It’s possible that I shall make an ass of myself. But in that case one can always get out of it with a little dialectic. I have, of course, so worded my proposition as to be right either way (K.Marx, Letter to F.Engels on the Indian Mutiny)
Sunday, March 07, 2021
Biden signs executive order to expand voting rights: ‘If you have the best ideas, you have nothing to
‘Every eligible voter should be able to vote and have it counted’
President Joe Biden marked the 56-year anniversary of the “Bloody Sunday” march in Selma, Alabama by signing an executive order to protect and strengthen nationwide voting access, while calling on states to expand voting rights for all eligible Americans.
The order was described by the White House as an “initial step” towards securing voting rights just days after the passage of HR1, legislation focusing on expanding access to mail-in voting and making it easier for Americans to register to vote.
In prepared remarks, the president said: “Every eligible voter should be able to vote and have it counted.”
He added: “If you have the best ideas – you have nothing to hide. Let more people vote.”
Mr Biden’s latest order sought to modernise the government voter registration website Vote.gov and directed federal agencies to begin sharing additional information about mail-in voting access and voter registration across social media and on their own sites.
The action comes as civil rights advocates and Americans across the country reflect on the anniversary of the 1965 march on the Edmund Pettus Bridge that descended into violence as demonstrators were attacked by white Alabama state troopers.
The peaceful demonstrators were attempting to begin a march in support of voting rights from Selma to Montgomery. Many have attributed the day with sparking national outcry and a focus on the issues that eventually led to the passage of the Voting Rights Act.
On Sunday, Mr Biden attended the annual Martin and Coretta King Unity Breakfast in Selma, where he delivered the remarks before signing the executive order.
“In 2020 – with our very democracy on the line – even in the midst of a pandemic – more Americans voted than ever before,” Mr Biden said. “Yet instead of celebrating this powerful demonstration of voting, we saw an unprecedented insurrection on our Capitol and a brutal attack on our democracy on January 6th. A never-before-seen effort to ignore, undermine and undo the will of the people.”
QUANTUM BIOLOGY
Quantum physics can cause mutations in our DNA, study
An innovative study has confirmed that quantum mechanics plays a role in biological processes and causes mutations in DNA.
Using advanced computer simulations, scientists from Surrey’s Leverhulme Quantum Biology Doctoral Training Centre determined the role of proton tunneling in spontaneous mutations inside DNA.
Proton tunneling is a type of quantum tunneling involving the instantaneous disappearance of a proton in one site and the same proton’s appearance at an adjacent site separated by a potential barrier.
Scientists found that hydrogen bonds hold the two strands of the DNA‘s double helix together. Under certain circumstances, the hydrogen bonds can behave like spread-out waves that can exist in multiple locations at once, because of proton tunneling. This prompts these atoms to occasionally being found on the wrong strand of DNA, prompting mutations.
Despite having a short lifetime, these mutations can survive the DNA replication mechanism inside cells.
Dr. Marco Sacchi, the project lead and Royal Society University Research Fellow at the University of Surrey, said: “Many have long suspected that the quantum world—which is weird, counter-intuitive and wonderful—plays a role in life as we know it. While the idea that something can be present in two places at the same time might be absurd to many of us, this happens all the time in the quantum world, and our study confirms that quantum tunneling also happens in DNA at room temperature.”
Louie Slocombe, a Ph.D. student at the Leverhulme Quantum Biology Doctoral Training Centre and co-author of the study, said:
“There is still a long and exciting road ahead of us to understand how biological processes work on the subatomic level, but our study—and countless others over the recent years—have confirmed quantum mechanics are at play. In the future, we are hoping to investigate how tautomers produced by quantum tunneling can propagate and generate genetic mutations.”
Journal Reference: L. Slocombe et al. Quantum and classical effects in DNA point mutations: Watson–Crick tautomerism in AT and GC base pairs, Physical Chemistry Chemical Physics (2021). DOI: 10.1039/D0CP05781A
Singapore builds huge floating solar farm at sea in bid to tackle climate crisis
Oceans are ‘new frontier’ in electricity production, says firm tasked with carrying out project
Reaching into the Johor Strait, which lies between the city-state and Malaysia, construction of the solar farm has seen 13,000 solar panels laid out at sea, according to a report from AFP.
With the ability to produce up to five megawatts of electricity, the solar panels can provide enough energy to power at least residential 1,400 flats year-round.
Shawn Tan, vice-president of engineering at Sunseap Group, the Singaporean firm tasked with carrying out the project, told AFP that the sea had presented a solution for a country with limited space on dry land for producing renewable energy. “The sea is a new frontier for solar to be installed,” Mr Tan said.
“After exhausting the rooftops and the available land, which is very scarce, the next big potential is actually our water area,” said Jen Tan, senior vice-president and head of solar in southeast Asia at Sembcorp Industries, a business working on another solar project for Singapore.
The new effort comes as Singapore seeks to address its record as one of Asia’s biggest per-capita carbon dioxide emitters.
With limited space, along with a lack of options for hydro-electricity and wind power, Singapore has faced logistical challenges in the push towards renewable energy.
Environmental advocacy groups have long accused the country of failing to do enough to address climate change, even as rising sea levels have become a growing threat to Singapore’s future.
Climate Action Tracker (CAT) said in its analysis that while Singapore has strengthened its efforts to combat climate change, its 2020 and 2030 targets have been “weak”.
“Singapore updated its 2030 target in March 2020, but the updated target is not an increase in climate action, contrary to the Paris Agreement requirement to scale it up,” CAT states on its website.
Furthermore, CAT says that while Singapore released a long-term low emissions development strategy in April last year, aimed at halving emissions from their peak in 2030 by 2050, the plan “shows a lack of commitment to reaching net-zero emissions, aiming to achieve net zero ‘as soon as viable’ in the ‘second half of the century’.”
“Singapore needs to substantially strengthen its 2030 Paris Agreement target, which could form the basis for a more ambitious long-term target,” CAT states.
Despite the country’s expansion of its renewable energy capacity, natural gas is still the primary energy source in Singapore, accounting for 96 per cent of electricity generated, the organisation said
How To Nearly Sink a $2.9 Billion Dollar Submarine: Leave a Hatch Open.
As mishaps go the Arihant may have been among the more embarrassing but at least it didn’t result in the loss of life.
Here’s What You Need to Remember: Since their inception submarines have been called a “steel tomb” due to the inherent dangers involved in their routine operations. It almost seems unnatural to design a boat that would travel under the water’s surface, and that is why it took a brave type of sailor to volunteer for such duty. During the American Civil War, the CSS Hunley became the first “successful” submarine in that it could effectively submerge yet had problems surfacing—and sadly that cost the lives of its entire crew.
During the Cold War, the Soviet Navy suffered a number of submarine accidents, with many being due to fires; while one particular accident involving the K-431 was later revealed to be due to mishandling of the boat’s nuclear rods, which were lifted too high into the air. That resulted in a reactor achieving critical mass, followed by a chain reaction and explosion.
Other accidents have been what can only be described as “human error” of the most extreme kind. A German Type VIIC submarine sank on its maiden voyage during World War II because the boat’s new deepwater high-pressure toilet was used “improperly,” by the captain no less!
Yet, none of those mishaps compares to what happened to INS Arihant, India’s first nuclear-powered ballistic missile submarine, in 2017. The brand new $2.9 billion submarine was left completely inoperative for nearly a year after a hatch was left open, which allowed seawater to rush in, almost sinking the boat.
The nuclear submarine was the first of an expected five in class, designed and constructed as part of the Indian Navy’s Advanced Technology Vessel project. The Arihant was designed with four launch tubes that could carry a dozen K-15 short-range missiles or K-4 intermediate-range nuclear missiles.
While the subs were advanced the training of the crew certainly wasn’t.
Moreover, the Arihant faced a number of problems from the start, and this included delays in its construction and notably major differences between the Russian-supplied design and the indigenous fabrication.
Those were all minor of course compared to the damage that occurred from human error.
That resulted in a hatch that was left open by mistake while the boat was in the harbor, and in addition to filling the propulsion compartments with seawater, there was substantial damage to the pipes that ran through the submarine. Given how corrosive seawater can be the various pipes, including those that carry pressurized water coolant to and from the ship’s eighty-three-megawatt nuclear reactor, all had to be cut out and replaced.
The six-thousand-ton INS Arihant remained out of service at the docks while the water was pumped out, and the pipes replaced. The entire process took ten months. Its absence was first noted in the Doklam border standoff with China in the summer of 2017—and the Indian military only confirmed that the submarine had undergone repairs in early 2018.
As mishaps go the Arihant may have been among the more embarrassing but at least it didn’t result in the loss of life.
GOOD NEWS
Earth’s atmospheric oxygen will last for another billion years
The fundamental timescale of the oxygen-rich atmosphere on Earth remains uncertain.
Earth’s oxygenation is an increase in the concentration of atmospheric molecular oxygen (O2). Larger amounts of atmospheric oxygen became possible because of shifts in the competition between oxygen production derived from photosynthesis and the rate of oxygen consumption by various geological processes.
Earth’s modern atmosphere is a remotely detectable signal of its surface biosphere. However, the lifespan of oxygen-based biosignatures in Earth’s atmosphere remains uncertain, particularly for the distant future.
A recent study found the answer to this. Using a numerical model of biogeochemistry and climate, scientists from the Toho University reveal Earth’s oxygen-rich atmosphere’s future lifespan.
Knowing Earth’s oxygen-rich atmosphere’s future lifespan has great ramifications for the future of Earth’s biosphere and the search for life on Earth-like planets beyond the solar system.
The study reveals that the future lifespan of Earth’s oxygen-rich atmosphere is approximately one billion years.
Kazumi Ozaki, Assistant Professor at Toho University, said, “Indeed, it is generally thought that Earth’s biosphere will come to an end in the next 2 billion years due to the combination of overheating and CO2 scarcity for photosynthesis. If true, one can expect that atmospheric O2 levels will also eventually decreases in the distant future. However, it remains unclear exactly when and how this will occur.”
Scientists examined how Earth’s atmosphere will evolve in the future. For this, they built an Earth system model which simulates climate and biogeochemical processes. Because modeling future Earth evolution intrinsically has uncertainties in geological and biological evolutions, scientists adopted a stochastic approach. This allowed scientists to obtain a probabilistic assessment of the lifespan of an oxygenated atmosphere.
Running the model for more than 400 thousand times by varying model parameter, scientists found that Earth’s oxygen-rich atmosphere will probably persist for another one billion years (1.08±0.14 (1σ) billion years) before rapid deoxygenation rendered the atmosphere reminiscent of early Earth before the Great Oxidation Event around 2.5 billion years ago.
Ozaki said, “The atmosphere after the great deoxygenation is characterized by elevated methane, low-levels of CO2, and no ozone layer. The Earth system will probably be a world of anaerobic life forms.”
The study suggests that Earth’s oxygenated atmosphere would not be a permanent feature. The oxygen-rich atmosphere might only be possible for 20-30% of the Earth’s entire history as an inhabited planet.
Journal Reference: Ozaki, K., Reinhard, C.T. The future lifespan of Earth’s oxygenated atmosphere. Nat. Geosci. (2021). DOI: 10.1038/s41561-021-00693-5
Drones vs hungry moths: Dutch use hi-tech to protect crops
MONSTER, Netherlands — Dutch cress grower Rob Baan has enlisted high-tech helpers to tackle a pest in his greenhouses: palm-sized drones seek and destroy moths that produce caterpillars that can chew up his crops.
“I have unique products where you don’t get certification to spray chemicals and I don’t want it,” Baan said in an interview in a greenhouse bathed in the pink glow of LED lights that help his seedlings grow. His company, Koppert Cress, exports aromatic seedlings, plants and flowers to top-end restaurants around the world.
A keen adopter of innovative technology in his greenhouses, Baan turned to PATS Indoor Drone Solutions, a startup that is developing autonomous drone systems as greenhouse sentinels, to add another layer of protection for his plants.
The drones themselves are basic, but they are steered by smart technology aided by special cameras that scan the airspace in greenhouses.
The drones instantly kill the moths by flying into them, destroying them in midair.
“So it sees the moth flying by, it knows where the drone is ... and then it just directs the drone towards the moth,” said PATS chief technical officer Kevin van Hecke.
There weren't any moths around on a recent greenhouse visit by The Associated Press, but the company has released video shot in a controlled environment that shows how one bug is instantly pulverized by a drone rotor.
The drones form part of an array of pest control systems in Baan's greenhouses that also includes other bugs, pheromone traps and bumblebees.
The drone system is the brainchild of former students from the Technical University in Delft who thought up the idea after wondering if they might be able to use drones to kill mosquitos buzzing around their rooms at night.
Baan says the drone control system is smart enough to distinguish between good and bad critters.
“You don’t want to kill a ladybug, because a ladybug is very helpful against aphids," he said. "So they should kill the bad ones, not the good ones. And the good ones are sometimes very expensive — I pay at least 50 cents for one bumblebee, so I don’t want them to kill my bumblebees.”
The young company is still working to perfect the technology.
“It’s still a development product, but we ... have very good results. We are targeting moths and we are taking out moths every night in an autonomous way without human intervention," said PATS CEO Bram Tijmons. "I think that’s a good step forward.”
Baan also acknowledges that the system still needs refining.
"I think they still need too many drones ... but it will be manageable, it will be less,” he said. “I think they can do this greenhouse in the future maybe with 50 small drones, and then it’s very beneficial.”
Mike Corder, The Associated Press
JUST IN TIME PRODUCTION
Seat Foam Shortage Could Cut Car Production, and Texas Grid Failure Is Blamed
The recent Texas grid shutdown meant oil refineries didn't make byproducts needed for car and truck seating, and now automakers are scrambling for alternatives.
The massive winter storm that hit Texas in February caused widespread damage to water and electric infrastructure, and it also shut down oil refineries in the state.
That meant fewer refinery byproducts were produced, which meant there was less polyurethane foam produced, which meant no foam for car seats—and now automakers might have to stop or slow production in March until replacement supplies can be found.
One anonymous auto executive told Automotive News that this is going to be a bigger problem than the microchip shortage the industry is already dealing with.
The Texas-size electric grid shutdown that made headlines last month continues to have an impact on people living in the state, but it may also now affect production of new automobiles. That's because the state's failure to prepare for the dramatic winter storm and the resulting power outages stopped local petrochemical plants from operating, which is having a domino effect on the foam required to make new vehicle seats.
When the state's processing plants had to shut down, they put a pause on refining oil, which meant that the oil refinery byproducts that eventually get used in seats (specifically the propylene oxide that's needed for polyurethane foam) were also not being produced for a while. And that lack is now becoming evident to the automotive industry to the degree that, according to Automotive News, which broke the news, the looming foam shortage could alter automobile production starting next week, perhaps even Monday. Other sources said the impact might not be felt until later in March. But everyone seems to agree that finding alternative sources for seat foam is a priority right now.
"Everyone is scrambling," one unnamed auto-industry executive told Crain's Detroit Business."This problem is bigger and closer than the semiconductor issue."
General Motors, Stellantis, Toyota, BMW, Hyundai, and Kia all told Automotive News that they're monitoring the situation but do not have any production stoppages to announce just yet.
The devastating winter storm that hit Texas in mid-February was caused by a blast of cold Arctic air moving further south than usual. It wasn't like the state didn't have any warning, with a senior meteorologist working for the state's unusual electric grid operator, ERCOT, writing in the days before the worst of the storm hit,"This period will go down in Texas weather history as one of the most extreme events to ever impact the state. Temperatures early next week will set widespread daily records that are likely to be the coldest experienced since the 1980s."
A possible foam shortage is not the only supply chain issue that automakers have faced recently. Late last year, the industry was not able to source enough microchips for new cars, which forced at least eight automakers in North America and more around the world to adjust schedules at production plants. That shortage was driven by auto plant shutdowns that happened in early 2020 when the coronavirus started spreading across the globe. At the time, automakers lowered their orders for more chips, thinking they would not need them if the virus dramatically lowered demand for new cars. But demand bounced back sooner than expected and automakers quickly learned chip suppliers had by then promised their products to companies making consumer electronics.
Globalization of cancer clinical trials linked to lower enrollment of Black patients
For the drug approval process in the United States, investigators have been expanding clinical trials to sites outside the country. However, a new study indicates that this trend may be widening racial disparities in patient enrollment in cancer clinical trials. The study is published by Wiley early online in CANCER, a peer-reviewed journal of the American Cancer Society.
Without adequate representation in clinical trials, it is difficult to assess whether a medication will be safe and effective for all populations. Unfortunately, Black individuals have historically been poorly represented in clinical trials of anticancer medications, and their inclusion has been decreasing in recent years. Globalization of cancer clinical trial enrollment may play a role in this trend: to reduce costs and expedite patient enrollment, trials have increasingly enlisted clinical sites outside the United States.
To investigate the issue, a team led by Matthew Galsky, MD and Serena Tharakan, BS, of the Icahn School of Medicine at Mount Sinai in New York City, analyzed demographic information from 21 cancer clinical trials leading to U.S. Food and Drug Administration approvals between 2015 and 2018.
The team found that clinical trials conducted primarily outside the United States were significantly less likely to enroll Black participants than U.S. clinical trials--on average, global trials enrolled less than half the proportion of Black patients than trials conducted primarily within the country. Of the 21 clinical trials supporting 18 FDA drug approvals where race and location data were available, 64 percent of patients were enrolled outside the United States, with Black patients accounting for only an average of 3.2 percent of enrollment.
"There have been a number of studies investigating factors such as access to healthcare, physician biases, and socioeconomic status that may lead to underrepresentation of Black patients," said Tharakan. "However, to our knowledge, our findings are the first to quantitatively demonstrate that the globalization of cancer clinical trials may also be a key driver of racial disparities in the U.S. drug approval process."
The study's investigators hope that their results may help to inform policies focused on addressing racial disparities in cancer research and care.
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Additional Information
NOTE: The information contained in this release is protected by copyright. Please include journal attribution in all coverage. A free abstract of this article will be available via the Cancer News Room upon online publication. For more information or to obtain a PDF of any study, please contact:
Full Citation: "The impact of globalization of cancer clinical trials on enrollment of Black patients." Serena Tharakan, Xiaobo Zhong, and Matthew D. Galsky. CANCER; Published Online: March 8, 2021 (DOI: 10.1002/cncr.33463).
CANCER is a peer-reviewed publication of the American Cancer Society integrating scientific information from worldwide sources for all oncologic specialties. The objective of CANCER is to provide an interdisciplinary forum for the exchange of information among oncologic disciplines concerned with the etiology, course, and treatment of human cancer. CANCER is published on behalf of the American Cancer Society by Wiley and can be accessed online.
Follow us on Twitter @JournalCancer
About Wiley
Wiley drives the world forward with research and education. Through publishing, platforms and services, we help students, researchers, universities, and corporations to achieve their goals in an ever-changing world. For more than 200 years, we have delivered consistent performance to all of our stakeholders. The Company's website can be accessed at http://www.wiley.com.
Investigating youth suicides among children involved with the welfare system
Youth with child welfare involvement are at an elevated risk for suicide but may benefit from suicide prevention interventions targeting health care settings and family-preservation
Suicide is the second leading cause of death among youth aged 5 to 21 years in the United States. Between 2010 and 2019, suicide rates among this group increased 40%.
Youth involved in the child welfare system experience an even greater risk of suicidal behavior, yet research on this vulnerable population is minimal.
To better understand and prevent suicide in this at-risk group, researchers at Nationwide Children's Hospital conducted the first study to compare characteristics and health service utilization patterns of youth suicide decedents (those who died by suicide) and non-decedents who were involved with the child welfare system.
The study, published in Pediatrics and supported by a grant from the National Institute of Mental Health (NIMH), found that youth with child welfare system involvement who died by suicide were significantly more likely to experience out-of-home placements (with the frequency and length of those placements strongly predicting suicidal behavior), more likely to have been diagnosed with mental health and chronic medical conditions or substance use disorders and more likely to have visited physical and mental health care settings in the months before their deaths than matched controls.
Researchers studied 1,320 young people aged 5 to 21 who had at least one open case in Ohio's Statewide Automated Child Welfare Information System (SACWIS) between 2010 and 2017, matching 120 cases of youth who died by suicide to 10 non-decedent controls each based on sex, race, ethnicity, age and year of open case. The study sample was 66% male, 63% non-Hispanic White, 25% non-Hispanic Black and 4% Hispanic. Nearly half of those studied were 15-19 years old when their SACWIS case was opened (44%), with an average age of 15 years.
Youth who died by suicide were twice as likely to have accessed mental health services in the one month and six months prior to their deaths than controls, regardless of the health care setting. Nearly half of suicide decedents with child welfare system involvement used some type of health care services in the one month prior to their death, and almost 90% did so in the preceding six months, compared to 69% of controls. In fact, the odds of a mental health visit in any period or setting were significantly greater for the youth in the child welfare system who died by suicide. A higher incidence of mental health diagnoses among all youth who died by suicide may account for these findings.
Previous research has found that over 90% of all youth who died by suicide had a mental health condition. In this study, however, 59% of suicide decedents had a diagnosed mental health condition compared to less than a third of the control group (31%).
"These findings raise potential concerns about the quality and consistency of mental health screening and care for youth in the welfare system," said Donna Ruch, PhD, a research scientist in the Center for Suicide Prevention and Research at Nationwide Children's and the study's lead author. "They also validate growing recommendations to screen for suicide risk in health care settings. Given the nature of child welfare system involvement, where children are in contact with varied service providers, integrating suicide prevention strategies as a core component of health care delivery in these settings is important."
Additionally, although the number of open SACWIS cases did not significantly differ between suicide decedents and non-decedent controls, those who died by suicide were significantly more likely to have been removed from their homes and placed in foster care, kinship care or another alternative setting.
"Our research suggests youth with child welfare involvement may benefit from both suicide prevention strategies targeting health care settings, such as the Zero Suicide approach, and those that align with family preservation programs," said Dr. Ruch.
Future research to explore and provide empirical support for these kinds of interventions is critical to reduce suicide deaths in this vulnerable population.
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Among children and young adults ages 5-21, warning signs of suicide can vary. Information about suicide warning signs, resources for suicide prevention and resources for families, including those who have lost a loved one to suicide, are available at NationwideChildrens.org.
If you or your child are feeling suicidal, talk to someone. Call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255) or the Youth Psychiatric Crisis Line for Franklin County residents at (614) 722-1800; connect to the Lifeline Crisis Chat at crisischat.org; or reach the Crisis Text Line by texting "START" (or in Ohio, "4HOPE") to 741-741.
If you ever have immediate/urgent concerns about your safety or the safety of anyone else, call 911. If you believe an overdose has occurred, call the national Poison Help hotline at 1-800-222-1222.
New Lancet series shows mixed progress on maternal and child undernutrition in last decade
Series authors issue a call to action for fast-tracked funding to improve program coverage and quality service delivery which have been adversely affected by the COVID-19 crisis
THE LANCET SERIES ON MATERNAL AND CHILD UNDERNUTRITION PROGRESS
IMAGE: INTERNATIONAL CENTER FOR EQUITY IN HEALTH view more
CREDIT: INTERNATIONAL CENTER FOR EQUITY IN HEALTH
The Lancet today published the latest Series on Maternal and Child Undernutrition Progress, including three new papers that build upon findings from the previous 2008 and 2013 Series, which established an evidence-based global agenda for tackling undernutrition over the past decade. The papers conclude that despite modest progress in some areas, maternal and child undernutrition remains a major global health concern, particularly as recent gains may be offset by the COVID-19 pandemic. The Series reiterates that previously highlighted interventions continue to be effective at reducing stunting, micronutrient deficiencies, and child deaths and emphasizes the importance of delivering these nutrition interventions within the first 1,000 days of life. However, despite this evidence, program delivery has lagged behind the science and further financing is needed to scale up proven interventions.
The Series finds that the prevalence of childhood stunting rates fell in low-income countries from 47.1 percent to 36.6 percent from 2000 to 2015, but less so in middle-income countries where rates fell from 23.8 percent to 18.0 percent. Yet, the world is falling short of achieving the World Health Assembly Nutrition Target of reducing stunting by 50 percent by 2025. By comparison, there was little progress in the percentage of children who are wasted in both middle- and low-income countries. A new finding also shows that nearly 5 (4.7) percent of children are simultaneously affected by both stunting and wasting, a condition associated with a 4.8-times increase in mortality. The incidence of stunting and wasting is highest in the first 6 months of life, but also exists in part at birth. For maternal nutrition, although the prevalence of undernutrition (low body mass index) has fallen, anemia and short stature remain very high.
"While there have been small improvements, specifically in middle-income countries, progress remains too slow on child wasting and stunting," said Dr. Victora of the International Center for Equity in Health, Federal University of Pelotas in Brazil. "The evidence also reinforces the need to focus on delivering interventions within the first 1,000 days, and to prioritize maternal nutrition for women's own health as well as the health of their children."
Since the 2013 Series, evidence on the efficacy of 10 recommended interventions has increased, along with evidence of newer interventions. New evidence strongly supports the use of preventive small-quantity lipid-based nutrient supplementation (SQ-LNS) for reducing childhood stunting, wasting, and underweight. It also supports the scale up of antenatal multiple micronutrient supplementation for preventing adverse pregnancy and birth outcomes and improving maternal health.
Based on this new evidence, the Series presents a new framework for categorizing nutrition actions into direct and indirect interventions as well as health and non-health-care sector interventions. This framework highlights that evidence-based interventions continue to be a combination of direct interventions (e.g., micronutrient supplementation and breastfeeding counselling), and indirect interventions (e.g., family planning and reproductive health services; cash transfer programs; and water, sanitation, and hygiene promotion) to address the underlying determinants of malnutrition. Nutritional interventions delivered within and outside the health-care sector are equally crucial for preventing and managing malnutrition.
"Our evidence supports the continued effectiveness of all the interventions from the 2013 Series. New evidence further supports the scale up of multiple micronutrient supplements that include iron and folic acid for pregnant women instead of iron-folic acid alone, and the inclusion of SQ-LNS for children, which brings us to 11 core interventions," said Dr. Emily Keats of the Centre for Global Child Health at the Hospital for Sick Children in Toronto, Canada. "We now need to focus on improving intervention coverage, especially for the most vulnerable, through multi-sectoral actions," added Dr. Jai Das of the Center of Excellence in Women and Child Health at Aga Khan University in Karachi, Pakistan.
An additional paper finds that coverage of direct nutrition interventions showed little improvement over the last decade and that renewed commitment, new insights from implementation research, and fast-tracked funding to increase coverage and improve quality of service delivery is desperately needed. It also highlights how both the evidence-base for and the implementation of interventions spanning nutrition, health, food systems, social protection, and water, sanitation, and hygiene has evolved since the 2013 Lancet Series.
The authors conclude the Series with a global call to action to recommit to the unfinished agenda of maternal and child undernutrition.
"Governments and donors must recommit to the unfinished agenda of maternal and child undernutrition with sustained and consistent financial commitments," said Dr. Zulfiqar A. Bhutta from the Centre for Global Child Health, Toronto and Aga Khan University, who is the Series coordinator and senior author of the interventions paper. "Governments must expand coverage and improve quality of direct interventions-especially in the first 1,000 days; identify and address the immediate and underlying determinants of undernutrition through indirect interventions; build and sustain a political and regulatory environment for nutrition action; and invest in monitoring and learning systems at national and subnational levels."
"The COVID-19 pandemic continues to cripple health systems, exacerbate food insecurity, and threatens to reverse decades of progress," said Dr. Rebecca Heidkamp of the Department of International Health at the Johns Hopkins Bloomberg School of Public Health. "For both the pandemic response and the rapidly approaching World Health Assembly 2025 global nutrition target deadlines, nutrition actors at all levels must respond to the call to action to bring together resources, leadership, and coordination-along with data and evidence--to address the worldwide burden of undernutrition."
In an accompanying commentary to the Series, Dr. Meera Shekar, Global Lead for Nutrition at The World Bank and co-authors note: "Progress on delivering what is known to work is unacceptably slow. To change this dynamic, we strongly believe that beyond prioritizing what to do, countries need much better guidance on how to do it at scale, with insights into how much financing is needed and how best to allocate resources to maximize impact."
In the last decade, nutrition has risen on the global agenda, spurred in part by the findings from the 2008 and 2013 Series. This new Series comes at a critical time, as 2021 has been deemed the Nutrition for Growth (N4G) Year of Action--which will culminate in the UN Food Systems Summit in September 2021 and the Tokyo N4G Summit in December 2021.
