It’s possible that I shall make an ass of myself. But in that case one can always get out of it with a little dialectic. I have, of course, so worded my proposition as to be right either way (K.Marx, Letter to F.Engels on the Indian Mutiny)
Thursday, July 20, 2023
UBC Okanagan researchers investigate new use for plastic bottles
Instead of going to a landfill, they may help with future soil stabilization
For years, unrecycled plastic bottles have been dumped in landfills. Now, thanks to new research from UBC Okanagan, those bottles may have a second life in that landfill—stabilizing its earth walls.
Used plastic bottles and textiles pose an increasing problem for landfills worldwide. Researchers say nearly a hundred million metric tons of polyethylene terephthalate (PET), also known as microplastics, are produced globally each year—with a fraction of that number being recycled—making it one of the largest sources of plastic waste.
“One way we can manage plastic waste is through integrating it into geotechnical construction,” explains doctoral student Alok Chandra. “By finding new ways to use these discarded plastics, we can divert them from landfills and use them to stabilize cover materials within landfills.”
Chandra and his supervisor, UBCO Engineering Professor Dr. Sumi Siddiqua, have developed a new method of incorporating PET waste into clay soil stabilization.
“Due to its nontoxicity, low biodegradability and accessibility, it shows considerable potential for use in landfill designs. However, a considerable amount of research is still required,” says Dr. Siddiqua. “This not only solves the solid waste problem but also increases the economic value of waste and encourages its re-circulation back from already polluted lands and oceans.”
The study suggests the reused material strengthens the soil and serves as a water-resistant layer that will keep pollutants such as lead from escaping the landfill.
“Our results show great potential, but there is still some work to be done before we will integrate the PET waste into landfill soil stabilization management,” says Chandra.
The research is published in the journal Waste Management and funded by the Natural Sciences and Engineering Research Council of Canada Discovery Grants Program.
Patients and members of the public will be able to more easily take part in impactful research thanks to a new tool developed by the University of Birmingham’s work on Long COVID.
These resources are detailed in a paper published today in Nature Medicine from researchers working within the University of Birmingham’s Institute of Applied Health Research, the NIHR Birmingham Biomedical Research Centre (BRC) and NIHR Applied Research Collaboration West Midlands, reporting the evaluation of patient and public involvement and engagement (PPIE) for the Therapies for Long COVID in non-hospitalised individuals (TLC) Study.
Researchers can use the new tool to guide in the planning, implementation and evaluation of projects that work with patient and public groups. The tool draws on best practice and enables researchers to follow checklists to ensure that all aspects of PPIE work are incorporated into research design.
The TLC Study was funded by the UK’s National Institute for Health and Care Research (NIHR) and UK Research and Innovation to investigate the burden of Long COVID on patients, provide a better understanding of the condition, and explore potential interventions. As the long-term effects of Long COVID are yet to be fully understood, involving individuals with lived experiences of the condition was key to the success of the study.
The paper covers the impacts and outcomes of PPIE throughout all stages of research, reflecting on areas of success and improvement – from the development of the grant application and study set up, to study design, the co-creation of data gathering tools and interventions, and the dissemination of the findings.
Researchers faced especially tight time and resource constraints, as the TLC study was conducted in the context of urgent population-level medical need and its outcomes would inform national policy. However, by adopting a flexible approach with public contributors and providing different opportunities and modalities to get involved, the group succeeded in maximising patient involvement within the constraints of the study timeline.
As a legacy of this work, the TLC Study Group created two checklists with key and desirable considerations for PPI to be used in all studies. These are based on items that were deemed the most important by patient partners and researchers involved in the project, and cover all stages and aspects of research.
The full list of domains on the checklists comprises: development of grant proposal, project set-up, study design, undertaking research, dissemination of study findings and engagement, practical considerations, membership of PPIE group, and evaluation of PPIE. By using this tool, other medical researchers will now be able to better plan, implement, and evaluate PPIE for future studies.
Professor Melanie Calvert, Director of the University of Birmingham’s Centre for Patient-Reported Outcomes Research (CPROR), co-lead of the BRC Patient Reported Outcomes research theme and co-PI for the TLC study, said: “Patient partners play a central role in our research team, helping us understand what matters to them and ways to make our research more inclusive and accessible. Building relationships is key, but it takes time and there is a lot to consider to ensure meaningful engagement. Together with our patient partners, we have summarised key considerations for patient and public involvement in health research. Although we provide checklists, this should not be a tick box exercise – our work aims to support a considered approach to working in partnership with patients and the public to influence and shape research, that can in turn inform care and improve health outcomes.”
Dr Lee Aiyegbusi, Associate Professor at the University of Birmingham’s CPROR, co-lead of the BRC Patient Reported Outcomes research theme, and PPI lead of the TLC study, commented: “The active involvement and engagement of patient partners has had tangible and substantial impacts on the TLC study. We hope that other researchers can draw on our experience and use the checklists which we have developed and reported in this article to facilitate patient and public involvement and engagement in future health research.”
Patient partner Flic Jeyes said: “Research is fantastic in moving the world forward and providing us with evidence to prepare us all for tomorrow. Including PPI in research ensures that studies focus on real life needs, as lived and breathed by real people, and have a tangible impact for the communities we live in.
“Working with the University of Birmingham as a PPI partner to the TLC study I have felt empowered to contribute, while being encouraged to respect my own needs and limitations as someone living with Long COVID. I have been able to grow in confidence, offer suggestions that influenced the direction of the study, and learnt to balance that with a long-term health condition.”
IMAGE: THE PATIENT-CENTERED OUTCOMES RESEARCH INSTITUTE (PCORI) IS AN INDEPENDENT NONPROFIT ORGANIZATION AUTHORIZED BY CONGRESS IN 2010. ITS MISSION IS TO FUND RESEARCH THAT WILL PROVIDE PATIENTS, THEIR CAREGIVERS AND CLINICIANS WITH THE EVIDENCE-BASED INFORMATION NEEDED TO MAKE BETTER-INFORMED HEALTH CARE DECISIONS. PCORI IS COMMITTED TO CONTINUOUSLY SEEKING INPUT FROM A BROAD RANGE OF STAKEHOLDERS TO GUIDE ITS WORK.view more
WASHINGTON, DC – The Patient-Centered Outcomes Research Institute (PCORI) today announced the approval of $9 million for the first seven studies through its groundbreaking Science of Engagement initiative. An unprecedented research program dedicated to funding studies to demonstrate how best to engage patients, caregivers and other health care community members in comparative clinical effectiveness research (CER) and other health research, the initiative aims to grow a more robust evidence base to advance patient-centered, community-driven approaches to conducting research.
Since its establishment in 2010, PCORI has accelerated the movement toward transforming health research into a community-driven, participatory enterprise that involves those who ultimately use and rely on study results as partners throughout the research life cycle. PCORI’s efforts have produced a growing number of resources for building multistakeholder research teams and collaboration in CER studies.
Although these and others’ efforts over many years have shown that partner engagement enhances studies in meaningful ways, little systematic evidence exists about why engagement activities achieve the observed effects and which methods are most successful so that those approaches can be employed by others. Additionally, there are critical evidence gaps about how to facilitate and promote inclusion of historically underrepresented populations as partners in patient-centered CER as well as how to measure the impact of including a diverse array of patients and other research partners on study outcomes.
“The time is right to catalyze this nascent field of study called the science of engagement in order to transform our nation’s health research enterprise into a truly patient-centered, community-driven endeavor. Such an enterprise engages those who for far too long have been largely left out of health research,” said PCORI Executive Director Nakela L. Cook, M.D., MPH. “As more and more research teams seek to conduct research in a patient-centered way, PCORI’s Science of Engagement initiative addresses the surging demand for data on how to do it robustly, inclusively and genuinely, and for validated and rigorous ways to measure its effects.”
The first seven studies funded through this initiative focus on the foundational areas of developing or validating measures of engagement and developing and testing engagement techniques. One project, for example, will develop a survey of co-creation in the design and conduct of studies and another will develop a survey of adolescent engagement in research. Another study will compare methods for engaging children, adolescents and their parents with low health literacy.
Several of the projects will consider strategies to improve outreach to and involvement of populations that have been underrepresented in research, including people with limited health literacy skills, people from underserved communities, and children and adolescents.
Research teams for all funded studies will participate in a PCORI Science of Engagement Learning Network that will provide opportunities to engage in peer learning and sharing as well as offer lessons learned to the field.
PCORI launched the Science of Engagement initiative in 2022 with an initial investment of up to $36 million over three years to bolster development of a toolbox of validated measures of engagement. Future Science of Engagement funding awards will advance evidence on the mechanisms by which engagement techniques contribute to research studies’ processes and outcomes and test which approaches are most effective.
“The comprehensive approach and scale with which PCORI has implemented engagement—requiring engagement in all the comparative clinical effectiveness research studies it funds—has served and continues to serve as a laboratory for innovation,” said Harv Feldman, M.D., MSCE, PCORI’s deputy executive director for patient-centered research programs. “PCORI is building on its important work in this area to date to advance a systematic understanding of how to most effectively conduct engagement in research with different individuals and communities. This will strengthen patient-centered, community-driven CER as well as benefit the entire health research enterprise.”
The Science of Engagement funding awards were approved pending a business and programmatic review by PCORI staff and the issuance of formal award contracts. With these latest awards, PCORI has invested more than $4 billion to fund patient-centered CER and support other projects designed to enhance CER methods, engagement, dissemination and implementation, and the infrastructure necessary to conduct CER efficiently. Details of all studies and projects approved for PCORI funding to date are available on PCORI’s website.
About PCORI
The Patient-Centered Outcomes Research Institute (PCORI) is an independent nonprofit organization authorized by Congress in 2010. Its mission is to fund research that will provide patients, their caregivers and clinicians with the evidence-based information needed to make better-informed health care decisions. PCORI is committed to continuously seeking input from a broad range of stakeholders to guide its work.
Wake Forest University School of Medicine approved for $4.4 million PCORI funding award to study telehealth
The award has been approved pending completion of a business and programmatic review by PCORI staff and issuance of a formal award contract.
Telehealth experienced a rapid expansion with the COVID-19 pandemic, but questions remain about the most effective, evidence-based ways to incorporate telehealth as part of routine care, especially in chronic disease management, and how best to mitigate health disparities.
“In-person appointments can be incredibly challenging for families with medically fragile children,” said Savithri Nageswaran, MBBS, professor of pediatrics at Wake Forest University School of Medicine and co-principal investigator of the study. “Caregivers often must miss work to attend the many in-person appointments these children need, which can cause a financial strain. There’s also an enormous amount of planning ahead of time, given the medical complexity of the child, with feeding and medicines.”
Researchers will conduct a multicenter randomized control trial to test the benefits of a telehealth intervention called enhanced primary care (E-PRIME) at 36 primary care pediatric offices across North Carolina.
The research team plans to enroll 400 children who will be randomized to either the early (first six months of the study) or delayed implementation (later six months of the study) of E-PRIME.
“Our primary objective is to improve the delivery of care to these children,” said Sabina Gesell, Ph.D., professor of social sciences at Wake Forest University School of Medicine and co-principal investigator of the study. “We would really like to understand health disparities in this population, and we expect to recruit at least 180 children from minority groups.”
The research team will evaluate the effectiveness of E-PRIME by measuring hospitalizations, emergency room visit rates and caregiver stress. All participants will be followed for one year.
“This study was selected for PCORI funding for its potential to answer the need for real-world evidence about how best to incorporate telehealth into the primary care of people with multiple chronic conditions and how this may differ among populations at risk for health disparities,” said Nakela L. Cook, M.D., the executive director of PCORI. “We look forward to following the study’s progress and working with Wake Forest University School of Medicine to share the results.”
PCORI is an independent, nonprofit organization authorized by Congress in 2010. Its mission is to fund research that will provide patients, their caregivers and clinicians with the evidence-based information needed to make better-informed health-care decisions.
FOR PROFIT HEALTHCARE U$A
New findings show private equity investments in healthcare may not lower costs or improve quality of care
A research team supervised by a health policy researcher at the University of Chicago has found that increasingly common private equity investments in healthcare are generally associated with higher costs to patients and payers.
A research team supervised by a health policy researcher at the University of Chicago has found that increasingly common private equity investments in healthcare are generally associated with higher costs to patients and payers. That’s according to a new study published July 19 in The BMJ. The study is thought to be the first systematic review of global private equity ownership trends in medical settings.
“Over the last few decades, private equity activity in healthcare has exploded, with financial institutions buying up hospitals, nursing homes and fertility clinics — pretty much every area of healthcare,” said Joseph Dov Bruch, PhD, Assistant Professor of Public Health Sciences at UChicago, who is the study’s co-senior author. “News reports have highlighted increasing investment by private equity and a number of studies have set out to examine the phenomenon, but until now there has been no large systematic review of global private equity activity in healthcare. This study is intended to fill that gap.”
Private equity funding can come from multiple types of institutions, with different firms implementing varying investment strategies. As a result, Bruch said, the team wanted to review broad trends to gauge impact on the healthcare sector as a whole rather than limiting analysis to a specific setting.
Although the influence of the financial sector has grown across many fields, “private equity is uniquely interested in healthcare because of the many loopholes and cost-cutting strategies that exist within this industry,” said Bruch.
Performing a global search, Bruch and his research team found 55 previous academic research studies that investigated private equity in healthcare and performed a systematic review across four dimensions: healthcare quality, cost to payers and patients, cost to healthcare operators and health outcomes. They found that in every studied healthcare setting, private equity acquisitions have increased in prevalence since 2000. Across the four dimensions, private equity investment was most closely associated with up to a 32 percent increase in costs for payers and patients. Private equity ownership was also associated with mixed to harmful effects on healthcare quality, while the impact on health outcomes and operator costs was inconclusive.
Proponents of private equity have argued the cash infusions from financial firms provide direct downstream benefits for patients. However, this hypothesis was not supported by the results of the team’s review. The authors did not identify any consistently beneficial impacts of private equity ownership.
“The fact that we are not seeing improvements means we’re not seeing clear indications that private equity makes healthcare more efficient by reducing administrative burden, streamlining processes or offering technology advances,” said Bruch.
The researchers hope the study will make healthcare providers, policymakers and members of the public more aware of the growing influence of the financial sector in the healthcare system. In addition, the team said, healthcare providers may need to pay more attention to the financial burden placed on patients. And the researchers said they believe their findings may spark greater policymaker discussion on antitrust regulation and corporate practice of medicine laws.
While patients may not be able to identify specific changes in the care they receive, Bruch said it is good to be aware that one’s hospital, nursing home, doctor’s office or fertility treatment center may be owned by private equity and that these firms have specific financial targets that may inform care decisions.
“Private equity has been made to be a bogeyman,” said Bruch. “It certainly is an important financial actor growing in activity, and evidence suggests it should raise important concerns for patients, but it is a symptom of a health system that is becoming increasingly financialized.”
The team is continuing their research to examine the role of venture capital, management consultants, financial lenders and real estate investment trusts in healthcare.
The study, “Evaluating trends in private equity ownership and impacts on health outcomes, costs, and quality: systematic review,” was published in The BMJ in July 2023. Study co-authors include Alexander Borsa of Columbia University, Geronimo Bejarano of the University of Texas, and Moriah Ellen of the University of Toronto and the Ben-Gurion University of the Negev.
IMAGE: A CONVENTIONAL CITRUS ORCHARD IN CYPRUSview more
CREDIT: PENELOPE FIALAS
Bat activity falls as farms make the transition to organic agriculture, new research shows.
Organic farming is better for biodiversity than conventional farming, which relies heavily on substances such as pesticides, herbicides and fertilisers.
However, little is known about how wildlife is affected by the transition period when a farm goes organic.
The new study, led by the universities of Bristol, Göttingen and Exeter, assessed the effects of organic farming by monitoring insect-eating bats at citrus orchards in Cyprus.
Activity of three of the four species included in the study was significantly lower at farms in the transition period, compared to conventional farms.
However, activity increased on established organic farms – suggesting a “time-lag” before the organic biodiversity boost for the most abundant bat species.
“We were surprised by our results – we expected the transition to organic farming to bring positive effects from the start,” said Penelope Fialas, from the University of Exeter.
“We can’t be certain why bats are negatively affected, but previous research suggests soil can suffer – with knock-on effects for other wildlife – when fertilisers, pesticides and other aspects of conventional farming stop.
“The soil and the wider ecosystem may take time to recover.”
Fialas added: “Our findings suggest the transition to organic farming should be managed carefully, to limit any negative effects on biodiversity.
“For example, neighbouring farms could avoid simultaneous transitions, allowing wildlife to find alternative habitats nearby while each farm switches its methods.”
Gareth Jones, from the University of Bristol, said: “We’ve long known that organic farms often harbour higher biodiversity than otherwise similar conventional farms.
“The transition to organic farming has been little studied, however, and determining if the detrimental effects during transition observed here hold for other animals and plants would be an interesting future research project.”
The study examined 22 matched pairs of citrus orchards, comparing bat activity at certified organic farms with conventional farms, and organic-transition farms with conventional farms.
The bat species included in the study were: Kuhl's pipistrelle (P. kuhlii), Savi's pipistrelle (H. savii), common bent-wing (M. schreibersii) and common pipistrelle (P. pipistrellus).
The findings showed:
Activity of Savi's pipistrelles was three times lower – and activity of Kuhl's pipistrelles and common bent-wings was twice as low – on organic-transitional farms compared to conventional farms.
Activity of Kuhl's pipistrelles was twice as high on organic farms compared to conventional farms.
Activity of Kuhl's pipistrelles and Savi's pipistrelles was higher or organic farms than on organic-transition farms (by threefold and twofold respectively).
The presence of “semi-natural” areas surrounding the farms did not affect these differences.
The study was partially funded by the University of Göttingen.
The paper, published in the Journal of Applied Ecology, is entitled: “Transition to organic farming negatively affects bat activity.”
IMAGE: SANDIA NATIONAL LABORATORIES RESEARCHER RYAN SCHOELL USES A SPECIALIZED TRANSMISSION ELECTRON MICROSCOPE TECHNIQUE DEVELOPED BY KHALID HATTAR, DAN BUFFORD AND CHRIS BARR TO STUDY FATIGUE CRACKS AT THE NANOSCALE.view more
CREDIT: CRAIG FRITZ, SANDIA NATIONAL LABORATORIES
ALBUQUERQUE, N.M. — Scientists for the first time have witnessed pieces of metal crack, then fuse back together without any human intervention, overturning fundamental scientific theories in the process. If the newly discovered phenomenon can be harnessed, it could usher in an engineering revolution — one in which self-healing engines, bridges and airplanes could reverse damage caused by wear and tear, making them safer and longer-lasting.
The research team from Sandia National Laboratories and Texas A&M University described their findings today in the journal Nature.
“This was absolutely stunning to watch first-hand,” said Sandia materials scientist Brad Boyce.
“What we have confirmed is that metals have their own intrinsic, natural ability to heal themselves, at least in the case of fatigue damage at the nanoscale,” Boyce said.
Fatigue damage is one way machines wear out and eventually break. Repeated stress or motion causes microscopic cracks to form. Over time, these cracks grow and spread until — snap! The whole device breaks, or in the scientific lingo, it fails.
The fissure Boyce and his team saw disappear was one of these tiny but consequential fractures — measured in nanometers.
“From solder joints in our electronic devices to our vehicle’s engines to the bridges that we drive over, these structures often fail unpredictably due to cyclic loading that leads to crack initiation and eventual fracture,” Boyce said. “When they do fail, we have to contend with replacement costs, lost time and, in some cases, even injuries or loss of life. The economic impact of these failures is measured in hundreds of billions of dollars every year for the U.S.”
Although scientists have created some self-healing materials, mostly plastics, the notion of a self-healing metal has largely been the domain of science fiction.
“Cracks in metals were only ever expected to get bigger, not smaller. Even some of the basic equations we use to describe crack growth preclude the possibility of such healing processes,” Boyce said.
Unexpected discovery confirmed by theory’s originator
In 2013, Michael Demkowicz — then an assistant professor at the Massachusetts Institute of Technology’s department of materials science and engineering, now a full professor at Texas A&M — began chipping away at conventional materials theory. He published a new theory, based on findings in computer simulations, that under certain conditions metal should be able to weld shut cracks formed by wear and tear.
The discovery that his theory was true came inadvertently at the Center for Integrated Nanotechnologies, a Department of Energy user facility jointly operated by Sandia and Los Alamos national laboratories.
“We certainly weren’t looking for it,” Boyce said.
Khalid Hattar, now an associate professor at the University of Tennessee, Knoxville, and Chris Barr, who now works for the Department of Energy’s Office of Nuclear Energy, were running the experiment at Sandia when the discovery was made. They only meant to evaluate how cracks formed and spread through a nanoscale piece of platinum using a specialized electron microscope technique they had developed to repeatedly pull on the ends of the metal 200 times per second.
Surprisingly, about 40 minutes into the experiment, the damage reversed course. One end of the crack fused back together as if it was retracing its steps, leaving no trace of the former injury. Over time, the crack regrew along a different direction.
Hattar called it an “unprecedented insight.”
Boyce, who was aware of the theory, shared his findings with Demkowicz.
“I was very glad to hear it, of course,” Demkowicz said. The professor then recreated the experiment on a computer model, substantiating that the phenomenon witnessed at Sandia was the same one he had theorized years earlier.
Their work was supported by the Department of Energy’s Office of Science, Basic Energy Sciences; the National Nuclear Security Administration and the National Science Foundation.
A lot remains unknown about the self-healing process, including whether it will become a practical tool in a manufacturing setting.
“The extent to which these findings are generalizable will likely become a subject of extensive research,” Boyce said. “We show this happening in nanocrystalline metals in vacuum. But we don’t know if this can also be induced in conventional metals in air.”
Yet for all the unknowns, the discovery remains a leap forward at the frontier of materials science.
“My hope is that this finding will encourage materials researchers to consider that, under the right circumstances, materials can do things we never expected,” Demkowicz said.
Sandia National Laboratories is a multimission laboratory operated by National Technology and Engineering Solutions of Sandia LLC, a wholly owned subsidiary of Honeywell International Inc., for the U.S. Department of Energy’s National Nuclear Security Administration. Sandia Labs has major research and development responsibilities in nuclear deterrence, global security, defense, energy technologies and economic competitiveness, with main facilities in Albuquerque, New Mexico, and Livermore, California.
Fusion Healing
Green marks the spot where a fissure formed, then fused back together in this artistic rendering of nanoscale self-healing in metal, discovered at Sandia National Laboratories. Red arrows indicate the direction of the pulling force that unexpectedly triggered the phenomenon.
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