Migration and sustainable development.

To understand the implications of migration for sustainable development requires a comprehensive consideration of a range of population movements and their feedback across space and time. This Perspective reviews emerging science at the interface of migration studies, demography, and sustainability, focusing on consequences of migration flows for nature-society interactions including on societal outcomes such as inequality; environmental causes and consequences of involuntary displacement; and processes of cultural convergence in sustainability practices in dynamic new populations. We advance a framework that demonstrates how migration outcomes result in identifiable consequences on resources, environmental burdens and well-being, and on innovation, adaptation, and challenges for sustainability governance. We elaborate the research frontiers of migration for sustainability science, explicitly integrating the full spectrum of regular migration decisions dominated by economic motives through to involuntary displacement due to social or environmental stresses. Migration can potentially contribute to sustainability transitions when it enhances well-being while not exacerbating structural inequalities or compound uneven burdens on environmental resources.

Sustainability transitions in consumption-production systems.

The need for faster and deeper transitions toward more sustainable development pathways is now widely recognized. How to meet that need has been at the center of a growing body of academic research and real-world policy implementation. This paper presents our perspective on some of the most powerful insights that have emerged from this ongoing work. In particular, we highlight insights on how sustainability transitions can be usefully conceptualized, how they come about and evolve, and how they can be shaped and guided through deliberate policy interventions. Throughout the paper, we also highlight some of the many how questions that remain unresolved and on which progress would be especially helpful for the pursuit of sustainable development. Our approach to these "how" questions on sustainability transitions draws on two strands of solution-driven research and policy advice: one emerging from studies of how human societies interact with nature and the other emerging from studies of how those societies interact with their technologies. Consumption-production systems have been a focus of extensive work in both strands. To help build bridges between them, we recently brought together a cross-section of relevant scholars for a PNAS Special Feature on "Sustainability transitions in consumption-production systems." Their contributions are summarized in a companion paper we have written to introduce the Special Feature [F. W. Geels, F. Kern, W. C. Clark, Proc. Natl. Acad. Sci. U.S.A. (2023)]. We draw on that work in the Perspective we present here as well as our reading of the relevant literatures.

Progress in modeling dynamic systems for sustainable development.

This Perspective evaluates recent progress in modeling nature-society systems to inform sustainable development. We argue that recent work has begun to address longstanding and often-cited challenges in bringing modeling to bear on problems of sustainable development. For each of four stages of modeling practice-defining purpose, selecting components, analyzing interactions, and assessing interventions-we highlight examples of dynamical modeling methods and advances in their application that have improved understanding and begun to inform action. Because many of these methods and associated advances have focused on particular sectors and places, their potential to inform key open questions in the field of sustainability science is often underappreciated. We discuss how application of such methods helps researchers interested in harnessing insights into specific sectors and locations to address human well-being, focus on sustainability-relevant timescales, and attend to power differentials among actors. In parallel, application of these modeling methods is helping to advance theory of nature-society systems by enhancing the uptake and utility of frameworks, clarifying key concepts through more rigorous definitions, and informing development of archetypes that can assist hypothesis development and testing. We conclude by suggesting ways to further leverage emerging modeling methods in the context of sustainability science.

Crafting usable knowledge for sustainable development.

This paper distills core lessons about how researchers (scientists, engineers, planners, etc.) interested in promoting sustainable development can increase the likelihood of producing usable knowledge. We draw the lessons from both practical experience in diverse contexts around the world and from scholarly advances in understanding the relationships between science and society. Many of these lessons will be familiar to those with experience in crafting knowledge to support action for sustainable development. However, few are included in the formal training of researchers. As a result, when scientists and engineers first venture out of the laboratory or library with the goal of linking their knowledge with action, the outcome has often been ineffectiveness and disillusionment. We therefore articulate here a core set of lessons that we believe should become part of the basic training for researchers interested in crafting usable knowledge for sustainable development. These lessons entail at least four things researchers should know, and four things they should do. The knowing lessons involve understanding the coproduction relationships through which knowledge making and decision making shape one another in social-environmental systems. We highlight the lessons that emerge from examining those coproduction relationships through the ICAP lens, viewing them from the perspectives of Innovation systems, Complex systems, Adaptive systems, and Political systems. The doing lessons involve improving the capacity of the research community to put its understanding of coproduction into practice. We highlight steps through which researchers can help build capacities for stakeholder collaboration, social learning, knowledge governance, and researcher training.

Boundary work for sustainable development: Natural resource management at the Consultative Group on International Agricultural Research (CGIAR).

Previous research on the determinants of effectiveness in knowledge systems seeking to support sustainable development has highlighted the importance of "boundary work" through which research communities organize their relations with new science, other sources of knowledge, and the worlds of action and policymaking. A growing body of scholarship postulates specific attributes of boundary work that promote used and useful research. These propositions, however, are largely based on the experience of a few industrialized countries. We report here on an effort to evaluate their relevance for efforts to harness science in support of sustainability in the developing world. We carried out a multicountry comparative analysis of natural resource management programs conducted under the auspices of the Consultative Group on International Agricultural Research. We discovered six distinctive kinds of boundary work contributing to the successes of those programs-a greater variety than has been documented in previous studies. We argue that these different kinds of boundary work can be understood as a dual response to the different uses for which the results of specific research programs are intended, and the different sources of knowledge drawn on by those programs. We show that these distinctive kinds of boundary work require distinctive strategies to organize them effectively. Especially important are arrangements regarding participation of stakeholders, accountability in governance, and the use of "boundary objects." We conclude that improving the ability of research programs to produce useful knowledge for sustainable development will require both greater and differentiated support for multiple forms of boundary work.

Making technological innovation work for sustainable development.

This paper presents insights and action proposals to better harness technological innovation for sustainable development. We begin with three key insights from scholarship and practice. First, technological innovation processes do not follow a set sequence but rather emerge from complex adaptive systems involving many actors and institutions operating simultaneously from local to global scales. Barriers arise at all stages of innovation, from the invention of a technology through its selection, production, adaptation, adoption, and retirement. Second, learning from past efforts to mobilize innovation for sustainable development can be greatly improved through structured cross-sectoral comparisons that recognize the socio-technical nature of innovation systems. Third, current institutions (rules, norms, and incentives) shaping technological innovation are often not aligned toward the goals of sustainable development because impoverished, marginalized, and unborn populations too often lack the economic and political power to shape innovation systems to meet their needs. However, these institutions can be reformed, and many actors have the power to do so through research, advocacy, training, convening, policymaking, and financing. We conclude with three practice-oriented recommendations to further realize the potential of innovation for sustainable development: (i) channels for regularized learning across domains of practice should be established; (ii) measures that systematically take into account the interests of underserved populations throughout the innovation process should be developed; and (iii) institutions should be reformed to reorient innovation systems toward sustainable development and ensure that all innovation stages and scales are considered at the outset.

A self calibrating, magnetic sensor approach accurately positions an aortic damage control stent in a porcine model.

Objectives: Non-compressible torso hemorrhage remains a high mortality injury, with difficulty mobilizing resources before exsanguination. Previous studies reported on a retrievable stent graft for damage control and morphometric algorithms for rapid placement, yet fluoroscopy is impractical for the austere environment. We hypothesized that magnetic sensors could be used to position stents relative to an external magnet placed on an anatomic landmark, whereas an electromagnet would allow self-calibration to account for environmental noise. Methods: A magnetic sensor alone (MSA) and with integrated stent (MSIS) were examined in a porcine model under anesthesia. A target electromagnet was placed on the xiphoid process (position 0 cm). Sensors were placed in the aorta and measurements obtained at positions 0 cm, +4 cm, and +12 cm from the magnet and compared with fluoroscopy. Sensors were examined under conditions of tachycardia/hypertension, hypotension, vibration, and metal shrapnel to simulate environmental factors that might impact accuracy. General linear models compared mean differences between fluoroscopy and sensor readings. Results: Both sensors were compatible with a 10 French catheter system and provided real-time assessment of the distance between the sensor and magnetic target in centimeters. Mean differences between fluoroscopy and both magnetic sensor readings demonstrated accuracy within ±0.5 cm for all but one condition at 0 cm and +4 cm, whereas accuracy decreased at +12 cm from the target. Using the control as a reference, there was no significant difference in mean differences between fluoroscopy and both MSA or MSIS readings at 0 cm and +4 cm for all conditions. The system retained effectiveness if the target was overshot. Conclusion: Magnetic sensors achieved the highest accuracy as sensors approached the target. Oscillation of the electromagnet on and off effectively accounts for environmental noise.This approach is promising for rapid and accurate placement of damage control retrievable stent grafts when fluoroscopy is impractical. Level of evidence: Not applicable.

Barriers to the implementation of green chemistry in the United States.

This paper investigates the conditions under which firms are able to develop and implement innovations with sustainable development benefits. In particular, we examine "green chemistry" innovations in the United States. Via interviews with green chemistry leaders from industry, academia, nongovernmental institutions (NGOs), and government, we identified six major categories of challenges commonly confronted by innovators: (1) economic and financial, (2) regulatory, (3) technical, (4) organizational, (5) cultural, and (6) definition and metrics. Further analysis of these barriers shows that in the United States, two elements of these that are particular to the implementation of green chemistry innovations are the absence of clear definitions and metrics for use by researchers and decision makers, as well as the interdisciplinary demands of these innovations on researchers and management. Finally, we conclude with some of the strategies that have been successful thus far in overcoming these barriers, and the types of policies which could have positive impacts moving forward.

Linking international agricultural research knowledge with action for sustainable development.

We applied an innovation framework to sustainable livestock development research projects in Africa and Asia. The focus of these projects ranged from pastoral systems to poverty and ecosystems services mapping to market access by the poor to fodder and natural resource management to livestock parasite drug resistance. We found that these projects closed gaps between knowledge and action by combining different kinds of knowledge, learning, and boundary spanning approaches; by providing all partners with the same opportunities; and by building the capacity of all partners to innovate and communicate.

The global health system: actors, norms, and expectations in transition.

In the first in a series of four articles highlighting the changing nature of global health institutions, Nicole Szlezák and colleagues outline the origin and aim of the series.

Damage control of caval injuries in a porcine model using a retrievable Rescue stent.

OBJECTIVE: Early hemorrhage control before the operating room is essential to reduce the significant mortality associated with traumatic injuries of the vena cava. Conventional approaches present logistical challenges on the battlefield or in the trauma bay. A retrievable stent graft would allow rapid hemorrhage control in the preoperative setting when endovascular expertise is not immediately available and without committing a patient to the limitations of current permanent stents. This study details a refined retrievable Rescue stent for percutaneous delivery that was examined in a porcine survival model of penetrating caval hemorrhage. METHODS: A retrievable caval stent was reduced in delivery profile to a 9F sheath using finite element analysis. The final stent was constructed with a "petal and stem" design using nitinol wire followed by covering with polytetrafluoroethylene. Seven Yorkshire pigs (79-86 kg) underwent 22F injury of the infrarenal vena cava with intentional class II hemorrhage (1200 mL). Percutaneous deployment of the Rescue stent was used to temporize hemorrhage for 60 minutes, followed by resuscitation with cell saver blood and permanent caval repair. Hemorrhage control was documented with photography and angiography. Vital signs were recorded and laboratory values were measured out to 48 hours postoperatively. Data were examined with a repeated-measures analysis of variance. RESULTS: The profile of the caval Rescue stent was successfully reduced from 16F to 9F while remaining within fracture and shape memory limits for nitinol. In addition, both rapid deployment and recapture were preserved. Following intentional hemorrhage after caval injury, animals revealed a significant drop in mean arterial pressure (average, 30 mm Hg), acidosis, and elevated lactate level compared with before injury. Compared with uncontrolled hemorrhage, which resulted in death in <9 minutes, the Rescue stent achieved hemorrhage control in <1 minute after venous access in all seven animals. All animals were successfully recovered after permanent repair. There was no significant change in levels of transaminases, bilirubin, creatinine, or hemoglobin at 48 hours compared with preinjury baseline. CONCLUSIONS: A retrievable Rescue stent achieved rapid percutaneous hemorrhage control after a significant traumatic injury of the vena cava and allowed successful recovery of all injured animals. Further development of this approach may have utility in preoperative damage control of caval injuries.

A retrievable rescue stent graft and radiofrequency positioning for rapid control of noncompressible hemorrhage.

BACKGROUND: Noncompressible hemorrhage of the torso remains a challenging surgical dilemma. Stent graft repair requires endovascular expertise, imaging, and inventory that are not available within the critical window of massive hemorrhage. We developed a retrievable stent graft for rapid hemorrhage. We further investigated a radiofrequency (RF) positioning approach as a possible alternative to the logistics of fluoroscopy. METHODS: A retrievable stent graft was constructed with a novel "petal and stem" design from nitinol and covered with a sleeve of electrospun polyurethane. The stent graft was tested using an in vitro model of simulated hemorrhage. Next, the stent graft was examined in vivo using a porcine model of noncompressible hemorrhage. The stent was examined for hemorrhage control in a porcine model of either aortic or caval injury. An RF reader was assembled from an Arduino processor while RF tags were affixed to the ends of the stent graft. Detection accuracy of a handheld RF wand for an RF tag was quantified both in vitro and through tissue. RESULTS: The retrievable RESCUEstent graft was deployed within minutes and rapidly controlled traumatic hemorrhage angiographically in both aortic injury (n = 3) and caval injury (n = 2). Stent grafts were easily recaptured in both models in under 15 seconds. The LED light of a handheld RF detector illuminated when positioned directly over an RF tag. The RF detection approach revealed positioning accuracy to within 1 cm of the intended target, despite tissue interference. CONCLUSION: This study demonstrates the rapid deployment and retrieval of a RESCUE stent graft as well as the ability to tamponade injuries of the aorta and cava. In addition, this study demonstrates the feasibility of RF tags to guide stent placement through tissue. More rigorous models are needed to define the effectiveness of this approach in the setting of vascular injury and shock.

Ecosystem stewardship: sustainability strategies for a rapidly changing planet.

Ecosystem stewardship is an action-oriented framework intended to foster the social-ecological sustainability of a rapidly changing planet. Recent developments identify three strategies that make optimal use of current understanding in an environment of inevitable uncertainty and abrupt change: reducing the magnitude of, and exposure and sensitivity to, known stresses; focusing on proactive policies that shape change; and avoiding or escaping unsustainable social-ecological traps. As we discuss here, all social-ecological systems are vulnerable to recent and projected changes but have sources of adaptive capacity and resilience that can sustain ecosystem services and human well-being through active ecosystem stewardship.

Learning from the U.S. National Assessment of Climate Change Impacts.

The U.S. National Assessment of the Potential Consequences of Climate Variability and Change was a federally coordinated nationwide effort that involved thousands of experts and stakeholders. To draw lessons from this effort, the 10 authors of this paper, half of whom were not involved in the Assessment, developed and administered an extensive survey, prepared a series of working papers, and conducted an invitational workshop in Washington, DC, on April 29, 2004. Considering all these sources, the authors conclude that the Assessment was largely successful in implementing its basic design of distributed stakeholder involvement and in achieving its basic objectives. Future assessments could be significantly improved if greater attention were devoted to developing a collective understanding of objectives, preparing guidance materials and providing training for assessment participants, developing a budgeting mechanism which would allow greater freedom in allocating resources across various assessment activities, and creating an environment in which assessments were part of an ongoing process.

Techniques for assessing and achieving fluid balance in acute renal failure.

Fluid therapy, together with attention to oxygen supply, is the cornerstone of resuscitation in all critically ill patients. Hypovolemia results in inadequate blood flow to meet the metabolic requirements of the tissues and must be treated urgently to avoid the complication of progressive organ failure, including acute renal failure. The kidney plays a critical role in body fluid homeostasis. Renal dysfunction disturbs this homeostasis and requires special attention to issues of fluid balance and fluid overload. In addition, fluid therapy is the only treatment that has been shown to be effective in the prevention of acute renal failure. Special attention to volume status is therefore required in patients at risk for acute renal failure. Hypovolemia is also a major causal factor of morbidity during hemodialysis and may contribute to further renal insults. Although the importance of fluid management is generally recognized, the choice of fluid, the amount, and assessment of fluid status are controversial. As the choice of fluids becomes wider and monitoring devices become more sophisticated, the controversy increases. This article provides an overview of the concept of fluid management in the critically ill patient with acute renal failure.

Knowledge systems for sustainable development.

The challenge of meeting human development needs while protecting the earth's life support systems confronts scientists, technologists, policy makers, and communities from local to global levels. Many believe that science and technology (S&T) must play a more central role in sustainable development, yet little systematic scholarship exists on how to create institutions that effectively harness S&T for sustainability. This study suggests that efforts to mobilize S&T for sustainability are more likely to be effective when they manage boundaries between knowledge and action in ways that simultaneously enhance the salience, credibility, and legitimacy of the information they produce. Effective systems apply a variety of institutional mechanisms that facilitate communication, translation and mediation across boundaries.