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)
Wednesday, May 28, 2025
Involving communities in nature-based solutions to climate challenges leads to greater innovation, study shows
Involving communities in nature-based solutions to tackle urban climate and environmental challenges leads to innovation and multiple benefits, a study shows.
Participation of citizens in NBS projects leads to innovation in design and quality, as well as people gaining greater benefits from green and blue spaces (for access, recreation and health and wellbeing), researchers found. The study showed that involving communities.
Projects are also more likely to be successful in supporting nature renewal when they involve policymakers from across different sectors, rather than being carried out in silos, and when they align with government policy and strategy.
Researchers carried out interviews and workshops in three European cities – Paris Region, France, Velika Gorica, Croatia, and Aarhus, Denmark as part of the EU Horizon 2020-funded REGREEN project.
They found the size and complexity of the urban area and the ways the cities were governed had an impact on the outcome of the NBS.
In all areas the increased prevalence and severity of climate change effects (e.g. flooding, heat effects) and witnessing initiatives from other countries were drivers of NBS innovation.
Also influential were shifts in public and media perception around climate change, a tradition of use of public spaces by citizens and support from politicians and political leaders.
However, the research found that encouraging participation by residents and others, and experimentation may not necessarily lead to desired outcomes where there are also strong external (top-down) policy drivers (e.g. housing development pressures).
Dr Petersen said: “When NBS projects aligned with and were integrated into government strategy with support from local leaders, this helped promote innovation in all three cities, as did involving local people in the co-design of NBS initiatives.
“We also found key differences. In the Paris Region there was more evidence of citizens and local NGOs developing their own NBS initiatives, based on tackling external factors and priorities such as increasing the liveability of urban areas, biodiversity, health and wellbeing, and climate adaptation, without government assistance, at least initially. Whereas, in Velika Gorica the barriers to local groups doing this, such as funding, were reported to be greater.
“Key differences that led to differing NBS outcomes included the size and complexity of urban areas, the effectiveness of enforcement of planning regulations, and the extent to which the governing architecture enabled citizens and local NGOs to develop their own NBS initiatives.
“The analysis indicates that where citizen participation and consultation were built into NBS projects, this brought both innovation in terms of the design, quality, biodiversity and or multi-functionality of green/blue spaces—whether this was greening of schoolyards, redesign of under-used green spaces or river restoration.”
New Haven, Conn. — As rising global temperatures alter ecosystems worldwide, animal species usually have two choices: adapt to changing local conditions or flee to a cooler clime. Ecologists have long assumed that the world’s bird species were best equipped to respond to the pressures of climate change simply because they have the option of flying to higher altitudes or towards global poles.
But a new Yale study finds that few bird species are able to escape the realities of a warming world.
The findings were published May 28 in the journal Nature Ecology and Evolution.
“They can’t move fast enough or far enough to keep up with how quickly climate change is occurring,” said Jeremy Cohen, the study’s lead author. He is an associate research scientist in Yale’s Department of Ecology & Evolutionary Biology and member of the lab of co-author Walter Jetz.
Jetz, a professor of ecology and evolutionary biology in Yale’s Faculty of Arts and Sciences, is also director of the Yale Center for Biodiversity and Global Change and Jack and Laura Dangermond Scientific Chair of the E.O. Wilson Biodiversity Foundation.
For the study, Cohen and Jetz analyzed data on the movements of 406 species of North American birds collected from citizen observers over two decades as well as corresponding local temperature changes. They found that many of the assumptions they’d made about how bird species are responding to climate change were correct. During summer, for instance, bird species on average relocated between 40 and 50 miles northward during the period covered in the data — and sometimes relocated to higher elevations. And, on average, the northbound movement helped birds avoid a temperature increase of about 1.28 degrees Celsius — or about half of the temperature increase they would have experienced if they stayed put.
But, on average, birds still experienced a 1.35-degree Celsius increase in temperature during the summer months compared with temperatures in their original home range. During winter months, birds had only minimal success in limiting their exposure to warming, experiencing only 11% less warming than had they not moved. In winter, birds experienced on average a whopping 3.7-degree Celsius increase in temperatures over the 20 years, reducing their potential exposure only by half a degree via their movement north.
Birds’ ability to escape higher temperatures also varied by species. Overall, more than 75% of birds managed to reach slightly cooler climes in response to warming temperatures. But some species, like the cactus wren, which is native to deserts and arid systems in North America, did not move at all, making them more susceptible to climate-triggered changes to their environmental niches. These so-called climatic “niche shifters” could be limited in flight capability or prevented from leaving their current home environment or competing for them in new locations by specific fine-scale habitat needs and ecological dependencies.
Bird species capable of flying long distances were the most successful in limiting their exposure to warmer climates and retaining their historic climatic niches, the researchers found. This included the blue-winged warbler, which traveled more than 100 miles northward and experienced two fewer degrees of warming than if it had stayed put. But even these birds are dealing with temperatures that exceed those they’d known in their original home range 20 years ago.
For species that are far less mobile than birds, such as reptiles and mammals, the options for escaping the rapid warming are even more limited.
Climate change is expanding the gap between the climatic niche species have evolved into over thousands of years and what they experience in their home grounds, the authors say.
“In a uniquely well-studied continental system, we find that even a highly mobile group, such as birds, is unable to relocate quickly enough to keep up with this velocity,” Jetz said. “This raises deep concerns about the ability of all the other, less mobile species and lesser known species to persist in a warmer world. A much better understanding and management of most likely climate change victims — those most ecologically and geographically tied down — is needed to fend off an impending extinction crisis.”
The study was funded in part by the E.O. Wilson Biodiversity Foundation in furtherance of the Half-Earth Project.
# # #
Journal
Ecology and Evolution
Electric buses struggle in the cold, Cornell researchers find
ITHACA, N.Y. – Cornell University researchers have released new insights on a pilot program involving all-electric buses in Ithaca – with implications for cities, schools and other groups that are considering the electrification of their fleets, as well as operators, policymakers and manufacturers.
The study is the first to assess and analyze electric buses’ performance in the northeastern U.S., with an unprecedented dataset that covers significant distance – nearly 50,000 miles– at cold temperatures.
Tompkins Consolidated Area Transit (TCAT) in Ithaca faced issues with the manufacturers of the buses, in addition to the buses struggling in Ithaca’s hilly terrain and being unreliable, with reduced range, in cold weather.
For the study, researchers analyzed two years of data and quantified the increased energy consumption of the pilot fleet, finding that the batteries on the electric buses consumed 48% more energy in cold weather (between 25 to 32 degrees Fahrenheit) and nearly 27% more in a broader temperature range (10 to 50 degrees Fahrenheit).
“One of the lessons we’ve learned is that these buses should be designed for the whole country, including states with colder climates,” said senior author Max Zhang, professor of engineering. “We’ve also found that they’re different from conventional diesel buses, with different behaviors, which require different strategies to take advantage of this.”
The researchers found that half of the increased consumption in cold weather comes from the batteries’ need to heat themselves. Batteries in electric vehicles operate at an optimal temperature of around 75 degrees Fahrenheit, and the colder the battery is when the bus starts, the more energy it takes to warm it. The other main culprit is the heating of the bus’s cabin. With frequent stops, especially on urban routes in which the doors are opened and closed every few minutes, the batteries must work harder to heat the cabins.
The researchers also found that regenerative braking, whereby the battery recharges by capturing energy during braking, was less efficient in cold weather. They said this is likely because the battery, which is about eight times the size of a standard electric vehicle battery, struggles to maintain an even temperature across its cells.
Short-term strategies to improve the batteries’ function include storing the buses indoors when not in use, so the ambient temperature is warmer; charging the batteries when they’re still warm; and limiting the length of time the bus doors are open at stops.
On a larger scale, first author and doctoral student Jintao Gu said the research points to the need for greater adjustments in, or assessments of, infrastructure to accommodate electric buses.
“You have to try to optimize the schedule of all of the buses and to consider the capability of your infrastructure – how many charging stations you have, and if you have your own garage,” he said. “You have to train the drivers, the dispatchers and the service workers. I think from an operational and infrastructure perspective, there are a lot of messages here for future transit system planning.”
Irvine, Calif., May 28, 2025 — Many home healthcare agencies adopted telehealth services during the COVID-19 pandemic, but the absence of federal reimbursements for these services has led to an increasing number of providers discontinuing these options, a national survey conducted by the University of California, Irvine, and other institutions reveals. Results are published in Health Services Research.
The National Institute on Aging-funded study offers valuable insights into the role of telehealth in home healthcare, a rapidly expanding sector. As the population ages and seeks alternatives to nursing homes, this field is expected to grow by 10 percent annually.
The survey’s findings spotlight the urgent need for policy considerations from the Centers for Medicare & Medicaid Services, which has not reimbursed home healthcare agencies for telehealth services, even during the pandemic.
Conducted from October 2023 to November 2024, the study queried 791 home healthcare agencies, with a response rate of 37 percent. It focused on businesses that served a significant portion of dementia patients, averaging 33 percent of their clientele. The results revealed that only 23 percent of home healthcare agencies had adopted telehealth by 2019. However, that number surged to 65 percent by 2021, primarily driven by the implementation of virtual visits to mitigate disease transmission and address staffing and equipment shortages during the COVID-19 pandemic. Nevertheless, 19 percent of adopting agencies had discontinued telehealth by 2024. The reasons cited for this included a lack of Medicare reimbursement and concerns about the suitability of telehealth for the home healthcare of older, less tech-savvy patients.
“This study is the first to provide a comprehensive national picture of telehealth’s trajectory in home healthcare,” said corresponding author Dana B. Mukamel, UC Irvine Distinguished Professor of medicine. “Our findings suggest that without [Centers for Medicare & Medicaid Services] reimbursement, many agencies may abandon telehealth, potentially missing opportunities to improve care and manage costs as home health demand skyrockets.”
The survey revealed that 33 percent of home healthcare agencies never adopted telehealth, even during the pandemic, often believing it inappropriate for the sector’s hands-on model. Virtual visits saw the largest adoption spike in 2020 (21.1 percent), but 22 percent of users had discontinued them by about 2022. Among this group, 60 percent echoed concerns about patient suitability, while 55 percent highlighted costs and lack of reimbursement. Remote patient monitoring and client surveys saw smaller adoption increases and similar discontinuation trends.
These patterns suggest that COVID-19 disrupted telehealth’s natural diffusion into home healthcare, which was gaining traction pre-pandemic, with 23 percent adoption by 2019. The study posits that without the pandemic, telehealth might have continued spreading as agencies recognized its benefits. However, the lack of reimbursement and perceptions of telehealth’s limitations for older adults pose barriers to sustained use.
As the Centers for Medicare & Medicaid Services considers telehealth reimbursement policies, the study calls for rigorous evaluations of telehealth’s cost-effectiveness and patient outcomes. With home healthcare expenditures projected to grow significantly, policies supporting telehealth could enhance care delivery and manage costs. The results also underscore the need for future research to assess whether these trends hold across all home healthcare agencies, given the study’s focus on dementia-serving businesses.
The study, co-authored by experts from UC Irvine, UCLA, Brown University, the University of Minnesota and other institutions, is a critical resource for policymakers navigating the future of home healthcare. As the nation grapples with an aging population and rising care demands, understanding telehealth’s role could shape effective, sustainable solutions.
About the University of California, Irvine: Founded in 1965, UC Irvine is a member of the prestigious Association of American Universities and is ranked among the nation’s top 10 public universities by U.S. News & World Report. The campus has produced five Nobel laureates and is known for its academic achievement, premier research, innovation and anteater mascot. Led by Chancellor Howard Gillman, UC Irvine has more than 36,000 students and offers 224 degree programs. It’s located in one of the world’s safest and most economically vibrant communities and is Orange County’s second-largest employer, contributing $7 billion annually to the local economy and $8 billion statewide. For more on UC Irvine, visit www.uci.edu.
Media access: Radio programs/stations may, for a fee, use an on-campus studio with a Comrex IP audio codec to interview UC Irvine faculty and experts, subject to availability and university approval. For more UC Irvine news, visit news.uci.edu. Additional resources for journalists may be found at https://news.uci.edu/media-resources.
Journal
Health Services Research
Article Title
Telehealth Use by Home Health Agencies Before, During, and After COVID-19
Article Publication Date
22-May-2025
Reducing hospital stays through treatment algorithms that make a difference
Emergency and hematology/oncology physicians at the Medical University of South Carolina join forces to standardize care for children with sickle cell disease who present with a fever
MUSC Children's Health hematologists/oncologists Dr. Michelle Hudspeth (left) and Dr. Shayla Bergmann (right) conducted a study of a new algorithm to standardize the care of children with sickle cell disease who present to the ED with a fever.
Credit: Medical University of South Carolina. Photo by Julie Taylor.
The Pediatric Emergency Medicine and Pediatric Hematology/Oncology divisions at the Medical University of South Carolina (MUSC) joined forces to create and test an algorithm for treating children with sickle cell disease who present to the Emergency Department (ED) with a fever.
With the new algorithm, emergency physicians at MUSC Shawn Jenkins Children’s Hospital confer with the hematology/oncology team to determine patients’ levels of risk, recommending that low-risk patients be treated as outpatients. The algorithm creates a consistent and standardized pathway of care that could reduce hospitalizations.
“We were thrilled to partner with our ED colleagues and with the MUSC Value Institute to create a treatment pathway to streamline care for our patients with sickle cell disease and safely reduce the burden of repeated hospitalizations for their families,” remarked senior author Michelle Hudspeth, M.D., the division chief for Pediatric Hematology/Oncology at MUSC Children’s Health.
Sickle cell disease is a genetic, lifelong condition that affects red blood cells, causing them to become sickle-shaped and block blood flow to other parts of the body. This disease is most seen in people of African descent. According to the National Heart, Lung, and Blood Institute, patients with sickle cell disease face lifelong health complications, such as chronic pain, lung problems and poor function of the spleen.
“Your spleen does a lot of things,” said first author Jason Erno, M.D., who joined the project as a first-year medical student and continued through his first year of residency. “One of the most important is to help to prevent infections.”
That’s why it’s so important to monitor for infections in young children with sickle cell disease, explained Erno, who is now a second-year resident in internal medicine at the University of Virginia.
“These kids are susceptible to more severe infections than your average kid, which is why it can be so scary when they get sick,” he said. Historically, any sickle cell disease patient under 2 years old who came to the ED with a fever would be admitted to the hospital immediately. This practice resulted in a high number of unnecessary and burdensome hospital stays. These stays cost both the patient’s family and the hospital time and money.
Hudspeth explained that hospitals across the country are transitioning the admission age from 2 years to 1 year with additional criteria, citing the increased protection of vaccinations.
“That’s what we sought to do here – see if we could safely reduce the age of required admission for fever with a clearly standardized protocol that included predefined risk factors,” Hudspeth said.
Co-author of the article, MUSC Children’s Health pediatric hematologist/oncologist Shayla Bergmann, M.D., agreed. “This algorithm safely allows our care of these patients to align with national thoughts and practice while also considering quality of life for our patients and their families.”
The interdisciplinary team came together to create an agreed-upon diagnostic algorithm that would inform the decision for admitting or discharging a pediatric patient with sickle cell disease and a fever. Their goal was to discharge safely patients who could recover at home with close follow-up.
The research team implemented the algorithm for a year and compared admissions data for that year with the year prior, seeing a 10% decrease in admissions with no difference in readmissions. Though not statistically significant, these findings suggested that low-risk patients could be treated safely as outpatients, and the close follow-up could be working.
“Having the algorithm makes everybody feel a little more comfortable that we’re doing the right thing,” Erno commented.
The algorithm continues to be used and studied at MUSC Children’s Health. Its success, Bergmann said, highlights the power of collaboration and proves that improved patient care doesn’t have to come at a price. “It lessens the burden of hospital stays and complications,” she said, “and it lowers time missed from work for parents and caregivers.”
The interdisciplinary team put incredible amounts of time and effort into developing and testing this important tool. The team is satisfied with having a standardized protocol in place, and everyone is optimistic that their young patients will also see the impact. To change the course of care for their patients, Erno, Bergmann and Hudspeth reiterated the same hopeful outcome: more home days. Fewer hospital stays.
# # #
About MUSC
Founded in 1824 in Charleston, MUSC is the state’s only comprehensive academic health system, with a mission to preserve and optimize human life in South Carolina through education, research and patient care. Each year, MUSC educates over 3,100 students in six colleges and trains 950+ residents and fellows across its health system. MUSC leads the state in federal and National Institutes of Health and research funding. For information on our academic programs, visit musc.edu.
As the health care system of the Medical University of South Carolina, MUSC Health is dedicated to delivering the highest-quality and safest patient care while educating and training generations of outstanding health care providers and leaders to serve the people of South Carolina and beyond. In 2024, for the 10th consecutive year, U.S. News & World Report named MUSC Health University Medical Center in Charleston the No. 1 hospital in South Carolina. To learn more about clinical patient services, visit muschealth.org.
MUSC has a total enterprise annual operating budget of $7.1 billion. The 31,000 MUSC members include world-class faculty, physicians, specialty providers, scientists, contract employees, affiliates and care team members who deliver groundbreaking education, research, and patient care.
About the SCTR Institute
The South Carolina Clinical & Translational Research (SCTR) Institute is the catalyst for changing the culture of biomedical research, facilitating the sharing of resources and expertise and streamlining research-related processes to bring about large-scale change in clinical and translational research efforts in South Carolina. Our vision is to improve health outcomes and quality of life for the population through discoveries translated into evidence-based practice. To learn more, visit https://research.musc.edu/resources/sctr.
Rural Georgians may find it difficult to access medication that could slow the progression of Alzheimer’s disease, according to a new study from the University of Georgia.
That’s especially concerning because rural counties experience a significantly higher burden of the disease.
The researchers analyzed the availability of facilities that offered the IV medication lecanemab and the accessibility of PET scans, which are used to diagnose Alzheimer’s, in all of Georgia’s 159 counties.
The study found that none of Georgia’s rural counties had a PET scan facility. Only one had an infusion center.
Georgians in rural counties faced drive times of over an hour to reach a facility that provided PET scans. Drive times to lecanemab infusion sites were even longer, sometimes more than three hours.
“It’s hard for people to find a trained, capable physician in Alzheimer’s disease to be able to make a diagnosis,” said Niying Li, lead author of the study and an assistant professor in the UGA College of Pharmacy.
“Once you get that diagnosis and are ready to start the drug, you need to be connected to an infusion center. And once you’re connected to the center, you will need to have a family caregiver go with you for infusions every two weeks because you cannot drive yourself due to potential side effects of the medication.”
For many rural Georgians, those barriers put care out of reach.
Rural counties face heavy burden of Alzheimer’s disease, lack resources
More than 188,000 Georgians are living with Alzheimer’s disease. Hundreds of thousands more are providing unpaid care to loved ones with the condition, according to the Alzheimer’s Association.
The researchers found most of the state’s 28 lecanemab infusion centers are clustered around the Atlanta area. Only one is located in a rural county.
Of the six Memory Assessment Clinics that offer or refer patients out for PET scans, none are located in rural counties.
"Rural patients with Alzheimer’s disease … are lacking support.” —Niying Li, College of Pharmacy
People with early Alzheimer’s disease can become agitated when taken out of their normal routines. The long drive to reach the facility coupled with sitting for over an hour to receive an infusion and then making the long trip back home is not just a hassle for these patients and their caregivers.
It’s often impossible, Li said.
“I think that this study really points out that rural patients with Alzheimer’s disease are lacking resources,” Li said. “They are lacking support.”
Shortage of health care providers, medical knowledge another barrier to care
But it’s not just long drive times that prevent Alzheimer’s patients from accessing care.
“We also have a shortage of health professionals who are able to make you a diagnosis that will make you potentially eligible for the drug,” Li said. “And we have a shortage of health care professionals who are familiar with the use of this drug.”
Eighteen Georgia counties lack a family medicine doctor. And those counties are almost exclusively rural.
For Georgians in these areas, just getting an Alzheimer’s diagnosis requires access to reliable transportation and to someone who can take time off work to get patients to their appointment.
Few options to treat Alzheimer’s disease
While the drug does have its drawbacks — it’s exorbitantly expensive and requires extensive follow-up imaging due to potentially life-threatening side effects — lecanemab is one of few breakthroughs in the treatment of Alzheimer’s disease.
For many years, Alzheimer’s treatments focused only on easing symptoms. Over the past few years, the Food and Drug Administration approved only three medications to delay the progression of the disease. And one of them was pulled off the market last year.
The remaining two drugs have the potential to transform care for early Alzheimer’s disease patients, the researchers said. But only if patients can access them.
Published in Alzheimer’s and Dementia, the Journal of the Alzheimer’s Association, the study was co-authored by Samruddhi Borate and Mohammed Zuber of UGA’s College of Pharmacy, Darshan Chudasama of UGA’s College of Public Health, and Stephen Correia and Lisa Renzi-Hammond of UGA’s Institute of Gerontology. Other co-authors include Kai Zhang and Yiran Han.
