Alternative societal solutions to pharmaceuticals in the aquatic environment

Environmental contamination with pharmaceuticals is widespread, inducing risks to both human health and the environment. This paper explores potential societal solutions to human and veterinary pharmaceuticals in the aquatic environment. To this end, we adopt transition research’s multi-level perspective framework, which allows us to understand the dynamics underlying pharmaceutical emissions and to recognize social and technical factors triggering change. Our qualitative analysis is based on data collected through literature research and interviews with actors from pharmaceutical industry, the health and agricultural sector. The research aims at identifying potential future solutions including requirements for as well as barriers to pathways leading to these solutions and describing the role of key actors involved. The three alternative societal solutions identified are: 1) accepting pharmaceuticals in the environment - substantial changes to the system are not required; 2) reconfiguring the current system by implementing various innovations that reduce pharmaceutical emissions; 3) fundamentally changing the current system to (largely) avoid pharmaceutical emissions. The paper further elicits societal, financial, organizational, regulatory and technological requirements that can facilitate implementation of these solutions. This work is novel as it constitutes a systemic view on all stages of the pharmaceutical lifecycle, comprehensively synthesizing options and measures along the entire lifecycle into societal solutions that are framed as transition pathways. Deriving societal solutions from key actor’s perspectives is innovative and provides insights to reflect on choices societies are going to have to make regarding pharmaceuticals in the environment.The authors gratefully thank interviewees who allocated time to answer interview questions, shared valuable insights and expressed opinions. Thanks to G. Niebaum for feedback after a trial interview and to E. Aukes for methodological advice. Brugnach’s contribution was partially supported by the Spanish Government’s María de Maeztu excellence accreditation (Ref. MDM-2017-0714 ). The authors acknowledge funding by the European Regional Development fund of the European Union under the INTERREG project MEDUWA-Vecht(e) (project number 142118)

Science and technology networks: a helping hand to boost implementation of the Sendai Framework for Disaster Risk Reduction 2015–2030?

The Sendai Framework for Disaster Risk Reduction 2015–2030 underlines the importance of Science and Technology (S&T) and S&T networks for effective disaster risk reduction (DRR). The knowledge of existing S&T networks and their exact role in DRR, however, is limited. This opinion piece initiates a discussion on the role of S&T networks in the implementation of the Sendai Framework. The article highlights that current practice is oriented towards a narrative that emphasizes the potential of S&T for DRR and stresses a collaborative approach delivered through networks. But a true understanding of whether and how S&T networks can mobilize and enable S&T for DRR is missing. We call for a review of existing S&T networks for DRR and the development of good practice guidelines on S&T networks for DRR. This review should include knowledge on how to overcome common challenges and maximize the benefits, along with a framework for successful evaluation of such networks. This knowledge would provide much needed guidance for existing and emerging networks

A systematic review on the use of quantitative imaging to detect cancer therapy adverse effects in normal-appearing brain tissue

Cancer therapy for both central nervous system (CNS) and non-CNS tumors has been previously associated with transient and long-term cognitive deterioration, commonly referred to as ‘chemo fog’. This therapy-related damage to otherwise normal-appearing brain tissue is reported using post-mortem neuropathological analysis. Although the literature on monitoring therapy effects on structural magnetic resonance imaging (MRI) is well established, such macroscopic structural changes appear relatively late and irreversible. Early quantitative MRI biomarkers of therapy-induced damage would potentially permit taking these treatment side effects into account, paving the way towards a more personalized treatment planning. This systematic review (PROSPERO number 224196) provides an overview of quantitative tomographic imaging methods, potentially identifying the adverse side effects of cancer therapy in normal-appearing brain tissue. Seventy studies were obtained from the MEDLINE and Web of Science databases. Studies reporting changes in normal-appearing brain tissue using MRI, PET, or SPECT quantitative biomarkers, related to radio-, chemo-, immuno-, or hormone therapy for any kind of solid, cystic, or liquid tumor were included. The main findings of the reviewed studies were summarized, providing also the risk of bias of each study assessed using a modified QUADAS-2 tool. For each imaging method, this review provides the methodological background, and the benefits and shortcomings of each method from the imaging perspective. Finally, a set of recommendations is proposed to support future research

An integrated modelling approach to derive the grey water footprint of veterinary antibiotics

Water pollution by veterinary antibiotics (VAs) resulting from livestock production is associated with severe environmental and human health risks. While upward trends in global animal product consumption signal that these risks might exacerbate toward the future, VA related water pollution is currently insufficiently understood. To increase this understanding, the present research assesses processes influencing VA pollution from VA administration to their discharge into freshwater bodies, using an integrated modelling approach (IMA). For the VAs amoxicillin, doxycycline, oxytetracycline, sulfamethazine, and tetracycline we estimate loads administered to livestock, excretion, degradation during manure storage, fate in soil and transport to surface water. Fate and transport are modelled using the VA transport model (VANTOM), which is fed with estimates from the Pan-European Soil Erosion Risk Assessment (PESERA). The grey water footprint (GWF) is used to indicate the severity of water pollution in volumetric terms by combining VA loads and predicted no effect concentrations. We apply our approach to the German-Dutch Vecht river catchment, which is characterized by high livestock densities. Results show a VA mass load decrease larger than 99% for all substances under investigation, from their administration to surface water emission. Due to metabolization in the body, degradation during manure storage and degradation in soil, VA loads are reduced by 45%, 80% and 90% on average, respectively. While amoxicillin and sulfamethazine dissipate quickly after field application, significant fractions of doxycycline, oxytetracycline and tetracycline accumulate in the soil. The overall Vecht catchment's GWF is estimated at 250,000 m3 yr−1, resulting from doxycycline (81% and 19% contribution from the German and Dutch catchment part respectively). Uncertainty ranges of several orders of magnitude, as well as several remaining limitations to the presented IMA, underscore the importance to further develop and refine the approach

Acupuncture in the treatment of rheumatoid arthritis: a double-blind controlled pilot study

<p>Abstract</p> <p>Background</p> <p>In planning a randomized controlled trial of acupuncture, we conducted a pilot study using validated outcome measures to assess the feasibility of the protocol, and to obtain preliminary data on efficacy and tolerability of 3 different forms of acupuncture treatment as an adjunct for the treatment of chronic pain in patients with Rheumatoid arthritis (RA).</p> <p>Methods</p> <p>The study employs a randomized, prospective, double-blind, placebo-controlled trial to evaluate the effect of electroacupuncture (EA), traditional Chinese acupuncture (TCA) and sham acupuncture (Sham) in patients with RA. All patients received 20 sessions over a period of 10 weeks. Six acupuncture points were chosen. Primary outcome is the changes in the pain score. Secondary outcomes included the changes in the ACR core disease measures, DAS 28 score and the number of patients who achieved ACR 20 at week 10.</p> <p>Results</p> <p>From 80 eligible patients, 36 patients with mean age of 58 ± 10 years and disease duration of 9.3 ± 6.4 years were recruited. Twelve patients were randomized to each group. Twelve, 10 and 7 patients from the EA, TCA and Sham group respectively completed the study at 20 weeks (p < 0.03); all except one of the premature dropouts were due to lack of efficacy. At week 10, the pain score remained unchanged in all 3 groups. The number of tender joints was significantly reduced for the EA and TCA groups. Physician's global score was significantly reduced for the EA group and patient's global score was significantly reduced for the TCA group. All the outcomes except patient's global score remained unchanged in the Sham group.</p> <p>Conclusion</p> <p>This pilot study has allowed a number of recommendations to be made to facilitate the design of a large-scale trial, which in turn will help to clarify the existing evidence base on acupuncture for RA.</p> <p>Trial registration</p> <p>ClinicalTrials.gov NCT00404443</p

Efficacy of acupuncture for chronic low back pain: protocol for a randomized controlled trial

<p>Abstract</p> <p>Background</p> <p>Chronic back pain is a major public health problem and the primary reason patients seek acupuncture treatment. Therefore, an objective assessment of acupuncture efficacy is critical for making informed decisions about its appropriate role for patients with this common condition. This study addresses methodological shortcomings that have plagued previous studies evaluating acupuncture for chronic low back pain.</p> <p>Methods and Design</p> <p>A total of 640 participants (160 in each of four arms) between the ages of 18 and 70 years of age who have low back pain lasting at least 3 months will be recruited from integrated health care delivery systems in Seattle and Oakland. They will be randomized to one of two forms of Traditional Chinese Medical (TCM) acupuncture needling (individualized or standardized), a "control" group (simulated acupuncture), or to continued usual medical care. Ten treatments will be provided over 7 weeks. Study participants and the "Diagnostician" acupuncturists who evaluate participants and propose individualized treatments will be masked to the acupuncture treatment actually assigned each participant. The "Therapist" acupuncturists providing the treatments will not be masked but will have limited verbal interaction with participants. The primary outcomes, standard measures of dysfunction and bothersomeness of low back pain, will be assessed at baseline, and after 8, 26, and 52 weeks by telephone interviewers masked to treatment assignment. General health status, satisfaction with back care, days of back-related disability, and use and costs of healthcare services for back pain will also be measured. The primary analysis comparing outcomes by randomized treatment assignment will be analysis of covariance adjusted for baseline value. For both primary outcome measures, this trial will have 99% power to detect the presence of a minimal clinically significant difference among all four treatment groups and over 80% power for most pairwise comparisons. Secondary analyses will compare the proportions of participants in each group that improve by a clinically meaningful amount.</p> <p>Conclusion</p> <p>Results of this trial will help clarify the value of acupuncture needling as a treatment for chronic low back pain.</p> <p>Trial registration</p> <p>Clinical Trials.gov NCT00065585.</p