone with an addiction may have a short window of time during which they're willing to go and get treatment,” Andraka-Christou says. “From a public health standpoint, it’s very important to not have prior-authorization requirements for these types of medicines. The injection is also very expensive because it's still on patent, so those requirements probably exist to cut costs. However, if someone had to wait days for the injection and has an overdose in that timeframe, then it might be less costly to not require prior authorization.”   

The barriers related to the oral version of buprenorphine have been a topic of conversation in U.S. healthcare for a while, but Andraka-Christou’s team found that prior-authorization requirements for oral versions are minimal today compared to 10 years ago. With this new finding, she urges researchers, advocates and policymakers to shift their attention to the intramuscular injection version and work on addressing those barriers.

“I think providing access to life-saving treatment needs to be a priority for policymakers and community advocates, and that’s where my passion comes from,” Andraka-Christou says. “The fact is that we have this ongoing, horrific crisis, but we also have tools like buprenorphine and methadone that could cut the risk of overdose deaths in half if they weren’t so underused. State lawmakers could help lead this effort by requiring insurers to cover extended-release buprenorphine without prior authorization.”

Researcher Credentials

Andraka-Christou received both her juris doctorate and doctorate in law and social science from Indiana University Bloomington. She joined UCF’s School of Global Health Management and Informatics, part of UCF’s College of Community Innovation and Education, in 2017. Her areas of expertise include health services, health policy and substance-use disorder treatment. Much of her research on the evolving opioid epidemic is summarized in her book The Opioid Fix: America’s Addiction Crisis and the Solution They Don’t Want You to Have (Johns Hopkins University Press, 2020).

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JOURNAL

Health Affairs

DOI

10.1377/hlthaff.2022.01513 

METHOD OF RESEARCH

Data/statistical analysis

SUBJECT OF RESEARCH

Not applicable

ARTICLE TITLE

Buprenorphine Treatment For Opioid Use Disorder: Comparison Of Insurance Restrictions, 2017–21

Doctors warn of looming threat to America’s surgical research

Peer-Reviewed Publication

UNIVERSITY OF VIRGINIA HEALTH SYSTEM

 

IMAGE: UVA HEALTH'S BRUCE SCHIRMER, MD (LEFT), AND ADISHESH K. NARAHARI, MD, WARN THAT A "BROKEN PIPELINE" OF FUNDING FOR SURGEON-SCIENTISTS COULD HARM PATIENT-CARE INNOVATION. view more 

CREDIT: COURTESY ADISHESH K. NARAHARI, MD

Surgeons who also conduct important biomedical research are struggling to obtain research funding, and that “broken pipeline” could spell extinction for surgeon-scientists and slow innovations for patients if something isn’t done, a team of UVA Health experts warns. 

Researchers led by Bruce Schirmer, MD, of UVA's Department of Surgery, found that surgeon-scientists often succeed in obtaining research support early in their careers but then are much less likely than peers in internal medicine to translate that into ongoing research funding. 

The reasons for this are complex, Schirmer and colleagues say in a new scientific paper, but include the heavy clinical demands surgeons face and the ongoing need to maintain and refine their skills. This often leaves them with little time to compete for research funding and to conduct research that would ultimately benefit patients. 

That, Schirmer and colleagues warn, could have dire implications for the future. 

“Surgeons have been responsible for many of the significant advancements in treatments of diseases, especially those of the cardiovascular, digestive, neurologic, endocrine, pulmonary and urologic systems, as well as most types of cancer. Lack of ongoing funding for surgical research could limit such contributions in the future,” Schirmer said. “These data should be a wake-up call to the surgical community to reconsider when research is optimally performed during surgical training and how resources to subsequently support it can be best secured.”

Surgical Research Funding

Schirmer and his team looked at research grants obtained by trainees in both surgery and internal medicine. They found that trainees obtained F32 grants from the National Institutes of Health to support dedicated research at similar rates, but the internal medicine trainees were almost six times more likely to parlay that later into R01 grants, the NIH’s oldest and most competitive funding mechanism. The internal medicine researchers were also five times more likely to obtain a career development K-award from the NIH.

The researchers label the discrepancy a “shocking drop-off” and say it represents a “major problem” for the surgical specialty.

“Surgeons are struggling to find funding, and many of them are not able to obtain funding despite trying for 10 years. Surgeon-scientists have made many advances in biomedical research in fields such as transplantation, oncology and diabetes,” said UVA Health surgery intern Adishesh K. Narahari, MD, PhD, the first author of the new scientific paper. “In short, surgeons need to apply for funding early and become proficient at navigating the biomedical research world. Otherwise, we may see a decrease in innovation and lack of new solutions to not only surgical problems but many areas of biomedical research.”

Narahari, Schirmer and their collaborators say swift action is needed and have formulated recommendations to address the problem. These suggestions include:

• Develop alternate grant-funding mechanisms to support surgeon-scientists;
• Establish programs at individual institutions to support surgical residents who wish to do research;
• Encourage surgeons to do research by evaluating surgeon-scientists using different job-performance metrics than surgeons who do not do research.

If steps aren’t taken, the UVA researchers warn, surgical research will suffer.

“We hope this paper sparks a movement to encourage the development of surgeon-scientists through curricular, programmatic and supportive mechanisms that foster those highly interested in such career paths to be most productive and successful,” Schirmer said. “We hope those who oversee surgical education and training will strongly consider these findings.”

Findings Published

The researchers have published their findings in the scientific journal Annals of Surgery. The team consisted of Narahari, Anirudha S. Chandrabhatla, Emily Fronk, Simon White, Shreya Mandava, Hannah Jacobs-El, J. Hunter Mehaffey, Curtis G. Tribble, Mark Roeser, John Kern, Irving L. Kron and Schirmer. 

Narahari was supported by NIH grant F30CA236370.

To keep up with the latest medical research news from UVA, subscribe to the Making of Medicine blog.

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DOI

10.1097/SLA.0000000000005956 

High ozone exposure linked to increased mortality: new insights from a comprehensive Chinese National Cohort study

Peer-Reviewed Publication

CHINESE SOCIETY FOR ENVIRONMENTAL SCIENCES

 

IMAGE: GRAPHICAL ABSTRACT view more 

CREDIT: ENVIRONMENTAL SCIENCE AND ECOTECHNOLOGY

In a new study published in Volume 15 of the journal Environmental Science and Ecotechnology, researchers from Wuhan University of Science and Technology revealed that even a modest increase of 10 μg m−3 in O3 concentration was associated with a hazard ratio of 1.18 for all-cause mortality, indicating an 18% higher risk of death. The investigation encompassed a robust cohort of 20,882 participants nationwide and spanned a comprehensive seven-year period from 2011 to 2018. An intriguing aspect of this study is its particular focus on warm-season O3 exposure, which, despite the implementation of the Air Pollution Prevention and Control Action Plan in 2013, remains a significant concern in China. Furthermore, the relationship between long-term O3 exposure and mortality risk exhibited a J-shaped pattern, implying a non-linear association with a potential threshold of O3 concentration. A crucial discovery highlights that people in colder climates face heightened mortality risks due to long-term O3 exposure. This underscores the necessity of considering geographical and climate factors when assessing the health impacts of air pollution. The study also revealed a notable regional discrepancy, with China exhibiting higher risk estimates than recent estimates from Europe and North America. These variations could be attributed to variances in exposure metrics, population susceptibility, and generally lower O3 concentrations in developed nations.

Highlights

•A national cohort study on O3 exposure and all-cause mortality is conceived in China.

•Long-term O3 exposure is associated with increased mortality risk.

•A J-shaped O3-mortality relationship is identified in middle-aged and older adults.

However, it is essential to note that despite the significant findings, the study had certain limitations. The assessment of O3 exposure was based on data at the city level rather than individual-level exposure Furthermore, the study did not consider factors such as indoor O3 exposure and potential unmeasured confounders (e.g., traffic noise or other climatic factors). Additionally, the lack of clinical diagnoses regarding the cause of death restricts the exploration of associations between O3 exposure and cause-specific mortality.

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References

Funding information

Youth Fund Project of Humanities and Social Sciences Research of the Ministry of Education (21YJCZH229).

DOI

10.1016/j.ese.2023.100241

About Environmental Science and Ecotechnology

Environmental Science and Ecotechnology (ISSN 2666-4984) is an international, peer-reviewed, and open-access journal published by Elsevier. The journal publishes significant views and research across the full spectrum of ecology and environmental sciences, such as climate change, sustainability, biodiversity conservation, environment & health, green catalysis/processing for pollution control, and AI-driven environmental engineering. ESE received its latest impact factor of 12.6, according to the Journal Citation ReportTM 2022.

The C–R curve for O3 and all-cause mortality was fitted using a natural cubic spline. A nonlinear association between long-term O3 exposure and mortality risk (P for nonlinearity < 0.001) was observed at 60.7–142.4 μg m−3. Intuitively, we observed a J-shaped relationship, revealing a relatively flat curve as O3 levels fell below approximately 110 μg m−3, while the slope (i.e., increase in mortality risk) was steeper at higher concentrations.

CREDIT

Environmental Science and Ecotechnology

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JOURNAL

Environmental Science and Ecotechnology

DOI

10.1016/j.ese.2023.100241 

SUBJECT OF RESEARCH

Not applicable

ARTICLE TITLE

Excess mortality associated with high ozone exposure: A national cohort study in China

Eyes in the skies confirm the end of trash burning in the Maldives

A new AI approach needs only a small amount of visual data to identify and track plumes of smoke in satellite imagery

Peer-Reviewed Publication

DUKE UNIVERSITY

 

IMAGE: PLUMES OF SMOKE FROM BURNING TRASH RISE FROM THILAFUSHI ISLAND IN THE MALDIVES. NEW RESEARCH USING SATELLITE IMAGERY WAS ABLE TO CONFIRM THAT A RECENT BAN ON THE PRACTICE HAS BEEN EFFECTIVE AT ELIMINATING SUCH POLLUTION. view more 

CREDIT: CREATIVE COMMONS BY IBRAHIM ASAD

DURHAM, N.C. – White sand beaches. Crystalline waters. Toxic smoke plumes wafting across a paradise clogged with plastic trash. 

That was the Republic of Maldives in early 2021, which prompted its government to ban open trash burning and single-use plastics later that year. But until recently, uncertainty remained as to whether or not the government actually put its money where its mouth was and enforced the policy changes.

New research from Duke University which used advanced AI techniques to analyze satellite images of the nation of islands in the middle of the Indian Ocean has demonstrated that the government’s ban on open burning has indeed effectively stamped out the smoke plumes.

This approach has the potential to spot similar plumes generated by wildfires, power plants, or industrial facilities. The findings were published on July 7th in Environmental Science & Technology Letters.

The Maldives is made of 1200 islands. Its largest, Male, is one of the most densely populated places on earth, generating hundreds of tons of waste every day. A nearby artificial island named Thilafushi serves as its dump — but at sea level, much of the plastic trash deposited there was washing into the ocean. Much more of it was being burned, sending toxic smoke drifting across the islands and pristine Indian Ocean. There was massive plastic contamination at every level.

Mike Bergin, the Sternberg Family Professor of Civil & Environmental Engineering at Duke, runs a large global air quality program that uses low-cost sensors to gather information. Bergin’s group was working with collaborators in the Maldives to install air quality sensors when he first heard about the situation on Thilafushi. He wanted to know what kind of air quality data was available for the island country, so he turned to satellite imagery from a commercial data company called PlanetLabs. What he saw troubled him. 

“The island was smoking all the time,” said Bergin. He asked colleague David Carlson, assistant professor of civil and environmental engineering at Duke and a machine learning expert, if there was anything they could do to help track who was being exposed to the toxic smoke.  

The two decided to develop an AI tool that used advanced image segmentation and something called transfer learning to examine satellite imagery of the island to see whether or not they could identify the smoke plumes from space. 

Soon after Bergin and Carlson began, however, the Maldivian government banned both trash burning and single-use plastics on its islands. The massive policy changes created a unique opportunity for the pair to see whether an AI tool could tell the difference between images of Thilafushi before and after the ban — and to confirm whether the ban had actually been enacted.

Training AI tools to recognize a certain shape usually requires thousands of images, but environmental applications generally don’t have huge data sets to work from. To get around this shortfall, the team turned to an approach called transfer learning, which borrows from lessons already learned by existing convolutional neural networks trained on similar tasks, allowing the AI to gain accuracy from far fewer images.

Carlson started with a model trained on a canonical image recognition task — classifying an unnamed animal as either a cat or a dog. “It initializes your AI tool, so that when you apply it in a new area, the established baseline allows it to succeed with far less data,” said Carlson. 

Image segmentation — the ability of an AI tool to recognize a shape and lift it from the background — has gotten a lot better in recent years, and those advances also played a big role. “Highlighting the area in each image that might be a plume provides a lot of additional information to the AI tool, so that it continues to learn,” said Carlson. “Localized info teaches it exactly what is relevant, so that it gets better and better at the task.”

They were then able to apply their AI tool to the image classification problem at hand. The verdict? There were no smoke plumes in the images of Thilafushi after the burning ban was instated. 

And after comparing the AI’s abilities against its human teachers’, the researchers found that the tool achieved 88% accuracy in its classification task. Through the process, it also learned the typical shape of a plume and how to distinguish between plumes and clouds, which have similar diffuse boundaries.

“Asking a human to identify a plume is such an objective task,” said CEE PhD student Sarah Scott, the paper’s first author. “That’s why we had several people performing it, and why we blended plume images together  — to show how different people might perceive the shapes. But the computer is looking at when the signals change within the image, pixel by pixel. Humans can’t see change at that level.” 

“The results were impressive, and confirmed the time the ban was implemented,” said Noora Khaleel, a PhD student at the University of Malaya, who worked with the Duke team on the project. “It is encouraging for a small developing country like the Maldives to be recognized for its efforts to regulate environmental problems.”

In the future, if the AI tool is made more robust — something that Carlson and Bergin acknowledge will take much more data and the participation of a large citizen science effort — it could give people more power to surveil numerous environmental problems around the world.

“It would be amazing to be able to scan for plumes, find them and keep track of them,” said Bergin. “We could let the public know when they’re being exposed to pollution from plumes, and they could hold parties accountable to clean up their acts.”  

This material is based upon work supported by the Department of Energy/National Nuclear Security Administration (DE-NA0003921) and a grant from the US Department of State.

CITATION: “Identifying Waste Burning Plumes Using High Resolution Satellite Imagery and Machine Learning: A Case Study in the Maldives,” Sarah R. Scott, Philemon E. Hailemariam, Prakash V. Bhave, Michael H. Bergin, David E. Carlson. Environmental Science & Technology Letters, July 7, 2023. DOI: 10.1021/acs.estlett.3c00225

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JOURNAL

Environmental Science & Technology Letters

DOI

10.1021/acs.estlett.3c00225 

METHOD OF RESEARCH

Experimental study

SUBJECT OF RESEARCH

Not applicable

ARTICLE TITLE

Identifying Waste Burning Plumes Using High Resolution Satellite Imagery and Machine Learning: A Case Study in the Maldives

Drexel’s titanium oxide material lets sunlight drive green hydrogen production

Stable photocatalyst material opens new possibilities for harvesting hydrogen

Peer-Reviewed Publication

DREXEL UNIVERSITY

 

IMAGE: RESEARCHERS FROM DREXEL UNIVERSITY AND THE NATIONAL INSTITUTE OF MATERIALS PHYSICS IN ROMANIA, HAVE DISCOVERED A TITANIUM OXIDE-BASED PHOTOCATALYTIC MATERIAL THAT COULD OPEN A NEW PATH FOR GREEN HYDROGEN PRODUCTION. view more 

CREDIT: DREXEL UNIVERSITY

Clean energy plans, including the U.S. Infrastructure Investment Act’s “Clean Hydrogen Road Map,” are counting on hydrogen as a fuel of the future. But current hydrogen separation technology is still falling short of efficiency and sustainability goals. As part of ongoing efforts to develop materials that could enable alternative energy sources, researchers in Drexel University’s College of Engineering have produced a titanium oxide nanofilament material that can harness sunlight to unlock the ubiquitous molecule’s potential as a fuel source.

The discovery offers an alternative to current methods that generate greenhouse gas and require a great deal of energy. Photocatalysis, a process that can split hydrogen from water using only sunlight, has been explored for several decades, but has remained a more distant consideration because the catalyst materials enabling the process can only survive it for a day or two, which limits its long-term efficiency and, as a result, its commercial viability.

Drexel’s group, led by College of Engineering researchers Michel Barsoum, PhD, and Hussein O. Badr, PhD, in collaboration with scientists from the National Institute of Materials Physics in Bucharest, Romania, recently reported its discovery of photocatalytic titanium oxide-based, one-dimensional nanofilament material that can help sunlight glean hydrogen from water for months at a time. Their article “Photo-stable, 1D-nanofilaments TiO2-based lepidocrocite for photocatalytic hydrogen production in water-methanol mixtures,” published in the journal Matter, presents a sustainable and affordable path for creating hydrogen fuel, according to the authors.

“Our titanium oxide one-dimensional nanofilaments photocatalyst showed activity that is substantially higher — by an order of magnitude — than its commercial titanium oxide counterpart,” Hussein said. “Moreover, our photocatalyst was found to be stable in water for 6 months — these results represent a new generation of photocatalysts that can finally launch the long-awaited transition of nanomaterials from lab to market.”

Barsoum’s group discovered hydroxides-derived nanostructures (HDNs) — the family of titanium oxide nanomaterials, to which the photocatalytic material belongs — two years ago, as it was working out a new process for making MXene materials, which Drexel researchers are exploring for a number of applications. Instead of using the standard, caustic hydrofluoric acid to chemically etch out the layered two-dimensional MXenes from a material called a MAX phase, the group used an aqueous solution of a common organic base, tetramethylammonium hydroxide.

But rather than producing a MXene, the reaction produced thin, fibrous titanium oxide-based strands — that the team would come to find possessed the ability to facilitate the chemical reaction that splits hydrogen out of water molecules when exposed to sunlight.

“Titanium-oxide materials have previously demonstrated photocatalytic abilities, so testing our new nanofilaments for this property was a natural part of our work,” he said. “But we did not expect to find that not only are they photocatalytic, but they are extremely stable and productive catalysts for hydrogen production from water-methanol mixtures.”

The group tested five photocatalyst materials — titanium oxide-based HDNs, derived from various low-cost and readily available precursor materials — and compared them to Evonik Aeroxide’s titanium oxide material, called P25, which is widely accepted as the photocatalyst material closest to commercial viability.

Each material was submerged in a water-methanol solution and exposed to ultraviolet-visible light produced by a tunable illuminator lamp that mimics the spectrum of the sun. The researchers measured both the amount of hydrogen produced and duration of activity in each reactor assembly, as well as the number of photons from the light that produced hydrogen when they interacted with the catalyst material — a metric for understanding the catalytic efficiency of each material.

They found that all five titanium oxide-based HDNs photocatalysts performed more efficiently at using sunlight to produce hydrogen than the P25 material. One of them, derived from binary titanium carbide, is 10 times more efficient than P25 at enabling photons to split off hydrogen from the water.

This improvement is quite significant on its own, the team reports, but an even more significant finding was that the material remained active after more than 180 days of exposure to the simulated sunlight.

“The fact that our materials appear to possibly be thermodynamically stable and photochemically active in water-methanol mixtures for extended durations cannot be overemphasized,” Hussein said. “Since our material is not costly to make, easy to scale up, and incredibly stable in water, its applications in various photocatalytic processes become worth exploring.”

The next step for the research is better understanding why the material behaves this way, so it can be further optimized as a photocatalyst. The team’s current theory posits that the one-dimensional nature and theoretical high surface area of the material contribute to its sustained activity, but additional testing is needed to confirm these suggestions.

The group is also working to find other additives, aside from methanol, to serve as “hole quenchers” — chemicals that prevent the water-splitting reaction from reversing course, which is a common occurrence due to the somewhat chaotic nature of photocatalytic reactions.

The results are so promising that the group has founded a green hydrogen startup around the technology and is working with the Drexel Office of Innovation and the National Science Foundation’s Innovation Corps to move toward commercializing it.

“We are very excited about the possibilities of this discovery,” Barsoum said. “The world needs massive new clean fuels that can supplant fossil fuels. We believe this material can unlock the potential of green hydrogen.”

In addition, the group is exploring a number of other applications for HDNs, including using them in batteries, solar cells, water purification and medical treatments. Their ability to be easily and safely produced in large quantities, sets HDNs apart from other nanomaterials, which opens them to a variety of possible uses, according to Hussein.

“Our HDNs family of nanostructures continue to impress the very different communities with whom we are collaborating. These titanium oxide nanofilaments can be used for number of applications including water purification, dye degradation, perovskite solar cells, lithium-ion and lithium-sulfur batteries, urea dialysis and breast cancer therapy, among many more.”

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JOURNAL

Matter

DOI

10.1016/j.matt.2023.05.026 

METHOD OF RESEARCH

Experimental study

SUBJECT OF RESEARCH

Not applicable

ARTICLE TITLE

Photo-stable, 1D-nanofilaments TiO2-based lepidocrocite for photocatalytic hydrogen production in water-methanol mixtures