Comprehensive environmental assessment: a meta-assessment approach

Developing a shared understanding of translational science within CTSA hubs through facilitated retreats: A case study

Translation of critical and broadly impactful health advancements is stymied by insufficient scientific scrutiny of barriers and roadblocks in the process. The Clinical & Translational Science Award (CTSA) funding opportunity announcement released in July 2021 makes clear the distinction between translational research and translational science (TS) and urges a shift from the former to the latter. This represents a significant shift in the overall scientific direction of the CTSA program and necessitates corresponding shifts in CTSA hub operations. To better support TS, the Team Science Core of the Duke CTSA hub designed and facilitated a virtual retreat for hub personnel that (1) enabled organizational learning about TS and (2) identified anticipated challenges and opportunities. A post-retreat survey was utilized to assess the degree to which the retreat met its stated goals. Our survey received a 62% response rate; 100% of respondents would recommend the session to others. Respondents also reported gains in all areas assessed, with evidence for greater understanding of TS and increased perspective of the value and relevance of TS. In this paper, we provide a roadmap for designing and implementing facilitated TS retreats, which we argue is a key step in TS capacity building through workforce development.

Main Challenges of Incorporating Environmental Impacts in the Economic Evaluation of Health Technology Assessment: A Scoping Review

Health technology assessment (HTA) provides evidence-based information on healthcare technology to support decision making in many countries. Environmental impact is a relevant dimension of a health technology's value, but it has been poorly addressed in HTA processes in spite of the commitment that the health sector must have to contribute to mitigating the effects of climate change. This study aims to identify the state of the art and challenges for quantifying environmental impacts that could be incorporated into the economic evaluation (EE) of HTA. We performed a scoping review that included 22 articles grouped into four types of contribution: (1) concepts to draw up a theoretical framework, (2) HTA reports, (3) parameter designs or suitable indicators, and (4) economic or budgetary impact assessments. This review shows that evaluation of the environmental impact of HTAs is still very incipient. Small steps are being taken in EE, such as carbon footprint estimations from a life-cycle approach of technologies and the entire care pathway.

Incorporating environmental and sustainability considerations into health technology assessment and clinical and public health guidelines: a scoping review

Healthcare systems account for a substantial proportion of global carbon emissions and contribute to wider environmental degradation. This scoping review aimed to summarize the evidence currently available on incorporation of environmental and sustainability considerations into health technology assessments (HTAs) and guidelines to support the National In stitute for Health and Care Excellence and analogous bodies in other jurisdictions developing theirown methods and processes. Overall, 7,653 articles were identified, of which 24 were included in this review and split into three key areas - HTA (10 studies), healthcare guidelines (4 studies), and food and dietary guidelines (10 studies). Methodological reviews discussed the pros and cons of different approaches to integrate environmental considerations into HTAs, including adjustments to conventional cost-utility analysis (CUA), cost-benefit analysis, and multicriteria decision analysis. The case studies illustrated the challenges of putting this into practice, such as lack of disaggregated data to evaluate the impact of single technologies and difficulty in conducting thorough life cycle assessments that consider the full environmental effects. Evidence was scant on the incorporation of environmental impacts in clinical practice and public health guidelines. Food and dietary guidelines used adapted CUA based on life cycle assessments, simulation modeling, and qualitative judgments made by expert panels. There is uncertainty on how HTA and guideline committees will handle trade-offs between health and environment, especially when balancing environmental harms that fall largely on society with health benefits for individuals. Further research is warranted to enable integration of environmental considerations into HTA and clinical and public health guidelines.

Assessing the carbon footprint of digital health interventions: a scoping review

OBJECTIVE

Integration of environmentally sustainable digital health interventions requires robust evaluation of their carbon emission life-cycle before implementation in healthcare. This scoping review surveys the evidence on available environmental assessment frameworks, methods, and tools to evaluate the carbon footprint of digital health interventions for environmentally sustainable healthcare.

MATERIALS AND METHODS

Medline (Ovid), Embase (Ovid). PsycINFO (Ovid), CINAHL, Web of Science, Scopus (which indexes IEEE Xplore, Springer Lecture Notes in Computer Science and ACM databases), Compendex, and Inspec databases were searched with no time or language constraints. The Systematic Reviews and Meta-analyses Extension for Scoping Reviews (PRISMA_SCR), Joanna Briggs Scoping Review Framework, and template for intervention description and replication (TiDiER) checklist were used to structure and report the findings.

RESULTS

From 3299 studies screened, data was extracted from 13 full-text studies. No standardised methods or validated tools were identified to systematically determine the environmental sustainability of a digital health intervention over its full life-cycle from conception to realisation. Most studies (n = 8) adapted publicly available carbon calculators to estimate telehealth travel-related emissions. Others adapted these tools to examine the environmental impact of electronic health records (n = 2), e-prescriptions and e-referrals (n = 1), and robotic surgery (n = 1). One study explored optimising the information system electricity consumption of telemedicine. No validated systems-based approach to evaluation and validation of digital health interventions could be identified.

CONCLUSION

There is a need to develop standardised, validated methods and tools for healthcare environments to assist stakeholders to make informed decisions about reduction of carbon emissions from digital health interventions.

Toward Sustainable Environmental Quality: Priority Research Questions for North America

Anticipating, identifying, and prioritizing strategic needs represent essential activities by research organizations. Decided benefits emerge when these pursuits engage globally important environment and health goals, including the United Nations Sustainable Development Goals. To this end, horizon scanning efforts can facilitate identification of specific research needs to address grand challenges. We report and discuss 40 priority research questions following engagement of scientists and engineers in North America. These timely questions identify the importance of stimulating innovation and developing new methods, tools, and concepts in environmental chemistry and toxicology to improve assessment and management of chemical contaminants and other diverse environmental stressors. Grand challenges to achieving sustainable management of the environment are becoming increasingly complex and structured by global megatrends, which collectively challenge existing sustainable environmental quality efforts. Transdisciplinary, systems-based approaches will be required to define and avoid adverse biological effects across temporal and spatial gradients. Similarly, coordinated research activities among organizations within and among countries are necessary to address the priority research needs reported here. Acquiring answers to these 40 research questions will not be trivial, but doing so promises to advance sustainable environmental quality in the 21st century. Environ Toxicol Chem 2019;38:1606-1624. © 2019 The Authors. Environmental Toxicology and Chemistry published by Wiley Periodicals, Inc. on behalf of SETAC.

ENVIRONMENTAL IMPACT ASSESSMENT OF A HEALTH TECHNOLOGY: A SCOPING REVIEW

INTRODUCTION

The Health Technology Expert Review Panel is an advisory body to Canadian Agency for Drugs and Technologies in Health (CADTH) that develops recommendations on health technology assessments (HTAs) for nondrug health technologies using a deliberative framework. The framework spans several domains, including the environmental impact of the health technology(ies). Our research objective was to identify articles on frameworks, methods or case studies on the environmental impact assessment of health technologies.

METHODS

A literature search in major databases and a focused gray literature search were conducted. The main search concepts were HTA and environmental impact/sustainability. Eligible articles were those that described a conceptual framework or methods used to conduct an environmental assessment of health technologies, and case studies on the application of an environmental assessment.

RESULTS

From the 1,710 citations identified, thirteen publications were included. Two articles presented a framework to incorporate environmental assessment in HTAs. Other approaches described weight of evidence practices and comprehensive and integrated environmental impact assessments. Central themes derived include transparency and repeatability, integration of components in a framework or of evidence into a single outcome, data availability to ensure the accuracy of findings, and familiarity with the approach used.

CONCLUSIONS

Each framework and methods presented have different foci related to the ecosystem, health economics, or engineering practices. Their descriptions suggested transparency, repeatability, and the integration of components or of evidence into a single outcome as their main strengths. Our review is an initial step of a larger initiative by CADTH to develop the methods and processes to address the environmental impact question in an HTA.

Environmental Risk Assessment Strategy for Nanomaterials

An Environmental Risk Assessment (ERA) for nanomaterials (NMs) is outlined in this paper. Contrary to other recent papers on the subject, the main data requirements, models and advancement within each of the four risk assessment domains are described, i.e., in the: (i) materials, (ii) release, fate and exposure, (iii) hazard and (iv) risk characterisation domains. The material, which is obviously the foundation for any risk assessment, should be described according to the legislatively required characterisation data. Characterisation data will also be used at various levels within the ERA, e.g., exposure modelling. The release, fate and exposure data and models cover the input for environmental distribution models in order to identify the potential (PES) and relevant exposure scenarios (RES) and, subsequently, the possible release routes, both with regard to which compartment(s) NMs are distributed in line with the factors determining the fate within environmental compartment. The initial outcome in the risk characterisation will be a generic Predicted Environmental Concentration (PEC), but a refined PEC can be obtained by applying specific exposure models for relevant media. The hazard information covers a variety of representative, relevant and reliable organisms and/or functions, relevant for the RES and enabling a hazard characterisation. The initial outcome will be hazard characterisation in test systems allowing estimating a Predicted No-Effect concentration (PNEC), either based on uncertainty factors or on a NM adapted version of the Species Sensitivity Distributions approach. The risk characterisation will either be based on a deterministic risk ratio approach (i.e., PEC/PNEC) or an overlay of probability distributions, i.e., exposure and hazard distributions, using the nano relevant models.

Needs and challenges for assessing the environmental impacts of engineered nanomaterials (ENMs)

The potential environmental impact of nanomaterials is a critical concern and the ability to assess these potential impacts is top priority for the progress of sustainable nanotechnology. Risk assessment tools are needed to enable decision makers to rapidly assess the potential risks that may be imposed by engineered nanomaterials (ENMs), particularly when confronted by the reality of limited hazard or exposure data. In this review, we examine a range of available risk assessment frameworks considering the contexts in which different stakeholders may need to assess the potential environmental impacts of ENMs. Assessment frameworks and tools that are suitable for the different decision analysis scenarios are then identified. In addition, we identify the gaps that currently exist between the needs of decision makers, for a range of decision scenarios, and the abilities of present frameworks and tools to meet those needs.

Rethinking Environmental Protection: Meeting the Challenges of a Changing World

From climate change to hydraulic fracturing, and from drinking water safety to wildfires, environmental challenges are changing. The United States has made substantial environmental protection progress based on media-specific and single pollutant risk-based frameworks. However, today’s environmental problems are increasingly complex and new scientific approaches and tools are needed to achieve sustainable solutions to protect the environment and public health. In this article, we present examples of today’s environmental challenges and offer an integrated systems approach to address them. We provide a strategic framework and recommendations for advancing the application of science for protecting the environment and public health. We posit that addressing 21st century challenges requires transdisciplinary and systems approaches, new data sources, and stakeholder partnerships. To address these challenges, we outline a process driven by problem formulation with the following steps: a) formulate the problem holistically, b) gather and synthesize diverse information, c) develop and assess options, and d) implement sustainable solutions. This process will require new skills and education in systems science, with an emphasis on science translation. A systems-based approach can transcend media- and receptor-specific bounds, integrate diverse information, and recognize the inextricable link between ecology and human health.

Applying comprehensive environmental assessment to research planning for multiwalled carbon nanotubes: Refinements to inform future stakeholder engagement

Risk assessments and risk management efforts to protect human health and the environment can benefit from early, coordinated research planning by researchers, risk assessors, and risk managers. However, approaches for engaging these and other stakeholders in research planning have not received much attention in the environmental scientific literature. The Comprehensive Environmental Assessment (CEA) approach under development by the United States Environmental Protection Agency (USEPA) is a means to manage complex information and input from diverse stakeholder perspectives on research planning that will ultimately support environmental and human health decision making. The objectives of this article are to 1) describe the outcomes of applying lessons learned from previous CEA applications to planning research on engineered nanomaterial, multiwalled carbon nanotubes (MWCNTs) and 2) discuss new insights and refinements for future efforts to engage stakeholders in research planning for risk assessment and risk management of environmental issues. Although framed in terms of MWCNTs, this discussion is intended to enhance research planning to support assessments for other environmental issues as well. Key insights for research planning include the potential benefits of 1) ensuring that participants have research, risk assessment, and risk management expertise in addition to diverse disciplinary backgrounds; 2) including an early scoping step before rounds of formal ratings; 3) using a familiar numeric scale (e.g., US dollars) versus ordinal rating scales of "importance"; 4) applying virtual communication tools to supplement face-to-face interaction between participants; and 5) refining criteria to guide development of specific, actionable research questions.

Assessing interdependent operational, tactical and strategic risks for improved utility master plans

Risk management plays a key role in water utilities. Although risk tools are well-established at operational levels, approaches at the strategic level are rarely informed by systemic assessments of the water supply and lack a long-term perspective. Here, we report a baseline strategic risk analysis, founded on a systemic analysis of operational risks developed 'bottom-up' and validated in a large water utility. Deploying an action-oriented research method, supported by semi- structured interviews with in-house water utility risk experts, deep connections are established between operational risk and strategic risk that surpass those existing elsewhere in the sector. Accessible presentational formats - influence diagrams, risk "heat-maps" and supporting narratives are used to promote Board-level risk discussions, and characterise a baseline set of strategic risks core to forward utility master planning. Uniquely, the influence of operational events, exposures and potential harms, together with the mitigating measures in place to mediate these risks are linked to corporate objectives on business sustainability, profitability, water quality, water quantity, supply disruption and reputation.

Transparent stakeholder engagement in practice: Lessons learned from applying comprehensive environmental assessment to research planning for nanomaterials

As efforts to develop new applications of engineered nanoscale materials (ENMs) continue to grow, so too has interest in the environmental, health, and safety (EHS) implications of these materials. However, thorough evaluation and interpretation of such implications could require substantial resources (e.g., estimated as >$120 million per year in federal funding 2013-2017). A structured, strategic approach for transparently planning research would support improved linkages between ENM research and risk assessments, and thereby enhance the utility of financial and other resources for EHS studies of ENMs. For this reason, we applied Comprehensive Environmental Assessment (CEA) as an approach to provide transparent input into research planning for 2 types of ENMs: nanoscale titanium dioxide and nanoscale silver. For each of these CEA applications, we employed a collective judgment method known as Nominal Group Technique (NGT) in 2 workshops sponsored by the US Environmental Protection Agency (USEPA). The objective of this paper is to present the outcomes of these CEA applications in the context of how our methodology can inform future efforts to identify collective goals in science (e.g., research priorities) through structured decision support approaches. Outcomes include clear lists of research priorities for each ENM developed through transparently engaging stakeholders having diverse technical and sector perspectives. In addition, we identified several procedural aspects that could be refined, including emphasizing breakout group interactions, identifying broad information priorities before more detailed research questions, and using rating rather than ranking prioritization methods. Beyond the research directions identified for specific ENMs, lessons learned about engaging stakeholders in research planning are expected to inform future research planning efforts for ENMs and other emerging materials across the scientific community.

Sparking connections: toward better linkages between research and human health policy-an example with multiwalled carbon nanotubes

Risk assessment and subsequent risk management of environmental contaminants can benefit from early collaboration among researchers, risk assessors, and risk managers. The benefits of collaboration in research planning are particularly evident in light of (1) increasing calls to expand upon the risk assessment paradigm to include a greater focus on problem formulation and consideration of potential tradeoffs between risk management options, and (2) decreasing research budgets. Strategically connecting research planning to future decision making may be most critical in areas of emerging science for which data are often insufficient to clearly direct targeted research to support future risk assessment and management efforts. This article illustrates an application of the comprehensive environmental assessment approach to inform research planning for future risk assessment and management of one emerging material, multiwalled carbon nanotubes (MWCNTs). High-priority research areas identified for MWCNTs in flame-retardant coatings applied to upholstery textiles included the following: release across the product life cycle; environmental transport, transformation and fate in air, wastewater and sediment; exposure in human occupational and consumer groups; kinetics in the human body; impacts on human health and aquatic populations; and impacts on economic, social, and environmental resources. This article focuses on specific research questions related to human health and how these may connect to future risk assessments and risk management efforts. Such connections will support more effective collaborations across the scientific community and may inform the prioritization of research funding opportunities for emerging materials like MWCNTs.

A web-based tool to engage stakeholders in informing research planning for future decisions on emerging materials

Prioritizing and assessing risks associated with chemicals, industrial materials, or emerging technologies is a complex problem that benefits from the involvement of multiple stakeholder groups. For example, in the case of engineered nanomaterials (ENMs), scientific uncertainties exist that hamper environmental, health, and safety (EHS) assessments. Therefore, alternative approaches to standard EHS assessment methods have gained increased attention. The objective of this paper is to describe the application of a web-based, interactive decision support tool developed by the U.S. Environmental Protection Agency (U.S. EPA) in a pilot study on ENMs. The piloted tool implements U.S. EPA's comprehensive environmental assessment (CEA) approach to prioritize research gaps. When pursued, such research priorities can result in data that subsequently improve the scientific robustness of risk assessments and inform future risk management decisions. Pilot results suggest that the tool was useful in facilitating multi-stakeholder prioritization of research gaps. Results also provide potential improvements for subsequent applications. The outcomes of future CEAWeb applications with larger stakeholder groups may inform the development of funding opportunities for emerging materials across the scientific community (e.g., National Science Foundation Science to Achieve Results [STAR] grants, National Institutes of Health Requests for Proposals).

What do the data show? Knowledge map development for comprehensive environmental assessment

Environmental and human health risk assessments benefit from using data that cross multiple scientific domains. Although individual data points may often be readily understood, the total picture can be difficult to envision. This is especially true with gaps in the data (e.g., with emerging substances such as engineered nanomaterials [ENM]), such that simply presenting only known information can result in a skewed picture. This study describes a method for building knowledge maps (KM) to visually summarize factors relevant to risk assessment in a relatively easy to interpret format. The KMs were created in the context of the comprehensive environmental assessment (CEA) approach for research planning and risk management of environmental contaminants. Recent applications of CEA to emerging substances such as engineered nanomaterials that have numerous data gaps have suggested that a more visually based depiction of information would improve the approach. We developed KM templates as a pilot project, to represent pertinent aspects of conceptual domains, and to highlight gaps in available information for one particular portion of a specific CEA application: the comparison of environmental transport, transformation, and fate of multiwalled carbon nanotubes (MWCNTs) and decabromodiphenyl ether as flame retardants. The results are 3 KM templates representing Physical Properties, Transport, and Transformation. The 3 templates were applied to both substances, resulting in a total of 6 KMs. In addition to presenting the KMs, this paper details the process used to generate them, to aid KM development for other sections of CEA applied to MWCNTs, or to apply the process to new CEA applications.

Environmental exposure assessment of engineered nanoparticles: why REACH needs adjustment

Engineered nanomaterials (ENMs) possess novel properties making them attractive for application in a wide spectrum of fields. These novel properties are not accounted for in the environmental risk assessment methods that the Registration, Evaluation, Authorization, and Restriction of Chemicals (REACH) proposes in their guidance on environmental exposure estimation, although ENMs are already applied in a variety of consumer and industrial products. It is thus necessary to evaluate the guidance document REACH provides on environmental exposure estimation on its applicability to ENMs. This is most urgently the case for engineered nanoparticles (ENPs), as the novel properties are most often only applicable to them. The environmental fate of ENPs was reviewed and compared to the environmental fate of chemicals according to the REACH guidance. Major deviations between the fate of ENPs and predicted fate by REACH were found. They were related to at least 1 of 3 major assumptions made in REACH guidance: 1) in REACH, environmental alteration processes are all thought of as removal processes, whereas alterations of ENPs in the environment may greatly affect their properties, environmental effects, and behavior, 2) in REACH, chemicals are supposed to dissolve instantaneously and completely on release into the environment, whereas ENPs should be treated as nondissolved nanosized solids, and 3) in REACH, partitioning of dissolved chemicals to solid particles in air, water, and soil is estimated with thermodynamic equilibrium coefficients, but in the case of ENPs thermodynamic equilibrium between "dispersed" and "attached" states is generally not expected. The environmental exposure assessment of REACH therefore needs adjustment to cover the specific environmental fate of ENPs. Incorporation of the specific environmental fate processes of ENPs into the environmental risk assessment framework of REACH requires a pragmatic approach.

Assessing nanoparticle risk poses prodigious challenges

Risk assessment is used both formally and informally to estimate the likelihood of an adverse event occurring, for example, as a consequence of exposure to a hazardous chemical, drug, or other agent. Formal risk assessments in government regulatory agencies have a long history of practice. The precision with which risk can be estimated is inevitably constrained, however, by uncertainties arising from the lack of pertinent data. Developing accurate risk assessments for nanoparticles and nanoparticle-containing products may present further challenges because of the unique properties of the particles, uncertainties about their composition and the populations exposed to them, and how these may change throughout the particle's life cycle. This review introduces the evolving practice of risk assessment followed by some of the uncertainties that need to be addressed to improve our understanding of nanoparticle risks. Given the clarion call for life-cycle assessments of nanoparticles, an unprecedented degree of national and international coordination between scientific organizations, regulatory agencies, and stakeholders will be required to achieve this goal.