Designing Eco-Friendly Medical Devices.

For most of the 20 years that Carol Stillman has helped companies design medical devices, sustainability has always come second to other concerns. "There was a perception that it just wasn't something that made sense for medical device companies to do, because the safety and efficacy was so important," says Stillman, a project and program manager at Battelle, the nonprofit science and technology consulting firm focused on contract research and development work. "Trying to take into account these environmental aspects was something that was a low priority by comparison."

A Pleistocene legacy structures variation in modern seagrass ecosystems.

Distribution of Earth's biomes is structured by the match between climate and plant traits, which in turn shape associated communities and ecosystem processes and services. However, that climate-trait match can be disrupted by historical events, with lasting ecosystem impacts. As Earth's environment changes faster than at any time in human history, critical questions are whether and how organismal traits and ecosystems can adjust to altered conditions. We quantified the relative importance of current environmental forcing versus evolutionary history in shaping the growth form (stature and biomass) and associated community of eelgrass (Zostera marina), a widespread foundation plant of marine ecosystems along Northern Hemisphere coastlines, which experienced major shifts in distribution and genetic composition during the Pleistocene. We found that eelgrass stature and biomass retain a legacy of the Pleistocene colonization of the Atlantic from the ancestral Pacific range and of more recent within-basin bottlenecks and genetic differentiation. This evolutionary legacy in turn influences the biomass of associated algae and invertebrates that fuel coastal food webs, with effects comparable to or stronger than effects of current environmental forcing. Such historical lags in phenotypic acclimatization may constrain ecosystem adjustments to rapid anthropogenic climate change, thus altering predictions about the future functioning of ecosystems.

Driving Markets Toward a Greener Future: Kaiser Permanente.

The climate is changing, and, it seems, the health care sector has contributed to the problem. According to The Commonwealth Fund, the health care system accounts for about 10% of the carbon dioxide emitted annually in the United States. Globally, the health care sector is responsible for about 4.6% of worldwide greenhouse gas emissions. Recognizing their part in adding to an urgent global problem, more health care systems are cutting back on waste, carbon emissions, and energy use. As part of our continuing series looking at sustainability in health care, we've talked to three large health care systems to see what they're doing to clean up their act. This feature focuses on the climate change goals of Kaiser Permanente.

Ambitious Climate Goals by the Numbers: Providence Health and Services.

Health care systems account for about 10% of the carbon dioxide emitted annually in the USA. In fact, American hospitals produce approximately 6 million tons of waste each year and use approximately 7% of all water consumed in commercial and institutional settings. As climate change becomes a daily reality rather than just a future possibility, major hospital systems are actively pursuing ways to reduce their carbon footprint. In this series, IEEE Pulse explores what steps are being taken and what challenges remain in conversation with different health care systems. This feature focuses on the climate change goals of Providence Health and Services.

A Move Toward Sustainability in Health Care.

Like any large health care system, Cleveland Clinic goes through a lot of disposable cups each year. To be exact, employees, patients, and visitors at the multispecialty academic center with locations in Ohio, Florida, Nevada, London, and Abu Dhabi, use about 12 million polystyrene cups a year, or an average of 180 cups for every caregiver.

The biogeography of community assembly: latitude and predation drive variation in community trait distribution in a guild of epifaunal crustaceans.

While considerable evidence exists of biogeographic patterns in the intensity of species interactions, the influence of these patterns on variation in community structure is less clear. Studying how the distributions of traits in communities vary along global gradients can inform how variation in interactions and other factors contribute to the process of community assembly. Using a model selection approach on measures of trait dispersion in crustaceans associated with eelgrass (Zostera marina) spanning 30° of latitude in two oceans, we found that dispersion strongly increased with increasing predation and decreasing latitude. Ocean and epiphyte load appeared as secondary predictors; Pacific communities were more overdispersed while Atlantic communities were more clustered, and increasing epiphytes were associated with increased clustering. By examining how species interactions and environmental filters influence community structure across biogeographic regions, we demonstrate how both latitudinal variation in species interactions and historical contingency shape these responses. Community trait distributions have implications for ecosystem stability and functioning, and integrating large-scale observations of environmental filters, species interactions and traits can help us predict how communities may respond to environmental change.

Meeting the Green Health Challenge.

Given the urgency of our climate change problem, a trip to the hospital can be more than just a bit disconcerting for what it reveals about waste. From disposable blood pressure cuffs and one-use plastic medical gowns to powerful air filtration systems that consume immense quantities of energy, waste seems rife. Hospitals might argue that many of these measures are necessary to tamp down hospital-acquired infections, and indeed the U.S. Occupational Safety and Health Administration (OSHA) has required that hospitals dial up their air purification systems to battle COVID-19.

Filling a Cavity in Dental Care.

About a decade ago, Dian Baker, a professor at Sacramento State School of Nursing, responded to a directive from the Centers for Disease Control (CDC) asking health care practitioners to do something about the thorny and serious problem of ventilator hospital-acquired pneumonia, which afflicts thousands of people each year. After consulting with colleagues on the issue, Baker noticed something interesting. Although hospital ventilators had been widely assumed to be the cause of this problem, the truth was that most people getting pneumonia in hospitals weren't on ventilators. The true culprit may come as a surprise: Nurses were shirking the unpleasant task of brushing the teeth of seriously ill patients.

Joint effects of patch edges and habitat degradation on faunal predation risk in a widespread marine foundation species.

Human activities degrade and fragment coastal marine habitats, reducing their structural complexity and making habitat edges a prevalent seascape feature. Though habitat edges frequently are implicated in reduced faunal survival and biodiversity, results of experiments on edge effects have been inconsistent, calling for a mechanistic approach to the study of edges that explicitly includes indirect and interactive effects of habitat alteration at multiple scales across biogeographic gradients. We used an experimental network spanning 17 eelgrass (Zostera marina) sites across the Atlantic and Pacific oceans and the Mediterranean Sea to determine (1) if eelgrass edges consistently increase faunal predation risk, (2) whether edge effects on predation risk are altered by habitat degradation (shoot thinning), and (3) whether variation in the strength of edge effects among sites can be explained by biogeographical variability in covarying eelgrass habitat features. Contrary to expectations, at most sites, predation risk for tethered crustaceans (crabs or shrimps) was lower along patch edges than in patch interiors, regardless of the extent of habitat degradation. However, the extent to which edges reduced predation risk, compared to the patch interior, was correlated with the extent to which edges supported higher eelgrass structural complexity and prey biomass compared to patch interiors. This suggests an indirect component to edge effects in which the impact of edge proximity on predation risk is mediated by the effect of edges on other key biotic factors. Our results suggest that studies on edge effects should consider structural characteristics of patch edges, which may vary geographically, and multiple ways that humans degrade habitats.

Easing Burnout in Health Care.

Health care workers were already stressed before the pandemic. Now, deep into the second year of COVID-19, many find their mental health sliding even further. In the USA, some have had to care for desperately ill but recalcitrant patients who had access to a vaccine but refused to take it. Others, in both the USA and around the world, are working in hospitals, especially rural ones, which are perilously short-staffed [1].

A Devastating Disorder, Poorly Understood.

James Greenblatt, functional psychiatrist and chief medical officer at Walden Behavioral Care in Waltham, MA, has noticed a disturbing trend in the patient population he sees. "We didn't take 11- and 12-year-olds, five or 10 years ago," he says. "They were much fewer, and they could be treated outpatient. But the ages of onset are getting younger and the symptoms are getting more severe."

The Biology Behind Eating Disorders.

For many decades, the popular narrative surrounding anorexia nervosa was that it was an emotional disorder springing from profound cultural pressures combined with dysfunctional family dynamics. Teenage girls, typically, would refuse to eat in an obsessive bid to lose weight. They would imagine themselves to be fat, even if mirrors and scales demonstrated otherwise. Because of the surfeit of images of rail-thin preteen models cluttering the pages of trendy fashion magazines, it was easy to imagine this theory to be true. It made sense if some clinicians regarded anorexia as the inevitable result of a "you-can-never-be-too-rich-or-too-thin" culture.

In a Pandemic, Technology Has Its Limits.

If there's one thing made abundantly clear as the pandemic rages on, it's this: Technology alone can't save us.

Unmasked Behavior.

After initial assertions that the wearing of face masks was an unnecessary public health tool in the prevention of the spread of Covid-19, the advice coming out of the Centers for Disease Control (CDC) suddenly changed. In early April, the CDC issued new guidelines advising people to wear face coverings in public settings where social distancing is difficult.

Increased HIV diagnoses in West Virginia counties highly vulnerable to rapid HIV dissemination through injection drug use: a cautionary tale.

PURPOSE: To investigate HIV transmission potential from a cluster of HIV infections among men who have sex with men to persons who inject drugs in 15 West Virginia counties. These counties were previously identified as highly vulnerable to rapid HIV dissemination through injection drug use (IDU) associated with high levels of opioid misuse. METHODS: We interviewed persons with 2017 HIV diagnoses about past-year risk behaviors and elicited sexual, IDU, and social contacts. We tested contacts for HIV and assessed risk behaviors. To determine HIV transmission potential from persons with 2017 diagnoses to persons who inject drugs, we assessed viral suppression status, HIV status of contacts, and IDU risk behaviors of persons living with HIV and contacts. RESULTS: We interviewed 78 persons: 39 with 2017 diagnoses and 39 contacts. Overall, 13/78 (17%) injected drugs in the past year. Of 19 persons with 2017 diagnoses and detectable virus, 9 (47%) had more than or equal to 1 sexual or IDU contacts of negative or unknown HIV status. During the past year, 2/9 had injected drugs and shared equipment, and 1/9 had more than or equal to 1 partner who did so. CONCLUSIONS: We identified IDU risk behavior among persons with 2017 diagnoses and their contacts. West Virginia HIV prevention programs should continue to give high priority to IDU harm reduction.

Super-Resolution Nanoscopy Imaging Applied to DNA Double-Strand Breaks.

Genomic deoxyribonucleic acid (DNA) is continuously being damaged by endogenous processes such as metabolism or by exogenous events such as radiation. The specific phosphorylation of histone H2AX on serine residue 139, described as γ-H2AX, is an excellent indicator or marker of DNA double-strand breaks (DSBs). The yield of γ-H2AX (foci) is shown to have some correlation with the dose of radiation or other DSB-causing agents. However, there is some discrepancy in the DNA DSB foci yield among imaging and other methods such as gel electrophoresis. Super-resolution imaging techniques are now becoming widely used as essential tools in biology and medicine, after a slow uptake of their development almost two decades ago. Here we compare several super-resolution techniques used to image and determine the amount and spatial distribution of γ-H2AX foci formation after X-ray irradiation: stimulated emission depletion (STED), ground-state depletion microscopy followed by individual molecule return (GSDIM), structured illumination microscopy (SIM), as well as an improved confocal, Airyscan and HyVolution 2. We show that by using these super-resolution imaging techniques with as low as 30-nm resolution, each focus may be further resolved, thus increasing the number of foci per radiation dose compared to standard microscopy. Furthermore, the DNA repair proteins 53BP1 (after low-LET irradiations) and Ku70/Ku80 (from laser microbeam irradiation) do not always yield a significantly increased number of foci when imaged by the super-resolution techniques, suggesting that γ-H2AX, 53PB1 and Ku70/80 repair proteins do not fully co-localize on the units of higher order chromatin structure.

Latitude, temperature, and habitat complexity predict predation pressure in eelgrass beds across the Northern Hemisphere.

Latitudinal gradients in species interactions are widely cited as potential causes or consequences of global patterns of biodiversity. However, mechanistic studies documenting changes in interactions across broad geographic ranges are limited. We surveyed predation intensity on common prey (live amphipods and gastropods) in communities of eelgrass (Zostera marina) at 48 sites across its Northern Hemisphere range, encompassing over 37° of latitude and four continental coastlines. Predation on amphipods declined with latitude on all coasts but declined more strongly along western ocean margins where temperature gradients are steeper. Whereas in situ water temperature at the time of the experiments was uncorrelated with predation, mean annual temperature strongly positively predicted predation, suggesting a more complex mechanism than simply increased metabolic activity at the time of predation. This large-scale biogeographic pattern was modified by local habitat characteristics; predation declined with higher shoot density both among and within sites. Predation rates on gastropods, by contrast, were uniformly low and varied little among sites. The high replication and geographic extent of our study not only provides additional evidence to support biogeographic variation in predation intensity, but also insight into the mechanisms that relate temperature and biogeographic gradients in species interactions.

Small-Scale Die-Offs in Woodrats Support Long-Term Maintenance of Plague in the U.S. Southwest.

Our longitudinal study of plague dynamics was conducted in north-central New Mexico to identify which species in the community were infected with plague, to determine the spatial and temporal patterns of the dynamics of plague epizootics, and to describe the dynamics of Yersinia pestis infection within individual hosts. A total of 3156 fleas collected from 535 small mammals of 8 species were tested for Y. pestis DNA. Nine fleas collected from six southern plains woodrats (Neotoma micropus) and from one rock squirrel (Otospermophilus variegatus) were positive for the pla gene of Y. pestis. None of 127 fleas collected from 17 woodrat nests was positive. Hemagglutinating antibodies to the Y. pestis-specific F1 antigen were detected in 11 rodents of 6 species. All parts of the investigated area were subjected to local disappearance of woodrats. Despite the active die-offs, some woodrats always were present within the relatively limited endemic territory and apparently were never exposed to plague. Our observations suggest that small-scale die-offs in woodrats can support maintenance of plague in the active U.S. Southwestern focus.