Monday, November 06, 2023

Exercise therapy based on smart data to improve patients' quality of life

Establishing a digital assistance system based on artificial intelligence to support patients / Sports Medicine research group of Mainz University involved in two projects coordinated by the Mainz University Medical Center

Grant and Award Announcement

JOHANNES GUTENBERG UNIVERSITAET MAINZ

Regular and moderate physical activity can significantly improve the quality of life of people with internal diseases such as cancer and depression. Unfortunately, many people with internal disorders cannot sufficiently participate in exercise training for several reasons. For example, they often do not have access to appropriate exercise training programs, have a high therapeutic burden, fatigue, or simply no time to engage in physical activity. Accordingly, the Sports Medicine research group led by Professor Perikles Simon at Johannes Gutenberg University Mainz (JGU) investigates how physical activity can be promoted and integrated into patients' daily lives by applying digital tools such as wearables and mobile apps in combination with secure data transfer and state-of-the-art data analysis. Overall, the primary aim of the research approach is to improve patients' quality of life. "With this smart data concept, we want to employ a digital infrastructure to support people with internal diseases as well as the exercise therapists who guide the patients' exercise therapy," said Barlo Hillen, research associate of JGU's Department of Sports Medicine, Disease Prevention, and Rehabilitation. The JGU Sports Medicine is involved in two related research projects coordinated by the Mainz University Medical Center: DECIDE, sponsored by the German Federal Ministry of Education and Research, and the EU project RELEVIUM.

DECIDE: Algorithms and smartwatches to be used for the benefit of patients

The JGU Sports Medicine research group strives to ensure advanced exercise load management for patients. The group wants to support patients in better coping with their individual disorders, improve their personal well-being, and increase their capability to deal with daily tasks or at least maintain this ability even as the disease progresses. The new project "Decentralized Digital Environment for Consultation, Data Integration, Decision Making, and Patient Empowerment" (DECIDE) is coordinated by Dr. Torsten Panholzer, head of Medical Informatics at the Institute of Medical Biostatistics, Epidemiology, and Informatics (IMBEI) at the Mainz University Medical Center. One of the main objectives of DECIDE is to improve the level of support services available to patients with colon cancer, lung cancer, or depression living in the rural regions of Rhineland-Palatinate. The networking of regional hospitals, physicians, self-help groups, and researchers is coordinated by the University Medical Center of Johannes Gutenberg University Mainz. The research results are intended to directly support patients.

Collaborating with the Fraunhofer Institute for Industrial Mathematics (ITWM), the JGU research group plans to apply intelligent digital support systems that will enable individualized control of patients' daily physical activity. A smartwatch will register the patients' vital data as well as their perceived exertion and pain. The data is transmitted to an app on the patients' smartphone and from there to their therapists. A feedback loop and an automated data analysis system will ensure the appropriate modification of training recommendations for each individual on a regular basis. "In previous projects, it was necessary to analyze exercise protocols and draw up training plans manually. That was very time-consuming. Our digital tools will be able to process most of this work automatically, enhancing the efficiency of the process," added Hillen. Depending on the individual patient, recommendations may include moderate strength exercise, endurance exercise, i.e., brisk walking or jogging in intervals, and mobility training. The advocated forms of exercise will fit in the patient's daily routine. The aim is to minimize any potential logistical or financial barriers that might discourage patients from exercise participation.

Partners of the Mainz University Medical Center and the JGU Sports Medicine research group in the DECIDE project are the Fraunhofer Institute for Industrial Mathematics and the MCS Data Labs GmbH in Berlin. DECIDE is currently in the pilot phase studying healthy subjects. The German Federal Ministry of Education and Research (BMBF) is funding the project with EUR 5.5 million as part of its Digital Strategy program.

RELEVIUM: Improving the quality of life of pancreatic cancer patients

The EU project RELEVIUM aims to support patients with advanced pancreatic cancer. Their pain and uncontrolled weight loss should be alleviated based on highly personalized approaches including nutrition, physical activity, and pain management – along with chemotherapy. Digital systems with automated evaluation algorithms will in particular facilitate the monitoring of the patients' sarcopenia, nutritional intake, physical activity, and pain perception. The JGU Sports Medicine research group will give advice on suitable physical exercise and support the project consortium by planning and implementing randomized clinical trials in five medical centers in Europe, subsequently analyzing the extensive collected data.

"We will determine the effect of the smart data concept and investigate if patients do actually benefit from the use of digital tools and experience a better quality of life," said Barlo Hillen. With regard to physical activity, training programs will be organized similar to DECIDE, but these will be specifically adapted to the needs and abilities of people with pancreatic cancer. Pancreatic cancer has one of the lowest survival rates among cancers and is responsible for 95,000 cases of deaths per year in the EU alone.

The RELEVIUM consortium consists of 18 partners in ten countries. Major European medical and cancer centers in Belgium, Estonia, France, and Israel are included in RELEVIUM. The European research network is being coordinated by Professor Markus Moehler of Medical Clinic I at the Mainz University Medical Center. The project was launched on 1 September 2022 with a feasibility study involving both diseased and healthy participants and is planned to run until 2026. The European Union provides funding of about EUR 6 million for the project.

Related links:

https://www.blogs.uni-mainz.de/fb02-sports-medicine/ – Department of Sports Medicine, Prevention, and Rehabilitation at the JGU Institute of Sports Medicine
https://www.itwm.fraunhofer.de/en/departments/optimization/life-sciences/ai-lifestyle-pancreatic-cancer.html – RELEVIUM: Lifestyle Optimization for Pancreatic Cancer
https://www.releviumproject.eu/ – EU-funded project RELEVIUM
https://decide.imbei.uni-mainz.de/decide/ – DECIDE: Decentralized Digital Environment for Consultation, Data Integration, Decision Making, and Patient Empowerment [in German]
https://www.itwm.fraunhofer.de/en/departments/optimization/life-sciences/decide.html – DECIDE: Integrated Digital Solutions for Oncology

Alternative antibiotic selection can reduce the risk of healthcare-associated infections for patients with pneumonia

VA study finds a 45% reduction in Clostridioides difficile infections among high-risk patients with the use of doxycycline instead of azithromycin

Peer-Reviewed Publication

ASSOCIATION FOR PROFESSIONALS IN INFECTION CONTROL

Arlington, Va. — November 2, 2023 — A new study published today in the American Journal of Infection Control (AJIC) reveals that the use of doxycycline may help protect against Clostridioides difficile (C. diff) infection for some patients with pneumonia. Specifically, study authors found that for hospitalized patients with community-acquired pneumonia who had experienced C. diff infections in the prior year, the use of doxycycline, instead of the more commonly used azithromycin, reduced the development of new C. diff infections by 45%.

Often acquired by hospitalized patients taking broad-spectrum antibiotics, C. diff infections can be deadly. There are more than 450,000 C. diff infections in the U.S. each year, leading to as many as 30,000 deaths, according to public health estimates.1 These infections also confer a high risk of recurrence; more than a third of patients who suffer a C. diff infection will go on to have another in the future.2 Because pneumonia is so common and is typically treated with broad-spectrum antibiotics, hospitalized patients with pneumonia are at increased risk of developing a C. diff infection.

For patients who are admitted to a hospital with pneumonia, clinical guidelines typically recommend the use of azithromycin, which penetrates the lung tissue and can successfully treat Legionella pneumonia as well as more common types of pneumonia. While doxycycline should not be used to treat Legionella pneumonia, it can be effective against other types of pneumonia. In addition, doxycycline has optimal absorption in the upper gastrointestinal tract with minimal impact on the gut microbiome, which could account for the reduced risk of C. diff infection.

In this retrospective study, researchers analyzed outcomes of 156,107 patients treated for pneumonia in Veterans Affairs Hospitals between January 2009 and August 2022. For inclusion in the analysis, patients had to be admitted to the hospital no more than 48 hours before a pneumonia diagnosis to ensure that all cases were considered community-acquired pneumonia. Patients diagnosed with Legionella pneumonia or viral pneumonia were excluded from the study, because the recommended treatment for these conditions is different than that for typical community-acquired pneumonia. Any patient who was diagnosed with a C. diff infection within 30 days of antibiotic treatment was presumed to have antibiotic-associated C. diff.

As expected, based on clinical guidelines, most patients were treated with azithromycin (87%) while a small proportion received doxycycline (13%). Overall, less than 1% of patients developed C. diff infections, but among patients who had experienced a C. diff infection in the year before their pneumonia diagnosis, 12% developed a new C. diff infection associated with the antibiotic treatment. Among patients with no history of C. diff infections, there was no statistical difference in the rate of C. diff infections between those who received azithromycin and those who received doxycycline. However, for patients who had a C. diff infection in the prior year, the use of doxycycline was associated with a 45% reduction in antibiotic-associated C. diff infection compared to azithromycin.

“Our analysis found that in patients with a prior history of C. diff, doxycycline was the only factor associated with a reduction in the incidence of new C. diff infections,” said Kari A. Mergenhagen, PharmD, BCPS, BCIDP, residency director for infectious diseases at the Veterans Affairs of Western New York Healthcare System and senior author of the study. “These results suggest that in cases where Legionella pneumonia can be ruled out prior to treatment, patients at increased risk of C. diff may benefit from the use of doxycycline as a first-line agent.”

Additional findings from the study include:

A total of 1,234 patients were diagnosed with C. diff within 30 days of starting antibiotic treatment for pneumonia. That includes 1,085 patients treated with azithromycin and 149 treated with doxycycline.
Of the 1,234 patients who developed C. diff infections within 30 days, 1,104 of them had no prior history of C. diff.
Of the patients in the study, 1,064 had been diagnosed with C. diff in the year-long period prior to diagnosis with pneumonia.
Because the population in this study came from VA hospitals, the patients were predominantly male, elderly, and Caucasian. Additional studies will be needed to determine whether these findings hold for other patient populations.

“Healthcare facilities have a keen interest in reducing the incidence of dangerous and costly healthcare-associated C. diff infections,” said Patricia Jackson, RN, BSN, MA, CIC, FAPIC, 2023 APIC president. “This study shows that for patients with a history of C diff antibiotic choice is an important factor in decreasing these types of infections.”

References

1. Lessa FC, Mu Y, Bamberg WM, Beldavs ZG, Dumyati GK, Dunn JR, Farley MM, Holzbauer SM, Meek JI, Phipps EC, Wilson LE, Winston LG, Cohen JA, Limbago BM, Fridkin SK, Gerding DN, McDonald LC. Burden of Clostridium difficile infection in the United States. N Engl J Med. 2015 Feb 26;372(9):825-34. doi: 10.1056/NEJMoa1408913. PMID: 25714160.

2. Feuerstadt P, Theriault N, Tillotson G. The burden of CDI in the United States: a multifactorial challenge. BMC infectious diseases. 2023;23(1):132.

About APIC

Founded in 1972, the Association for Professionals in Infection Control and Epidemiology (APIC) is the leading association for infection preventionists and epidemiologists. With more than 15,000 members, APIC advances the science and practice of infection prevention and control. APIC carries out its mission through research, advocacy, and patient safety; education, credentialing, and certification; and fostering development of the infection prevention and control workforce of the future. Together with our members and partners, we are working toward a safer world through the prevention of infection. Join us and learn more at apic.org.

About AJIC

As the official peer-reviewed journal of APIC, The American Journal of Infection Control (AJIC) is the foremost resource on infection control, epidemiology, infectious diseases, quality management, occupational health, and disease prevention. Published by Elsevier, AJIC also publishes infection control guidelines from APIC and the CDC. AJIC is included in Index Medicus and CINAHL. Visit AJIC at ajicjournal.org.

NOTES FOR EDITORS

“Impact of Doxycycline on Clostridioides difficile Infection in Patients Hospitalized with Community-acquired Pneumonia,” by Ashley L. O'Leary, Arthur K. Chan, Bethany A. Wattengel, Jiachen Xu, and Kari A. Mergenhagen was published online in AJIC on November 2, 2023. Available at: https://doi.org/10.1016/j.ajic.2023.09.007

AUTHORS

Kari A. Mergenhagen, PharmD BCPS BCIDP (Corresponding author: Kari.Mergenhagen@va.gov), Department of Pharmacy, Veterans Affairs of Western New York Healthcare System

Ashley L. O'Leary, PharmD, AAHIVP, Department of Pharmacy, Veterans Affairs of Western New York Healthcare System, Department of Pharmacy Practice, D’Youville School of Pharmacy

Arthur K. Chan, PharmD, Department of Pharmacy, Veterans Affairs of Western New York Healthcare System

Bethany A. Wattengel, PharmD, BCPS, BCIDP, Department of Pharmacy, Veterans Affairs of Western New York Healthcare System

Jiachen Xu, PharmD, Department of Pharmacy, Veterans Affairs of Western New York Healthcare System

# # #

JOURNAL

American Journal of Infection Control

DOI

10.1016/j.ajic.2023.09.007

METHOD OF RESEARCH

Data/statistical analysis

SUBJECT OF RESEARCH

People

ARTICLE TITLE

Impact of Doxycycline on Clostridioides difficile Infection in Patients Hospitalized with Community-acquired Pneumonia

ARTICLE PUBLICATION DATE

2-Nov-2023

COI STATEMENT

The authors have no conflicts of interest to disclose. This research is the result of work supported with the use of resources and facilities at the VA Western New York HCS. The contents of this paper represent the work of the authors and are not intended to represent the views of the Department of Veterans Affairs or of the United States Government.

Survey finds most Americans are unaware of many signs that someone is having a seizure

Seizures don’t always look how they’re portrayed in movies, and knowing the more subtle signs like laughing or lip-smacking behavior may lead to diagnosis and effective treatment for epilepsy

Reports and Proceedings

ORLANDO HEALTH

News package — VIDEO:
A NEW NATIONAL SURVEY BY ORLANDO HEALTH FINDS A MAJORITY OF PEOPLE ARE UNAWARE OF LESSER-KNOWN SEIZURE SYMPTOMS.
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CREDIT: ORLANDO HEALTH

Orlando, Fla - If you’ve ever seen a movie or TV show in which a character has a seizure, you probably have a fairly standard mental picture of someone falling to the ground in full body convulsions while foaming at the mouth. But that doesn’t necessarily reflect reality. A new national survey by Orlando Health finds that while most Americans recognize those classic symptoms of what’s called a generalized tonic-clonic seizure, the majority fail to recognize the subtle signs, all of which can be dangerous and have a profound impact on the lives of those suffering from them.

“Anything that interrupts your brain’s circuit can cause seizures, from tumors, infections and strokes to high or low blood sugar or glucose levels to inherited genetic features. And different types of seizures can present with dozens of different symptoms,” said Dipali Nemade, MD, MPH, an epileptologist and neurologist at the Orlando Health Neuroscience Institute. “But because they often look different than those ‘cinematic seizures’ we see in movies and television, they can go undiagnosed for a long time.”

The survey, conducted by Ipsos, found less than half of Americans believe numbness or tingling (32%), blinking rapidly (35%), crying out or screaming (13%) and laughing (6%) are signs of a seizure, but Dr. Nemade says it’s important to pay attention to any odd or out-of-place behaviors and address them with your doctor.

“Even seizures with these less dramatic symptoms can make everyday activities like driving and cooking dangerous. For some people, their seizures present outwardly with very subtle signs like smacking their lips, picking at their clothes or just staring into space, and it’s important to recognize when you or someone around you is experiencing them so they can be accurately diagnosed and treated,” Dr. Nemade said. “By looking at their brainwaves (EEG), we can see if those behaviors are being caused by seizures.”

For Mike Sail, seizures start with a flushed feeling that travels from his abdomen to his throat, followed by raised arm hair causing his condition to initially be misdiagnosed as acid reflux. It wasn’t until he lost his memory of an entire week that he was finally referred to Dr. Nemade, who diagnosed his condition as epilepsy.

“I kept saying that it can’t be acid reflux because that doesn't cause the hair on your arms to stick up,” Sail said. “For the most part, these episodes were not very disruptive. They only lasted a minute or two and usually only happened once every few weeks. Sometimes I’d have them while I was doing things like playing golf, and afterwards I would just go about my business. So, I was shocked to find out they were seizures because it wasn’t what most people think a seizure looks like.”

Like most cases, Sail’s epilepsy is well-controlled with anti-seizure medication, lifestyle changes and adequate sleep, and he no longer fears that uneasy feeling he gets before having what he now knows were seizures. Dr. Nemade says education is needed to help others like Sail raise a red flag when they’re having unexplained symptoms on a regular basis.

“If people don’t know that these symptoms can be caused by epileptic seizures, their condition will be misdiagnosed or ignored and it will continue to affect their quality of life. That can be very isolating and frustrating, which is why many people with uncontrolled epilepsy experience anxiety and depression,” Dr. Nemade said. “Too many people never go to the doctor because they don’t feel like it is profoundly affecting their lives, or they don’t know how to explain what they’re feeling.”

For rare cases of epilepsy that are resistant to anti-seizure medication, there are some advanced treatments that Dr. Nemade and her team offer at the Orlando Health Neuroscience Institute’s epilepsy center, such as intracranial monitoring (sEEG/subdural) and mapping the brain to find the exact spot where seizures are originating and removing a small piece of tissue. If they are not able to remove the tissues safely, then neuromodulation options like responsive neurostimulation, deep brain stimulation and vagus nerve stimulation are effective palliative options. It’s effective treatments like these that are not only improving lives, but also saving them by preventing sudden unexpected death in epilepsy, or SUDEP, which claims about 3,000 lives in the U.S. each year. But Dr. Nemade says they can only help if symptoms are recognized and action is taken.

If you suspect someone is experiencing a seizure, sit them down in a safe place without any sharp or heavy objects in their surroundings and ensure they can breathe freely until symptoms subside. If a seizure lasts more than five minutes, call 911. Those who have never received an epilepsy diagnosis or another explanation for their seizure should follow up with their doctor or a neurologist.

Survey method
Editor’s note:
This survey was conducted online within the United States by Ipsos on the KnowledgePanel® from October 5 to October 8, 2023, and surveyed 1,024 U.S. adults ages 18 and older. This poll is based on a nationally representative probability sample and has margin of sampling error of plus or minus 3.3 percentage points at the 95% confidence level, for results based on the entire sample of adults. For complete survey methodology, including weighting variables and subgroup sample sizes, please contact: christopher.moessner@ipsos.com

Mike Sail plays a board game with his wife, Ann, while hooked to an IV treatment as part of his seizure care plan. Hair standing up on his arms and a flushed feeling that starts in his abdomen were misdiagnosed as acid reflux until he underwent testing at the Orlando Health Neuroscience Institute to determine that, for him, these were symptoms of seizures.

Dipali Nemade, MD, conducts a neurological examination on a patient at her clinical office at the Orlando Health Neuroscience Institute. The exam tests behavior, movements and mental function to assist in diagnosing seizures. A national survey by Orlando Health found that most people are unaware of many of the subtle signs of a seizure.

CREDIT

Orlando Health

About Orlando Health
Orlando Health, headquartered in Orlando, Florida, is a not-for-profit healthcare organization with $9.2 billion of assets under management that serves the southeastern United States and Puerto Rico.

Founded more than 100 years ago, the healthcare system is recognized around the world for Central Florida’s only pediatric and adult Level I Trauma program as well as the only state-accredited Level II Adult Trauma Center in Pinellas County. It is the home of the nation’s largest neonatal intensive care unit under one roof, the only system in the southeast to offer open fetal surgery to repair the most severe forms of spina bifida, the site of an Olympic athlete training facility and operator of one of the largest and highest performing clinically integrated networks in the region. Orlando Health has pioneered life-changing medical research and its Graduate Medical Education program hosts more than 350 residents and fellows.

The 3,888-bed system includes 29 hospitals and emergency departments – 24 of which are currently operational with five coming soon. The system also includes nine specialty institutes, more than 100 adult and pediatric primary care practices, skilled nursing facilities, an in-patient behavioral health facility under the management of Acadia Healthcare, and more than 60 outpatient facilities that include imaging and laboratory services, wound care centers, home healthcare services in partnership with LHC Group, and urgent care centers in partnership with FastMed Urgent Care. More than 4,750 physicians, representing more than 100 medical specialties and subspecialties have privileges across the Orlando Health system, which employs more than 27,000 team members and more than 1,200 physicians.

In FY22, Orlando Health served nearly 142,000 inpatients and 3.9 million outpatients. The healthcare system provided more than $782 million in total value to the communities it serves in the form of charity care, community benefit programs and services, community building activities and more in FY 21, the most recent period for which this information is available. Additional information can be found at http://www.orlandohealth.com, or follow us on LinkedIn, Facebook, Instagram and Twitter @orlandohealth.

METHOD OF RESEARCH

Survey

SUBJECT OF RESEARCH

People

Paper argues reducing greenhouse gas emissions is not enough to combat climate change

Peer-Reviewed Publication

OXFORD UNIVERSITY PRESS USA

James Hansen — IMAGE:
JAMES HANSEN
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CREDIT: JAMES HANSEN/ OXFORD OPEN CLIMATE CHANGE

According to a new paper in Oxford Open Climate Change, published by Oxford University Press, the strategies humanity must pursue to reduce climate change will have to include more than reducing greenhouse gases. This comes from an analysis of climate data led by researcher James Hansen.

Scientists have known since the 1800s that infrared-absorbing (greenhouse) gases warm the Earth’s surface and that the abundance of greenhouse gases changes naturally as well as from human actions. Roger Revelle, who was one of the early scientists to study global warming, wrote in 1965 that industrialization meant that human beings were conducting a “vast geophysical experiment” by burning fossil fuels, which adds carbon dioxide (CO2) to the air. CO2 has now reached levels that have not existed for millions of years.

Climate sensitivity

A long-standing issue concerns how much global temperature will rise for a specified CO2 increase. A 1979 study released by the United States National Academy of Sciences concluded that doubling atmospheric CO2 with ice sheets fixed would likely cause global warming between 1.5 and 4.5° Celsius. This was a large range, and there was additional uncertainty about the delay in warming caused by Earth’s massive ocean. This new paper reevaluates climate sensitivity based on improved paleoclimate data, finding that climate is more sensitive than usually assumed. Their best estimate for doubled CO2 is global warming of 4.8°C, significantly larger than the 3°C best estimate of the United Nations Intergovernmental Panel on Climate Change.

Aerosols

The authors also conclude that much of the expected greenhouse gas warming in the past century has been offset by the cooling effect of human-made aerosols – fine airborne particles. Aerosols have declined in amount since 2010 as a result of reduced air pollution in China and global restrictions on aerosol emissions from ships. This aerosol reduction is good for human health, as particulate air pollution kills several million people per year and adversely affects the health of many more people. However, aerosol reduction is now beginning to unmask greenhouse gas warming that had been hidden by aerosol cooling. The authors have long termed the aerosol cooling a “Faustian bargain” because, as humanity eventually reduces air pollution, payment in the form of increased warming comes due.

Prediction

This new paper predicts that a post-2010 acceleration of global warming will soon be apparent above the level of natural climate variability. The 1970-2010 global warming rate of 0.18°C per decade is predicted to increase to at least 0.27°C per decade during the few decades after 2010. As a result, the 1.5°C global warming level will be passed this decade and the 2°C level will be passed within the following two decades.

Policy

In a final section, Hansen describes his perspective based on decades of experience in trying to affect government policies. First, he believes that achievement of rapid phasedown of CO2 emissions requires a rising domestic carbon fee with a border duty on products from nations without a carbon fee, as well as support of modern nuclear power to complement renewable energies. Second, he argues that the West, which is primarily responsible for climate change, must cooperate with developing nations to help them achieve energy paths consistent with a propitious climate for all. Third, even with these efforts, Hansen believes that global warming will reach levels with dangerous consequences; he argues we should also carry out research and development for temporary, purposeful, actions to address Earth’s now enormous energy imbalance.

A decade ago, Hansen noted that Earth was out of energy balance by 0.6 W/m2 (watts per square meter). There was that much more energy coming in (absorbed sunlight) than going out (heat radiation to space). That excess – which is the proximate cause of global warming – is equivalent to 400,000 Hiroshima atomic bombs per day, with most of that energy going into the ocean. Now, largely because of decreasing aerosols, the imbalance has doubled to about 1.2 W/m2. This huge imbalance is the proximate cause of accelerated global warming and increased melting of polar ice, which is likely to shut down overturning ocean circulations and cause large, rapidly rising, sea level later this century.

The paper argues that such action will be essential to avoid the greater geotransformation that will occur in the absence of such action. Potential actions include injection of stratospheric aerosols, for which volcanoes provide relevant but inadequate test cases, and spraying of salty ocean water by autonomous sail boats in regions susceptible to cloud seeding.

Hansen suggests that young people focus on an underlying problem that has developed in western democracies, especially the United States: “The ideal of one person/one vote has been replaced by one dollar/one vote,” Hansen argued. “Special financial interests – the fossil fuel industry, the chemical industry, the lumber industry, the food industry, for example – are allowed to buy politicians. It is no wonder that climate is running out of control, environmental toxicity is in the process of exterminating insects including pollinators, forests are mismanaged, and agriculture is designed for profit, not for nutrition and the public’s well-being.”

“We live on a planet with a climate characterized by delayed response, which is a recipe for intergenerational injustice,” Hansen continued. “Young people need to understand this situation and the actions needed to assure a bright future for themselves and their children.”

The paper, “Global warming in the pipeline,” will be available (at midnight on November 2nd) at: https://doi.org/10.1093/oxfclm/kgad008.

Direct correspondence to:
James Hansen
Director, Program on Climate Science, Awareness, and Solutions,
Earth Institute at Columbia University
475 Riverside Drive (Room 401-O)
New York, NY 10115
jeh1@columbia.edu

To request a copy of the study, please contact:
Daniel Luzer
daniel.luzer@oup.com