Arctic monitoring program plays vital role in global pollution reduction efforts

Peer-Reviewed Publication

CHINESE SOCIETY FOR ENVIRONMENTAL SCIENCES

 

IMAGE: GRAPHICAL ABSTRACT. view more 

CREDIT: ENVIRONMENTAL SCIENCE AND ECOTECHNOLOGY

Historically, the Arctic was considered a pristine region, but scientific research spanning the last three decades has revealed the harsh reality of long-range transported pollutants reaching the Arctic from different corners of the world. In response to this alarming discovery, AMAP was created with the mission to monitor pollution and its effects on the Arctic environment and human health.

In a new article published on 26 July 2023, in the journal Environmental Science and Ecotechnology, researchers from Arctic Knowledge Ltd, presents the initiation and implementation of a systematic scientific and political cooperation in the Arctic related to environmental pollution and climate change, with a special focus on the role of the Arctic Monitoring and Assessment Programme (AMAP). AMAP's pioneering approach, with equal participation of indigenous peoples' organizations alongside Arctic states, seamlessly blending scientific and local knowledge in assessments, has been crucial in understanding the risks posed by persistent organic pollutants (POPs), mercury, radioactivity, and oil pollution, among others. The far-reaching impacts of AMAP's scientific results are evident as its data played a key role in establishing international agreements like the UN Stockholm Convention on POPs and the UN Minamata treaty, resulting in reduced pollution levels not only in the Arctic but also globally. Additionally, AMAP's work has inspired initiatives beyond the Arctic, with ICIMOD establishing HIMAP based on AMAP's model in the Hindu Kush Himalaya (HKM) region. Furthermore, the proposal for the Antarctic Monitoring and Assessment Programme (AnMAP) seeks advice from AMAP, extending the program's influence beyond its original scope. Despite challenges in data sharing and accessing geographical areas for observations, AMAP remains steadfast in its commitment to enhance Arctic monitoring and research data accessibility for international networks and agreements. Given the rapid changes in the Arctic, AMAP's role in fostering continued collaboration and providing science-based policy advice has become more critical than ever. In this regard, AMAP stands as a powerful example of the potential of international cooperation in addressing global challenges and promoting peace and prosperity through science.

Highlights

• AMAP has monitored and assessed Arctic pollution since 1991.
• The main source of Arctic pollution is long-range transport from lower latitudes.
• AMAP data have been fundamental in developing international chemical regulations.
• Food advice has reduced contaminant exposure in local communities.
• Other monitoring and assessment frameworks have been developed after AMAP's model.

In conclusion, AMAP's systematic scientific and political cooperation has been instrumental in recognizing, understanding, and mitigating environmental pollution and climate change in the Arctic. Its efforts have not only led to significant reductions in pollutants in the Arctic but have also influenced global agreements and inspired similar initiatives in other regions.

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References

DOI

10.1016/j.ese.2023.100302

Funding information

The authors wish to acknowledge the scientists and local communities involved in the AMAP monitoring and assessments as well as the reviewers of the scientific assessments. This long-term work would not have been possible without the dedicated contributions from the AMAP Working Group and the Secretariat. The AMAP work benefitted from financial support by the Arctic countries, the Nordic Council of Ministers, the Nordic Environment Finance Corporation (NEFCO) and the Global Environment Facility Programme (GEF).

About Environmental Science and Ecotechnology

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

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JOURNAL

Environmental Science and Ecotechnology

DOI

10.1016/j.ese.2023.100302 

SUBJECT OF RESEARCH

Not applicable

ARTICLE TITLE

The role of the Arctic Monitoring and Assessment Programme (AMAP) in reducing pollution of the Arctic and around the globe

Even treated wastewater affects our rivers

New study by Goethe University Frankfurt shows: Effluents from wastewater treatment plants change the invertebrate communities in Hesse’s waters

Peer-Reviewed Publication

GOETHE UNIVERSITY FRANKFURT

 

IMAGE: TREATED WASTEWATER IS DISCHARGED INTO A NEARBY STREAM. IN THIS WAY, NUMEROUS TRACE SUBSTANCES ENTER OUR WATERS. view more 

CREDIT: JONAS JOURDAN

Effluents from wastewater treatment plants have a dual effect: Some species disappear, while others benefit. Especially certain insect orders, such as stonefly and caddisfly larvae, are decimated. Certain worms and crustaceans, by contrast, can increase in number. A team from Goethe University Frankfurt led by Daniel Enns and Dr. Jonas Jourdan has corroborated this in a comprehensive study, which has now been published in the journal Water Research. They examined 170 wastewater treatment plants in Hesse in relation to species composition.

Wastewater treatment plants are an indispensable part of our modern infrastructure; they have made a significant contribution to improving the quality of our surface waters. However, their ability to completely remove what are known as micropollutants from wastewater is mostly limited. These substances include, for example, active ingredients from pharmaceuticals and personal care products, pesticides and other synthetic substances enter waterbodies via the treated wastewater, placing an additional burden on rivers and streams. This exacerbates the challenges faced by already vulnerable insect communities and aquatic fauna. Previous studies – which have primarily focused on single wastewater treatment plants – have already shown that invertebrate communities downstream of such effluents are generally dominated by pollution-tolerant taxa.

Until now, however, it was unclear how ubiquitous these changes are. That is why a team of biologists from Goethe University Frankfurt has now studied extensively how wastewater from 170 wastewater treatment plants in Hesse has an impact on the species composition of invertebrates. This has prompted a change in the common conception that human-induced stressors reduce the number of species in a habitat and thus their diversity: Rather, the findings indicate that a shift in species composition can be observed. The researchers were able to identify significant shifts in the composition of the species community between sites located upstream and downstream of wastewater treatment plants. Some species were particularly affected by effluents from wastewater treatment plants – such as stonefly and caddisfly larvae, which disappear entirely in some places. Other taxa, such as certain worms and crustaceans, by contrast, benefit and are found in greater numbers. This change can be observed especially in streams and smaller rivers. Overall, wastewater treatment plants alter conditions downstream to the advantage of pollution-tolerant taxa and to the disadvantage of sensitive ones.

How can we reduce water pollution?

Modern treatment techniques such as ozonation or activated charcoal filtering can make water treatment in wastewater treatment plants more efficient, allowing a wider range of pollutants, including many trace substances, to be removed from the wastewater before it is released into the environment. Merging smaller wastewater treatment plants can also contribute to reducing the burden on the environment. Whatever measures are taken, it is important to make sure that upstream sections are not already degraded and are in a good chemical and structural condition.

 

Publication: Enns D, Cunze S, Baker NJ, Oehlmann J, Jourdan J (2023) Flushing away the future: The effects of wastewater treatment plants on aquatic invertebrates. Water Research, 120388. doi.org/10.1016/j.watres.2023.120388

 

Picture download: https://www.uni-frankfurt.de/141365425

 

Caption:

Images 1+2: Treated wastewater is discharged into a nearby stream. In this way, numerous trace substances enter our waters. (Photos: Jourdan)

Image 3: The photograph shows a typical wastewater treatment plant. The wastewater passes through various treatment stages to remove pollutants before the treated water is discharged into the environment. (Photo: Jourdan)

 

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JOURNAL

Water Research

DOI

10.1016/j.watres.2023.120388 

CORRECTION: Outdoor air pollution may increase non-lung cancer risk in older adults

HARVARD T.H. CHAN SCHOOL OF PUBLIC HEALTH

 NEWS RELEASE 11-AUG-2023

*This press release was amended on August 9, 2023. Due to a mistake in interpretation of data, the previous version of the release stated the study found that NO2 exposure is associated with a decreased risk of breast cancer. The authors have confirmed that the results showed that NO2 exposure is associated with an increased risk of breast cancer.

 

Key points:

• A cohort study of millions of Medicare beneficiaries found that chronic exposures to PM2.5 and NO2 over a 10-year period increased the risk of developing colorectal and prostate cancers.
• Even in areas with low pollution levels, researchers found substantial associations between exposures to these pollutants and the risk of developing colorectal and prostate cancers, in addition to breast and endometrial cancers.

Boston, MA—Chronic exposure to fine particulate air pollutants (PM2.5) and nitrogen dioxide (NO2) may increase non-lung cancer risk in older adults, according to a study led by Harvard T.H. Chan School of Public Health. In a cohort study of millions of Medicare beneficiaries, the researchers found that exposures to PM2.5 and NO2 over a 10-year period increased the risk of developing colorectal and prostate cancers. The researchers also found that even low levels of air pollution exposure may make people particularly susceptible to developing these cancers, in addition to breast and endometrial cancers.

“Our findings uncover the biological plausibility of air pollution as a crucial risk factor in the development of specific cancers, bringing us one step closer to understanding the impact of air pollution on human health,” said Yaguang Wei, research fellow in the Department of Environmental Health. “To ensure equitable access to clean air for all populations, we must fully define the effects of air pollution and then work towards reducing it.”

The study was published online August 1, 2023, in Environmental Epidemiology.

While air pollution has been established as a risk factor for lung cancer, and a link to breast cancer risk has been emerging, few studies have looked at its effects on prostate, colorectal, and endometrial cancer risk.

Researchers analyzed data from national Medicare beneficiaries aged 65 or older, collected from 2000 to 2016. All subjects were cancer-free for at least the initial 10 years of the study period. The researchers created separate cohorts for each type of cancer—breast, colorectal, endometrial, and prostate—with between 2.2 million and 6.5 million subjects in each cohort. Separate analyses looked at cancer risk under the impacts of air pollutants for various subgroups by factors including age, sex (for colorectal cancer only), race/ethnicity, average BMI, and socioeconomic status.

Drawing from a variety of air pollution data sources, the researchers developed a predictive map of PM2.5 and NO2 concentrations across the contiguous U.S. This was then linked to beneficiaries’ residential ZIP codes to enable the researchers to estimate individual exposures over a 10-year period.

Findings from the nationwide analysis showed that chronic PM2.5 and NO2 exposures increased the risk of developing colorectal and prostate cancers but were not associated with endometrial cancer risk. For breast cancer, NO2 exposure was associated with an increased risk, while the association for PM2.5 was inconclusive. The researchers suggested that the mixed associations may be due to variations in the chemical composition of PM2.5, which is a complex mixture of solid and liquid particles.

When the analysis was restricted to regions where air pollution levels were significantly below national standards and the composition of PM2.5 remained fairly stable, their effect on breast cancer risk was more pronounced. Stronger associations between exposures to both pollutants and endometrial cancer risk were also found at lower pollution levels.

In their analysis of risk by subgroups, the researchers found evidence suggesting that communities with higher average BMI may face disproportionately higher risk of all four cancers from NO2 exposure, and that Black Americans and those enrolled in Medicaid may be more susceptible to cancer risks (prostate and breast, respectively) from PM2.5 exposure.

The researchers noted that even communities with seemingly clean air were not immune to cancer risk. They found substantial associations between exposure to the two pollutants and the risks of all four cancers even at pollution levels below newly updated World Health Organization guidelines (which are lower than current U.S. standards).

“The key message here is that U.S. air pollution standards are inadequate in protecting public health,” said senior author Joel Schwartz, professor of environmental epidemiology. “The Environmental Protection Agency recently proposed stricter standards for PM2.5, but their proposal doesn’t go far enough in regulating this pollutant. Current NO2 standards are also woefully inadequate. Unless all of these standards become much, much stricter, air pollution will continue to result in thousands of unnecessary cases of multiple cancers each year.”

Other Harvard Chan School authors include Edgar Castro, Cristina Su Liu, Xinye Qiu, James Healy, and Bryan Vu.

Funding for the study came from the National Institutes of Health grants R01ES032418 and P30ES000002.

“Additive effects of ten-year exposures to PM2.5 and NO2 and primary cancer incidence in American older adults,” Yaguang Wei, Mahdieh Danesh Yazdi, Tszshan Ma, Edgar Castro, Cristina Su Liu, Xinye Qiu, James Healy, Bryan N. Vu, Cuicui Wang, Liuhua Shi, Joel Schwartz, Environmental Epidemiology, online August 1, 2023, doi: 10.1097/EE9.0000000000000265

Visit the Harvard Chan School website for the latest news, press releases, and multimedia offerings.

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Harvard T.H. Chan School of Public Health brings together dedicated experts from many disciplines to educate new generations of global health leaders and produce powerful ideas that improve the lives and health of people everywhere. As a community of leading scientists, educators, and students, we work together to take innovative ideas from the laboratory to people’s lives—not only making scientific breakthroughs, but also working to change individual behaviors, public policies, and health care practices. Each year, more than 400 faculty members at Harvard Chan School teach 1,000-plus full-time students from around the world and train thousands more through online and executive education courses. Founded in 1913 as the Harvard-MIT School of Health Officers, the School is recognized as America’s oldest professional training program in public health.

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JOURNAL

Environmental Epidemiology

DOI

10.1097/EE9.0000000000000265 

METHOD OF RESEARCH

Observational study

SUBJECT OF RESEARCH

Not applicable

ARTICLE TITLE

Additive effects of ten-year exposures to PM2.5 and NO2 and primary cancer incidence in American older adults

Behind the rind: new genomic insights into watermelon evolution, quality, and resilience

Peer-Reviewed Publication

BOYCE THOMPSON INSTITUTE

Watermelon is a globally significant agricultural product, both in terms of the total amount produced and the total economic value generated.

Scientists at the Boyce Thompson Institute have constructed a comprehensive "super-pangenome" for watermelon and its wild relatives, uncovering beneficial genes lost during domestication that could improve disease resistance and fruit quality of this vital fruit crop.

"We aimed to delve deeper into the genetic variations that make watermelons so diverse and unique," stated Professor Zhangjun Fei, the study's lead author. "Our findings not only provide insights into the evolutionary journey of watermelons but also present significant implications for breeding and disease resistance."

The watermelon super-pangenome was built using reference genome sequences and genome resequencing data from 547 watermelon accessions spanning four species - cultivated watermelon (Citrullus lanatus) and its wild relatives C. mucosospermus, C. amarus, and C. colocynthis.

Analyses of the super-pangenome revealed that many disease-resistance genes present in wild species were lost during domestication, as early farmers selected for fruit quality traits like sweetness, flesh color, and rind thickness. "These beneficial genes could be reintroduced into modern cultivars to breed more resilient watermelon varieties," noted Fei.

A key discovery of the research, recently published in the Plant Biotechnology Journal, was the identification of a tandem duplication of the sugar transporter gene ClTST2 that enhances sugar accumulation and fruit sweetness in cultivated watermelon. This genetic variant was rare in wild watermelons but was selected during domestication.

"The super-pangenome provides a valuable genetic toolkit for breeders and researchers to improve cultivated watermelon," said Fei. "By understanding the genetic makeup and evolutionary patterns of watermelons, we can develop varieties with enhanced yield, increased disease resistance, and improved adaptability."

This research was supported by grants from the USDA National Institute of Food and Agriculture Specialty Crop Research Initiative (2015-51181-24285 and 2020-51181-32139) and the US National Science Foundation (IOS-1855585).

About Boyce Thompson Institute
Founded in 1924, Boyce Thompson Institute (BTI) is a premier plant biology and life sciences research institution located in Ithaca, New York. BTI scientists conduct investigations into fundamental research with the goals of increasing food security, improving environmental sustainability, and making basic discoveries that will enhance human health. Throughout this work, BTI is committed to inspiring and educating students and to providing advanced training for the next generation of scientists. BTI is an independent nonprofit research institute that is affiliated with Cornell University. For more information, please visit BTIscience.org.

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JOURNAL

Plant Biotechnology Journal

DOI

10.1111/pbi.14120 

METHOD OF RESEARCH

Data/statistical analysis

SUBJECT OF RESEARCH

Cells

ARTICLE TITLE

A Citrullus genus super-pangenome reveals extensive variations in wild and cultivated watermelons and sheds light on watermelon evolution and domestication

Hundred-year storms? That's how long they last on Saturn.

Megastorms leave marks on Saturn’s atmosphere for centuries

Peer-Reviewed Publication

UNIVERSITY OF CALIFORNIA - BERKELEY

 

IMAGE: A HUGE STORM DOMINATES THE RATHER FEATURELESS SURFACE OF SATURN IN AN IMAGE TAKEN BY THE CASSINI SPACECRAFT ON FEB. 25, 2011, ABOUT 12 WEEKS AFTER THE POWERFUL STORM WAS FIRST DETECTED IN THE PLANET'S NORTHERN HEMISPHERE. THE MEGASTORM IS SEEN OVERTAKING ITSELF AS IT ENCIRCLES THE ENTIRE PLANET. ASTRONOMERS HAVE FOUND DEEP IN THE ATMOSPHERE THE AFTEREFFECTS OF MEGASTORMS THAT OCCURRED HUNDREDS OF YEARS AGO. THE DARK STRIPES ARE THE SHADOWS OF SATURN'S RINGS. view more 

CREDIT: NASA/JPL/SPACE SCIENCE INSTITUTE

The largest storm in the solar system, a 10,000-mile-wide anticyclone called the Great Red Spot, has decorated Jupiter's surface for hundreds of years.

A new study now shows that Saturn — though much blander and less colorful than Jupiter — also has long-lasting megastorms with impacts deep in the atmosphere that persist for centuries.

The study was conducted by astronomers from the University of California, Berkeley, and the University of Michigan, Ann Arbor, who looked at radio emissions from the planet, which come from below the surface, and found long-term disruptions in the distribution of ammonia gas.

The study was published today (Aug. 11) in the journal Science Advances.

Megastorms occur approximately every 20 to 30 years on Saturn and are similar to hurricanes on Earth, although significantly larger. But unlike Earth's hurricanes, no one knows what causes megastorms in Saturn's atmosphere, which is composed mainly of hydrogen and helium with traces of methane, water and ammonia.

“Understanding the mechanisms of the largest storms in the solar system puts the theory of hurricanes into a broader cosmic context, challenging our current knowledge and pushing the boundaries of terrestrial meteorology,” said lead author Cheng Li, a former 51 Peg b Fellow at UC Berkeley who is now an assistant professor at the University of Michigan.

Imke de Pater, a UC Berkeley professor emerita of astronomy and of earth and planetary sciences, has been studying gas giants for over four decades to better understand their composition and what makes them unique, employing the Karl G. Jansky Very Large Array in New Mexico to probe the radio emissions from deep inside the planet.

“At radio wavelengths, we probe below the visible cloud layers on giant planets. Since chemical reactions and dynamics will alter the composition of a planet’s atmosphere, observations below these cloud layers are required to constrain the planet’s true atmospheric composition, a key parameter for planet formation models,” she said. “Radio observations help characterize dynamical, physical and chemical processes including heat transport, cloud formation and convection in the atmospheres of giant planets on both global and local scales.”

As reported in the new study, de Pater, Li and UC Berkeley graduate student Chris Moeckel found something surprising in the radio emissions from the planet: anomalies in the concentration of ammonia gas in the atmosphere, which they connected to the past occurrences of megastorms in the planet’s northern hemisphere.

According to the team, the concentration of ammonia is lower at midaltitudes, just below the uppermost ammonia-ice cloud layer, but has become enriched at lower altitudes, 100 to 200 kilometers deeper in the atmosphere. They believe that the ammonia is being transported from the upper to the lower atmosphere via the processes of precipitation and reevaporation. What’s more, that effect can last for hundreds of years.

The study further revealed that although both Saturn and Jupiter are made of hydrogen gas, the two gas giants are remarkably dissimilar. While Jupiter does have tropospheric anomalies, they have been tied to its zones (whitish bands) and belts (darkish bands) and are not caused by storms like they are on Saturn. The considerable difference between these neighboring gas giants is challenging what scientists know about the formation of megastorms on gas giants and other planets and may inform how they’re found and studied on exoplanets in the future.

The National Radio Astronomy Observatory (NRAO) is a facility of the National Science Foundation, operated under cooperative agreement by Associated Universities Inc.

Radio image of Saturn taken with the VLA in May 2015, with the brighter radio emissions from Saturn and its rings subtracted to enhance the contrast in the fainter radio emissions between the various latitudinal bands in the atmosphere. Since ammonia blocks radio waves, the bright features indicate areas where ammonia is depleted and the VLA could see deeper in the atmosphere. The broad bright band at northern latitudes is the aftermath of the 2010 storm on Saturn, which apparently depleted ammonia gas just below the ammonia-ice cloud, which is what we see with the naked eye.

CREDIT

R. J. Sault and I. de Pater

Cassini and VLA Saturn composite 

In the optical, Saturn's banded atmosphere appears to smoothly shift from color to color. But seen here in radio light — VLA data overlays a Cassini image of Saturn — the distinct nature of the bands is apparent. Scientists used VLA data to better understand ammonia in the gas giant's atmosphere and learned that megastorms transport the ammonia from the upper to the lower atmosphere.

CREDIT

S. Dagnello (NRAO/AUI/NSF), I. de Pater et al (UC Berkeley)

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JOURNAL

Science Advances

DOI

10.1126/sciadv.adg9419 

ARTICLE TITLE

Long-lasting, deep effect of Saturn’s Giant Storms

ARTICLE PUBLICATION DATE

11-Aug-2023

 

New concussion headset shows when it's safe to return to play

Peer-Reviewed Publication

UNIVERSITY OF CALIFORNIA - SAN FRANCISCO

A new digital headset designed to measure alterations in brain function could change decisions about how quickly an athlete is ready to return to play after a concussion. In an evaluation of the device, UC San Francisco researchers found it revealed brain changes even in athletes whose concussion symptoms had gone away, suggesting they could be playing too soon.

Although not yet approved by the Food and Drug Administration (FDA), the device could fill an important niche among athletes, clinicians, trainers and coaches, who are concerned about the long-term effects of repeated sports-related concussions. These include chronic traumatic encephalopathy, Alzheimer’s and Parkinson’s diseases. 

The headset – patented by UCSF and licensed by MindRhythm, a medical technology company – picked up changes in what the researchers call “headpulse,” which are subtle forces exerted on the skull as the heart contracts. 

The researchers observed how the device performed on 101 young adults playing Australian Rules Football, who had experienced 44 concussions. Results appeared Aug. 11, 2023, in JAMA Network Open.

On average, the changes detected by the headset lasted 12 days longer than the players’ symptoms. 

“We found a mismatch between symptoms and changes in biometrics recorded by the device,” said Cathra Halabi, MD, of the UCSF Department of Neurology and the Weill Institute for Neurosciences, who is the first author of the study. “This raises concern about relying on symptoms for return-to-play decisions. Delays could be recommended for those symptom-free athletes if head pulse abnormalities persist.” 

Researchers said the headset should be used in conjunction with medical expertise.

“We believe that it can provide critical objective biometric measures that can be used by athletes and medical professionals to decide when to return to play,” said senior author Wade S. Smith, MD, PhD, chief of the UCSF Neurovascular Division and co-founder of MindRhythm. “The headset is also used to monitor athletes afterward to ensure measures remain in the normal range.” 

Concussed Brain at Risk if Physical Activity Resumed

Playing sports with concussion puts the brain at increased risk of damage. “There is a rare condition called second impact syndrome, where a soon-after second concussion can cause near immediate brain death,” Smith said.

More commonly, playing sports with concussion may result in an increased risk for subsequent brain injury, due to symptoms like delayed reaction time, impaired balance or vision. 

“Recurrent concussions in close succession can lead to more debilitating symptoms that last longer, keeping athletes out of the game,” Halabi said. 

While the headset was tested in young adults, its use eventually may be expanded to minors. MindRhythm is hoping to acquire FDA approval within one year, said co-founder and chief executive officer John Keane. “The plan is to make the technology available to the medical community, with the most likely areas of interest being sports medicine physicians and concussion clinics,” he said. 

Athletes with concussion may be able to record their own biometric measurements, the researchers noted. Clinicians or athletic trainers would monitor the data remotely and provide guidance on when it is safe to resume sports and other physical activities.

Co-Authors: Lynda Norton, RN, MPH, and Kevin Norton, PE, PhD, of the University of South Australia, Adelaide.

Funding: Sport and Real Knowledge, John Madden Family, MindRhythm. 

Disclosures: Smith is partial owner of MindRhythm and has a patent pending with UCSF. For other disclosures, please see the study.

 

About UCSF Health: UCSF Health is recognized worldwide for its innovative patient care, reflecting the latest medical knowledge, advanced technologies and pioneering research. It includes the flagship UCSF Medical Center, which is a top-ranked specialty hospital, as well as UCSF Benioff Children’s Hospitals, with campuses in San Francisco and Oakland; Langley Porter Psychiatric Hospital and Clinics; UCSF Benioff Children’s Physicians; and the UCSF Faculty Practice. These hospitals serve as the academic medical center of the University of California, San Francisco, which is world-renowned for its graduate-level health sciences education and biomedical research. UCSF Health has affiliations with hospitals and health organizations throughout the Bay Area. Visit https://www.ucsfhealth.org/. Follow UCSF Health on Facebook or on Twitter

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Follow UCSF
ucsf.edu | Facebook.com/ucsf | Twitter.com/ucsf | YouTube.com/ucsf

 

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JOURNAL

JAMA Network Open

 

SLU ethicists, leading scholars publish guidance for parents, physicians making medical decisions for children

Peer-Reviewed Publication

SAINT LOUIS UNIVERSITY

ST. LOUIS – How should others make decisions for pediatric patients?

For decades, there has been debate in academic literature about the ethical principles that govern medical decision-making for children. In response to this, a group of leading scholars in pediatric ethics participated in a June 2022 symposium, “Best Interests and Beyond: Standards of Decision Making in Pediatrics,” at Saint Louis University. Over the course of three days, the 17 scholars debated one question – in the context of U.S. pediatric care, what moral precepts ought to guide parents and clinicians in medical decision-making for children?

A group of leading scholars participated in a June 2022 symposium, “Best Interests and Beyond: Standards of Decision Making in Pediatrics,” at Saint Louis University. Submitted photo. 

The symposium and further discussions led to six recommendations for pediatric decision-making. Those findings, “Pediatric Decision Making: Consensus Recommendations,” appeared in Pediatrics on Aug. 9.

Erica K. Salter, Ph.D., associate professor of health care ethics and pediatrics at Saint Louis University, is the paper’s lead author. Johan Bester, M.B.Ch.B, Ph.D., associate dean for pre-clerkship curriculum at Saint Louis University School of Medicine and Lou Vinarscik, an M.D./Ph.D. student in health care ethics, also contributed to the work. Bester is an associate professor in family and community medicine and health care ethics at SLU.

The American Academy of Pediatrics offers four standards for pediatric decision-making – the Best Interest Standard, Diekema’s Harm Principle, Ross’s Constrained Parental Authority and Shared Family Centered Decision Making. This constellation of principles often confused pediatric clinicians about the ethical norms of decision-making, especially when parents and physicians disagree about a particular course of action.

The recommendations from the SLU symposium aim to provide a unified set of decision-making principles that will be more accessible and applicable for clinicians, parents and legal guardians for children from infancy to primary school.

This work brought together experts in pediatric ethics who have defended different points of view and who have different backgrounds and perspectives. The stand-out feature of this work is that they could identify points of consensus regarding which moral precepts are fundamental to medical decision-making for children. 

“The fact that this group of distinguished pediatric ethicists, in particular, was able to reach consensus about these six recommendations represents an important step forward in pediatric ethics,” Salter said.   

Recommendations 

1. Parents should be presumed to have wide, but not unlimited, discretion to make health care decisions for their children.
2. Parents should protect and promote the health interests of their children while balancing practical constraints and/or other important obligations and interests.
3. A clinician’s primary responsibility is to protect and promote their pediatric patients’ health interests. Clinicians’ recommendations should be informed by professional judgment and the best available evidence.
4. To respect children and promote their well-being, clinicians and parents should inform pediatric patients of salient information and invite their perspective to the degree that it is developmentally appropriate.
5. In addition to fulfilling state-mandated reporting requirements, clinicians should seek state intervention when all less-restrictive alternatives have failed and a parental decision places the child at significant risk of serious imminent harm or fails to meet the child’s basic interests.
6. Clinicians and parents should strive to collaborate in a shared decision-making process to promote the child’s interest.

“With these recommendations, we hope that pediatric providers feel better equipped to engage in decision-making with parents and patients, especially when there may be disagreement. It can be very distressing when providers and parents disagree about what treatment option is best for a given child, but differences of opinion are not uncommon and should sometimes be expected,” said Salter.

“The recommendations demonstrate that parents and physicians come to the decision-making table with different sets of priorities because they play different roles in the decision-making process. Pediatric providers can now engage in those discussions with a better sense of their role and its ethical justification.” 

This work will help practicing clinicians and bioethicists to make decisions for children grounded in shared moral values. These principles will also help with teaching of pediatric ethics, and with guiding academic work in the field of pediatric ethics.

The authors say further evaluation is needed to determine if these principles apply to newborn babies, teenagers and wards of the state or if modifications are needed for those patient populations.

Sponsors of the symposium include the Harvey and Bernice Jones Chair in Pediatrics at Arkansas Children’s Hospital, the Gnaegi Center for Health Care Ethics, Saint Louis University’s Mellon Award, Saint Louis Children’s Hospital and SSM Health.

Other authors include D. Micah Hester, Ph.D., University of Arkansas for Medical Sciences and Arkansas Children’s Hospital; Armand H. Matheny Antommaria, M.D. Ph.D., Cincinnati Children’s Hospital and University of Cincinnati College of Medicine; Jeffrey Blustein, Ph.D., City College of New York; Ellen Wright Clayton, M.D. J.D., Vanderbilt University Medical Center and Vanderbilt University; Douglas S. Diekema, M.D. MPH, University of Washington School of Medicine; Ana S. Iltis, Ph.D., Wake Forest University; Loretta M. Kopelman, Ph.D., East Carolina University and Georgetown University; Jay R. Malone, M.D. Ph.D., Washington University in St. Louis; Mark R. Mercurio, M.D., Yale University School of Medicine; Mark C. Navin, Ph.D., Oakland University and Corwell Health East; Erin Talati Paquette, M.D. J.D., Northwestern University and Ann and Robert H. Lurie Children’s Hospital of Chicago; Thaddeus Mason Pope, J.D. Ph.D., Mitchell Hamline School of Law; Rosamond Rhodes, Ph.D., Icahn School of Medicine at Mount Sinai; and Lainie F. Ros, M.D. Ph.D., University of Chicago and the University of Rochester.

Albert Gnaegi Center for Health Care Ethics

The Albert Gnaegi Center for Health Care Ethics at Saint Louis University is committed to excellence in teaching, service and research in health care. Engaging in both secular and religious discourse, the center brings Catholic, Jesuit tradition into the interdisciplinary study of philosophical and legal bioethics. 

Saint Louis University School of Medicine

Established in 1836, Saint Louis University School of Medicine has the distinction of awarding the first medical degree west of the Mississippi River. The school educates physicians and biomedical scientists, conducts medical research, and provides health care on a local, national and international level. Research at the school seeks new cures and treatments in five key areas: cancer, liver disease, heart/lung disease, aging and brain disease, and infectious diseases. 

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JOURNAL

PEDIATRICS

DOI

10.1542/peds.2023-061832 

METHOD OF RESEARCH

Commentary/editorial

SUBJECT OF RESEARCH

People

ARTICLE TITLE

Pediatric Decision Making: Consensus Recommendations

ARTICLE PUBLICATION DATE

9-Aug-2023