Woods Hole Oceanographic Institution researchers say accounting for plastic persistence can minimize environmental impacts

New approach will help design functional and sustainable plastic products; switching to alternative materials for single-use coffee cup lids could reduce the environmental costs to society by hundreds of millions of dollars

Peer-Reviewed Publication

WOODS HOLE OCEANOGRAPHIC INSTITUTION

 

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RESEARCHERS, INCLUDING THOSE AT THE WOODS HOLE OCEANOGRAPHIC INSTITUTION, HAVE DEVELOPED A SUSTAINABILITY METRIC FOR THE ECOLOGICAL DESIGN OF PLASTIC PRODUCTS, LIKE CUP-LIDS, THAT BREAK-DOWN MORE QUICKLY IN THE ENVIRONMENT. 

 

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CREDIT: BRYAN JAMES/WOODS HOLE OCEANOGRAPHIC INSTITUTION

Woods Hole, Mass. (January 8, 2024) -- With plastic pollution posing a significant threat to ecosystems and human health, various strategies to lessen this type of pollution include reducing the production of plastic, decreasing the generation of plastic waste, and improving the material and product design of plastic items. 

Now, researchers have developed a sustainability metric for the ecological design of plastic products that have low persistence in the environment. Adhering to this metric could provide substantial environmental and societal benefits, according to a new study led by researchers at the Woods Hole Oceanographic Institution (WHOI), and published in the journal ACS Sustainable Chemistry & Engineering.

“While plastic pollution threatens ecosystems and human health, the use of plastic products continues to increase. Limiting its harm requires design strategies for plastic products informed by the threats that plastics pose to the environment. Thus, we developed a sustainability metric for the eco-design of plastic products with low environmental persistence and uncompromised performance,” according to the study.

Designing single-use plastics using this approach can have a substantial impact. Analyses in the study say switching to alternative materials for single-use coffee cup lids, such as cellulose diacetate and polyhydroxyalkanoates, could reduce the environmental costs to society by hundreds of millions of dollars.

In general, products are designed to be environmentally friendly primarily by balancing the trade-offs between various environmental concerns, such as greenhouse gas emissions and resource depletion, because there are some frameworks and data sets to estimate these types of impacts. Selecting one kind of plastic over another is often used to accomplish this goal. However, to date, no material selection framework has considered or quantified environmental persistence, or the time that a plastic item remains in the environment as pollution, as a key environmental concern.

“What’s important to determine is how can we design functional, sustainable, and benign materials, products, and processes that embody all of the principles of green materials engineering into the future world that we are going to live in,” said lead author Bryan James, a materials scientist and engineer who is a postdoctoral investigator in WHOI’s Marine Chemistry & Geochemistry Department. “What are the next set of strategies and tools that engineers, product designers, and even the average consumer can use to make the best choices for the environment, while not having to sacrifice on product performance?”

To develop the sustainability metric, the researchers “integrated the environmental degradation rate of plastic into established material selection strategies, deriving material indices for environmental persistence. Our analysis identifies the materials and their properties that deserve development, adoption, and investment to create functional and less environmentally impactful plastic products,” the study notes.

Establishing and implementing a sustainability metric for persistence has been challenging because of the lack of sufficient data for the wide range of plastics used in consumer goods. Only recently have scientists had sufficient data on realistic environmental degradation rates of different types of plastic so that they can better consider different types of plastic properties and implement them in design.

With this data, the researchers now show that while switching one plastic material for another can reduce a product’s cost and embodied greenhouse gas emissions, that switch could provide a far greater benefit in terms of minimizing environmental lifetime, persistence. For example, if a product designer only considered cost and greenhouse gas emissions, polylactic acid would be a good choice. Yet, this material persists in the ocean. Comparatively, cellulose diacetate and polyhydroxyalkanoates, while currently only a bit more expensive than polylactic acid, can have lower greenhouse gas emissions and do not persist in the ocean.

 

“Ninety-nine percent of the papers that have been published on plastic pollution tell us how bad it is. This paper is looking at the issue in a much more forward-thinking way, about how do you address a problem in a meaningful scientific way that's attainable, achievable, and economically viable,” said co-author Christopher Reddy, senior scientist in WHOI’s Marine Chemistry & Geochemistry Department.

 

As an example, the researchers applied the metric to the redesign of an everyday single-use plastic item, coffee cup lids. Currently, billions of disposable coffee cup lids are used each year, accounting for about five percent of all plastic debris collected by coastal cleanup efforts worldwide. With three different coffee cup lids currently in use—including lids made from polylactic acid, polypropylene, and polystyrene—researchers evaluated which on-the-market lid material reduces the environmental impact the most.

“Which is better: a lid that has a bit more greenhouse gas emissions but persists less in the environment or a lid that has fewer greenhouse gas emissions but will persist for a longer time? To answer this, we put a dollar value on both options in terms of cost to make the product and cost to the environment and ecosystem services,” said James. “Simply making products that persist less by virtue of not being there, or going away faster, reduces that cost to society tremendously.”

“When you are charged with making a new coffee cup lid that needs to be sustainable and green, and you have to figure out which polymer is best for the environment, currently, green might take into consideration how much energy is used to make the plastic or how much greenhouse gases are emitted. But the current calculus for a designer does not consider what the lid’s persistence is. What Bryan has done with the development of this metric is groundbreaking,” added Reddy, who co-advises James along with co-author Collin Ward, associate scientist in WHOI’s Marine Chemistry & Geochemistry Department.

“What’s important about this study is that it helps shift the narrative away from defining the problem of plastic pollution to arriving at solutions to the problem. Plastics are extremely useful materials – they’re not going anywhere anytime soon. But everyone agrees the amount of plastic leaking into the environment is a problem. The framework presented in this study represents an important first step towards solving this problem by designing materials that simultaneously meet the needs of consumers and do not persist if incidentally leaked into the environment,” said Ward.

James noted that through thoughtful strategies to make good design decisions, “scientists, engineers, and designers have an opportunity to make a significant impact in the plastic pollution crisis. The metrics and methods developed in this study can direct design decisions and research priorities to reach this goal.”

This work was supported by the Postdoctoral Scholar Program at WHOI, with funding provided by the Weston Howland Jr. Postdoctoral Scholarship. Additional support was provided by the WHOI Ocean Vision Fund 2030, the U.S. National Science Foundation, The Seaver Institute, and The March Marine Initiative (a program of March Limited, Bermuda) through WHOI’s Marine Microplastics Innovation Accelerator program.

Authors : Bryan D. James,1,2,* Collin P. Ward1, Mark E. Hahn2, Steven J. Thorpe3, and Christopher M. Reddy1

Affiliations :

1Department of Marine Chemistry and Geochemistry, Woods Hole Oceanographic Institution, Woods Hole, MA, USA

2Department of Biology, Woods Hole Oceanographic Institution, Woods Hole, MA, USA

3Department of Materials Science & Engineering, University of Toronto, Canada

 

About Woods Hole Oceanographic Institution

The Woods Hole Oceanographic Institution (WHOI) is a private, non-profit organization on Cape Cod, Massachusetts, dedicated to marine research, engineering, and higher education. Established in 1930, its primary mission is to understand the ocean and its interaction with the Earth as a whole, and to communicate an understanding of the ocean’s role in the changing global environment. WHOI’s pioneering discoveries stem from an ideal combination of science and engineering—one that has made it one of the most trusted and technically advanced leaders in basic and applied ocean research and exploration anywhere. WHOI is known for its multidisciplinary approach, superior ship operations, and unparalleled deep-sea robotics capabilities. We play a leading role in ocean observation and operate the most extensive suite of data-gathering platforms in the world. Top scientists, engineers, and students collaborate on more than 800 concurrent projects worldwide—both above and below the waves—pushing the boundaries of knowledge and possibility. For more information, please visit www.whoi.edu

 

Key takeaways:

•             Researchers have developed a sustainability metric for the ecological design of plastic products that have low persistence in the environment. Adhering to this metric could provide substantial environmental and societal benefits, according to a new study led by researchers with the Woods Hole Oceanographic Institution.

•             By comparing indices for the environmental impact of on-the-market plastics and proposed alternatives, researchers show that accounting for the environmental persistence of plastics in design could translate to societal benefits of hundreds of millions of dollars for a single consumer product. The analysis identifies the materials and their properties that deserve development, adoption, and investment to create functional and less environmentally impactful plastic products.

•             In general, products are designed to be environmentally friendly primarily by balancing the trade-offs between various environmental concerns, such as greenhouse gas emissions and resource depletion, because there are some frameworks and data sets to estimate these types of impacts. To date, no material selection framework has considered or quantified environmental persistence, or the time that a plastic item remains in the environment as pollution, as a key environmental concern.

•             Scientists, engineers, and designers have an opportunity to intervene in curbing plastic pollution. The metrics and methods put forth can direct their design decisions and research priorities toward these ideals. This framework will continue to improve with further research on the environmental impacts of plastics, particularly through the robust measurement of plastic degradation under realistic environmental conditions. Ultimately, minimizing the persistence of mismanaged plastic products will require innovative plastic formulations and product form factors, along with concerted effort across the plastic life cycle to mitigate leakage.

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JOURNAL

ACS Sustainable Chemistry & Engineering

DOI

10.1021/acssuschemeng.3c05534 

ARTICLE TITLE

Minimizing the Environmental Impacts of Plastic Pollution through Ecodesign of Products with Low Environmental Persistence

ARTICLE PUBLICATION DATE

8-Jan-2024

Disclaimer: AA

 

AGING BOOMERS

Could a drug prevent hearing loss from loud music and aging?

Peer-Reviewed Publication

UNIVERSITY OF CALIFORNIA - SAN FRANCISCO

Researchers have found a gene that links deafness to cell death in the inner ear in humans – creating new opportunities for averting hearing loss. 

A person’s hearing can be damaged by loud noise, aging and even certain medications, with little recourse beyond a hearing aid or cochlear implant.  
 
But now, UCSF scientists have achieved a breakthrough in understanding what is happening in the inner ear during hearing loss, laying the groundwork for preventing deafness.  
 
The research, published on Dec. 22, 2023, in the Journal of Clinical Investigation Insight, links animal studies on hearing loss with a rare type of inherited deafness in humans. In both cases, mutations to the TMTC4 gene trigger a molecular domino effect known as the unfolded protein response (UPR), leading to the death of hair cells in the inner ear. 
 
Intriguingly, hearing loss from loud noise exposure or drugs such as cisplatin, a common form of chemotherapy, also stems from activation of the UPR in hair cells, suggesting that the UPR may underly several different forms of deafness.   
 
There are several drugs that block the UPR – and stop hearing loss – in laboratory animals. The new findings make a stronger case for testing these drugs in people who are at risk of losing their hearing, according to the researchers. 
 
“Millions of American adults lose their hearing due to noise exposure or aging each year, but it’s been a mystery what was going wrong,” said Dylan Chan, MD, PhD, co-senior author on the paper and director of the Children’s Communication Center (CCC) in the UCSF Department of Otolaryngology. “We now have solid evidence that TMTC4 is a human deafness gene and that the UPR is a genuine target for preventing deafness.” 
 
 How hair cells in the ear self-destruct 
 
In 2014, Elliott Sherr, MD, PhD, director of the UCSF Brain Development Research Program and co-senior author of the paper, noticed that several of his young patients with brain malformations all had mutations to TMTC4. But laboratory studies of this gene soon presented a conundrum. 
 
“We expected mice with TMTC4 mutations to have severe brain defects early on, like those pediatric patients, yet to our surprise, they seemed normal at first,” Sherr said. “But as those animals grew, we saw that they didn’t startle in response to loud noise. They had gone deaf after they had matured.” 
 
Sherr partnered with Chan, an expert on the inner ear, to look into what was happening to the mice, which looked like an accelerated version of age-related hearing loss in humans. They showed that mutations to TMTC4 primed hair cells in the ear to self-destruct, and loud noise did the same thing. In both cases, hair cells were flooded with excess calcium, throwing off the balance of other cellular signals, including the UPR. 
 
But they found there was a way to stop this. ISRIB, a drug developed at UCSF to block the UPR’s self-destruct mechanism in traumatic brain injury, prevented animals who were exposed to noise from going deaf. 
 
The first adult human deafness gene 
 
In 2020, scientists from South Korea, led by Bong Jik Kim, MD, PhD, connected Chan and Sherr’s 2018 findings with genetic mutations they found in two siblings who were losing their hearing in their mid-20s. The mutations were in TMTC4 and matched what Chan and Sherr had seen in animals, although they were distinct from those in Sherr’s pediatric neurology patients. 
 
“It’s rare to so quickly connect mouse studies with humans,” Sherr said. “Thanks to our Korean collaborators, we could more easily prove the relevance of our work for the many people who go deaf over time.” 
 
Kim, an otolaryngologist at the Chungnam National University College of Medicine (Korea), facilitated the shipping of cells from those patients to UCSF. Sherr and Chan tested those cells for UPR activity and found that, indeed, this flavor of TMTC4 mutation turned on the destructive UPR pathway in a human context.  
 
When Chan and Sherr mutated TMTC4 only in hair cells in mice, the mice went deaf. When they mutated TMTC4 in cells from individuals in the Korean family who hadn’t gone deaf, and in laboratory human cell lines, the UPR drove the cells to self-destruct. TMTC4 was more than a deafness gene in mice – it was a deafness gene in humans, too. 
 
Translating a discovery to prevent deafness 
 
Understanding TMTC4 mutations gives researchers a new way of studying progressive deafness, since it is critical for maintaining the health of the adult inner ear. The mutations mimic damage from noise, aging or drugs like cisplatin. 
 
The researchers envision a future where people who must take cisplatin, or who have to be exposed to loud noises for their jobs, take a drug that dampens the UPR and keeps hair cells from withering away, preserving their hearing. 
 
The science also suggests that the UPR could be targeted in other contexts where nerve cells become overwhelmed and die, including diseases long thought to be incurable, like Alzheimer’s or Lou Gehrig’s disease. 
 
“If there's any way that we can get in the way of the hair cells dying, that's how we're going to be able to prevent hearing loss,” Chan said. 

 

About UCSF: The University of California, San Francisco (UCSF) is exclusively focused on the health sciences and is dedicated to promoting health worldwide through advanced biomedical research, graduate-level education in the life sciences and health professions, and excellence in patient care. UCSF Health, which serves as UCSF's primary academic medical center, includes top-ranked specialty hospitals and other clinical programs, and has affiliations throughout the Bay Area. UCSF School of Medicine also has a regional campus in Fresno. Learn more at https://ucsf.edu, or see our Fact Sheet.

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JOURNAL

JCI Insight

 

High-quality nursing home dementia care is not only a matter of adding staff

UC Irvine-led study finds that specialized training and stable labor force are also critical

Peer-Reviewed Publication

UNIVERSITY OF CALIFORNIA - IRVINE

Irvine, Calif., Jan. 8, 2024 — Additional staffing alone will not be sufficient to bridge the quality-of-care and health outcome disparities among nursing home facilities with varying percentages of residents with dementia, according to a first-of-its-kind study led by the University of California, Irvine. Specialized training, an easy-to-navigate environment and staff stability are also critical to meeting the unique challenges presented by this population.

 

The findings, recently published online in the journal Health Services Research, indicate that increased staffing generally improves outcomes for all patients but that at any given level of staffing, discrepancies between high- and low-dementia facilities remain. The impact on care differed by percentage of residents with dementia and various outcomes, ranging from daily activities such as independently bathing, dressing and eating to the number of emergency room visits and incidents of pressure sores.

 

“We wanted to understand the association of staffing hours with care quality and compare the health outcomes in nursing homes with high- and low-dementia populations,” said first author Dana Mukamel, UCI professor of medicine. “We found that registered nurses’ and certified nurse assistants’ staffing hours per resident-day were likely to improve outcomes for both high- and low-census dementia facilities but that simply increasing staff is not likely to be a solution.”

 

More than 40 percent of nursing home residents nationally are estimated to have Alzheimer’s disease, related dementia or cognitive impairment, according to the Alzheimer’s Association. Their difficulty in communicating symptoms and needs requires that staff receive training in special techniques to recognize nonverbal cues and gain experience in understanding how individuals express themselves.

 

“Current studies compare health outcomes of dementia patients receiving specialized care to dementia patients in general care. We wanted to investigate the dynamics of dementia, staffing and health outcomes in nursing homes compared with residents without dementia and embarked on this study to offer insights into this complex, three-way relationship,” Mukamel said.

 

Researchers conducted regression analyses on a national sample of nursing homes between 2017 and 2019, drawing on a variety of datasets, including Medicare claims and the Centers for Medicare and Medicaid Services’ Payroll Based Journal. Independent variables included staff hours per resident-day and dementia population percentage, controlling for other resident and facility characteristics. Separate linear models were utilized to predict six long-term facility-level outcomes.

 

“Our findings highlight the fact that high-quality care involves not only increased staffing, but also specialized training in practices proven to be effective in managing the complexities of this condition, as well as providing a secure environment and maintaining staff consistency,” Mukamel said. “Further research is required to identify specific areas that can be targeted to pinpoint opportunities for improvement in both low- and high-dementia facilities.”

 

Other team members included Heather Ladd, research associate in UCI’s Department of Medicine; Dr. Debra Saliba, UCLA professor of medicine; and R. Tamara Konetzka, Louis Block Professor of Public Health Sciences and professor of medicine at the University of Chicago.

 

This work was supported by the National Institutes of Health’s National Institute on Aging under award number R01AG066742.

 

About the University of California, Irvine: Founded in 1965, UCI is a member of the prestigious Association of American Universities and is ranked among the nation’s top 10 public universities by U.S. News & World Report. The campus has produced five Nobel laureates and is known for its academic achievement, premier research, innovation and anteater mascot. Led by Chancellor Howard Gillman, UCI has more than 36,000 students and offers 224 degree programs. It’s located in one of the world’s safest and most economically vibrant communities and is Orange County’s second-largest employer, contributing $7 billion annually to the local economy and $8 billion statewide. For more on UCI, visit www.uci.edu.

 

Media access: Radio programs/stations may, for a fee, use an on-campus ISDN line to interview UCI faculty and experts, subject to availability and university approval. For more UCI news, visit news.uci.edu. Additional resources for journalists may be found at https://news.uci.edu/media-resources.

 

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JOURNAL

Health Services Research

ARTICLE TITLE

Dementia, nurse staffing, and health outcomes in nursing homes

 

Five finalists announced in Alliance for Pediatric Device Innovation’s “Make Your Medical Device Pitch For Kids!”™ competition in collaboration with MedTech Color

Up to $50,000 in potential awards for pediatric medical devices created by Hispanic and African American innovator

Grant and Award Announcement

CHILDREN'S NATIONAL HOSPITAL

 

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FIVE FINALISTS ANNOUNCED IN ALLIANCE FOR PEDIATRIC DEVICE INNOVATION’S “MAKE YOUR MEDICAL DEVICE PITCH FOR KIDS!”™ COMPETITION IN COLLABORATION WITH MEDTECH COLOR

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CREDIT: CARBONARA GROUP

WASHINGTON (January 8, 2023) – Alliance for Pediatric Device Innovation (APDI), the federally funded consortium led by Children’s National Hospital, announces the finalists of its special MedTech Color edition of “Make Your Medical Device Pitch for Kids!”™ competition. This edition supports pediatric medical device advancements from African American and Hispanic innovators.

 

The competition aims to advance devices that meet critical patient needs while promoting a more inclusive approach to medical technology innovation. The finalists will compete for a share of up to $50,000 in grants funded by the Food and Drug Administration (FDA) that will support innovators’ efforts to bring their devices to the commercial market for the benefit of children everywhere.

 

“The children we serve come from diverse backgrounds, so nurturing diversity among our innovators will help us ensure that their needs are met,” said Kolaleh Eskandanian, Ph.D., MBA, vice president and chief innovation officer at Children’s National and APDI program director and principal investigator. “We are delighted to partner with MedTech Color in this endeavor.”

 

The five pediatric medical device finalists are:

 

• Kofimi Technology Inc. – Danvers, Mass. – This patent-pending pulse oximeter device is designed specifically for pediatric populations to provide superior accuracy for all levels of skin pigmentation. A pulse oximeter measures oxygen levels in the blood.
• Rubitection – Pittsburgh, Pa.– A low-cost skin assessment management tool for chronic wounds, Rubitection measures the properties of the skin. The system allows the user to monitor incremental changes in skin health to predict risk, monitor progression and customize care.
• SealCath LLC – Mount Pleasant, S.C. – An innovative, double balloon catheter, SethCath is designed to treat infants facing bowel disorders. Specifically designed for mucous fistula refeeding, this catheter offers a gentle and precise method to provide essential nutrition and support.
• TNC Medical Solutions – Los Angeles, Calif. – TNC Medical Solutions offers an advancement in gastrostomy tube (g-tube) reinsertion designed to improve the quality of life for patients reliant on enteral feeding.
• WearableDose Inc. – Bowie, Md. – Harnessing artificial intelligence for real-time, precise dosimetry in cancer treatment, WearableDose aims to transform patient care with innovative wearable technology.

 

Additionally, two of the finalists, Kofimi Technology and SealCath, were chosen to compete in the broader MedTech Color competition, held the same day and open to adult and pediatric devices. These two finalists will have the opportunity to make their pitch in both competitions.

 

Pediatric finalists were chosen from a field of 27 pediatric entries by a panel of expert judges that included representation from MedTech Color and ADPI. Finalists will compete on March 15 at the MedTech Color 4th Annual Pitch Competition at the UCLA campus. Event registration and additional details are available here.

 

"The competition's additional investment in companies developing technologies for the pediatric population is significant,” said Kwame Ulmer, MedTech Color founder and board member. “This means more patients will get access to medtech ecosystem accelerants. As more pitch finalists from diverse backgrounds finally get access to funding, this will provide more opportunities for children and young adults in overlooked communities."

 

Founded in 2017, MedTech Color is a nonprofit organization built on the same ideal: diverse leadership in the medical technology ecosystem leads to greater innovation and better outcomes. The organization works to advance the representation of people of color in the medical device industry and to nurture the next generation of founders. MedTech Color aims to build a cohesive community of leaders of color, drive thought leadership and increase the number of underrepresented executives in the industry. For more information on MedTech Color, visit medtechcolor.org.

 

APDI is one of five nonprofit consortia in the FDA’s Pediatric Device Consortia program that receives funding to provide a platform of services, expertise, and grants to support pediatric innovators in bringing medical devices to the market that address the needs of children. Along with Children’s National, APDI members include Johns Hopkins University, CIMIT at Mass General Brigham, Tufts Medical Center, Medstar Health Research Institute, OrthoPediatrics Corp. and MedTech Color.

 

Advancements in pediatric medical devices continue to lag significantly behind those of adults, which is why APDI is focused on helping more pediatric medical device innovations achieve commercialization. For more information on APDI, visit innovate4kids.org

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About Children’s National Hospital

Children’s National Hospital, based in Washington, D.C., was established in 1870 to help every child grow up stronger. Today, it is the No. 5 children’s hospital in the nation and ranked in all specialties evaluated by U.S. News & World Report. Children’s National is transforming pediatric medicine for all children. The Children’s National Research & Innovation Campus opened in 2021, a first-of-its-kind pediatric hub dedicated to developing new and better ways to care for kids. Children’s National has been designated three times in a row as a Magnet® hospital, demonstrating the highest standards of nursing and patient care delivery. This pediatric academic health system offers expert care through a convenient, community-based primary care network and specialty care locations in the D.C. metropolitan area, including Maryland and Virginia. Children’s National is home to the Children’s National Research Institute and Sheikh Zayed Institute for Pediatric Surgical Innovation. It is recognized for its expertise and innovation in pediatric care and as a strong voice for children through advocacy at the local, regional and national levels. As a nonprofit, Children's National relies on generous donors to help ensure that every child receives the care they need.

 

Media Contacts: Cherri Carbonara | 713-524-8170 | c. 832- 473-6380 | cherri@carbonaragroup.com

 

Acute pediatric critical illness definition enables global research

Peer-Reviewed Publication

ST. JUDE CHILDREN'S RESEARCH HOSPITAL

 

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FIRST AND CORRESPONDING AUTHOR ANITA ARIAS, M.D., ST. JUDE DEPARTMENT OF PEDIATRIC MEDICINE AND SENIOR AUTHOR ASYA AGULNIK, M.D., MPH, ST. JUDE GLOBAL CRITICAL CARE DIRECTOR.

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CREDIT: ST. JUDE CHILDREN'S RESEARCH HOSPITAL

(MEMPHIS, Tenn. – January 05, 2023) St. Jude Children’s Research Hospital investigators collaborated with a global group of acute pediatric critical illness experts to reach a consensus definition of the condition. Research on how to improve care in low- and middle-income countries has been stymied because conventional pediatric critical illness definitions are not applicable in these settings. The new, more universal definition, reached by consensus among researchers and clinicians from 40 countries, will enable scientists to study pediatric critical illness more universally, which should lead to improvements in patient outcomes globally. The full definition was published today in The Lancet Global Health. 

 

“We now have a common language for acute pediatric critical illness,” said first and corresponding author Anita Arias, M.D., St. Jude Department of Pediatric Medicine. “That shared understanding will improve data collection globally and increase patient sample size, which will lead to more and better clinical studies of evidence-based interventions.”

 

The new full definition is: “An infant, child or adolescent with an illness, injury or post-operative state that increases the risk for or results in acute physiological instability (abnormal physiological parameters or vital organ dysfunction or failure) or a clinical support requirement (such as frequent or continuous monitoring, or time-sensitive intervention) to prevent further deterioration or death. The patient can meet this definition by having physiological instability, support requirements or both.”

 

St. Jude researchers, led by Arias and senior author Asya Agulnik, M.D., MPH, St. Jude Global Critical Care director, coordinated an international group of acute pediatric critical illness researchers and clinicians to assemble the definition. In total, 109 experts from 40 countries contributed. The participants used a method called modified Delphi, which anonymized those involved so they could freely vote and express their opinions on draft statements. The final definition was a consensus among these experts, with particular attention to being more inclusive of hospitals of differing resource levels. 

 

A more inclusive patient-centered definition

 

Historically, acute pediatric critical illness has had many definitions. Studies from higher-income countries tend to use definitions that include technical or resource-based terminology, such as admission to an Intensive Care Unit (ICU). While that criterion has proven clinically useful, it does not translate to resource-limited health care settings in other countries, which may not have an ICU in their hospitals.

 

“With our new framework, we’re trying to be more inclusive,” Arias said. “As many hospitals around the world don’t even have an ICU, older definitions were excluding a huge population of patients from research.”

 

“While the global burden of childhood mortality is mostly in low-and middle-income countries, to date, the study of acute pediatric critical illness has largely been centered on hospitals in high-resource settings,” Agulnik said. “This definition, which allows for classification of patients as critically ill regardless of critical care resources, would address this research disparity by facilitating research in hospitals of all resource settings.”

The focus on ICUs reveals a larger problem: previous definitions excluded patients experiencing acute critical illness but lacking access to critical care resources. To increase inclusivity, the international group recognized the need to define the condition based on the patient’s status rather than on resources, such as specific department admission or intervention use.

 

“One example of why we needed a new definition is the studies of respiratory failure,” Arias explained. “Traditionally, these studies include patients who are on mechanical ventilation, but the fact that a hospital might not have mechanical ventilation doesn’t mean that the patient doesn't have acute respiratory illness or failure.”

 

The new definition focuses on the patient to address that need without regard to local resources. It looks at two different states — what is happening with the patient’s bodily systems, and the need for clinical support, such as needing a ventilator, but not the actual materials used to address the patient’s needs.

 

The framework also provides eight attributes and 28 statements to clarify and explain its application. The entirety of that framework is termed the DEFinition for acute pediatric CRITical illness (DEFCRIT). 

 

Improving care globally

 

Slow improvement in critical care can be attributed to the historical lack of a standardized and inclusive definition of acute pediatric critical illness, particularly in low- and middle-income countries. Given the difficulty in adapting methods to these settings, even measuring the total burden of critical illness has evaded researchers. DEFCRIT will help lead to a better understanding of the burden of disease and begin to compare populations and interventions in a more standardized and inclusive way.

 

“We have started bridging a gap for researchers and clinicians to understand the global burden of critical illness,” Arias said. “This could eventually lead to better care delivery by gaining the ability to determine how effective intervention can be in different populations, environments and stages of illness.”

 

Multiple global groups of pediatric disease researchers have already accepted DEFCRIT. The Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network on Behalf of the PALISI Global Health Subgroup is a co-author of the paper. In addition, the World Federation of Pediatric Intensive and Critical Care Societies (WFPICCS) and the Society of Critical Care Medicine (SCCM) both endorsed the framework.

 

“There was an iniquity in research that we, as a global group, wanted to address,” Arias said. “With a universal DEFCRIT, we’ve stopped impeding research progress. We’re now going to be able to start pushing the field toward improving the care for patients globally through better research.”

 

Authors and funding

The study’s other authors are Abdelhafeez Abdelhafeez, of St. Jude; Teresa Kortz, University of California, San Francisco; Michael Lintner-Rivera, Adnan Bhutta, Indiana University School of Medicine; Nadeem Shafi, University of Tennessee Health Science Center and Le Bonheur Children’s Hospital; Qalab Abbas, Aga Khan University Hospital; Muhammad Ali, Pakistan Institute of Medical Sciences; Hala Ammar, Children’s Hospital of Benghazi; Ali Anwar, Lincoln Memorial University-DeBusk College of Osteopathic Medicine; John Adabie Appiah, Komfo Anokye Teaching Hospital; Jonah Attebery, University of Colorado; Willmer Diaz Villalobos, Unidad de Terapia Intensiva Pediátrica del Hospital Materno Infantil; Daiane Ferreira, Barretos Children’s Hospital; Sebastián González-Dambrauskas, LARed Network, Centro Hospitalario Pereira Rossell and Universidad de la República; Muhammad Irfan Habib, ChildLife Foundation; Jan Hau Lee, KK Women's and Children's Hospital and Duke-NUS Medical School; Niranjan Kissoon, BC Children's Hospital; Atnafu Mekonnen Tekleab, Saint Paul's Hospital Millennium Medical College; Elizabeth Molyneux, Kamuzu University of Health Sciences; Brenda Morrow, University of Cape Town; Vinay Nadkarni, Children's Hospital of Philadelphia; Jocelyn Rivera, Hospital Infantil Teletón de Oncología; Rebecca Silvers, University of California, San Francisco; Mardi Steere, Women’s and Children’s Hospital and Royal Flying Doctor Service; and Daniel Tatay, Hospital de Niños de la Santísima Trinidad.

 

The study was supported by ALSAC, the fundraising and awareness organization of St. Jude.

 

St. Jude Media Relations Contacts

Chelsea Bryant

Cell: (256) 244-2048

Desk: (901) 595-0564

chelsea.bryant@stjude.org

media@stjude.org

 

Rae Lyn Hartley

Cell: (901) 686-2597

raelyn.hartley@stjude.org

media@stjude.org

 

St. Jude Children’s Research Hospital

St. Jude Children’s Research Hospital is leading the way the world understands, treats and cures childhood cancer, sickle cell disease and other life-threatening disorders. It is the only National Cancer Institute-designated Comprehensive Cancer Center devoted solely to children. Treatments developed at St. Jude have helped push the overall childhood cancer survival rate from 20% to 80% since the hospital opened more than 60 years ago. St. Jude shares the breakthroughs it makes to help doctors and researchers at local hospitals and cancer centers around the world improve the quality of treatment and care for even more children. To learn more, visit stjude.org, read St. Jude Progress blog, and follow St. Jude on social media at @stjuderesearch. 

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JOURNAL

The Lancet Global Health

DOI

10.1016/S2214-109X(23)00537-5 

ARTICLE PUBLICATION DATE

5-Jan-2024

 

Migrants can be ‘transformative force’ for sustainable development

Peer-Reviewed Publication

UNIVERSITY OF EXETER

Well-managed migration can enable migrants to boost sustainable development, research shows.

Sustainable development means enhancing wellbeing in ways that equitably meet needs of present and future generations.

Migration is often viewed as a threat to this – and to stability and security – while the benefits for migrants and host nations and regions are overlooked.

The new research – a set of studies published in the journal Proceedings of the National Academy of Sciences – shows new policies are needed for managing migration to maximise sustainability, and to minimise involuntary displacement due to conflict or disasters.

The studies are based on evidence from a variety of locations including Thailand, Pacific island nations, the world’s largest refugee camps, and European and American cities.

“Migrants can be a transformative force in their new locations, bringing energy and ideas that can boost economies – including the green transition,” said Professor Neil Adger, from the University of Exeter.

“However, poorly managed migration can deepen inequality and increase environmental damage.”

Professor Bill Clark, of Harvard University, said: “To understand properly the relationships between sustainability and migration, we need a comprehensive assessment that includes people who move in search of opportunities to enhance their wellbeing.

“This new research helps to fill these gaps, showing us the impacts of migration – both positive and negative – on the challenges for sustainability governance.”

Dr Sonja Fransen, of Maastricht University, said: “At present, sustainability and migration are often managed separately.

“We need new policies that manage migration in the interests of people and the planet, both now and into the future.

“Research to date has tended to focus on people fleeing conflict or disasters.”

Dr Ricardo Safra de Campos said: “It is crucial to consider the impact of migration on the places people leave behind, as well as the places they go.

“More than one billion people today  are ‘lifetime migrants’, meaning they live in a place distant from where they were born.

“From a global perspective, only a quarter to a third of these migrants cross international borders. 

“The majority consists of people moving within their countries of birth.

“The vast majority of migrants move voluntarily in search of a better life.

“But a growing number – now perhaps 10% of the total migrant pool – move involuntarily, fleeing social or environmental stresses such as conflict and climate change.

“Global averages, however, are only the beginning of the story.

“Most involuntary migrants end up concentrated in a few places relatively near to the places they are fleeing and pose disproportionate challenges there.”

The studies in the new collection include one that focusses on three atoll islands in the Pacific region.

It found that people’s sense of “belonging” affected the sustainability of those societies. Current patterns of emigration from these areas reduce pressure on natural resources, while emigrant diasporas still support and promote their origin communities through their social and economic ties.

Another paper focusses on Florida, where sea-level rise is expected to lead to outward migration – with younger, economically active adults moving first. Such migration would lead to pressures in destination cities, and aging populations in coastal areas.

Several of the researchers involved in the new studies are working on the MISTY project, an international consortium led by the University of Exeter and funded by Belmont Forum.

The new studies are published in a PNAS special issue entitled: “Migration and sustainable development.”

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JOURNAL

Proceedings of the National Academy of Sciences

ARTICLE TITLE

Migration and sustainable development

ARTICLE PUBLICATION DATE

8-Jan-2024

 

Real-world analysis: COVID-19 vaccine strongly effective for children and adolescents during delta and omicron

Peer-Reviewed Publication

UNIVERSITY OF PENNSYLVANIA SCHOOL OF MEDICINE

Children and adolescents who received one of the main COVID-19 vaccines were significantly protected from the illness and showed no increased signs of cardiac complications compared to young people who were not vaccinated, according to a new real-world study led by researchers from the Perelman School of Medicine at the University of Pennsylvania and Children’s Hospital of Philadelphia (CHOP). When the Delta variant rose to prominence, the study showed that vaccinated young people were 98 percent less likely to be infected than their unvaccinated peers, and data indicated that the vaccine’s effectiveness decline slightly when the Omicron variant became dominant. The paper was published today in Annals of Internal Medicine.

In their analysis of 250,000 patients with around half of them received at least one dose of the BNT162b2 vaccine (the vaccine produced by a collaboration between Pfizer and BioNTech), the researchers—led by Yong Chen, PhD, and Jeffrey Morris, PhD, both professors of Biostatistics at the Perelman School of Medicine, and Christopher Forrest, MD, PhD, a professor of Pediatrics at CHOP and Penn—covered the periods in which the Delta and Omicron variants became dominant, in mid-2021 and 2022, respectively.

While previous clinical trials established that the vaccines provided strong protection against infection for children and adolescents, limited evidence of the vaccine’s performance existed beyond controlled settings. So, the researchers conducted one of the largest COVID-19 vaccine studies of children and adolescents in the United States with the assistance of data from electronic health records gleaned from a national network of pediatric medical centers, known as PEDSnet.

“Our study has longer follow-up than any previous study, which enabled us to evaluate the real-world, long-term durability of vaccine protection against Delta and Omicron variants,” said Chen. “Further, it covered a diverse representation of U.S. pediatric populations from primary care, specialty care, emergency department, testing centers, and inpatient settings.”

One of the main ideas behind the work, as stated by the study’s first authors—Qiong Wu, PhD, a postdoctoral research fellow at Penn Medicine and Jiayi Tong, a PhD candidate in Biostatistics at Penn—was to help address under-reporting in vaccine status to give a clearer picture of its effects.

Yet, infection prevention wasn’t the study’s only area of focus. The researchers also explored potential effects on risk of heart conditions.

“We found no indication of increased cardiac risks during either variant phase,” said Morris.

During the period of time in which the Delta variant of the SARS-CoV-2 virus emerged and became dominant, the researchers found that adolescents (defined as patients who were 12-to 20-years old) who received the vaccine were approximately 98 percent less likely to be infected or have severe disease compared to those who did not receive it, with no evidence of increased cardiac complications or significant waning infection protection over the subsequent four months.

Vaccination proved strongly protective against the Omicron wave, albeit at a lower magnitude than during Delta. Among adolescents, those who were vaccinated were roughly 86 percent less likely to be infected compared to unvaccinated peers, and their protection against severe illness and ICU admission was similarly high, being approximately 85 and 91 percent less likely, respectively, than the unvaccinated.

Among children, (those who were 5-to-11 years old at the time of vaccination during Omicron), the protection against infection was 74 percent better than unvaccinated peers. Their comparative protection against severe illness and ICU admission stood at 76 and 85 percent, respectively.

During the Omicron wave, the data showed some reduction in effectiveness in the four months following vaccination, while the vaccinated actually had a lower risk of cardiac complications during this time period.

In a follow-up study, the researchers are conducting further work to characterize the direct and indirect impacts of vaccination on outcomes tied to Long COVID, the phenomenon in which symptoms related to the illness linger for months or even years.

Additionally, the researchers believe even longer-term work is needed to better understand how well the vaccines continue to protect their recipients.

“Children and adolescents were the last age group to be enrolled in COVID-19 vaccine clinical trials. Although the pandemic has been declared over, the risk of COVID-19 is present throughout U.S. communities,” Forrest said. “Thus, more information is needed on effectiveness of vaccination delivered to children and adolescents during more recent time periods.”

This research was funded, in part, by the National Institutes of Health (OT2HL161847-01, 1R01LM012607, 1R01AI130460, 1R01AG073435, 1R56AG074604, 1R01LM013519, 1R56AG069880, 1R01AG077820, 1U01TR003709) and the Patient-Centered Outcomes Research Institute’s Project Program Awards (ME-2019C3-18315 and ME-2018C3-14899).

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JOURNAL

Annals of Internal Medicine

METHOD OF RESEARCH

Data/statistical analysis

SUBJECT OF RESEARCH

People