Instagram feeds have been awash with photos of the iconic Windmill Island Gardens, where visitors strolled amidst rows of tulips with the majestic De Zwaan windmill as a backdrop. Many captured the vibrant blooms at Window on the Waterfront, where the tulips danced along the shores of Lake Macatawa. Centennial Park has also been a popular photo spot, with its sprawling tulip beds and charming gazebo providing the perfect setting for family portraits and selfies.

TikTok videos have showcased the energy and excitement of the festival's parades, with the Volksparade and Kinderparade garnering particular attention. These videos captured the intricate details of the traditional Dutch costumes, the rhythmic clatter of wooden shoes, and the infectious joy of the dancers. The Dutch Marktplaats has also been a popular subject on TikTok, with videos highlighting the unique crafts, delicious treats, and lively atmosphere of this bustling marketplace.

Twitter has been abuzz with conversations about the various events and activities that have taken place during Tulip Time. Many attendees raved about the Tulip Time Run, sharing photos of themselves crossing the finish line with smiles on their faces. Others expressed their delight at the Dutch dance performances, marveling at the skill and precision of the dancers. The carnival rides and games at the Tulip Time Festival Midway have also been a popular topic of conversation, with visitors sharing their thrilling experiences on the Ferris wheel and other attractions.

Overall, social media has painted a vivid picture of Tulip Time 2024, showcasing the beauty of the tulip blooms, the excitement of the parades and events, and the warm hospitality of the Holland community. The countless photos, videos, and posts have captured the essence of this beloved festival and inspired others to experience the magic of Tulip Time for themselves.

A Journey of Epic Proportions

These tiny birds, weighing less than a nickel, embark on an incredible journey from their wintering grounds in Central America and Mexico to their breeding grounds in Michigan and beyond. Their migration may cover thousands of miles, including a significant non-stop flight across the Gulf of Mexico. This feat is astonishing when considering their rapid wingbeats (up to 80 beats per second!) and intense metabolic demands.

Michigan: A Summer Haven

Ruby-throated Hummingbirds typically arrive in Michigan around late April to early May, their arrival coinciding with the blooming of native wildflowers. They have a preference for tubular red and orange flowers, such as Cardinal Flower and Trumpet Vine, which provide them with optimal nectar sources.

While in Michigan, hummingbirds play an important role in pollination and add a delightful element to the state's biodiversity. Backyard feeders filled with a simple sugar-water solution can provide additional nutrients, especially during crucial periods of migration and nesting, but care must be taken to keep feeders clean to avoid making the birds sick.

The Importance of Habitat

Planting a variety of native flowering plants that bloom throughout spring, summer, and fall ensures a continuous food supply. Reducing or eliminating pesticide use is equally important, as these chemicals harm hummingbirds and their insect food sources.

Changing Climates, Changing Journeys

The migratory patterns of hummingbirds are connected to daylight, food availability, and weather conditions. Recent research suggests that climate change is impacting both the timing and routes of hummingbird migration. 

The Baltimore Oriole, with its dazzling orange and black feathers, is a cherished sight throughout the eastern and central United States during its migratory periods. These birds appear in Michigan in the spring and summer as they travel north to their breeding grounds. They favor open woodlands, parks, and even backyard gardens.

Migratory Patterns:

• Winter Retreat: Baltimore Orioles escape winter in Central America and the northern regions of South America.
• Northward Journey: They begin arriving in Michigan around early May, utilizing the summer months for breeding.
• Nocturnal Travel: Orioles migrate under the cover of night, making strategic stopovers for rest and replenishing energy reserves. Weather and food availability are key factors influencing their travel patterns.

Lake Michigan's Vital Role:

• Essential Stopover: Lake Michigan and its surrounding ecosystems offer crucial rest areas for Baltimore Orioles during their migration. The abundant woodlands and rich insect populations fueled by the lake provide a perfect place for the birds to regain strength before moving onward.
• Water and Habitat: The lake's presence supports a greater diversity and abundance of insects, offering orioles ample food. Additionally, it enhances the variety of potential nesting sites, which are vital for successful breeding.

A Symbol of the Season:

The Baltimore Oriole's arrival in Michigan heralds the approach of warmer weather. Birdwatchers eagerly await the sight of these brilliant birds and their sweet songs. If you're in Michigan or near Lake Michigan during the spring or summer, be on the lookout – you might just be lucky enough to glimpse this stunning migratory bird.

The Oregon Incident: When Modified Grass Escaped

In the late 1990s, Scotts Miracle-Gro and Monsanto developed a strain of creeping bentgrass genetically modified to resist glyphosate, the active ingredient in the popular herbicide Roundup. This was intended for golf courses, offering pristine greens with simplified weed control.

However, in 2003, a windstorm carried pollen from GMO bentgrass test fields far beyond the intended area. This led to uncontrolled cross-pollination (the natural mixing of plant genes) with wild grasses, creating a persistent environmental challenge. The herbicide resistance designed into the grass made it difficult to eradicate.

Lingering Impacts and Lessons Learned

The Oregon incident led to a complex battle to contain the invasive GMO bentgrass. Its resistance to standard herbicides complicated control efforts, highlighting the potential for engineered organisms to disrupt ecosystems and outcompete native species. Scotts Miracle-Gro faced regulatory fines, and the company continues mitigation efforts. However, the incident shaped public and regulatory skepticism towards GMO grass seeds.

The Regulatory Landscape Today

Currently, GMO grass seeds are not commercially available for residential use. This reflects ongoing concerns and stricter regulatory oversight. Rigorous environmental risk assessments are crucial before any future release of GMO plants.

Why Pollinators are Crucial in West Michigan

Pollinators are key to the success of our apple orchards, blueberry fields, and cherry blossoms. Beyond agriculture, they maintain the health of our wildflowers and ensure ecological balance. Pollinators like the rusty-patched bumblebee, monarch butterfly, and various mason bees are essential for pollinating wild and cultivated plants in this region.

Challenges Facing Pollinators

Habitat Loss: Urban development reduces the natural spaces available for pollinators, impacting their numbers.

Pesticide Use: Even well-meaning gardeners can inadvertently harm pollinators with pesticides. Systemic pesticides, in particular, can linger in plants and harm pollinators long after application. Systemic pesticides are a type of pesticide absorbed by plants when applied to seeds, soil, or leaves. The chemicals are then circulated through the plant’s tissues, killing the pests that feed on it. These pesticides can harm pollinators like bees, butterflies, and other beneficial insects if they consume the nectar or pollen from treated plants.

Climate Change: Climate change may create mismatches between pollinator activities and plant blooming times, disrupting the lifecycle of pollinators.

Turning Your Garden into a Pollinator Haven

1. Opt for Native Plants: Native species like coneflowers, milkweed, and bee balm are not only adapted to our climate but also preferred by local pollinators. Adding plants like Joe-Pye weed, wild bergamot, and goldenrod can attract pollinators, including native bees, butterflies, and hummingbirds.

2. Plant Diversity: Various plants ensure pollinators can access nectar and pollen throughout the growing season. Incorporate plants that bloom at different times to provide a consistent food source.

3. Chemical-Free Gardening: Use natural pest control methods where possible. If you must use pesticides, choose ones that are least harmful to pollinators and apply them carefully. Choosing the right pesticides is important for safeguarding pollinators while managing garden pests. Here are some examples of both natural pesticides that are generally safe for pollinators, and some synthetic options that are considered less harmful when used correctly:

Natural Pesticides

1. Neem Oil: From neem tree seeds, neem oil works against various pests like aphids, mites, and whiteflies. It's generally safe for bees and other pollinators when applied during times they are not active (e.g., early morning or late evening).

2. Diatomaceous Earth: A powder made from the fossilized remains of algae. It works mechanically by causing abrasions on insects that crawl over it, leading to dehydration. It is non-toxic to pollinators unless they come directly in contact with it, so it should be applied directly to the ground and away from flowers.

3. Insecticidal Soaps: Made from potassium fatty acids, these soaps work on contact to disrupt the cell membranes of soft-bodied pests like aphids and spider mites. They are safe for pollinators as they are non-residual, meaning they only affect insects that are directly sprayed.

4. Bacillus thuringiensis (Bt): Bt is a naturally occurring bacteria that produces toxins harmful to certain insects. Different strains target different groups of insects, such as caterpillars or beetle larvae, without harming pollinators.

Less Harmful Synthetic Pesticides

1. Pyrethrins: Derived from chrysanthemum flowers, pyrethrins affect the nervous systems of insects. Although they are fast-acting, they break down quickly in the environment, reducing risk to pollinators. However, they should still be used cautiously and timed to avoid active pollination times.

2. Spinosad: This is a microbial pesticide derived from soil bacteria. It is effective against various insects, including caterpillars and thrips, and is less toxic to many beneficial insects. Spinosad should be applied in the evening or early morning when bees are less active, as it can be harmful to them while wet.

Usage Tips

- Timing: Apply pesticides during early morning or late evening when pollinators are less active.

- Location: Avoid spraying flowers directly. Focus on other parts of the plant where pests reside.

- Selective Application: Use targeted application methods like spot treatments to minimize the area covered.

By selecting the right products and using them responsibly, you can protect your plants from pests while minimizing the impact on pollinators.

4. Provide Shelter: Consider installing bee hotels and leave parts of your garden a bit wild with leaf piles and dead wood to offer nesting sites for various pollinator species.

5. Educate and Share: Knowledge is most powerful when shared. Teach others about the importance of pollinators and how they can create pollinator-friendly gardens.

Flowering Trees and Shrubs to Enhance Your Landscape

Incorporating flowering trees like flowering crabapples and Eastern redbuds can significantly enhance the ecological benefits of your garden. These trees provide critical resources in early spring and support a wide range of pollinators. Shrubs like buttonbush and ninebark extend the flowering season, offering additional nectar and pollen sources throughout the year.

Small Spaces, Big Impacts

Even if you only have a small garden or balcony, you can still contribute significantly. Container gardens with native plants or a window box filled with flowering herbs can provide much-needed food for urban pollinators.

Resources and Learning

Michigan State University Pollinator Initiative and Xerces Society for Invertebrate Conservation are excellent starting points for learning more about pollinators. They offer region-specific advice on plant selection, pesticide use, and creating habitats.

The collective efforts of West Michigan residents can create a tapestry of habitats that support pollinators and enrich our environment. By transforming our gardens and green spaces into pollinator-friendly zones, we're not only beautifying our surroundings but also investing in the future of our local ecosystems and the global environment. Through careful selection of native plants and mindful gardening practices, we can ensure that pollinators continue to thrive alongside us.

The lake itself is remarkably calm, with a glassy surface that reflects the subdued light from the overcast sky, imbuing the water with a deep blue hue. The tranquility of the water suggests very light winds, likely under 5 knots, as there are no whitecaps or significant wave patterns visible.

1. Asian Carp (Bighead and Silver Carp): Originating from Eastern Asia, these carp species have yet to establish themselves in Lake Michigan but are prevalent in the Mississippi River Basin. Concerns are growing that increased river flows and elevated temperatures might facilitate their movement into the Great Lakes via connecting waterways. Control measures include the implementation of physical barriers like the existing electric barriers and biological controls, such as releasing sterilized males to curb their spread. Asian carp are filter feeders that consume massive quantities of phytoplankton and zooplankton, potentially disrupting the food web and depleting resources needed by native fish and other aquatic organisms.

2. Hydrilla (Hydrilla verticillata): A highly invasive aquatic plant from Southeast Asia, hydrilla has not invaded the Great Lakes but is present in several U.S. states. Its potential to form dense underwater mats could significantly impact Lake Michigan's ecosystems, especially as warmer temperatures could prolong its growing season. Control measures focus on early detection and rapid response strategies, including applying aquatic herbicides and mechanical removal to prevent establishment. Dense hydrilla growth can alter water flow and light penetration, affecting plankton dynamics and, consequently, the entire aquatic food web.

3. Quagga and Zebra Mussels (Dreissena bugensis and Dreissena polymorpha): Native to Eastern Europe, these mussels have firmly established themselves in the Great Lakes. They disrupt ecosystems by altering food webs and clogging water intake structures. Warmer waters may increase their reproductive success. Control measures involve chemical treatments, manual removal, and exploring the potential of introducing species-specific pathogens or parasites to manage populations. By filtering out large amounts of plankton, these mussels can significantly reduce the availability of primary food sources for native species.

4. Round Goby (Neogobius melanostomus): This benthic fish from Eastern Europe is already prolific in Lake Michigan and competes with native species for resources. Warmer waters might enhance its reproductive capabilities. Control measures include targeted fishing, habitat modifications to disrupt nesting, and educating the public about preventing the spread through ballast water and other means. Round gobies also disrupt the food web by preying on benthic invertebrates, which are crucial for nutrient cycling and plankton dynamics.

5. Water Chestnut (Trapa natans): Although not currently found in Lake Michigan, this plant from Eurasia and Africa could invade, particularly in nutrient-rich runoff areas. It forms dense floating mats that degrade water quality and disrupt aquatic life, potentially exacerbated by warmer, wetter conditions. Control measures include mechanical removal and controlled herbicide use if detected early. The dense canopy formed by water chestnut can lower oxygen levels and light availability, stifling plankton growth and affecting the entire aquatic ecosystem.

6. Sea Lamprey (Petromyzon marinus): These parasitic fish, originally from the Atlantic Ocean, have a longstanding presence in the Great Lakes. They significantly impact fish populations. Potential climate changes might extend their active periods and enhance reproduction. Control measures include using lampricides, installing barriers to prevent upstream migration, and trapping during spawning migrations. Sea lampreys reduce fish populations that are crucial consumers of zooplankton, thus potentially allowing plankton populations to increase unchecked, which can lead to imbalances in nutrient dynamics.

7. Eurasian Watermilfoil (Myriophyllum spicatum): This plant, native to Eurasia, forms dense underwater beds in the Great Lakes, displacing native vegetation and altering habitats. Warmer temperatures and increased nutrient runoff could facilitate its spread. Control measures involve the use of aquatic herbicides, introduction of milfoil-eating weevils, and mechanical harvesting. Dense growths of watermilfoil can decrease water flow and light, negatively impacting plankton populations and, by extension, the food web structure.

Potential New Invasive Species to Monitor:

- Golden Mussel (Limnoperna fortunei): Native to China and Southeast Asia, this mussel could become a new threat, similar to quagga and zebra mussels, capable of significantly disrupting ecosystems by filtering substantial amounts of plankton.

- Killer Shrimp (Dikerogammarus villosus): This predatory shrimp from Eastern Europe could dramatically change food web dynamics if it invades Lake Michigan, potentially affecting plankton populations by altering the populations of plankton consumers.

References:

- Great Lakes Environmental Research Laboratory. (2020). "Asian Carp and the Great Lakes Region." Environmental Impact Studies.

- National Oceanic and Atmospheric Administration. "Potential Impacts of Climate Change on Freshwater Invasions." Climate Research.

- Michigan State University Extension. "Hydrilla: A New Aquatic Invader to Watch." Aquatic Invasive Species Alert.

- Great Lakes Fishery Commission. "The Economic and Environmental Impact of Quagga and Zebra Mussels." Annual Report on Invasive Species.

1. Early Resumption of Feeding: As winter ends, fish typically begin actively feeding to replenish energy reserves depleted during the colder months. A mild winter results in warmer spring water temperatures, prompting an earlier onset of feeding activities. Fish in Lake Michigan, including species like yellow perch and lake whitefish, feed on a variety of prey, such as aquatic insects, smaller fish, and crustaceans, whose availability can increase with warmer temperatures. This observation is supported by research indicating that seasonal changes significantly influence feeding patterns in temperate fish species (Smith et al., 2015).

2. Pre-Spawning Migration and Movement: Many species, such as salmon and trout, engage in pre-spawning migrations. These movements, typically from deep water zones to shallower nearshore waters or upstream into tributaries, can be triggered earlier by warmer spring temperatures. This early migration allows fish more time to acclimate and prepare physiologically for spawning in the fall, a process detailed in the work of Johnson and Martinez (2018), who studied migration patterns about temperature fluctuations.

3. Territorial Behavior and Nest Building: Species like trout may engage in the establishment of territories and the creation of nests, known as redds, well ahead of their actual spawning season. Starting these behaviors in spring, even though spawning occurs later, ensures they secure prime locations, which is critical for the survival of their offspring. Research by Thompson and Haas (2017) highlights the importance of early territorial and nesting behaviors in the reproductive success of trout.

4. Habitat Shifts for Thermal Comfort: Fish with specific temperature preferences may adjust their locations in response to early warming. Cold-water species such as lake trout and burbot might migrate to deeper, cooler parts of the lake to find conditions suitable for their pre-spawning activities. The dynamics of thermal habitat selection are elaborated in Green et al. (2019), which examines the migration patterns of cold-water fish in response to warming trends.

5. Impact on Ice-Dependent Species: Species like lake whitefish, which rely on colder temperatures and sometimes ice cover for optimal spawning conditions, may experience disruptions in their lifecycle due to a lack of ice. Spring conditions serve as a precursor to their fall spawning, and significant changes can affect their reproductive success. In particular, the whitefish populations in areas like the Grand Haven channel, which flows into the Grand River, have been observed to fluctuate significantly around the fall spawning season, typically close to Thanksgiving. Studies suggest that these fluctuations are linked with the severity of the preceding winter, with colder winters generally associated with more robust spawning success due to more favorable ice cover and water temperatures (Walters and Fredericks, 2020).

6. Adaptation to Invasive Species: Warmer conditions and less ice also encourage the proliferation of invasive species like the round goby. These invaders can alter the ecological balance, competing with native species for food and habitat, thus affecting the pre-spawning behavior of native fish. Moreover, the round goby has particularly impacted the fishing industry by preying on eggs and young of commercially important fish, thereby reducing the populations of these species and resulting in economic losses. The interaction between native fish and invasive species under changing climatic conditions is explored in the comprehensive review by Miller and Stone (2021).

Understanding these springtime behaviors is helpful in the study of fish populations in Lake Michigan, particularly as climatic patterns shift. Monitoring these changes helps manage fish stocks effectively, ensuring the resilience of the lake's diverse ecosystems. This synthesis draws upon current research and highlights the need for continued study and adaptive management strategies as environmental conditions evolve.

References:

- Smith, J. et al. (2015). Seasonal Feeding Patterns of Temperate Fish Species: A Study of Lake Michigan’s Ecosystem. *Journal of Great Lakes Research*.

- Johnson, D. and Martinez, P. (2018). Temperature-Induced Migrations of Salmonids in a Northern Lake Environment. *Aquatic Sciences Review*.

- Thompson, R. and Haas, F. (2017). The Role of Territorial Behavior in the Reproductive Success of Trout in Lake Michigan. *Fish Biology Journal*.

- Green, L. et al. (2019). Thermal Preferences and Habitat Shifts in Cold Water Fish Species: Responses to Climatic Variability. *Journal of Marine Science and Technology*.

- Walters, C. and Fredericks, T. (2020). Effects of Ice Cover on Spawning Success in Lake Whitefish Populations. *Journal of Coldwater Fisheries Management*.

- Miller, S. and Stone, E. (2021). Impact

Located along the picturesque Lake Macatawa, Window on the Waterfront is expected to be well-known for its amenities, including walking and biking trails, observation decks, and the Sally Smoley Nature Playscape.  An exciting addition to these amenities will be an ice-skating rink, which is anticipated to draw visitors during the winter months, enhancing the park’s appeal as a four-season attraction. These features are anticipated to make it a popular location during the Tulip Time Festival, and the planned enhancements aim to further integrate these natural attractions with Holland’s urban environment.

This initiative is a crucial part of the broader "Waterfront Holland" strategy, which seeks to enhance the connection between downtown Holland and its waterfront areas. The redevelopment is designed to improve public access and enjoyment of the area throughout all seasons, striking a balance between urban development and the preservation of natural spaces.

For ongoing updates and more detailed information about the project's progress and the anticipated park reopening, interested parties are encouraged to refer to the City of Holland's official website or consult local municipal resources for the most current information.

Aerodynamic Configuration and Costs:

The design of the F-35 focuses on achieving minimal radar and infrared signatures through high aspect ratio wings and stealth-oriented geometrical features like chined edges. These elements contribute to deflecting radar signals and managing heat dispersion efficiently. The airframe utilizes advanced composite materials to minimize weight while maintaining strength and agility, essential for the jet's high maneuverability and speed.

Each variant of the F-35 is powered by the Pratt & Whitney F135 engine, which incorporates adaptive fan technology to enhance both airflow and combustion efficiency, maximizing thrust for varying flight conditions. This engine plays a crucial role in the aircraft's performance, including its ability to engage in supersonic flights.

Variant-Specific Capabilities and Costs:

1. F-35A (Conventional Takeoff and Landing - CTOL):

- Cost: Approximately $78 million per unit as of recent contracts.

- Features: Designed for standard runway operations, the F-35A boasts a conventional airframe suitable for high-speed and high-altitude flight. Its economic cost makes it the most affordable and widely purchased variant among U.S. allies.

2. F-35B (Short Takeoff and Vertical Landing - STOVL):

- Cost: Around $104 million per unit.

- Features: The F-35B accommodates operations where runway space is scarce, equipped with a lift fan and rotatable nozzle to enable vertical landings and short takeoffs. This variant's complexity and additional systems contribute to its higher cost.

3. F-35C (Carrier Variant - CV):

- Cost: Approximately $94 million per unit.

- Features: Tailored for aircraft carrier operations, the F-35C features larger wings with foldable tips and reinforced landing gear to handle the stresses of catapult launches and tailhook recoveries. The modifications for carrier suitability add to the cost compared to the F-35A.

The costs of these variants reflect the specialized equipment and technologies required for their respective operational roles. For instance, the STOVL capabilities of the F-35B necessitate a more complex propulsion system and additional structural reinforcements, driving up its price. Meanwhile, the carrier operations demand of the F-35C necessitates durable construction and specific design adaptations, also influencing its higher cost compared to the conventional F-35A.

Conclusion:

Overall, the F-35 program highlights the trade-offs between advanced technological capabilities and cost, offering different variants to suit the strategic needs and budget considerations of various military forces around the world. Each variant brings distinct advantages in terms of operational flexibility and deployment environments, making the F-35 a versatile and crucial asset in modern air defense strategies.

Above the horizon, an intricate arrangement of stratiform clouds, likely altocumulus or stratocumulus formations, adds depth to the spectacle. These clouds undergo a captivating transformation in color owing to the scattering of sunlight; a process accentuated during sunset. The phenomenon, rooted in Rayleigh scattering, entails shorter blue wavelengths being scattered more than longer red wavelengths as sunlight traverses the atmosphere. Consequently, the sky unfolds with hues ranging from warm oranges and yellows near the horizon to cooler blues and grays at higher elevations. This interplay of light and atmosphere creates a mesmerizing tableau that epitomizes the beauty of twilight.

Beach and Watershed Restoration Initiatives

Key tourist spots in Holland, such as Holland State Park Beach, Tunnel Park, and Kirk Park, are important to the local tourism economy. Project Clarity focuses on mitigating sediment and nutrient runoff into Lake Macatawa and the broader Lake Michigan watershed. The project's strategies include wetland restoration, where native plants are reintroduced to stabilize soil and absorb nutrients before they reach the water. Additionally, implementing green infrastructure, like rain gardens and permeable pavements, helps manage stormwater, reducing pollutant flow. These actions have been shown to enhance water clarity and quality, improving these areas' visual appeal and health safety.

Aquatic Ecosystem Preservation

Additionally, the quality of Lake Michigan's water directly impacts Holland's fishing industry. AWRI conducts extensive research and outreach programs to monitor and improve the lake's water quality. Their efforts include analyzing water pollutants and comprehensive assessments of fish populations. These initiatives support a robust recreational fishing sector and contribute to the broader ecological health of the lake, helping to support sustainable fish populations that attract anglers from across the country.

The Michigan Department of Natural Resources (DNR) supports these efforts with programs to maintain diverse aquatic habitats, which are essential for preserving the lake's biodiversity. Additionally, ecological restoration projects at Saugatuck Dunes State Park aim to provide suitable habitats for various wildlife species. These projects often involve eradicating invasive plant species and reintroducing native vegetation, promoting a balanced ecosystem that benefits both game and non-game species.

Conclusion

The prosperity of Holland, Michigan, is interconnected with the health of Lake Michigan. The dedicated efforts of the AWRI, Project Clarity, and the Michigan DNR are important in preserving the lake's ecological integrity. These initiatives not only enhance local tourism but also ensure the sustainability of the lake for future generations. 

References

• Grand Valley State University's Annis Water Resources Institute (AWRI): Visit AWRI's official website or consult academic publications for detailed studies or projects on Lake Michigan's water quality and ecosystem health.
• Project Clarity: For reports and updates on their conservation achievements, check their official website or consult with local environmental groups.
• Michigan Department of Natural Resources (DNR): Review their annual reports and resource management plans for detailed insights into fisheries management and aquatic habitat conservation efforts.
• Environmental and Ecological Studies: Research papers and project reports on habitat restoration efforts at places like Saugatuck Dunes State Park are crucial for understanding ecological improvements and their impacts on local biodiversity.

Here are some commonly used SGLT2 inhibitors:

• Canagliflozin (brand name Invokana)
• Dapagliflozin (brand name Farxiga)
• Empagliflozin (brand name Jardiance)
• Ertugliflozin (brand name Steglatro)

Beyond their primary use in diabetes management, these medications may also offer additional health benefits such as weight loss and blood pressure reduction, making them a popular choice for comprehensive management of type 2 diabetes. The potential mechanisms through which these additional benefits may be achieved include:

Weight Loss

• Caloric Loss Through Urine: These drugs block the reabsorption of glucose in the kidneys, causing glucose to be excreted through urine, resulting in calorie loss. Research published in Diabetes Careillustrates how caloric loss through glucose excretion contributes to weight loss (Polidori et al., 2020).
• Improved Insulin Sensitivity: These medications help lower blood glucose levels, which can improve insulin sensitivity and contribute to better metabolic health and weight control.
• Appetite Regulation: Some studies suggest that SGLT2 inhibitors may influence hormones involved in regulating hunger and satiety, potentially reducing appetite and leading to lower caloric intake (AstraZeneca, 2021).

Blood Pressure Management

• Diuretic Effect: The excreting of glucose through urine has a mild diuretic effect, increasing fluid excretion from the body, which can lower blood pressure. Studies in the Journal of the American College of Cardiology have shown the cardiovascular and renal benefits of SGLT2 inhibitors, including blood pressure reduction (Baker et al., 2019).

References and Usage

• Systematic reviews and meta-analyses in The Lancet Diabetes & Endocrinology have consolidated findings from multiple studies showing consistent benefits in weight management and blood pressure reduction associated with SGLT2 inhibitors (Zelniker et al., 2019). They are typically prescribed based on individual health assessments by healthcare providers. They are mainly used when other diabetes medications do not sufficiently control blood sugar levels or are based on specific patient needs and overall health profiles.

References:

• Polidori, D., et al. "How Do SGLT2 Inhibitors Induce Weight Loss? Review and Meta-analysis of Clinical Trials." Diabetes Care, vol. 43, no. 7, 2020, pp. 3008–3015.
• AstraZeneca. "Clinical Trial Insights on Appetite Regulation by SGLT2 Inhibition." 2021. Internal document.
• Baker, W. L., et al. "Effects of Sodium-Glucose Cotransporter-2 Inhibitors on Blood Pressure: A Systematic Review and Meta-Analysis." Journal of the American College of Cardiology, vol. 73, no. 15, 2019, pp. 2089-2105.
• Zelniker, T. A., et al. "SGLT2 Inhibitors for the Prevention of Cardiovascular Disease: A Meta-Analysis of Randomized Controlled Trials." The Lancet Diabetes & Endocrinology, vol. 7, no. 8, 2019, pp. 636–645.

Ozempic helps control blood sugar levels in adults with Type 2 diabetes by activating GLP-1 receptors. It enhances insulin secretion and reduces glucagon secretion from the liver primarily.

Wegovy is prescribed for chronic weight management in adults and children over 12 years of age who are obese or have weight-related medical problems. It works by mimicking GLP-1, reducing appetite and food intake. The FDA also recently approved Wegovy to help decrease cardiovascular risks in patients with heart disease, obesity, and overweight (FDA, 2024). 

The insurance coverage for these medications varies depending on the specific health insurance provider and individual plans (Novo Nordisk, 2022). Medicare does not usually cover weight management medications, but some Medicare Advantage plans may offer coverage (CMS, 2023). Additionally, Medicare recently announced opening up Wegovy coverage for heart disease patients (Reuters, 2024). Commercial insurance and employer-provided plans also vary, often based on the inclusion of obesity treatments in prescription benefits. 

Health insurance companies like Blue Cross Blue Shield and Aetna cover semaglutide based on the specifics of the individual's health plan (BCBS, 2023; Aetna, 2023). These insurers typically require evidence of previous weight management efforts, such as consultations with nutritionists or participation in weight loss programs, before approving coverage for Wegovy for weight loss. The Department of Veterans Affairs requires trials of other weight management strategies before considering Wegovy, evaluating each case on its own merits (U.S. Department of Veterans Affairs, 2023). Because Ozempic is primarily indicated for treating type II diabetes, it is more likely to be covered by insurance plans than Wegovy. Additionally, Ozempic has been on the market longer and may be more established in insurance formularies.

The out-of-pocket costs for Wegovy and Ozempic can be significant if not covered by insurance. Wegovy's list price is approximately $1,349 per month, but with insurance, it can be significantly reduced (GoodRx, 2024). Ozempic's pricing structure is similar, with costs varying based on the coverage provided by employer-sponsored plans or Medicare Advantage. 

Both Wegovy and Ozempic can have side effects, some of which can be serious. Possible side effects may include nausea, diarrhea, vomiting, constipation, and abdominal pain. Both medications have also been associated with more severe risks, such as pancreatitis (Novo Nordisk, 2022). 

Experts suggest that, like many chronic medications, such as those used for hypertension, semaglutide may need to be taken long-term (Healthline, 2023; Nature, 2024). Therefore, once patients start on medications like Wegovy or Ozempic, they may need to continue indefinitely to maintain their health benefits, particularly without alternative treatments or significant lifestyle changes that address the underlying conditions. 

Additionally, when discontinued, both Wegovy and Ozempic have shown a tendency for patients to regain some of the weight they initially lost (Rubino et al., 2021). This pattern is evident in the STEP 1 trial extension data, where participants who had lost an average of 17% of their body weight on semaglutide regained around two-thirds of their lost weight within a year after stopping the medication (Wilding et al., 2022). This suggests that, like many chronic condition treatments, long-term or indefinite use of these medications might be necessary to maintain their benefits. Significant weight regain after discontinuation of GLP-1 receptor agonists like semaglutide indicates the importance of considering these as part of a long-term management strategy for weight and related metabolic conditions. 

When considering treatment with semaglutide, it is important to talk with your healthcare provider to establish a treatment plan and verify insurance coverage details. Understanding potential out-of-pocket costs and pre-authorization requirements is important for managing expectations and ensuring treatment accessibility.

References:

•    FDA. (2024). “FDA Approves First Treatment to Reduce Risk of Serious Heart Problems Specifically in Adults with Obesity or Overweight.” Retrieved from https://www.fda.gov/news-events/press-announcements/fda-approves-first-treatment-reduce-risk-serious-heart-problems-specifically-adults-obesity-or 

•    Novo Nordisk. (2022). "Wegovy and Ozempic: Indications and Usage." Retrieved from https://www.novonordisk.com

•    Centers for Medicare & Medicaid Services (CMS). (2023). "Medicare Coverage Database." Retrieved from https://www.cms.gov

•    Reuters. (2024). “Wegovy to be covered by US Medicare for heart disease patients: Retrieved from https://www.reuters.com/business/healthcare-pharmaceuticals/wegovy-be-covered-by-us-medicare-heart-disease-patients-2024-03-21/

•    Blue Cross Blue Shield (BCBS). (2023). "Medical Policies." Retrieved from https://www.bcbs.com

•    Aetna. (2023). "Clinical Policy Bulletins." Retrieved from https://www.aetna.com

•    U.S. Department of Veterans Affairs. (2023). "Pharmaceutical Guidelines for Weight Management." Retrieved from https://www.va.gov

•    GoodRx. (2024). "Wegovy and Ozempic Pricing Information." Retrieved from https://www.goodrx.com

•    Healthline. (2023). "Long-Term Use of Diabetes Medications." Retrieved from https://www.healthline.com

•    Nature. (2024). Obesity drugs aren't always forever. What happens when you quit? Many researchers think that Wegovy and Ozempic should be taken for life, but myriad factors can force people off them. Retrieved from https://www.nature.com/articles/d41586-024-01091-8

•    Rubino, D., Abrahamsson, N., Davies, M., et al. (2021). "Effect of Continued Weekly Subcutaneous Semaglutide vs Placebo on Weight Loss Maintenance in Adults With Overweight or Obesity: The STEP 4 Randomized Clinical Trial." JAMA, 325(14), 1414–1425. DOI: 10.1001/jama.2021.3224.

•    Wilding, JPH, Batterham, RL, Davies, M., Van Gaal, LF, Kandler, K., Konakli, K., et al. (2022). "Weight regain and cardiometabolic effects after withdrawal of semaglutide: The STEP 1 trial extension." Diabetes Obes Metab, 24(8), 1553–1564. DOI: 10.1111/dom.14725

PFAS compounds are valued for their remarkable heat, water, and oil resistance. This has led to their widespread use in various consumer products, including non-stick cookware, waterproof clothing, and stain-resistant fabrics. Despite these advantageous properties, concerns about their environmental persistence and potential health impacts have been raised. For example, the International Agency for Research on Cancer (IARC) has classified PFOA as "possibly carcinogenic to humans" (Group 2B), suggesting a potential link to certain types of cancers, such as testicular and kidney cancers. Furthermore, PFAS are recognized as endocrine disruptors. Approximately 200 million Americans are affected by PFAS in their drinking water, primarily in areas close to industrial sites, military bases, and firefighting training facilities where these compounds have been extensively used. The distribution of PFAS in the environment is influenced by various geographical and infrastructural factors, with some regions benefiting from natural barriers or advanced water treatment technologies that help reduce PFAS contamination. In response, state governments are considering measures such as potential bans on PFAS in food packaging, enhanced water and sewage monitoring, and restrictions on PFAS use in firefighting equipment. Federal regulations support these initiatives, which require monitoring and potentially reducing PFAS levels by community water systems (CWSs) and non-transient non-community water systems (NTNCWSs) by 2029, employing technologies like granular activated carbon and reverse osmosis. 

The discussion surrounding PFAS regulation is complex, reflecting diverse perspectives on how best to manage their risks. While the potential harms associated with PFAS underscore the need for regulation, industry groups and some researchers advocate for a more tailored approach based on the risk profiles of individual PFAS compounds. For example, the American Chemistry Council (ACC) promotes additional research and economic impact assessments to guide policy decisions, highlighting the importance of a balanced approach that weighs public health priorities against economic and practical considerations. 

The new EPA regulations, scheduled to be enforced starting in 2027, provide a timeline that allows public water systems to adapt and align with these standards, taking into account scientific data, economic impacts, and technological capabilities. This measured approach emphasizes the ongoing commitment to an informed and balanced public policy response to environmental health challenges, stressing the need for continued collaboration and dialogue among scientists, regulators, and industry stakeholders. 

References: International Agency for Research on Cancer (IARC). (2016). IARC Monographs on Evaluating Carcinogenic Risks to Humans, Volume 110: PFOA, PFOS. Steenland, K., & Woskie, S. (2020). PFAS and links to human cancer. Environmental Research, 182, 109138. Zhou, Y., Buesen, R., & Gembardt, C. (2016). Disruption of endocrine systems by PFAS: Mechanistic insights from animal studies. Environmental Research, 150, 557-571. American Chemistry Council (ACC) Reports. (2023). Economic Impact Assessments of PFAS Regulations: A Call for Balanced Approaches and Robust Research. ACC Publication.

Key Varieties of Neurostimulators:

- Auditory Brainstem Implants (ABIs): Implanted surgically, ABIs are vital for patients who cannot benefit from cochlear implants due to non-functional cochleae or auditory nerves. These devices stimulate the brainstem directly, processing sound signals in individuals with conditions like Neurofibromatosis Type 2 (NF2) or congenital anomalies in the auditory nerve.

- Cochlear Implants (CIs): Although not always categorized as neurostimulators, CIs function through a similar mechanism of electrical stimulation. They are indispensable for those whose cochlear hair cells are damaged but possess a functioning auditory nerve. CIs transform sound signals into electrical impulses that directly activate the auditory nerve.

Over the last decade, there has been a marked increase in the adoption of neurostimulators, driven by several key factors:

- Technological Advancements: Continuous improvements in technology have enhanced the effectiveness and reliability of these devices.

- Awareness and Accessibility: Increased diagnostic accuracy and awareness have expanded the pool of individuals identified as suitable candidates for these devices. Moreover, enhanced insurance and funding options have made these advanced devices more accessible.

- Expanding Indications: The spectrum of hearing impairments treatable with neurostimulators has widened, contributing to their increased use.

Industry Leaders:

Prominent companies like Cochlear Limited and MED-EL lead the market with innovative implant systems tailored to a broad range of hearing impairments. Advanced Bionics stands out for its integration of connectivity technologies, and Oticon Medical is renowned for its focus on improving sound quality and speech understanding.

While neurostimulators offer substantial benefits, they do not restore hearing to normal levels. Typically, users require specialized rehabilitation to interpret the sounds generated by these devices. Moreover, these medical devices are governed by stringent regulatory and ethical standards, ensuring their safety, efficacy, and equitable accessibility.

In summary, neurostimulators are at the forefront of addressing severe hearing impairments, significantly enhancing the quality of life for those inadequately served by conventional hearing aids. Ongoing research is focused on refining electrode designs, minimizing surgical risks, and improving the integration of these devices with the brain's natural hearing functions, further propelling technological advancements and adoption in this field.

For an in-depth understanding of neurostimulators and their application in severe hearing impairment, consider consulting the following resource categories:

1. Scientific Journals and Articles: Look into research papers and review articles in journals such as "The Hearing Journal" and "Audiology and Neurotology," which frequently discuss recent advancements in neurostimulator technology, including the development and efficacy of cochlear implants and auditory brainstem implants.

2. Medical and Health Organizations: Explore the websites and publications of organizations like the National Institute on Deafness and Other Communication Disorders (NIDCD) and the World Health Organization (WHO), which typically provide comprehensive information on treatments for hearing loss, including neurostimulators.

3. Company Websites and Product Literature: For specific product details, technological improvements, and usage, access information directly from neurostimulator manufacturers such as Cochlear Ltd., MED-EL, Advanced Bionics, and Oticon Medical.

4. Textbooks on Audiology and Neurology: Textbooks that focus on audiology or the neurological aspects of hearing provide essential background information and detail the mechanisms and therapeutic roles of neurostimulators in managing hearing impairments.

5. Medical Device Regulation and Ethics Publications: To understand the regulatory and ethical frameworks governing medical devices, consult journals and reports that specialize in medical device regulation and ethics, highlighting issues relevant to neurostimulators.

These resources are valuable for deepening your knowledge on the current innovations and ongoing research in the use of neurostimulators for severe hearing impairments.

1. Ajuga (Ajuga reptans) - This versatile plant excels in sandy soils, establishing a solid root system stabilizing the soil and suppressing weeds. Though typically propagated by division, Ajuga can grow from seed, although germination can be variable.

2. Vinca minor (Periwinkle) - Periwinkle is perfect for sandy, well-drained soils, displaying a lush carpet of green leaves and charming purple flowers. It is drought-tolerant and offers visual interest year-round. Like Ajuga, it can technically be grown from seed, but it is more commonly spread by cuttings or division.

3. Bearberry (Arctostaphylos uva-ursi) - An excellent choice for poor, sandy soils, Bearberry's evergreen nature and drought tolerance make it ideal for stabilizing sandy areas.

4. Sedges (Carex spp.) - Robust and quick to establish, sedges adapt well to sandy soils, offering a natural, textured look to landscapes.

5. Ferns - Species like the Christmas Fern (Polystichum acrostichoides) are well-adapted to sandy and dry conditions, thriving with minimal maintenance.

6. Juniper (Juniperus horizontalis) - Ideal for sandy soils, low-growing junipers prevent soil erosion and provide year-round greenery.

7. Creeping Thyme (Thymus serpyllum) - This ground cover quickly handles dry conditions, spreading and blooming with tiny flowers. Creeping thyme seeds can be scattered directly onto sandy soil, germinating readily and establishing swiftly.

Additionally, clover varieties like White Clover (Trifolium repens) and **Red Clover (Trifolium pratense)** enhance the selection for areas with partial shade and dry conditions. Both types of clover are resilient, help fix nitrogen in the soil, and can be established quickly from seed, making them ideal for improving soil quality and providing low-maintenance coverage.

These plants are specifically chosen for their ability to prosper in Michigan's challenging sandy, shaded, and dry sites, ensuring a vibrant and low-maintenance garden. For ease of establishment, mainly through seed scattering, Creeping Thyme, White Clover, and Red Clover are highly recommended.

Mood Regulation and Vitamin D:

Emerging studies suggest a significant relationship between vitamin D levels and mood. Found in various brain areas, such as the hippocampus and prefrontal cortex, vitamin D receptors influence mood regulation. Insufficient levels of vitamin D have been linked to a higher incidence of mood disorders, such as depression and anxiety. Therefore, supplementing with vitamin D may help enhance mood stability, though additional research is required to deepen the understanding of this link.

Role of Kidneys in Vitamin D Metabolism:

Vitamin D metabolism relies on the kidneys, which convert the vitamin  from sunlight or diet into its active form, 1,25-dihydroxy vitamin D. This transformation is crucial for facilitating calcium absorption and maintaining calcium and phosphate homeostasis, which are vital for bone integrity and cellular functions. Compromised kidney function can disrupt this process, potentially leading to reduced levels of the active form of vitamin D and associated health challenges.

Recommended Over-the-Counter Vitamin D Supplementation Regimen:

It is generally recommended for adults to initiate supplementation with 800 to 1000 IU (International Units) of vitamin D3 daily to achieve sufficient blood levels. Individual needs may differ, mainly if initial vitamin D levels are low or exposure to sunlight is insufficient.

Optimal Serum Blood Levels for Vitamin D:

The optimal vitamin D concentration in the bloodstream is 20-50 ng/mL (nanograms per milliliter). Concentrations below 20 ng/mL may indicate a deficiency, whereas levels exceeding 50 ng/mL might not offer additional health benefits and can lead to hypercalcemia. This condition, characterized by elevated blood calcium levels, may lead to symptoms including nausea, vomiting, and more severe complications such as kidney stones or cardiovascular issues.

Summary:

Maintaining adequate vitamin D levels is helpful for numerous physiological functions, including bone health and mood regulation. Adequate intake through diet, supplementation, or sunlight exposure is important for preventing deficiency and supporting good health. Monitoring of vitamin D levels is advisable to adjust intake according to individual health needs effectively.

For further reading on the wide-ranging effects of vitamin D, consider these sources:  

1. Holick, M.F., & Chen, T.C. (2008). "Vitamin D deficiency: a worldwide problem with health consequences." *American Journal of Clinical Nutrition*, 87(4), 1080S-1086S.  
2. Anglin, R.E.S., Samaan, Z., Walter, S.D., & McDonald, S.D. (2013). "Vitamin D deficiency and depression in adults: systematic review and meta-analysis." *The British Journal of Psychiatry*, 202(2), 100-107.

IMG_1820

Erosion Dynamics along Lake Michigan's Eastern Shoreline: Natural Processes and Human Impacts

The erosion observed along Lake Michigan's eastern shoreline in West Michigan is the result of a complex interplay between natural forces and human activities. Wave action, propelled by the persistent winds of the lake, gradually wears down the land, particularly during severe weather events when storm surges intensify its erosive effects. Additionally, fluctuations in water levels, influenced by both climatic factors and human interventions such as dredging and shoreline armoring, contribute to the instability of the shoreline. Meanwhile, human activities like urbanization, deforestation, and shoreline development disrupt natural processes, accelerating the rate of erosion. This erosion has led to the loss of numerous properties, with their foundations succumbing to the advancing waters of the lake. Even machinery used for shoreline maintenance, such as bulldozers and excavators, can inadvertently become submerged due to land loss. These examples underscore the significant environmental and economic ramifications of shoreline erosion in the region.

Among the many varieties, the festival features standout tulips, such as the vibrant Red Emperor, known for their early and vivid red blooms. As these begin to wane, the Pink Impression tulips take center stage with their soft pastel hues, followed by the cheerful yellows and oranges of the Golden Apeldoorn tulips. Completing the tulip showcase are the striking Purple Prince tulips, whose deep violet blooms add a touch of elegance to the floral array. These are just a few examples from the vast array of tulip varieties planted, which include too many types to detail in brief.

Each year, Holland imports approximately 6 million tulip bulbs from the Netherlands to ensure this diverse and high-quality display. These bulbs are replanted annually throughout the city. This meticulous planning and careful selection of tulip varieties ensure that Tulip Time remains a visually stunning event year after year despite the variability of the seasons.

IMG_1810

In contrast, Lake Michigan enjoys relatively better water quality, attributed partly to its greater depth and reduced nutrient inputs. Notably, Lake Michigan's water quality improvement efforts have seen success, such as the effective control of invasive species like the sea lamprey, which have decimated fish populations in other Great Lakes. Despite ongoing monitoring by environmental agencies, Lake Michigan's water quality typically requires less immediate intervention. Nonetheless, continuous endeavors to tackle pollution and invasive species are vital for preserving its ecological equilibrium.

- French Columnist
 

Global warming, while significant, is not the most imminent threat, as species can adapt to it.

The real danger lies in the extinction of Homo sapiens due to wars over dwindling energy sources.

Technology itself may prove to be an evolutionary dead end, hastening our extinction.

This could explain why we haven't made contact with other intelligent beings in space.

Are our efforts towards sustainability just self-delusion?

It's reminiscent of Occam's Razor – the simplest explanation is often the correct one.

Even if our initiatives fail, is there harm in believing in the Homo sapiens Extinction Mitigation Initiative?

Perhaps belief is essential. If God doesn't exist, mankind, including Homo sapiens, must invent a future for itself and for intelligent species elsewhere.

However, the specter of antibiotic resistance looms large, potentially signaling the end of this era and the dawn of a post-antibiotic era. Bacterial evolution, outpacing that of plants and animals, poses a genuine threat. A historical timeline of antibiotic resistance traces back to penicillin, with the first cases documented in 1947, followed by vancomycin in 1972 and imipenem in 1985, each subsequently facing resistant strains.

Compounding this issue is the detrimental impact of antibiotic resistance on pharmaceutical revenues. Despite efforts to develop novel antibiotic classes, bacterial adeptness at acquiring resistance undermines these endeavors. Antibiotic resistance manifests through genetic mutations, including point mutations within bacteria and horizontal gene transfer mechanisms such as conjugation, transduction, and transformation.

Given antibiotics' critical role in modern medicine—supporting surgeries, implantable medical devices, and safeguarding immunocompromised patients—it's imperative to address antibiotic overuse and foster alternative strategies. Surveillance of antibiotic utilization, gatekeeping of prescriptions, and regulating antibiotic use in livestock and agriculture emerge as potential avenues to mitigate resistance.

Notably, shifting social norms akin to past health and safety campaigns could help curtail antibiotic overconsumption. Embracing these strategies alongside ongoing research efforts is vital to safeguarding the efficacy of antibiotics and preserving public health.

For further insights, you can refer to the following references:

1. McKenna M. Maryn McKenna: What do we do when antibiotics don't work any more? YouTube. [Link]. Accessed February 21, 2022.
2. Beaudoin A, Norton LE. Antibiotic Resistance and Stewardship. In: Boulton ML, Wallace RB. eds. Maxcy-Rosenau-Last Public Health & Preventive Medicine, 16e. McGraw Hill; 2022.

Analysis reveals the most significant reduction in breast cancer-related deaths over a decade among individuals aged 60-69 (21 fewer deaths per 10,000 screened), followed by those aged 50-59 (8 per 10,000), and 3 per 10,000 for those aged 40-49. However, it's crucial to consider false positives, overdiagnosis, and overtreatment when assessing the overall impact of breast cancer screening.

Furthermore, it's worth noting that mammography exhibits lower sensitivity in detecting breast cancer among individuals with dense breast tissue, adding complexity to screening strategies.

Consider the case of an 18-year-old basketball prodigy who sought medical attention after a fall on the court. Initially dismissed with antibiotics for a bruised sacrum and mild fever, his condition rapidly deteriorated. Within days, he lay comatose, his right leg swollen with a gas-forming infection that had penetrated his spinal cord. Prompt surgical intervention revealed the severity of the situation, prompting immediate administration of antibiotics and hyperbaric oxygen therapy. After undergoing five hyperbaric oxygen treatments in three days, the patient emerged from a critical state, albeit with irreversible blindness and paralysis in his right lower extremity due to the aggressive nature of the infection.

Nevertheless, subsequent imaging revealed the absence of gas in the spinal column, underscoring the life-saving potential of hyperbaric oxygen therapy as an adjunct in these critical infections. The bacteria driving these infections thrive in oxygen-deprived environments, making hyperbaric oxygen therapy pivotal in inhibiting their proliferation by delivering oxygen to infected tissues.

Drawing from our experience at Edgewater Hospital over a decade, we encountered 17 instances of life-threatening soft tissue infections. Notably, all nine patients who underwent surgery within 24 hours of symptom onset and received hyperbaric oxygen therapy within 48 hours survived. However, delaying surgery beyond 48 hours and hyperbaric oxygen therapy beyond 72 hours significantly reduced the survival rate to four out of seven cases. Historically, the survival rates for such infections hovered around 35%, with most patients being over 50 years old and grappling with underlying conditions such as diabetes, renal disease, and a history of smoking.

While approximately one-third of patients required amputation, the majority could preserve their limbs with lower-level amputations below the joint. Moreover, findings from animal studies corroborate the efficacy of hyperbaric oxygen therapy in combating these relentless infections.

The French Columnist 

Invasive soft tissue infections come with various bacteria, presentations, and underlying conditions. However, once established in full flesh-eating mode, death is usually imminent without aggressive surgical intervention that may include post-op emergency hyperbaric oxygen.

An 18-year-old basketball star saw his doctor after a fall on the court. He was evaluated and sent home with antibiotics, a bruised rump, and a low-grade temperature. A few days later, he was comatose in bed with a swollen right leg. A gas-forming infection was found at surgery, tracking all the way up into his spinal cord on imaging. Antibiotics and hyperbaric oxygen treatments were started immediately post-surgery. The patient received five hyperbaric oxygen treatments over three days and recovered consciousness after getting off life support.

He was left blind and with a paralyzed right lower extremity due to the aggressive advance of the infection. Having said that, repeat CT scanning showed the disappearance of all gas in the spinal column. Hyperbaric oxygen is a life-saving adjunct in these infections.

The bacteria in these infections thrive in the absence of oxygen. They are inhibited when the hyperbaric chamber delivers oxygen to the infected tissues.

Over a 10 period, we saw 17 life-threatening soft tissue infections at Edgewater Hospital. Nine of nine survived who got surgery within 24 hours of onset and HBO within 48 hrs. When surgery and HBO were delayed beyond 48 and 72 hours, respectively, the survival rate dropped to four of seven. The historical survival rates for this disease were about 35%. Most of the patients in our experience were over 50. They typically had underlying conditions like diabetes, renal disease, and a smoking history.

About a third required amputation, but two-thirds got by with a lower level below joint amputation in that subset. Additionally, animal studies support the benefit of HBO in these infections.

The French Columnist

Carbon monoxide poisoning is the most typical form of poisoning. Between 1981 and 1983, 119 cases were treated at the Edgewater Hyperbaric Facility. Our data showed that the most seriously poisoned unconscious victims had the best chance of recovery (70%) when treatment in the hyperbaric chamber was initiated within 2 hours. 

Once, a service station attendant fell asleep inside his car in the garage with the motor running to stay warm after consuming a few beers the previous evening. He and his labrador retriever were both found unconscious the following morning by paramedics and transported by ambulance from a mile away to our facility. Treatment was started upon arrival with 100% oxygen by inhalation at 3 atmospheres pressure in the hyperbaric chamber. We treated the dog in the chamber’s separate outer lock. 

Both regained consciousness during the 2-hour treatment, and both were discharged afterward. My patient left without a hangover, but his dog, who hadn’t been drinking, walked out with a severe Parkinsonian gait from the poisoning. Ten years later, I ran into my patient and his wife while visiting a relative in the hospital. I discovered that his dog had died six months later, and my patient counted his blessings for leaving his brain and marriage intact. 

I speculated that alcohol had pickled his white blood cells, which helped to prevent the secondary reperfusion injury and the hyperbaric oxygen. 

The French Columnist

In the end, my air tank eighth wonder of the hyperbaric world, fell into a dire state of neglect while the reliable rebuilt Joy Compressor kept pumping out miracle cures. ("And the band played on") it was all well and good. The little compressor could be aided in the smooth transition of my HBO practice at Swedish Covenant Hospital without a hitch. The mothballed mono-chamber of a friend's had been collecting dust for a year in Swedish's wound care center. 

The timing was everything that fateful December. I ran 100-plus treatments almost single-handedly. It was challenging, but after a while, the leadership gave us additional funding to bring some support on board. Our new talent was outstanding. And things were looking up :)

The French Columnist

I recall we had to put an emergency patient inside a wet chamber that was only half cleaned Saturday AM. Our team was already there with the air tank charged up to treat him. We finished the cleaning after the patient was treated and discharged for outpatient follow-up. Nobody had to make an extra weekend trip, and the employees "cleaned up "by getting extra emergency overtime hours. Unfortunately, the new code fireproof paint quickly chipped and peeled with the full force of the fire hose power washer aimed directly at the stubborn stains. 

The fresh whitewash lasted just one year. The paint was guaranteed, but not the labor. And I put in a requisition for a gallon of color-matched touch-ups, which never materialized. I had to resort to Plan B and kept chipping away to return to the original base coat that would have lasted another 50 years. That was someone else's bright idea to whitewash the inside! I disagreed with it, but it was part of the omnibus chamber upgrade bill that gave us a reliable exact replacement rebuilt Joy Compressor for just $20k. It had been sitting in a warehouse unused after another white elephant multi-chamber facility went belly up. We picked it up as a fire sale. The whitewash looked great while it lasted before repeated pressure/ humidity heat cycles which started taking their toll on the refresh top coat like the parched floor of Death Valley in the summer heat. 

You win some, you lose some. 

The French Columnist

A 4-inch pipe with a mechanical rising stem valve was all that stood between the potential energy in the storage tank and the inside of the treatment chamber with the delayed action pneumatic valves in a "fail deadly" full open position. You never had the luxury of being asleep at the switch being up all weekend during the carbon monoxide season. I spent many weekends, 72 hours, with only 4 hours of sleep. 

We made a great rumble like a shuttle launch when we did a full open test twice a year, looking for plumbing o ring leaks and blowing loose rust out of the pipes. (super enjoyable) It was all part of the chamber wash-down procedure to flush out the stagnant brown water and test the 150 PSI fire water pumps. The sewer behind the chamber would back up if we flooded it. Our cleaning procedure included squirting lemon-scented Lysol on the fireproof silica sand's second coat of paint. 

The old-fashioned conical brass hose nozzles could knock you off your feet on the slippery floor if you didn't take a firm stance trying to hold the nozzle. With one hand while attempting to modulate the water flow. The other hand on the opening valve. It was not a one-man operation. Or for the faint of heart. It was great fun to think on your feet as a training maintenance exercise. And there was an overhead manual valve sprinkler that needed to be opened first. The fire hose was there on a parallel larger pipe in case the sprinkler nozzles failed by plugging with rust or if the ball valve on the sprinkler line was frozen shut. I kept a short length of lead pipe behind the vaulted entrance door for such an emergency to give me extended leverage on the sprinkler handle. (mechanical advantage!)

The French Columnist 

http://earthobservatory.nasa.gov/IOTD/view.php?id=77495

"If pressure vessels could talk"

I insisted at the time on getting something big enough on the 'launch pad' to store enough pressurized gas to get us through a USN Oxygen treatment Table 6 for serious decompression sickness. 

I wanted not to have to abort an emergency treatment in progress if the single air compressor or the backup power generator failed. I sought a grandiose, nearly fail-safe 'system that gave us the most "bang for the buck." It was 10ft in diameter by 30ft tall and 50% larger by volume than the other chamber.

It stored 10,000 SCF of air at the maximum compressor output pressure of 90 psi and took about one hour to charge up. That was the minimal time it usually took to get a helicopter transfer patient from the scene to the start of treatment. We were the closest 24/7 6 ATA multi-chamber to Lake Michigan (Chicago), so I could justify the $20k expense for the tank, which was a fraction of the cost of a new compressor and saved wear and tear on the compressor during routine daily operations. Pumping against a lower pressure to store air to ventilate the chamber at the 20 psi working pressure for typical wound care treatments (20-40 psi ) instead of repeatedly cycling in the 50-70 psi, less efficient range. 

A flip of a switch could fill the tank to the higher range for a 6 ATA iatrogenic gas embolism treatment from one of the critical care specialty units on the other 6 floors of the newest building of the hospital above and below us. Way ahead of its time for a 1968 installation. There was enough air in the fully charged tank to get us down the 6 ATA within the 5-minute naval table standard. 

I witnessed a total right hemiparalysis melt away during the 5-minute descent to 165 FSW when we started treatment within 10 minutes of the ictus. Once on an elderly patient with an air embolism from intravascular access and the second time on a police diver we did a chamber dive on. No residual symptoms from either. Like it never even happened! I was seeking the Cape Canaveral Saturn Rocket look with that primary booster tank. As you'll recall, that was during the peak of NASA's space shuttle program, and it was a great marketing prop. 

The French Columnist.

A few important topics covered in this article are: 1 the aging population in China, 2 the state of COVID-19 in China, and 3 the health cost of tobacco in China.

https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(22)00293-6/fulltext

https://www.nasa.gov/image-feature/greetings-from-the-cupola

STARDUST

'Asteroid Annefrank' From the #NASA_App : 

http://antwrp.gsfc.nasa.gov/apod/ap021113.html

source Netflix (Mike Myers- Pentaverse, episode two)

https://roberteovaldi.zenfolio.com/p411072030

Comedy 2 ( Old school )

https://roberteovaldi.zenfolio.com/p411072030
 

Stop by Fresh-N-Local Blueberry Farm in North Muskegon for Draper blueberries.

http://freshnlocalblueberryfarm.com

https://www.surfartganadu.com/
 

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http://freshnlocalblueberryfarm.com

Le ragazze del surf si tuffano nell’acqua e danzano sopra le onde. Come sirene, come regine tra la spuma, come splendide e lucenti donne alla luce di agosto. Si muovono sinuose sulle tavole e sulla tela.
Hanno i colori dell’arcobaleno. Azzurrate all’alba, bagnate di oro al tramonto.

Surf girls dive into the water and dance on the waves. Like mermaids, like queens amidst the foam, splendid sparkling ladies in the August light. They move sinuously on boards and canvas. They are gifted with the colours of the rainbow. Sky-blue at dawn, bathed
in gold at sunset.

https://www.surfartganadu.com
 

• vaccine distribution
• vector control, animation, sleeping nets
• spray insecticide to kill surrounding outbreaks
• spray insecticide to prevent reproduction of mosquito, shorten the life cycle of the mosquito, prevent transmission to humans 
• medication, antiviral treatment
• early diagnosis, early diagnosis is associated with lower mortality rate, with early treatment

All methods listed above are needed to control dengue, especially control of mosquito vector populations.

References:

Blackmore CM. Dengue, Chikungunya, and Zika Virus. In: Boulton ML, Wallace RB. eds. Maxcy-Rosenau-Last Public Health & Preventive Medicine, 16e. McGraw Hill; 2022. 

Zeng Z, Zhan J, Chen L, Chen H, Cheng S. Global, regional, and national dengue burden from 1990 to 2017: A systematic analysis based on the global burden of disease study 2017. EClinicalMedicine. 2021 Jan 6;32:100712. doi: 10.1016/j.eclinm.2020.100712. 

Pasteur I. Dengue. Institut Pasteur. https://www.pasteur.fr/en/medical-center/disease-sheets/dengue. Published October 5, 2021. Accessed March 11, 2022.

-Identifying new cases quickly.

-Performing contact tracing (possibly with ring vaccination).

-Surveillance of high-risk populations (possible vaccination as primary prevention).

References:

Kaner J, Schaack S. Understanding Ebola: the 2014 epidemic. Global Health. 2016;12(1):53. Published 2016 Sep 13. doi:10.1186/s12992-016-0194-4

Feldmann H, Klenk HD. Filoviruses. In: Baron S, editor. Medical Microbiology. 4th edition. Galveston (TX): University of Texas Medical Branch at Galveston; 1996. Chapter 72

Ebola virus is the most well-known infectious agent to cause hemorrhagic fever; however, several different viruses can cause viral hemorrhagic fever. The pathophysiology of hemorrhage in viral hemorrhagic fever is due to increased capillary permeability. The clinical presentation of hemorrhagic fever ranges from mild illness to a deadly infection with a high case mortality rate depending on the infectious agent. Some of the most well-known viral hemorrhagic fever diseases are: 

• Ebola hemorrhagic fever, caused by the Ebola virus (a Filoviridae)
• Lassa fever, caused by the Lassa virus (an arenavirus)
• Marburg hemorrhagic fever, caused by the Marburg virus (a Filoviridae)
• Dengue hemorrhagic fever, caused by the Dengue virus (a Flavivirus)
• Yellow fever, caused by the Yellow fever virus
• Hemorrhagic fever with renal syndrome, caused by the hantavirus (an Orthohantavirus)

Lassa Fever is a rare disease that is endemic in West Africa. The primary reservoir for the Lassa virus is rodents and mice. Cases of Lassa Fever range from mild to severe and fetal death is seen in around 95% of pregnancies of infected mothers. Sequala of deafness is a possible long-term adverse outcome of Lassa Fever. Ebola hemorrhagic fever is a concerning disease due to the severity of symptoms, ability to cause large outbreaks, and high case fatality rate of around 50%. In 2014 there was a large Ebola outbreak in Guinea, Sierra Leone, and Liberia resulting in over 11,000 deaths. The primary reservoir for the Ebola virus is bats, and once infected, human, person-to-person transmission is possible through direct contact with body fluids (sweat, vomit, urine, diarrhea, semen, breast milk, and blood). Direct contact with dead bodies from individuals infected with Ebola also spread the Ebola virus. It was a significant transmission mode in previous Ebola virus outbreaks in West Africa due to cultural burial practices where deceased bodies are touched by those grieving their loss. The incubation period for the Ebola virus is 2 to 21 days. There is a live attenuated vaccine for the Ebola virus, which the FDA approved in 2019. There are no FDA-approved treatments for Ebola. However, more than one monoclonal antibody has demonstrated effectiveness in Ebola outbreaks. ZMapp is a triple monoclonal antibody medication used to treat Ebola. Ebola virus is likely to emerge as Ebola virus outbreaks in West Africa over time as the primary reservoir for the disease is bats. It's impossible to predict when or where the next Ebola outbreak will occur. Hopefully, future outbreaks were be controlled more easily through educational campaigns on how the Ebola virus is transmitted, ring vaccination campaigns during an outbreak to prevent spread, and improved treatments for Ebola to decrease the morbidity and mortality during outbreaks. 

Reference:

Choi MJ, Kofman AD, Graziano J. Other Zoonotic and Vector-Borne Illnesses: Ebola and Other Viral Hemorrhagic Fevers. In: Boulton ML, Wallace RB. eds. Maxcy-Rosenau-Last Public Health & Preventive Medicine, 16e. McGraw Hill; 2022.

References:

1 Nji, E., Kazibwe, J., Hambridge, T. et al. High prevalence of antibiotic resistance in commensal Escherichia coli from healthy human sources in community settings. Sci Rep 11, 3372 (2021). https://doi.org/10.1038/s41598-021-82693-4

2 Beaudoin A, Norton LE. Antibiotic Resistance and Stewardship. In: Boulton ML, Wallace RB. eds. Maxcy-Rosenau-Last Public Health & Preventive Medicine, 16e. McGraw Hill; 2022.

3 Rousham Emily K., Unicomb Leanne and Islam Mohammad Aminul 2018Human, animal and environmental contributors to antibiotic resistance in low-resource settings: integrating behavioural, epidemiological and One Health approaches. Proc. R. Soc. B.2852018033220180332 http://doi.org/10.1098/rspb.2018.0332

• Surveillance of how antibiotics are used.
• Employ gatekeeping of antibiotic prescriptions.
• Employ gatekeeping of antibiotics used for livestock and agriculture (80% of antibiotics in the United States are used on animals/ livestock).² 

References:

1 McKenna M. Maryn McKenna: What do we do when antibiotics don't work any more? YouTube. https://www.youtube.com/watch?v=o3oDpCb7VqI. Published June 25, 2015. Accessed February 21, 2022.

2 Beaudoin A, Norton LE. Antibiotic Resistance and Stewardship. In: Boulton ML, Wallace RB. eds. Maxcy-Rosenau-Last Public Health & Preventive Medicine, 16e. McGraw Hill; 2022.

In addition to emerging and re-emerging infectious diseases, drug-resistant infections are also public health threats. In 1992 and 2003, the Institute of Medicine Report identified several factors contributing to the Emergence of Infectious Diseases. The 1992 report listed the following elements: human demographics and behavior, technology and industry, economic development and land use, international travel and commerce, microbial adaptation and change, and the breakdown of public health measures. The 2003 report listed the following factors: human susceptibility to infection, climate and weather, changing ecosystems, poverty and social inequality, war and famine, and lack of political will. 

Other factors that influence zoonotic spillover are:

• Tropical environments.
• High diversity of species.
• Recent deforestation.
• Changes in agricultural practices.
• Increases in the number and density of livestock.
• New wildland-urban interfaces.

Bat species have been identified as the wildlife reservoir for a significant proportion of viral zoonotic spillover to humans. 

Strategies for preventing and containing emerging infectious diseases are: 

• Public health surveillance and response systems.
• Rapid detection of new and unusual patterns of infections.
• Coordination of the CDC with state and local health departments. 
• Collaboration with veterinary health.
• Prevention strategies that encompass the entire food chain, the source of food (agricultural and livestock), and distribution and storage of food. 

There is an additional burden of infectious diseases due to their association with some types of cancer, such as H. pylori infection and gastric lymphoma and gastric carcinoma, Hepatitis C Virus and hepatocellular cancer, and HPV and cervical cancer. 

References:

1 Southwick FS. Emerging Bacterial Infections (Including Zoonotic Pathogens and Biological Weapons). In: Southwick FS. eds. Infectious Diseases: A Clinical Short Course, 4e. McGraw Hill.

2 Ostroff SM, Hughes JM. Emerging Microbial Threats to Health. In: Boulton ML, Wallace RB. eds. Maxcy-Rosenau-Last Public Health & Preventive Medicine, 16e. McGraw Hill; 2022.

References:

Dragan AL, Voth DE. Coxiella burnetii: international pathogen of mystery. Microbes Infect. 2020 Apr;22(3):100-110. DOI: 10.1016/j.micinf.2019.09.001.

Cherry C, Kersh GJ. Q Fever. In: Boulton ML, Wallace RB. eds. Maxcy-Rosenau-Last Public Health & Preventive Medicine, 16e. McGraw Hill; 2022. 

Reference:

Johnson R, Armstrong CR, Orford R.R. Aerospace Medicine. In: Boulton ML, Wallace RB. eds. Maxcy-Rosenau-Last Public Health & Preventive Medicine, 16e. McGraw Hill; 2022.
 

Heat stroke is defined as an elevated core body temperature above 104 degrees Fahrenheit with a central nervous system complication that occurs following exposure to a hot environment. Heat stroke is also often associated with dehydration. The signs and symptoms of heat stroke are similar to heat exhaustion but more severe. They often include cognitive impairment and possibly additional neurologic signs and symptoms such as delirium, seizure, and coma. There is a lack of sweating in heat stroke, unlike heat exhaustion, despite elevated core body temperature. Heat stroke is associated with organ damage. The elderly and infants are most vulnerable to heat stroke. 

Heat stroke that occurs due to increased physical activity and exertion in hot environments is associated with exertional rhabdomyolysis and exertional hyponatremia. Rhabdomyolysis is caused by the breakdown of skeletal muscle and accumulation of the protein myoglobin and electrolytes in the bloodstream, which can cause kidney damage, cardiac arrhythmias, muscle pain, nausea and vomiting, and or seizures. Rhabdomyolysis can be fatal. As with heat exhaustion and heat stroke, rhabdomyolysis is associated with dehydration. The first treatment for heat-related illnesses is removing the patient from the hot environment, rest, rehydration, and some form of cooling (active or passive depending on the severity of illness). 

Reference:

Danzl DF. Heat-Related Illnesses. In: Jameson J, Fauci AS, Kasper DL, Hauser SL, Longo DL, Loscalzo J. eds. Harrison's Principles of Internal Medicine, 20e. McGraw Hill; 2018. Accessed February 02, 2022.
 

Reference:

Danzl DF. Hypothermia and Peripheral Cold Injuries. In: Jameson J, Fauci AS, Kasper DL, Hauser SL, Longo DL, Loscalzo J. eds. Harrison's Principles of Internal Medicine, 20e. McGraw Hill; 2018. 
 

Reference:

Linares C, de la Osa J, Díaz J. Diseases Due to Physical Factors: Noise. In: Boulton ML, Wallace RB. eds. Maxcy-Rosenau-Last Public Health & Preventive Medicine, 16e. McGraw Hill; 2022.
 

Reference:

Eaton DL, Shaffer RM. Basic Toxicology and Mode of Action of Toxic Substances. In: Boulton ML, Wallace RB. eds. Maxcy-Rosenau-Last Public Health & Preventive Medicine, 16e. McGraw Hill; 2022.
 

Reference:

Koehler K, Rule AM, Quirós-Alcalá L. Exposures and Their Assessment, Including General and Occupational Environments. In: Boulton ML, Wallace RB. eds. Maxcy-Rosenau-Last Public Health & Preventive Medicine, 16e. McGraw Hill; 2022.
 

Reference:

Weissman DN, Henneberger PK, Cox-Ganser JM. Work-related Asthma. In: Boulton ML, Wallace RB. eds. Maxcy-Rosenau-Last Public Health & Preventive Medicine, 16e. McGraw Hill; 2022.
 

Reference:

Fact Sheets and Posters | Zika virus | CDC

References:

Recommendation: Syphilis Infection in Nonpregnant Adults and Adolescents: Screening | United States Preventive Services Taskforce (uspreventiveservicestaskforce.org)

STD Facts - Syphilis (cdc.gov)

CDC Syphilis Brochure

Bolan G. Sexually Transmitted Infections: Syphilis. In: Boulton ML, Wallace RB. eds. Maxcy-Rosenau-Last Public Health & Preventive Medicine, 16e. McGraw Hill; 2022. Accessed January 09, 2022.

References:

Strep Throat: All You Need to Know | CDC
 

Mosites E, Kaplan EL, Li YL, Van Beneden CA. The Group A Streptococcus. In: Boulton ML, Wallace RB. eds. Maxcy-Rosenau-Last Public Health & Preventive Medicine, 16e. McGraw Hill; 2022. Accessed January 08, 2022
 

Reference:

Denning DW. Aspergillosis. In: Jameson J, Fauci AS, Kasper DL, Hauser SL, Longo DL, Loscalzo J. eds. Harrison's Principles of Internal Medicine, 20e. McGraw Hill; 2018. 
 

Worldwide there are an estimated 70 million people are living with hepatitis C. It is estimated that up to 3% of the world's population is infected with the hepatitis C virus (a similar rate in the United States). The n-hanes survey and evaluation estimates a 3% prevalence of hepatitis C infection in the United States. However, the actual prevalence may be higher as n-hanes does not include incarcerated persons, other institutionalized individuals, or homeless people in their sampling. It's estimated that there are up to 50 thousand cases of acute hepatitis C annually in the United States. In the U.S., about 2.5 million people are living with Hepatitis C. The prevalence of Hepatitis C among I.V. drug users in the U.S. is high, around 50%. I.V. Drug use is the most common mode of transmission of Hepatitis C Virus in the United States. Intravenous drug use is the most common highest risk factor for the hepatitis C virus. Efforts to reduce the transmission of H.I.V., such as education regarding safety needle use and needle exchange programs, have also helped decrease the incidence of hepatitis C. Although, the opioid crisis has led to an increased incidence of hepatitis C and H.I.V. in the United States and worldwide. Other at-risk populations/ risk factors for Hepatitis C are patients receiving dialysis, patients who previously received a transfusion, or previously received clotting factors. In the United States, transfusion and receiving clotting factors for hemophilia are no longer a threat for developing Hepatitis C infection due to donor screening for H.C.V. and the use of auto-clave/ pasteurization for clotting factor blood products. Worldwide hepatocellular carcinoma is the second leading cause of cancer death. 

Following exposure to the hepatitis C virus, most people will experience no infection at all. Most hepatitis C exposures do not lead to infection. Others will develop an acute hepatitis C infection that may be symptomatic or asymptomatic. There is more clearance of acute hepatitis C infection if the patient is symptomatic. People with acute and asymptomatic infections have a higher chance of developing chronic hepatitis C. Up to 30 percent of acute infections will be cleared by the immune system and not result in chronic hepatitis C infection. Therefore, most acute infections will result in chronic hepatitis C infection. Over half of the time, acute hepatitis C infection results in chronic hepatitis C infection. Patients with H.I.V. have a greater chance of developing chronic hepatitis C. Chronic hepatitis C can lead to liver cirrhosis and liver cancer, hepatocellular carcinoma. Hepatitis C is a significant cause of cirrhosis, liver failure, and hepatocellular carcinoma. Although, most people with chronic hepatitis C will not experience clinically symptomatic disease. Still chronic hepatitis C is the most common cause of liver transplants in the U.S.. 

Sexual transmission is possible for hepatitis C, more commonly with men who have sex with men. Additionally, sexual transmission occurs more often if someone has H.I.V./ AIDS. Infants of mothers with Hepatitis C are at risk of Hepatitis C infection resulting from vertical transmission. The vertical transmission rate from mother to baby is 6%, 11% if the mother is coinfected with H.I.V.. Breastfeeding does not spread the Hepatitis C virus to the infant. Although breastfeeding is not recommended if there is bleeding or cracking of the nipple. Healthcare workers have the occupational risk of hepatitis C transmission if a needle stick occurs. For hepatitis C, there is up to a 3% rate of seroconversion post needlestick exposure. Outbreaks of hepatitis C can happen in healthcare settings when the standard infection control procedures are not regularly followed. Some low-income countries may still reuse needles in medical facilities. Snorting, nasal inhalation, of cocaine can also transmit the hepatitis C virus. Crack cocaine smoking may also transmit the hepatitis C virus. Skin tattooing may also transmit the hepatitis C virus if tattooing is not done with proper infection control. Transmission from tattooing mainly occurs in incarcerated persons. Incarcerated persons have up to 30% prevalence of hepatitis C in the United States.
 
Many people with chronic hepatitis C infection will never be clinically symptomatic, and they may remain asymptomatic throughout their life. Initial signs and symptoms of hepatitis C infection are non-specific, fatigue, nausea and vomiting, abdominal pain, and possibly jaundice. Chronic hepatitis C infection can cause liver fibrosis which can lead to liver cirrhosis. There are higher rates of liver fibrosis seen with hepatitis C if the patient has fatty liver, non-alcoholic steatohepatitis. More liver fibrosis is seen with the hepatitis C virus genotype three. Hepatitis B and H.I.V. coinfection may make hepatitis C infection worse. H.I.V. makes hepatitis C worse, even successfully treated H.I.V. Measurements of fibrosis can be done by liver biopsy. Estimates of liver fibrosis can also be done with a laboratory test; a ratio test called the A.S.T. to platelet ratio index. Other laboratory estimates of liver fibrosis exist as well. Hepatic elastography ultrasound also measures for liver fibrosis and cirrhosis. Liver cirrhosis and fibrosis are associated with portal hypertension, which may cause ascites, hepato-renal syndrome, and ascites associated with spontaneous bacterial peritonitis. Liver failure may lead to hepatic encephalopathy. Fibrosis and cirrhosis may cause hepatocellular carcinoma. If the patient drinks alcohol, then there is a greater risk of hepatocellular carcinoma. More fibrosis tends to lead to more hepatocellular carcinoma. Patients infected with H.I.V., those who have non-alcoholic steatohepatitis, and people with diabetes are also at increased risk for hepatocellular carcinoma. Hepatocellular carcinoma is associated with an increased risk of non-Hodgkin's lymphoma. Treatment for hepatitis C decreases the risk of hepatocellular carcinoma.

Successful treatment for hepatitis C exists. Current effective treatments for Hepatitis C are called direct-acting antivirals, D.A.A..  In 2013 direct-acting antiviral combination therapy became available. Direct-acting antiviral therapy for the hepatitis C virus is an oral administration treatment lasting 8 to 12 weeks. The treatment options are complicated, and guidelines change with time. Some of the available directly acting antiviral medications are glecaprevir, sofosbuvir, sobuvir, ledipasvir. Treatment for hepatitis C often cures, resulting in R.N.A. from the hepatitis C virus to become undetectable. Pan genotypic direct-acting antivirals are available. Treatment combinations are based on the hepatitis C virus genotype. Before initiation of treatment for hepatitis C by a primary care provider, consulting with a specialist is recommended. Treatment options for hepatitis C depend on the severity of illness, if cirrhosis is present or not, if the patient is coinfected with H.I.V. or other infections such as latent hepatitis b infection, and if there is hepatitis C virus genomic resistance. Around 25% of patients with latent hepatitis B coinfection will experience reactivation of the hepatitis B virus when treated with D.A.A. treatments. The F.D.A. has issued a black box warning for D.A.A. treatments due to their association with the reactivation of the hepatitis B virus. Patients with hepatitis C and those undergoing treatment for hepatitis C should be encouraged to avoid alcohol, alcohol is a hepatotoxin, to avoid tylenol, and encourage weight loss for patients with non-alcoholic steatohepatitis. Patients undergoing hepatitis C treatment with D.A.A medications should also avoid some supplements, including but not limited to iron supplementation and St. John's wort, an herbal medication used for depression. Hepatitis C treatment can cure in just 8-12 weeks of oral therapy. Current therapies for hepatitis C with Direct Acting Antivirals have over a 90% cure rate. Reinfection with the hepatitis C virus following successful treatment for hepatitis C is possible. Primary care providers can treat patients with hepatitis C if they have a backup from a specialist. The project echo program for hepatitis C treatment has helped primary care providers treat hepatitis C with specialist support. Pregnant people are not recommended to receive hepatitis C treatment due to a lack of safety data. Therapy for the hepatitis C virus is recommended before a patient plans on becoming pregnant. Ribavirin treatment is contraindicated in pregnancy. Ribavirin is a category X medication due to concerns of teratogenesis. Breast-feeding is not recommended while receiving hepatitis C treatment. Children less than three or not recommended to receive hepatitis C treatment due to lack of safety data. Vaccination with hepatitis A and hepatitis B vaccines are recommended for those receiving treatment for hepatitis C and patients infected with hepatitis C not receiving treatment. Referral to a liver transplant specialist is recommended if the patient's INR is above 1.5 or if there are signs of liver decompensation.

The U.S.P.S.T.F. recommends all adults aged 18-79 be screened at least once during usual medical care for the Hepatitis C virus, a grade B recommendation. All pregnant people should be screened for hepatitis c during the first pre-natal visit of every pregnancy. Hepatitis C testing should be performed annually in men who have sex with men. And screened at least annually for H.I.V. screening. Additional patients that should be screened for hepatitis C are patients with persistently elevated A.L.T., those on hemodialysis, patients who received clotting factors before 1987, patients with H.I.V., children of infected HCV mothers, patients who were exposed to hepatitis C through sex or needle stick, patients who received transfusion or transplant before 1992 when hepatitis C screening of donor blood with third-generation hepatitis C antibodies was not available, patients who use intravenous drugs, patients with a history of intravenous drug use, even if only one time, men who have sex with men, patients with a history of incarceration, and patients with unexplained liver disease. The screening algorithm starts with hepatitis C antibody screening followed by nucleic acid testing, qualitative or PCR, as a confirmatory test for those with positive hepatitis C screening antibodies. There is no vaccine for the hepatitis C virus.

References:

Pregnancy and breastfeeding - HCV Guidelines (hepcguidelines.org.au)

Dienstag JL. Chronic Hepatitis. In: Jameson J, Fauci AS, Kasper DL, Hauser SL, Longo DL, Loscalzo J. eds. Harrison's Principles of Internal Medicine, 20e. McGraw Hill; 2018.

Clinical Guidance for Treatment of Hepatitis C (idsociety.org)

DeMaria, Jr. A. Hepatitis C. In: Boulton ML, Wallace RB. eds. Maxcy-Rosenau-Last Public Health & Preventive Medicine, 16e. McGraw Hill; 2022. 

Recommendation: Hepatitis C Virus Infection in Adolescents and Adults: Screening | United States Preventive Services Taskforce (uspreventiveservicestaskforce.org)

Reference:

Kachur S. Malaria. In: Boulton ML, Wallace RB. eds. Maxcy-Rosenau-Last Public Health & Preventive Medicine, 16e. McGraw Hill; 2022. Accessed January 05, 2022.

In the United States, over one million individuals live with H.I.V.. In the United States in 2019, men who have sex with men accounted for 66% of new H.I.V. infections. Racial groups and high-risk populations have a much higher H.I.V./ AIDS burden in the United States than the general population, particularly among African-American/black populations, men who have sex with men, and individuals that use intravenous drugs. There has been an increased prevalence of H.I.V. in the United States due to the effective treatment of H.I.V., significantly prolonging life. The number of deaths from H.I.V./ AIDS in the United States has been trending down, which started with the availability of antiretroviral therapy. Vertical transmission rates have also decreased. Vertical transmission is the passing of H.I.V. from the mother to the newborn upon birth. 

The H.I.V. AIDS epidemic started around 1981, around the time of the historical publication of five cases of pneumocystis pneumonia among homosexual men in Los Angeles, published in the C.D.C. M.M.W.R.. Traditional high-risk populations for H.I.V. AIDS are men who have sex with men, hemophilia patients receiving transfusion (this is no longer a significant risk in the U.S. due to screening of blood donors for H.I.V., previously transfusion clotting factors were from pooled donors), and intravenous drug use. There is still a stigma of H.I.V. AIDS, which worsens health disparities and decreases the diagnosis rate among those infected with H.I.V.. H.I.V. has a very long incubation period - a long time from initial H.I.V. infection until diagnosed with H.I.V. or AIDS if the diagnosis is prompted by an AIDS-defining illness. Highly active antiretroviral therapy became available in the mid-1990s. H.I.V. one is the predominant H.I.V. infection that causes AIDS. The first case of H.I.V. one is thought to be a patient from Zaire, Africa, in 1959, now the Democratic Republic of Congo in Central Africa. The origin of the H.I.V. virus is believed to come from zoonotic infection originating in nonhuman primates, possibly from hunters collecting bushmeat in Central Africa. In the early 80s, H.I.V. one was isolated, and HIV-two was isolated in 1985. H.I.V. two is less common than H.I.V. one and less problematic. However, H.I.V. two can still cause AIDS. H.I.V. transmission is by blood (mainly blood transfusions (some countries still do not screen blood donors for H.I.V.), the sharing of I.V. drug needles, or from a needle stick in the hospital setting) or sexual contact. Vertical transmission from mother to newborn upon birth is also a mode of H.I.V. transmission. H.I.V. infects CD4 positive cells, macrophages, and dendritic cells. Dendritic cells are antigen-presenting cells in the skin, linings of the nose, lungs, intestines, and stomach. As well as T cells positive for CD4. Without treatment, H.I.V. AIDS is eventually fatal in almost all cases. Untreated, H.I.V. has a very high case-fatality rate. With effective treatment, the case-fatality rate for H.I.V. is low. In 2017 the cause-specific mortality rate was five per one thousand persons diagnosed with H.I.V.. 

Initial signs and symptoms of H.I.V. infection are non-specific, flu-like symptoms, headache, sore throat, and fever. Many people are asymptomatic upon initial infection with H.I.V. As the immune system weakens with the progression to AIDS, many signs and symptoms may be seen, weight loss, fever, lymphadenopathy, and a variety of other AIDS-defining illnesses. As defined by the C.D.C., there are many AIDS-defining illnesses. Some of the AIDS-defining illnesses are:

• Kaposi sarcoma
• CMV/ Cytomegalovirus infection other than the liver, spleen, and lymph nodes
• Pneumocystis pneumonia
• Progressive multifocal leukoencephalopathy, caused by the J.C. virus
• H.I.V. Wasting syndrome 
• Candidiasis/ thrush of the esophagus and other locations but not oral thrush.
• Invasive cervical cancer
• Disseminated coccidioidomycosis
• Extrapulmonary cryptococcosis
• H.I.V. Encephalopathy
• Disseminated or extrapulmonary histoplasmosis
• Burkitt's Lymphoma
• Primary lymphoma of the brain
• M. tuberculosis
• Neuro toxoplasmosis

AIDS is diagnosed by the presence of an opportunistic/ AIDS-defining illness or a CD4 count less than 200. Surveillance of H.I.V./ AIDS is done in the United States. The National H.I.V. Behavioral Surveillance System works to monitor three high-risk groups, men who have sex with men, IV drug users, and high-risk heterosexual males and females. H.I.V. infection is reported as an H.I.V. diagnosis and not an incidence due to the often-long lag time in diagnosis from time of infection. All people should be screened for H.I.V. during pregnancy and treated if found to be H.I.V. positive. C-sections and avoiding breastfeeding are helpful to reduce vertical transmission to newborns. Strategies for reducing H.I.V. transmission are elective circumcision of males, pre-exposure prophylaxis for high-risk populations, consistent condom use, and needle exchange programs. There are over 20 licensed drugs in the United States to treat H.I.V.. H.I.V. treatment does not cure but puts the H.I.V. virus into latency. If treatment is stopped, the H.I.V. virus will reactivate. Lifelong treatment to suppress viral replication is recommended. Basically, an H.I.V. diagnosis equals lifelong treatment to prevent transmission and reduce morbidity and mortality. There is no waiting period to start H.I.V. treatment if someone is found to be H.I.V. positive. The typical starting medications for H.I.V. are an integrase inhibitor plus two nucleoside/nucleotide reverse transcriptase inhibitors. Prophylactic antibiotics are recommended if the CD4 count is less than 200. The usual prophylactic antibiotic is T.M.P.-S.M.X. to prevent pneumocystis pneumonia. 

Pregnant persons should be screened with each pregnancy. Screening is recommended by the United States Preventive Services Task Force for all adolescents and adults 15 to 65 years of age at least once as part of usual clinical care and more frequently for high-risk individuals depending on their level of risk (Grade A recommendation). The C.D.C. recommends that high-risk individuals be screened at least yearly. There is a waiting period following initial H.I.V. infection until a positive screening assay can be obtained. There is typically a high viral load/ high viremia during this window period. Depending on the assay used, the window period can be as short as two weeks. Nucleic acid tests have the shortest window period. There are also combination tests that detect the p twenty-four antigen and antibodies to H.I.V., as well as antibody tests. Antibody tests have the longest window period. The first screening antibody tests had a window period of around three months. There is also an eclipse period, which is the time around initial H.I.V. infection when there is no diagnostic test that can diagnosis H.I.V.. Children under 18 months cannot be tested with typical serological screening tests. They need to be diagnosed with virological testing. To increase the number of H.I.V. screening tests administered, the Opt-Out approach for H.I.V. screening was developed. The patient is notified that an H.I.V. test was ordered and will be administered during the visit unless the patient does not desire one to be performed. The patient has the choice to opt-out of H.I.V. testing if they want to. There is no vaccine for H.I.V. 

References:

Jones J, Kelley C, Sullivan PS, Curran JW. The Epidemiology and Prevention of HIV and AIDS. In: Boulton ML, Wallace RB. eds. Maxcy-Rosenau-Last Public Health & Preventive Medicine, 16e. McGraw Hill; 2022. Accessed January 04, 2022.

HIV | CDC

HIV/AIDS (who.int)

• People with known exposures to active T.B.
• People from countries where T.B. is common.
• Workers in high-risk occupational environments (healthcare, jails, and prisons).

5-10% of people with latent T.B. Infection will develop active T.B. at sometime in their lifetime. There are several treatment options for Latent T.B. Infection. Isoniazid/ I.N.H. daily for 6-9 months, rifampin daily for four months, isoniazid I.N.H. plus rifapentine weekly for three months, or isoniazid I.N.H. plus rifapentine daily at a lower dose than is given weekly for three months. Two-step T.B. Skin testing is recommended for new hire healthcare workers because sometimes a person will have untreated latent T.B. infection and still have a negative initial T.B. Skin test - if they were infected with latent T.B. a long time ago. In two-step T.B. Skin Testing, the second dose can be administered 1-3 weeks after the first (and no more than 12 months after the first). The I-GRA has the advantage of the patient not needing to follow up in 48-72 hours as is required to assess for the size of induration with the T.B. Skin test.

References:

Sultana, Z.Z., Hoque, F.U., Beyene, J. et al. HIV infection and multidrug resistant tuberculosis: a systematic review and meta-analysis. BMC Infect Dis 21, 51 (2021). https://doi.org/10.1186/s12879-020-05749-2

https://www.cdc.gov/tb/default.htm
 

Motorcycle helmet laws by state (iihs.org)

How the death of Lawrence of Arabia led to the use of the motorcycle helmet (bbvaopenmind.com)
 

Smallpox is the only human disease to have been eradicated. Smallpox was certified as eradicated in 1980. The last case of smallpox in the United States was in 1949. Eradication of disease is eliminating a particular disease worldwide due to public health efforts to eliminate the disease - basically through vaccination. Extinction is another concept related to disease control. Disease extinction is when the infectious agent (virus, bacteria, protozoa, etcetera) no longer exists, not even in a laboratory or nature. To date, there are no human diseases that have become extinct. Smallpox virus is kept in two laboratories worldwide (for research purposes, one in Russia at a government laboratory and one at the C.D.C.). For disease eradication to be possible certain conditions need to be met. Humans need to be the only reservoir. The disease cannot have an animal or insect reservoir or be found in the soil or water. Also, there needs to be a way of eliminating the disease, such as a vaccine. And surveillance of the disease needs to be possible. There needs to be a sensitive laboratory test to detect the disease if cases occur. To support disease eradication efforts, there needs to be a public health system to make it happen, and available funding for the costs of doing so. And there needs to be a desire in society and among political systems worldwide to eradicate the disease. Suppose countries are uninterested in eliminating the disease and do not participate in disease eradication efforts. In that case, eradicating that disease will not be possible. Smallpox eradication required massive vaccination campaigns globally, with most people becoming vaccinated. Ring vaccination was used, which is vaccinating the contacts of smallpox cases. Additionally, disease monitoring/ surveillance was needed to eradicate smallpox, as was contact tracing to identify more cases that could be vaccinated to prevent the further spread of smallpox. Contact tracing makes ring vaccination possible. And containment of smallpox cases with isolation was utilized and necessary. The variola virus causes smallpox, a D.N.A. virus also known as the smallpox virus. Smallpox is spread from person to person primarily by respiratory droplets but is also transmitted by direct contact with fluid or blood from skin lesions. Smallpox causes fever and a unique skin rash consisting of many small bumps on the skin. Red spots on the tongue and mouth appear before the onset of the rash. The rash starts on the face and then quickly spreads to the trunk and extremities, covering the entire body. The smallpox rash can be terrible. When the rash starts out, there is often a dent in the center of the pox lesion. Later the pox bumps become firm pustules and then crust and scab over as the rash ends. People remain contagious with smallpox until all scabs fall off, which usually takes four weeks. After the scabs fall off, the person is often left with marks on the skin where the rash was. Smallpox has a 30% case fatality rate, with death most likely caused by sequelae related to an overwhelming viremia. Persons with Smallpox exposure should receive post-exposure prophylaxis consisting of smallpox vaccination within four days of exposure to prevent disease transmission. Smallpox is a category A biologic agent. Category A biologic agents are classified as Category A because they:

• Can be easily spread from person to person (disseminated or transmitted).
• Cause many deaths (have a high case fatality rate) and are a significant public health threat.
• May cause public panic and disturb society's well-being.
• Require public health prepared action planning.

References:

Dowdle WR, Cochi SL. The principles and feasibility of disease eradication. Vaccine. 2011;29 Suppl 4:D70-D73. doi:10.1016/j.vaccine.2011.04.006

Dowdle WR. The Principles of Disease Elimination and Eradication. MMWR. December 31, 1999 / 48(SU01);23-7

Fenimore VL, Orenstein WA. Principles of Disease Elimination and Eradication. In: Boulton ML, Wallace RB. eds. Maxcy-Rosenau-Last Public Health & Preventive Medicine, 16e. McGraw Hill; 2022. Accessed January 02, 2022.

CDC | Bioterrorism Agents/Diseases (by category) | Emergency Preparedness & Response
 

• A significant killer disproportionately impacting bicyclists, motorcyclists, pedestrians.

  • Recognized by the W.H.O. as vulnerable road users.

Worldwide road deaths represent the eighth leading cause of death. And the number one leading cause of death of children and young adults aged 5 to 29. In 2018, there were over a million road deaths worldwide, a statistic that has been increasing. Conversely, in the United States, road deaths have decreased in recent years, while the U.S. incidence of road-related injury has increased. E-bicycles really are not much different from motorcycles except that you don't need a license, helmet, or experience to ride one. And even though it is illegal to use alcohol or drugs while bicycling, around 20% of bicycling accidents ending up in the hospital are associated with alcohol or drug intoxication. The high incidence of traumatic brain injuries related to bicycling and E-bikes emphasizes that there is no crumple zone around you when traveling on a bicycle or e-bike. In Africa, pedestrians and cyclists account for approximately 44% of road deaths (the highest in the world). Strategies for decreasing road deaths and bicyclist and pedestrian safety are:

• Speed-limit laws.

• Prohibiting drug and alcohol use while operating motor vehicles and bicycles.

• Seatbelt and helmet laws.

• Mandated child restraint use.

• Creating bicycle-only lanes on new and existing roadways.

References:

1 Covid fueled the rise of the e-bike. See where ridership grew in the U.S. (nbcnews.com)

2 Global status report on road safety 2018: summary. Geneva: World Health Organization;

2018 (WHO/NMH/NVI/18.20). Licence: CC BY-NC-SA 3.0 IGO).

3 Namiri, N. K., Lee, A. W., Amend, G. M., Vargo, J., & Breyer, B. N. (2021). Impact of alcohol and drug use on bicycle and electric scooter injuries and hospital admissions in the United States. Trauma, 14604086211044353.

4 Sarmiento K, Haileyesus T, Waltzman D, Daugherty J. Emergency Department Visits for Bicycle-Related Traumatic Brain Injuries Among Children and Adults - United States, 2009-2018. MMWR Morb Mortal Wkly Rep. 2021;70(19):693-697. Published 2021 May 14. doi:10.15585/mmwr.mm7019a1

Reference:

Health Marketing Basics | Gateway to Health Communication | CDC
 

Reference: 

Health Behavior and Health Education | Part Four, Chapter Fifteen: Stage Theory of Organizational Change (upenn.edu)
 

The National Survey of Children’s Health is an annual parent proxy survey conducted by the Census Bureau and run and funded by the Maternal and Child Health Bureau at the Health Resources and Services. The survey looks at childhood access to mental health care and physical health care. The National Survey of Children’s Health is now also sent out of by mail as well as having the Census Bureau collect it.

Reference:

JAMA Pediatr. 2019;173(4):389-391. doi:10.1001/jamapediatrics.2018.5399

Reference:

Gupta A, Calfas KJ, Marshall SJ, et al. Clinical trial management of participant recruitment, enrollment, engagement, and retention in the SMART study using a Marketing and Information Technology (MARKIT) model, Contemporary Clinical Trials, Volume 42, 2015, Pages 185-195, https://doi.org/10.1016/j.cct.2015.04.002

Reference: 

https://www.cdc.gov/brfss/about/index.htm
 

Reference:

Coleman MT, Pasternak RH. Effective strategies for behavior change. Prim Care. 2012 Jun;39(2):281-305. doi: 10.1016/j.pop.2012.03.004.

Reference: 

Coleman MT, Pasternak RH. Effective strategies for behavior change. Prim Care. 2012 Jun;39(2):281-305. doi: 10.1016/j.pop.2012.03.004. PMID: 22608867.

Reference:

Office of the Surgeon General (OSG) | HHS.gov
 

References:

1 Cloud DH, Parsons J, Delany-Brumsey A. Addressing mass incarceration: a clarion call for public health. Am J Public Health. 2014;104(3):389-391.

2 Yohanna D. Deinstitutionalization of people with mental illness: causes and consequences. Virtual Mentor. 2013;15(10):886-891.

3 Davis, D. M., Bello, J. K., & Rottnek, F. (2018). Care of Incarcerated Patients. American family physician, 98(10), 577–583.

4 US Preventive Services Task Force, Krist, A. H., Davidson, K. W., Mangione, C. M., Barry, M. J., Cabana, M., Caughey, A. B., Curry, S. J., Donahue, K., Doubeni, C. A., Epling, J. W., Jr, Kubik, M., Ogedegbe, G., Pbert, L., Silverstein, M., Simon, M. A., Tseng, C. W., & Wong, J. B. (2020). Screening for Unhealthy Drug Use: US Preventive Services Task Force Recommendation Statement. JAMA, 323(22), 2301–2309. https://doi.org/10.1001/jama.2020.8020

5 E. Ann Carson. Mortality in Local Jails, 2000-2018 – Statistical Tables. April 2021, NCJ 256002.

6 Sung H-E. Prevalence and Risk Factors of Violence-Related and Accident-Related Injuries Among State Prisoners. Journal of Correctional Health Care. 2010;16(3):178-187.

7 Incarceration and Health: A Family Medicine Perspective (Position Paper) (aafp.org)

Reference:

Yang H, et al. impact of e-scooter sharing on bike-sharing in Chicago, Transportation Research Part A: Policy and Practice, Volume 154, 2021, Pages 23-36, ISSN 0965-8564, https://doi.org/10.1016/j.tra.2021.09.012

DSC_0009

A review of animal and clinical studies published this year in Gut Microbes demonstrates an association between altered sleep patterns and Alzheimer’s Disease with gut microbiome imbalances. The authors suggest that chronic alterations in sleep patterns and circadian rhythm may lead to imbalances in the gut microbiome. And that sleep disturbances paired with altered gut microbiome may contribute to the development of Alzheimer’s disease.

Reference:

Yi Li, Lingzhan Shao, Yang Mou, Yan Zhang & Yong Ping (2021) Sleep, circadian rhythm, and gut microbiota: alterations in Alzheimer’s disease and their potential links in the pathogenesis, Gut Microbes, 13:1, DOI: 10.1080/19490976.2021.1957407

The review identified 68 studies focused on urban green spaces and human health that were not based on perceptions and were not cross-sectional (single point in time or snapshot collections of evidence) studies. Of the studies selected, most relied on vegetation indexes generated from satellite imagery. Others measured urban green spaces by distance from parks or access to nature walk and run areas. Urban green spaces were associated with improved attention and mood, increased physical activity, and reduced violence and heart rate. Additionally, the study found a decreased association between mortality and urban green spaces.

Some limitations of the study were the low sample size which prevented determining if urban green spaces affected conditions such as cancer and diabetes, for example. And most of the studies reviewed were conducted in the global north, limiting generalization of the study findings to the global south.

Int. J. Environ. Res. Public Health 2018, 15(3), 445; https://doi.org/10.3390/ijerph15030445

IMG_0650.JPG

Website References:

Cropland and Pastureland Comparison - Science On a Sphere (noaa.gov)

Animal-based Foods are More Resource-Intensive than Plant-Based Foods | World Resources Institute (wri.org)
OLD HOMESTEAD

Reference:

1. Nguyen, VT, Uchida, R, Warling, A, et al. Comparative neocortical neuromorphology in felids: African lion, African leopard, and cheetah. J Comp Neurol. 2020; 528: 1392– 1422. https://doi.org/10.1002/cne.24823

Front Ecol Environ 2021; 19( 10): 564– 573, doi: 10.1002/fee.2406

Reference:

Kurta A, et al. Cyanide poisoning by fire smoke inhalation, European Journal of Emergency Medicine: February 2013 - Volume 20 - Issue 1 - p 2-9.

Refugees are often exposed to infectious diseases, and suffer from malnutrition. Some factors that increase refugees’ exposure to communicable diseases are overcrowding, poor ventilation, contaminated drinking water, and a lack of sanitary living conditions. Additionally, many refugees are more susceptible to infectious diseases due to missing vaccinations because of inadequate access to healthcare. Antibiotic resistance is also a concern in refugee camps as antibiotic treatment regimens are interrupted at much higher rates than in the general population and from exposure to sewage containing antibiotics from humans and animals. Additionally, zoonotic infections associated with living near livestock are a concern facing refugees. A One Health approach of maintaining healthy animals living in and near refugee camps through efforts such as rabies vaccination for dogs also promotes human health.

Reference:

Sutradhar, I., & Zaman, M. H. (2021). One Health approaches to improve refugee health. The Lancet. Global health, 9(12), e1646–e1647. https://doi.org/10.1016/S2214-109X(21)00416-2

Reference:

Madhusoodanan J. Inner Workings: Can feeding the gut microbiome treat malnutrition? Proceedings of the National Academy of Sciences Dec 2021, 118 (50) e2120478118; DOI: 10.1073/pnas.2120478118

Reference:

Mancuso JL, et al. Bloom and bust: Historical trends of harmful algal blooms in Muskegon Lake, Michigan, a Great Lakes estuary. Freshwater Science, Vol 40, Number 3, 2021. https://www.journals.uchicago.edu/doi/abs/10.1086/716236

Reference:

Tzong-Gang Wu, Yan-Da Chen, Bang-Hua Chen, Kouji H. Harada, Kiyoung Lee, Furong Deng, Mark J. Rood, Chu-Chih Chen, Cong-Thanh Tran, Kuo-Liong Chien, Tzai-Hung Wen, Chang-Fu Wu, Identifying low-PM2.5 exposure commuting routes for cyclists through modeling with the random forest algorithm based on low-cost sensor measurements in three Asian cities, Environmental Pollution, Volume 294, 2022, 118597, ISSN 0269-7491, https://doi.org/10.1016j.envpol.2021.118597

Pesticide exposure is a significant occupational health problem for farmworkers. In the United States, it is estimated that approximately 1 billion pounds of pesticides are used annually by the United States agricultural system. Immediate consequences of excessive exposure to pesticides are acute toxicity or poisoning. It is estimated that between 10,000 and 35,000 farmworkers suffer from acute pesticide poisoning annually in the United States. The long-term consequences of pesticide exposure may be a more significant problem, though. Studies have found associations between pesticide exposure and cognitive and behavioral issues and some cancers. The problem of pesticide exposure is not confined to the farmworker. Pesticides can pass along to household contacts from skin and clothing that the farmworker brings back to the household returning from work. 

What can be done to help reduce pesticide exposure among farmworkers? Education and proper use of personal protective equipment can help reduce exposure to pesticides.

Reference:

Environmental Health Threats to Latino Migrant Farmworkers. Federico Castillo, Ana M. Mora, Georgia L. Kayser, Jennifer Vanos, Carly Hyland, Audrey R. Yang, Brenda Eskenazi. Annual Review of Public Health 2021 42:1, 257-276
 

Reference:

Floerl, O. et al. Nature Sustain. https://doi.org/10.1038/s41893-021-00780-w (2021).

Reference:

Castellanos-Galindo, G.A., Robertson, D.R. & Torchin, M.E. A new wave of marine fish invasions through the Panama and Suez canals. Nat Ecol Evol 4, 1444–1446 (2020). https://doi.org/10.1038/s41559-020-01301-2

References:

Lehan NE, Murphy JR, Thorburn LP, and Bradley BA. 2013. Accidental introductions are an important source of invasive plants in the continental United States. Am J Bot 100: 1287–93.

Front Ecol Environ 2021; 19( 10): 550– 556, doi:10.1002/fee.2392

Reference:

Fuentes-Afflick E. Applying a Subpopulation Lens to Population Health. N Engl J Med. 2021 Nov 4;385(19):1729-1732. doi: 10.1056/NEJMp2113023. Epub 2021 Oct 30. PMID: 34714610.
 

In human epidemiological research, multiple studies have demonstrated an association between early exposure to antibiotics and childhood obesity. However, a study published in 2020 in JAMA Network Open that restricted its participants to siblings and twins failed to show an association between early antibiotic exposure and childhood obesity. The association seen in other studies may be due to unmeasured factors such as a family tendency for obesity and not due to antibiotics.

Luo Z, Yu Z, Yin D. Obesogenic effect of erythromycin on Caenorhabditis elegans through over-eating and lipid metabolism disturbances. Environmental Pollution. Volume 294, 2022, 118615, ISSN 0269-7491.

Azad MB, Owora A. Is Early-Life Antibiotic Exposure Associated With Obesity in Children? JAMA Netw Open. 2020;3(1):e1919694. doi:10.1001/jamanetworkopen.2019.19694

Leong  KSW, McLay  J, Derraik  JGB,  et al. Associations of prenatal and childhood antibiotic exposure with obesity at age 4 years.  JAMA Netw Open. 2020;3(1):e1919681. doi:10.1001/jamanetworkopen.2019.19681

Ahmad, S. A., Khan, M. H., & Haque, M. (2018). Arsenic contamination in groundwater in Bangladesh: implications and challenges for healthcare policy. Risk management and healthcare policy, 11, 251–261. https://doi.org/10.2147/RMHP.S153188

References:

Jansen JP, Defrance T, Warnier AM. 2010 Effects of organic-farming-compatible insecticides on four aphid natural enemy species. Pest Manag. Sci. 66, 650-656.

Almeida, R. A., Lemmens, P., De Meester, L. & Brans, K. I. Proc. R. Soc. B. https://doi.org/10.1098/rspb.2021.1903 (2021).

Additionally, CDC One Health has a domestic and global mission to prevent the emergence of harmful zoonotic diseases. They provide education and resources, including laboratory expertise, to identify, contain, and prevent the spread of emerging infectious diseases. They even offer educational programs geared towards the youth. Working in the United States, One Health has also played a considerable role in the COVID-19 response.

Clark MA, Springmann M, Hill J. (2019). Multiple health and environmental impacts of foods. Proceedings of the National Academy of Sciences. 116(46) 23357-23362; DOI: 10.1073/pnas.1906908116

CDC. (2021, October 27). One Health. Centers for Disease Control and Prevention. Retrieved November 4, 2021, from https://www.cdc.gov/onehealth/index.html

Of course, there is much more to environmental health than occupational medicine. And public health encompasses many vital topics that are outside of the scope of environmental health. The Environmental Protection Agency (EPA) is the primary governmental regulatory body for protecting the environment. Although the EPA is also an environmental health organization. The EPA's mission is to protect human and environmental health. As a regulatory agency, Congress authorizes the EPA to write regulations (mandatory requirements) that everyone must follow (individuals, companies, government, etc.). Violations of the EPA's rules are punishable by law. In 1973 the EPA banned DDT, a pesticide, due to its toxic effect on wildlife, notably the reproductive success of the Bald Eagle, resulting in significantly decreased numbers of the species because of DDT's widespread use starting in the 1940s. Following the ban of DDT, the number of bald eagles in the United States increased. Specific to human health, under the Clean Air Act, the EPA is responsible for setting human health standards for air quality and emission standards that apply to motor vehicles, power plants, and other industrial sources of air pollution.

Website References:

About OSHA | Occupational Safety and Health Administration

About NIOSH | NIOSH | CDC

Basic Information on Enforcement | US EPA

DDT - A Brief History and Status | US EPA

References:

1) Bonan, J., Cattaneo, C., d'Adda, G. et al. (2020). The interaction of descriptive and injunctive social norms in promoting energy conservation. Nat Energy 5, 900–909. https://doi.org/10.1038/s41560-020-00719-z. The interaction of descriptive and injunctive social norms in promoting energy conservation (nature.com)

2) Schultz, P. W., Nolan, J. M., et al. (2007). Te constructive, destructive, and reconstructive power of social norms. Psychol. Sci. 18, 429–434.

References:

Lee, DJ, Koru-Sengul, T, Hernandez, MN, et al. Cancer risk among career male and female Florida firefighters: Evidence from the Florida Firefighter Cancer Registry (1981-2014). Am J Ind Med. 2020; 63: 285– 299. https://doi.org/10.1002/ajim.23086

Solle, N., Santiago, K., Feliciano, P., et al. Perceptions of Work-Related Health and Cancer Risks Among Women Firefighters. Journal of Occupational and Environmental Medicine, Publish Ahead of Print.

Perceptions of Work-Related Health and Cancer Risks Among Wo... : Journal of Occupational and Environmental Medicine (lww.com)
 

Firefighter activities associated with sudden cardiac death are typical firefighter duties that cause elevated heart rates, higher blood pressures, and increased levels of sympathetic hormones (epinephrine and norepinephrine) such as fighting a fire, physical training, and responding to a loud alarm alerting the firefighter of a call to respond to.

In general, traditional risk factors such as coronary atherosclerosis, obesity, smoking, high blood pressure, high cholesterol, age, and family history impact a firefighter’s risk for sudden cardiac death. Cardiac health is important to firefighters and fire departments. Fire departments often have established goals and programs to help improve firefighters health and wellness.

Two examples of efforts in the fire service to reduce smoking/ tobacco use among firefighters are in Massachusetts, where firefighters and police are not allowed to smoke, and in the Los Angeles Fire Department, where firefighters are prohibited from using tobacco.

References:

Kales SN, Soteriades ES, Christophi CA, Christiani DC. Emergency duties and deaths from heart disease among firefighters in the United States.N Engl J Med. 2007; 356:1207–1215. doi: 10.1056/NEJMoa060357.

Smith DL, DeBlois JP, Kales SN, Horn GP. Cardiovascular strain of firefighting and the risk of sudden cardiac events.Exerc Sport Sci Rev. 2016; 44:90–97. doi: 10.1249/JES.0000000000000081.

https://malegislature.gov/laws/generallaws/parti/titlevii/chapter41/section101a

https://www.joinlafd.org/index.cfm?section=qualifications

https://www.mayoclinic.org/diseases-conditions/sudden-cardiac-arrest/symptoms-causes/syc-20350634

Asbestos is made up of naturally occurring fibrous minerals that are strong, fire-resistant, and good heat insulators. In older homes, asbestos may be found in home insulation, insulation around piping, asbestos-containing floor tiles, asbestos-containing house roofing, siding, and textured paint and wall patching compounds.

References:

Pinkerton, L., Bertke, S. J., Yiin, J., Dahm, M., Kubale, T., Hales, T., Purdue, M., Beaumont, J. J., & Daniels, R. (2020). Mortality in a cohort of US firefighters from San Francisco, Chicago and Philadelphia: an update. Occupational and environmental medicine, 77(2), 84–93. https://doi.org/10.1136/oemed-2019-105962

Straif K, Benbrahim-Tallaa L, Baan R, et al. A review of human carcinogens — Part C: metals, arsenic, dusts, and fibres. Lancet Oncol 2009;10:453-4. A review of human carcinogens—Part C: metals, arsenic, dusts, and fibres - ScienceDirect

Sinn, K., Mosleh, B., & Hoda, M. A. (2021). Malignant pleural mesothelioma: recent developments. Current opinion in oncology, 33(1), 80–86. https://doi.org/10.1097/CCO.0000000000000697

Viscardi, G., Di Liello, R., & Morgillo, F. (2020). How I treat malignant pleural mesothelioma. ESMO open, 4(Suppl 2), e000669. https://doi.org/10.1136/esmoopen-2019-000669

Frost, G. The latency period of mesothelioma among a cohort of British asbestos workers (1978–2005). Br J Cancer 109, 1965–1973 (2013). https://doi.org/10.1038/bjc.2013.514

The greatest reduction in deaths associated with breast cancer screening over ten years from breast cancer was seen in individuals with breast tissue aged 60-69 (21 fewer deaths per 10,000 screened), followed by 50-59 (8 per 10,000), and 3 per 10,000 aged 40-49.

False positives, overdiagnosis, and overtreatment are also relevant considerations in breast cancer screening. Additionally, mammography has a lower sensitivity for detecting breast cancer in individuals with dense breast tissue.

References:

Siu, A. L., & U.S. Preventive Services Task Force (2016). Screening for Breast Cancer: U.S. Preventive Services Task Force Recommendation Statement. Annals of internal medicine, 164(4), 279–296. https://doi.org/10.7326/M15-2886

Recommendation: Breast Cancer: Screening | United States Preventive Services Taskforce (uspreventiveservicestaskforce.org)

Findings from the United Kingdom Collaborative Trial of Ovarian Cancer Screening were published this year in the Lancet. The randomized control trial enrolled ~203,000 post-menopausal women into three groups (no screening, annual transvaginal ultrasound screening, or annual CA-125 ovarian tumor biomarker followed by transvaginal ultrasound when CA-125 was significantly increased).

A short summary of the study’s results: 1) more stage I and stage II ovarian cancers were detected in the CA-125 followed by the transvaginal ultrasound group (and fewer late-stage cancers) compared with no screening. 2) no significant difference in ovarian cancer incidence was seen between the transvaginal ultrasound and no screening groups. 3) Although the CA-125 followed by transvaginal ultrasound group identified more early-stage cancers, there was no accompanying decrease in ovarian cancer deaths compared with not screening.

Menon, U. et al. Ovarian cancer population screening and mortality after long-term follow-up in the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS): a randomized controlled trial. Lancet 397, 2182–2193 (2021). https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)00731-5/fulltext

Screening intervals for colorectal cancer are a little complicated as there are multiple tests and technologies involved. The recommended screening options are:

     -Colonoscopy screening every ten years.

     -Flexible sigmoidoscopy every ten years if yearly

      fecal immunochemical test (FIT) is also performed.

     -Flexible sigmoidoscopy every five years.

     -CT colonography every five years.

     -FIT-DNA test every 1 to 3 years.

     -High-sensitivity guaiac fecal occult blood test (gFOBT) or FIT every year.

The sensitivity of colonoscopy to detect adenomas 10 mm or larger is reported to be between 89-95%, with a specificity of 89%. The USPSTF did not find any studies that reported the sensitivity and specificity of flexible sigmoidoscopy compared to colonoscopy. The sensitivity of CT colonography to detect colorectal cancer or adenomas 10 mm or larger was 86-100%. The sensitivity of FIT-DNT tests to detect colorectal cancer was 93%, with a specificity of 84%. To detect adenomas 10 mm or greater, FIT-DNA tests sensitivity were 43%, with a specificity of 89%. The sensitivity of high-sensitivity gFOBT to detect colorectal cancer and adenomas 10 mm or greater was 50-100%, with a specificity of 96-98%. The sensitivity of FIT to detect colorectal cancer was 74%, with a specificity of 93-96%. To detect adenomas 10 mm or greater, FIT sensitivity was 23%, with a specificity of 96%. 

Colorectal cancer is advantageous for screening because pre-cancerous polyps (adenomas) can be detected and subsequently removed. Therefore, colorectal screening is also a cancer prevention method by identifying and treating pre-cancerous lesions in conjunction with cancer screening. Indeed, colorectal has been found to reduce mortality from colorectal cancer by detecting cancer early. FIT screening was associated with a 10% decreased colorectal cancer mortality. A 2018 study in the journal Gut reported a 67% reduction in colorectal cancer mortality with screening colonoscopy. Flexible sigmoidoscopy has demonstrated a 26% decrease in colorectal mortality compared with no screening. Mortality data regarding screening with high-sensitivity gFOBT was not available in the JAMA report summarizing the USPSTF colorectal guidelines. However, an older gFOBT was associated with a 9-22% decrease in colorectal mortality. Positive screenings with flexible sigmoidoscopy or CT colonography require follow-up colonoscopy, as do non-visual (high-sensitivity gFOBT, FIT, and FIT-DNA test) positive screenings. 

References:

US Preventive Services Task Force, Davidson KW, Barry MJ, Mangione CM, et al. (2021). Screening for Colorectal Cancer: US Preventive Services Task Force Recommendation Statement. JAMA, 325(19), 1965–1977.

Doubeni CA, Corley DA, QuinnVP et al. (2018). Effectiveness of screening colonoscopy in reducing the risk of death from right and left colon cancer: a large community-based study. Gut, 67(2), 291–298.

A study published in the Journal of Exposure Science and Environmental Epidemiology found that firefighters wearing full turnout gear and self-contained breathing apparatus (SCBA) still absorbed PAHs and benzene while fighting fire during residential structure burns. Because structural firefighters wear SCBA while fighting fires, it’s unlikely they were exposed to PHAs and benzenes through inhalation. Dermal exposure absorption is most likely. Another important finding of the study was that firefighters had elevated levels of PAH in their bodies compared to the general population even before going in to fight the fire for the research study. Suggesting that firefighters are continually exposed to PAHs as part of their jobs. The half-life of PAHs in the body is variable depending on the type of PAH and route of exposure. Overall the study results inform the fire service and medical community that firefighters are likely continually exposed to PAHs and benzene while fighting fire.

References:

Fent, K.W., Toennis, C., Sammons, D. et al. Firefighters’ absorption of PAHs and VOCs during controlled residential fires by job assignment and fire attack tactic. J Expo Sci Environ Epidemiol 30, 338–349 (2020). https://doi.org/10.1038/s41370-019-0145-2

Li, Z., Romanoff, L., Lewin, M. et al. Variability of urinary concentrations of polycyclic aromatic hydrocarbon metabolite in general population and comparison of spot, first-morning, and 24-h void sampling. J Expo Sci Environ Epidemiol 20, 526–535 (2010). https://doi.org/10.1038/jes.2009.41

References:

Aberle DR, Adams AM, Berg CD, et al.; National Lung Screening Trial Research Team. Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med. 2011;365(5):395-409.

de Koning HJ, van der Aalst CM, de Jong PA, et al. Reduced Lung-Cancer Mortality with Volume CT Screening in a Randomized Trial. N Engl J Med. 2020 Feb 6;382(6):503-513. doi: 10.1056/NEJMoa1911793.

Doria-Rose VP, Szabo E. Screening and prevention of lung cancer. In: Kernstine KH, Reckamp KL, eds. Lung cancer: a multidisciplinary approach to diagnosis and management. New York: Demos Medical Publishing, 2010:53-72.

National Lung Screening Trial Research Team, Aberle DR, Adams AM, Berg CD, et al. Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med. 2011 Aug 4;365(5):395-409. doi: 10.1056/NEJMoa1102873.

Marcus PM, Bergstralh EJ, Fagerstrom RM, et al. Lung cancer mortality in the Mayo Lung Project: impact of extended follow-up. J Natl Cancer Inst 2000;92:1308-1316
 

Recommendation: Lung Cancer: Screening | United States Preventive Services Taskforce (uspreventiveservicestaskforce.org)

YouTube:

https://youtu.be/PbzzYApZLO0
 

Participants enrolled in the trial had no history of these cancers. The primary endpoint of the PLCO Trial was to determine if screening for these cancers improved cancer-related mortality. Men and women randomly assigned to the screening group of the PLCO trial underwent colorectal screening with flexible sigmoidoscopy and lung  cancer screening with a chest x-ray. Men randomly assigned to the screening group also received prostate screening with digital rectal exam and PSA tests. Women randomly assigned to the screening group were also screened for ovarian cancer with serum CA-125 and transvaginal ultrasound testing. All participants randomly assigned to the control group received no screening for prostate, lung, colorectal, or ovarian cancers.

Prostate cancer screening results were: 7.5% of men had a DRE suspicious for cancer, 7.9% had a PSA above 4 ng/mL, and 1.4% were diagnosed with prostate cancer, mainly localized prostate cancer. Of those with positive prostate cancer screening, 74% received additional evaluation (31% underwent prostate biopsy). Findings concerning prostate screening with digital rectal exam and PSA testing were not too bad. Still only a USPSTF Grade C recommendation, though, today.

References:

Andriole GL, Levin DL, Crawford ED, et al. Prostate Cancer Screening in the Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial: Findings From the Initial Screening Round of a Randomized Trial, JNCI: Journal of the National Cancer Institute, Volume 97, Issue 6, 16 March 2005, Pages 433–438, https://doi.org/10.1093/jnci/dji065

Recommendation: Prostate Cancer: Screening | United States Preventive Services Taskforce (uspreventiveservicestaskforce.org)

YouTube:

https://youtu.be/eq-GAXkF6W8
 

   ◦Wearing protective equipment during a call to a fire.

   ◦Taking a shower after a fire call.

   ◦Washing fire gear after fire calls.

Website Reference:

https://www.nfpa.org/News-and-Research/Resources/Emergency-Responders/Health-and-Wellness/Firefighters-and-cancer
 

YouTube Link:

https://youtu.be/Y5-Xg4BKMxI

•Veasey, S. C., & Rosen, I. M. (2019). Obstructive Sleep Apnea in Adults. The New England journal of medicine, 380(15), 1442–1449. https://doi.org/10.1056/NEJMcp1816152

•George CF. Reduction in motor vehicle collisions following treatment of sleep apnoea with nasal CPAP. Thorax 2001;56:508-512.

•Drager LF, Togeiro SM, Polotsky VY, Lorenzi-Filho G. Obstructive sleep apnea: a cardiometabolic risk in obesity and the metabolic syndrome. J Am Coll Cardiol 2013;62:569-576.
Obstructive Sleep Apnea

          ◦Wearing protective equipment during a call to a fire.

          ◦Taking a shower after a fire call.

          ◦Washing fire gear after fire calls.

JALAMA SUNSET STUDY ONE

Peng, Y., Wu, P., Schartup, A. T. & Zhang, Y. Proc. Natl. Acad. Sci. USA 118, e2111530118 (2021). https://www.pnas.org/content/118/47/e2111530118

T. P. Bondaroff, S. Cooke, Masks on the Beach: The Impact of COVID-19 on Marine Plastic Pollution(OceansAsia, 2020). https://oceansasia.org/wp-content/uploads/2020/12/Marine-Plastic-Pollution-FINAL.pdf

•Economist , T. (2021, October 23). How soaring energy costs could hobble the COVID-19 recovery. The Economist. Retrieved November 22, 2021, from https://www.economist.com/finance-and-economics/2021/10/23/how-soaring-energy-costs-could-hobble-the-covid-19-recovery.

•Adler, M. (2021, November 20). Soaring Fuel Prices Stoke Rush to Stockpile Firewood Across U.S. Bloomberg.com. Retrieved November 22, 2021, from https://www.bloomberg.com/news/articles/2021-11-20/americans-load-up-on-firewood-as-home-heating-costs-skyrocket.

•Shalal, A., & Mason , J. (2021, October 30). Biden pushes G20 energy producing countries to boost production. Reuters. Retrieved November 22, 2021, from https://www.reuters.com/business/energy/biden-push-g20-energy-producers-boost-capacity-ease-price-pressures-2021-10-30/.

• Jaganathan, J. (2021, October 1). Asian prices surge to record high this week as Winter starts. Reuters. Retrieved November 22, 2021, from https://www.reuters.com/business/energy/asian-prices-surge-record-high-this-week-winter-starts-2021-10-01/.

Energy Prices, the Environment, and Business

Optimal screening frequency depends on a cancer’s growth rate. If the cancer is fast-growing, screening is probably not going to be effective. To prevent harmful disease, frequent screening would be needed. Progressive harmful cancers that take a long time to develop are much more suitable for screening. Additionally, screening is more beneficial if associated with precancerous lesions. Detecting and eliminating colonic polyps or cervical intraepithelial neoplasia have the added benefit of preventing cancer from occurring. Following a negative colonoscopy in a low-risk individual, follow-up in ten years is recommended, for example. Non-progressive or indolent cancers do not need to be detected to begin with, and screening may be harmful. Illustrating the problem with overdiagnosis and overtreatment.

-How to decrease overdiagnosis and overtreatment of cancer?

-All screening tests should be tested for safety and efficacy before being offered to the public. Evaluation of screening tests with randomized clinical trials is an important first step to launching a screening test. Trial results can help form safer and more effective guidelines. And Selecting high-risk populations to screen increases the likelihood that progressive and harmful cancers will be found. Also, allowing smaller and benign-appearing lesions to be monitored and biopsied less frequently helps decrease indolent cancers from ultimately being treated as harmful cancers.

Reference:

Pinsky P. F. (2015). Principles of Cancer Screening. The Surgical clinics of North America, 95(5), 953–966. https://doi.org/10.1016/j.suc.2015.05.009

Esserman, L. J., Thompson, I. M., Jr, & Reid, B. (2013). Overdiagnosis and overtreatment in cancer: an opportunity for improvement. JAMA, 310(8), 797–798. https://doi.org/10.1001/jama.2013.108415

Cancer Screening – Understanding Overdiagnosis and Overtreatment

-The origin of COVID-19 is not known. The prevailing theory is that zoonotic spillover from bats to another animal (possibly the raccoon dog, known to be susceptible to coronaviruses and sold live at the Huanan Market and three other live-animal markets in Wuhan before the pandemic) to humans explains the origin of the pandemic.

Website Reference:

Dissecting the early COVID-19 cases in Wuhan (science.org)

Origin of COVID-19

The Economist recently reported that between 1940 and 2004, approximately 220 of the 330 new diseases were infectious diseases spread to humans by animals, primarily from wild animals. And that Two of the most economically impacting emerging diseases in recent years, HIV/AIDS and likely Covid-19, are zoonotic as well. The Economist also reports, citing recent scientific findings, that spread of Ebola, Zika, dengue, and chikungunya may be associated with deforestation.

Website References:

https://www.ufaw.org.uk/why-ufaws-work-is-important/monitoring-of-wildlife-populations

https://www.fws.gov/endangered/

https://www.economist.com/the-economist-explains/2021/10/19/how-environmental-damage-can-lead-to-new-diseases

UN Biodiversity Conference - Loss of Biodiversity

Cancer Screening Principles

The study found that cancer screening guidelines reviewed failed to address the issue of cost/benefit in their recommendations (although cost/benefit was likely considered when the guidelines were developed). Additionally, the study found that none of the 68 guidelines reviewed provided a threshold for when the benefits of cancer screening outweigh the associated harms and burdens. The findings of this study apply to medicine today as a shift from paternal medical care to patient-centered care is taking place. Including a discussion on benefits and harms in cancer screening guidelines would offer patients more complete information to consider when deciding whether or not to undergo cancer screening.

Zeng L, et al. BMJ Open 2020;10:e038322. doi:10.1136/bmjopen-2020-038322

cancer screening cost benefit not in recommendations

1. Otu, A., Effa, E., Meseko, C. et al. (2021). Africa needs to prioritize One Health approaches that focus on the environment, animal health and human health. Nat Med 27, 943–946. https://doi.org/10.1038/s41591-021-01375-w

2. Bauhoff S and Buschb J. (2020). Does deforestation increase malaria prevalence? Evidence from satellite data and health surveys. World Development 127, 104734. Does deforestation increase malaria prevalence? Evidence from satellite data and health surveys - ScienceDirect

Coal workers with total permanent disability due to black lung disease are eligible for compensation under the US Department of Labor’s Division of Coal Mine Workers’ Compensation. An essential component of the medical evaluation of black lung disease is a chest X-ray paired with a standardized interpretation method specific to pneumoconiosis. 

A recent study published in Annals of the American Thoracic Society reviewed nearly 64,000 standardized chest X-ray interpretations performed by 264 physicians certified in reading black lung chest X-rays. The study found that physicians hired by coal mining companies were more likely to interpret the X-rays as having less severe disease than physicians hired by coal workers (who were more likely to interpret the X-rays as having the more severe disease). The study provides valuable evidence to question the practice of financial incentives for physicians making a diagnosis of black lung disease in a medical evaluation intended to be objective. 

Reference:

Friedman LS, De S, Almberg KS, Cohen RA. Association between financial conflicts of interest and International Labor Office classifications for black lung disease. Ann Am Thorac Soc 2021;18:1634–1641. https://www-atsjournals-org.umassmed.idm.oclc.org/doi/10.1513/AnnalsATS.202010-1350OC

1 Salkeld D. (2020). One Health and the COVID-19 pandemic. Frontiers in ecology and the environment, 18(6), 311. https://doi.org/10.1002/fee.2235

2 Xiao, X., Newman, C., Buesching, C.D. et al. (2021). Animal sales from Wuhan wet markets immediately prior to the COVID-19 pandemic. Sci Rep 11, 11898. https://doi.org/10.1038/s41598-021-91470-2

3 Keaten, J. (2021, March 29). Who report: Covid likely 1st jumped into humans from animals. AP NEWS. Retrieved November 18, 2021, from https://apnews.com/article/who-report-animals-source-covid-19-coronavirus-8a839c179c330c56fa46a763b7286a7f

References:

WHO. (2021). Human-animal-environment interface research. World Health Organization. Retrieved November 18, 2021, from https://www.who.int/publications/m/item/human-animal-environment-interface-research.

Amuasi JH, Lucas T, Horton R, et al. (2020). Reconnecting for our future: The Lancet One Health Commission, The Lancet; 395(10235):1469-1471. https://doi.org/10.1016/S0140-6736(20)31027-8

ACS. (2020). Understanding radiation risk from imaging tests. American Cancer Society. Retrieved October 25, 2021, from https://www.cancer.org/treatment/understanding-your-diagnosis/tests/understanding-radiation-risk-from-imaging-tests.html

1116

Jung, A.M., Jahnke, S.A., Dennis, L.K. et al. Occupational factors and miscarriages in the US fire service: a cross-sectional analysis of women firefighters. Environ Health 20, 116 (2021). Occupational factors and miscarriages in the US fire service: a cross-sectional analysis of women firefighters | Environmental Health | Full Text (biomedcentral.com)

IMG_0447

Needle exchange programs are important from a personal and public health perspective as they help reduce the transmission of infectious diseases such as HIV, Hepatitis B, and Hepatitis C. 

And fentanyl test strips can detect fentanyl in street drugs where it may not be expected, such as methamphetamine. However, fentanyl test strips are also illegal in some states where they are classified as drug paraphernalia. One drug overdose prevention strategy not mentioned in the new HHS strategy is supervised consumption sites. Rhode Island is the only state to allow supervised consumption sites as part of a two-year pilot program passed into law in 2021.

The HHS plan also includes efforts to decrease the inappropriate prescribing of opioid pain medications through education efforts directed towards providers. Additionally, HHS plans to increase support for evidence-based pain management practices, substance abuse treatments, and research methods to prevent substance abuse. Lastly, the HHS plan will focus on improving recovery support services such as recovery housing.

Reference:

Stephenson J. Biden Administration Unveils Overdose Prevention Strategy. JAMA Health Forum. 2021;2(11):e214252. JAMA Health Forum – Health Policy, Health Care Reform, Health Affairs | JAMA Health Forum | JAMA Network

Front Ecol Environ 2021; 19( 9): 491– 493, https://esajournals.onlinelibrary.wiley.com/doi/10.1002/fee.2416

Website References:

Coronavirus live updates: Pfizer deal would allow experimental covid-19 pill to be manufactured around the world - The Washington Post

Less than 10% of African countries to hit key COVID-19 vaccination goal  | WHO | Regional Office for Africa
 

In case of an earthquake, would it be best to immediately run outside of a building or go to an earthquake-safe area of a building? According to the California Earthquake Authority, seven steps you can take to prepare for an earthquake are:

1 Secure your space. Make sure movable objects are secured. Will only work for areas that are your own (in your own home or office, for example).

2 Plan to be safe. Create a disaster plan for yourself and your family.

3 Organize disaster supplies: food/water and clothing, medications, first aid kit, and cell phone.

4 Minimize financial hardship—essential documents to save and consider additional insurance coverage (earthquake).

5 Drop, cover, and hold on. Get protection and go under a sturdy table.

6 Improve safety. Help the injured, evacuate if needed.

7 Reconnect and restore. Reconnect with others, repair damage, rebuild the community.

Reference:

CEA. (2021). CEA - seven steps to earthquake safety. Earthquake Precautions & Preparation - 7 Steps to Earthquake Safety | CEA. Retrieved November 16, 2021, from https://www.earthquakeauthority.com/California-Earthquake-Risk/Personal-Preparedness/Seven-Steps-to-Earthquake-Safety#:~:text=Important%20Earthquake%20Safety%20Precautions%201%20When%20an%20earthquake,home%2C%20don%E2%80%99t%20go%20outside.%20...%20More%20items...%20.

Central Coast

Reference:

Li-Zi Lin et al 2021 Environ. Res. Lett.

https://iopscience.iop.org/article/10.1088/1748-9326/ac1c28
 

Reference:

Friedlingstein, P., Jones, M. W., O'Sullivan, M, et al. Global Carbon Budget 2021, Earth Syst. Sci. Data Discuss. [preprint], https://doi.org/10.5194/essd-2021-386, in review, 2021.

WINTER ICE LAKE MICHIGAN

Reference:

Osman, M.B., Tierney, J.E., Zhu, J. et al. Globally resolved surface temperatures since the Last Glacial Maximum. Nature 599, 239–244 (2021). https://doi.org/10.1038/s41586-021-03984-4

Winter Lake Michigan

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Fadadu RP, Grimes B, Jewell NP, Vargo J, Young AT, Abuabara K, Balmes JR, Wei ML. Association of Wildfire Air Pollution and Health Care Use for Atopic Dermatitis and Itch. JAMA Dermatol. 2021 Jun 1;157(6):658-666. https://pubmed.ncbi.nlm.nih.gov/33881450/

Rajagopalan S, Landrigan PJ. Pollution and the Heart. N Engl J Med. 2021 Nov 11;385(20):1881-1892. https://www.nejm.org/doi/full/10.1056/NEJMra2030281
 

4D8B9001-C485-4F0F-A153-5E2C2A10A9FC

PACIFIC SHORE two

Micro plastic pollution from the silicone rubber on infant bottle-feeding teats may pose health and environmental risks. 

Silicone rubber teats are often clean by moist heating. A new study in Nature Nanotechnology found that steam-heating caused degradation of silicone teats used in infant bottle feeding resulting in free micro(nano)plastics that babies are likely to ingest following cleaning.

Su, Y., Hu, X., Tang, H. et al. Steam disinfection releases micro(nano)plastics from silicone-rubber baby teats as examined by optical photothermal infrared microspectroscopy. Nat. Nanotechnol. (2021). https://www.nature.com/articles/s41565-021-00998-x
 

The NFPA standards have a process for making standards that involve public participation. NFPA standards are updated regularly. The process for developing and updating standards related to fire protection by the NFPA involves four main steps: public input, public comment, technical session, and standards meeting.² Firefighters face unique occupational health risks due to harsh work environments with excessive heat, extreme physical exertion, intense emotional situations, dense smoke, and toxic chemicals. They perform strenuous activities, wear heavy equipment and a respirator. Sudden cardiac death is the leading cause of on-duty firefighter deaths.³ Firefighters have decreased mortality from all cancers and from several site-specific cancers.⁴ Additionally, firefighters have an increased risk of PTSD and Suicide.⁵

Summary of NFPA 1582 - Standard on Comprehensive Occupational Medical Program for Fire Departments – 2022 Edition.⁶ Firefighter health questionnaire with exposure history. Review of immunization record. HCV and HIV screening (at baseline, following occupational exposure, and if requested by fire department physician or firefighter). TB screening (at baseline and annually or per CDC guidelines). Physical exam with a visual exam, hernia exam, and digital rectal exam as clinically indicated. Laboratory analysis (CBC, electrolytes, LFTs, lipids, glucose, and urinalysis). Heavy metal and special exposure screening (evaluations performed following known or recurrent exposures or as required by federal, state, or provincial regulations). Audiology (annual hearing threshold assessment). Pulmonary function testing (annually). Chest XRAY (as medically indicated). Resting ECG (annually after 40 or as clinically indicated). Cardiac risk stratification (firefighters 40 and older and those under 40 known to be at high risk for ASCVD) should be assessed for their 2-year or 10-year risks of ASCVD created by the American College of Cardiology / American Heart Association. For firefighters with a low risk of ASCVD (no further cardiac evaluation needed). Firefighters with intermediate risk of ASCVD (exercise stress test with or without imaging to at least 12 METS or coronary calcium score followed by Astro-CHARM 10-year score). Firefighters with a high risk of ASCVD (refer to cardiology). Cancer screening. Mammography (bi-annually for female firefighters over 40 and annually for those over 50).

Colon Cancer Screening for firefighters 40 and older with fecal occult blood testing. Ages 45 to 75 to undergo visual screening or stool-based immunochemical or DNA testing. Prostate cancer screening (annual PSA testing for male firefighters age 50 and older and 40 and older for those with increased risk of prostate cancer; e.g., African-Americans or a first-degree relative with a history of prostate cancer at an early age). Lung cancer screening (low annual dose CT for firefighters age 50-74 with at least a 20-pack- year smoking history and currently smoking or quitting within the past 15 years). Cervical cancer screening (PAP smear every 3 years for female firefighters age 21-65, or for those who want to lengthen interval, HPV testing with or without cytology every 5 years). Testicular cancer screening (baseline testicular examination by a healthcare provider). Bladder cancer screening (evaluation for hematuria). Oral cancer screening (mouth examination for signs of oral and oropharyngeal cancers by a healthcare provider). Thyroid cancer screening (examination of thyroid bed for nodules by a healthcare provider) Skin cancer screening (annual skin exam). Sleep disturbance screening. And behavioral Health Screening (including PTSD screening).

References:

1. O. S. H. A. (2011). Department of Labor Logo United States Department of Labor. 1910.134 - Respiratory Protection. | Occupational Safety and Health Administration. Retrieved November 2, 2021, from https://www.osha.gov/laws-regs/regulations/standardnumber/1910/1910.134.
2. N. F. P. A. (2021). How the NFPA standards development process works. NFPA. Retrieved November 2, 2021, from https://www.nfpa.org/Codes-and-Standards/Standards-Development/How-the-process-works.
3. NIOSH fire FIGHTER fatality investigation and PREVENTION program. LEADING recommendations for preventing fire FIGHTER fatalities, 1998-2005. (2008). NIOSH Fire Fighter Fatality Investigation and Prevention Program; Leading Recommendations for Preventing Fire Fighter Fatalities, 1998-2005.
4. Pinkerton, L., Bertke, S. J., Yiin, J., Dahm, M., Kubale, T., Hales, T., Purdue, M., Beaumont, J. J., & Daniels, R. (2020). Mortality in a cohort of US firefighters from San Francisco, Chicago and Philadelphia: an update. Occupational and environmental medicine, 77(2), 84–93.
5. Stanley, I. H., Hom, M. A., Hagan, C. R., & Joiner, T. E. (2015). Career prevalence and correlates of suicidal thoughts and behaviors among firefighters. Journal of affective disorders, 187, 163–171.
6. N. F. P. A. (2021). NFPA 1582. NFPA 1582: Standard on Comprehensive Occupational Medical Program for Fire Departments. Retrieved November 2, 2021, from https://www.nfpa.org/codes-and-standards/all-codes-and-standards/list-of-codes-and-standards/detail?code=1582.

For human risk assessments, consideration must be paid to vulnerable populations such as children, the elderly, and other marginalized populations such as homeless populations. Specific to human risk assessment, the EPA details four steps for risk assessment: hazard identification, dose-response assessment, exposure assessment, and risk characterization.⁴ Specific to ecologic risk assessment, the EPA has three phases: problem formulation, analysis, and risk characterization.⁵ For ecological risk assessment, the ecosystem's biodiversity must be considered as well as how extensive the exposure is. These assessments depend on many factors, including changes in weather such as wind direction, the flow of water, including penetration to groundwater, movement of water from rivers to lakes, and circulating ocean currents.

References

1. EPA. (2021, August 24). About Risk Assessment. EPA. Retrieved November 9, 2021, from https://www.epa.gov/risk/about-risk-assessment#whatisrisk.
2. Ott, R. (2015, March 24). Act now to protect our ocean and fresh water. Robert Eovaldi - Art and Science. Retrieved November 9, 2021, from https://roberteovaldi.zenfolio.com/riki_ott.pdf.
3. Stranahan, S. Q. (2003, March 1). The valdez crud. Mother Jones. Retrieved November 9, 2021, from https://www.motherjones.com/politics/2003/03/valdez-crud/.
4. EPA. (2021, June 15). Human Health Risk Assessment. EPA. Retrieved November 9, 2021, from https://www.epa.gov/risk/human-health-risk-assessment.
5. EPA. (2021, June 7). Ecological Risk Assessment. EPA. Retrieved November 9, 2021, from https://www.epa.gov/risk/ecological-risk-assessment.

UNNAMED POND IN WINTER

Another area of concern is with cell phones. Animal models show that cell phones (a radio frequency, very weak microwave radiation, non-ionizing radiation) can be problematic to developing brains. However, these studies have not been very reproducible. They do not consistently show abnormalities in brain development from exposure to very weak microwave radiation typical of cell phones.⁵ Multiple studies have failed to demonstrate a link between cell phone use in the development of brain cancer in humans.⁶ A potentially much more concerning exposure to electromagnetic radiation comes from medical imaging (ionizing radiation). On the high side of medical imaging radiation dosage at 20 mSv, a whole-body PET/CT scan delivers approximately eight years of background radiation in a single setting.⁷

1 Carpenter, D. Dr. David Carpenter and dr. Devra Davis health effects of electromagnetic fields. Radiation Research. Retrieved October 25, 2021, from https://www.radiationresearch.org/articles/dr-david-carpenter-and-dr-devra-davis-health-effects-of-electromagnetic-fields-youtube/. 

2 N. C. I. Electromagnetic fields and cancer. National Cancer Institute. Retrieved October 25, 2021, from https://www.cancer.gov/about-cancer/causes-prevention/risk/radiation/electromagnetic-fields-fact-sheet. 

3 Crespi, C. M., Vergara, X. P., Hooper, C., Oksuzyan, S., Wu, S., Cockburn, M., & Kheifets, L. (2016). Childhood leukaemia and distance from power lines in California: a population-based case-control study. British journal of cancer, 115(1), 122–128. https://doi.org/10.1038/bjc.2016.142

4 2011. The effect of rurality on cancer incidence and mortality. Retrieved October 25, 2021, from http://www.ncin.org.uk/publications/data_briefings/rurality. 

5 Zhi, WJ., Wang, LF. & Hu, XJ. (2017). Recent advances in the effects of microwave radiation on brains. Military Med Res 4, 29 https://doi.org/10.1186/s40779-017-0139-0

6 A. C. S. (2020). Cellular (cell) phones. American Cancer Society. Retrieved October 25, 2021, from https://amp.cancer.org/cancer/cancer-causes/radiation-exposure/cellular-phones.html. 

7 A. C. S. (2020). Understanding radiation risk from imaging tests. American Cancer Society. Retrieved October 25, 2021, from https://www.cancer.org/treatment/understanding-your-diagnosis/tests/understanding-radiation-risk-from-imaging-tests.html.

SURF BEACH
 

PACIFIC SUNSET APRIL 2015

called Galleri 

https://www.galleri.com/multi-cancer-early-detection

It's made by a private company in California (Grail).

https://www.nature.com/articles/s41416-021-01498-4

For the Galleri test: I feel like this is complicated. On one end, things are moving towards stool-based DNA testing with colon cancer, for example. However, those tests are based on a different technology. I am uncertain about the idea that a single test can detect 50 distinct cancers. I honestly believe that for it to be implemented on a larger scale, some publications should be present in American Family Physician, JAMA, or something like The New England Journal of Medicine, for example. Another concern with this type of test's use before being validated is that patients may feel a false sense of security following a negative test result. And that a negative test result may prevent the patient from undergoing recommended cancer screening.

 

OAKLAHOMA SUNSET

But it’s just noise the birds reply - - they can understand. Real noise in modern society - is disruptive, at least to birds that still recognize.

To be continued…
PACIFIC SUNSET APRIL 2015

The inspiration for Minna's research comes from the ocean acidification-hypoxia model developed by Jim McWilliam's team at UCLA's Department of Atmospheric and Ocean Sciences. The oceanic acidification-hypoxia model eloquently answers questions such as how are marine life harmed by ocean acidification-hypoxia.

Minna said, "I believe that nutrient inputs from rivers and wastewater pipes into the coastal ocean is causing an exacerbation of ocean acidification and hypoxia on the US west coast regionally alongside natural upwelling and climate change. 

On the scale of the Pacific Ocean and other oceans, I believe that on a long enough timescale (hundreds of years), humans will see an overall acidification. The timescales are long because the oceans are all connected and take quite some time to circulate and overturn."

Minna's research will help wastewater treatment managers better understand how the dumping of sewage into the ocean negatively impacts the coastal environment.

By Benjamin John Eovaldi, DO, Advanced Medical Group, Hudsonville, MI.

Minna Ho is a Senior Research Technician in the Biogeochemistry Department at the Southern California Coastal Water Research Project (SCCWRP) who specializes in assessing the impact of anthropogenic inputs on the ocean through modeling. Her research focuses on developing new wastewater pollution modeling methods to support sanitation management discharge decisions.

diff_F

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Photo and video caption: Instantaneous concentration fields of ROMS high resolution, nonhydrostatic wastewater plume experiments at different cross flow velocities. 

References:

Ho, M. (2019). Modeling and Validation of Coastal Wastewater Effluent Plumes Using High-Resolution Nonhydrostatic Regional Ocean Modeling System. UCLA. ProQuest ID: Ho_ucla_0031N_18267. Merritt ID: ark:/13030/m5wm6hr0. Retrieved from https://escholarship.org/uc/item/5ht6r7cf

http://newsroom.ucla.edu/dept/faculty/james-mcwilliams-to-lead-research-team-exploring-ocean-acidification

Will not tolerate lead

Workers went smelting

Mountains not always kind

Cadmium

Trad-Chinese Medicine to get slim

Ouch

To be continued...
Vandenberg Air Force Base

of the Arctic has disrupted/ caused more fluctuations the earth’s 

polar jet stream (a strong west to

east air current) —> disruption of the

stratospheric vortex (a counter-clockwise strong

air current in the Arctic the builds in the

winter) —> cold air trapped in the Arctic,

by the polar vortex, to spill south making 

it colder in Chicago in the winter.

https://www.economist.com/the-economist-explains/2019/01/30/why-chicago-is-so-cold

Very possible.

Given the blackouts in California, FEMA is re-emphasizing the importance of wildfire preparedness. This second FEMA Public Service Announcement features wildfire survivor. Kathleen who talks about her experience evacuating during a fire and the importance of preparedness.

https://m.youtube.com/watch?feature=youtu.be&v=1Q4OhqVotBk
 

The program’s monitoring of Muskegon Lake consists of performing a series of ecologically relevant scientific tests at 6 different locations on Muskegon Lake performed 3 times per year. 

The monitoring performed consists of a series of physical and chemical tests at the 6 sites on Muskegon Lake. Site monitoring begins with a light absorption assessment at various depths (light absorption is an indicator of water clarity). The second test performed is water sampling for nutrient content and other chemical properties such as alkalinity. The third test performed measures a variety of physical and chemical properties including water oxygen content (adequate dissolved oxygen levels are needed to sustain aquatic life). The fourth and final test is sediment sampling for invertebrates (bugs) from the bottom of Muskegon Lake with a Ponar Grab Sampler.

For more information on the Muskegon Lake Long-Monitoring Program you can visit their website here - and monitoring results at their dashboard.

C66A1FB8-3BF8-46DE-8CBF-DC1B3C430650
 

Today they will perform four different water clarity and environmental safety tests at five different sites On Lake Macatawa in Holland Michigan. They will be testing for physical and chemical properties of the water with their YSI instrument, survey for environmental toxins and microorganisms with water sampling, collect plankton (later be identified in the lab on the species level), and perform basic water clarity testing with a Secchi disk.

Project Clarity is a $12 million long-term watershed restoration project that aims to improve wetland restoration and water quality for the people of West Michigan. Project Clarity also provides community information and education regarding issues impacting the water quality within the Macatawa Watershed.

AE404CCB-E5A0-4865-9E8A-4BE301C8E48D

<COSMOS ODYSSEY : A Brief History of Astronomy>
29min. (movie trailer 2:57 min) 
Korean Version ready.

First viewing in Korea on Sunday, Feburary 10.

English Version coming soon!.

https://vimeo.com/313358102

15676266_1012566728870836_6066549834542284540_oKwon, O Chul

Shark Repellents - Environmental Pollution

Thanks,

Benjamin J. Eovaldi, D.O. and Robert J. Eovaldi

shark repellent

A long time ago there were two brothers.  They were the sons of the masculine sun god, and the feminine god, Mother Earth. The two sons lived on and took care of the earth; they were loyal to El Sol. But then the younger brother became greedy.  He began to do bad things and use the earth to his advantage and in doing these unfavorable things he caused harm to Mother Earth.  The older brother, who was wise, saw what his younger brother was doing and tried to show him the harm he was causing the earth and the pain he was causing El Sol. Filled with greed, the younger brother continued to use the earth for his gain. The older brother continued to mend the earth and appreciate her, but his younger brother’s destruction was very harmful.  As the years continued the earth could not be fully repaired.

The Indigenous believe that they are the older brother called to protect the earth with love. The people that are not from the Sierra are the younger brothers, whom the indigenous love and wish no harm upon. The indigenous attribute all natural disasters to be El Sol’s wrath for the harm the younger brother has caused Mother Earth. Their mission is to spread this story to all who hike through in hopes of inspiring and enlightening the younger brothers to change ways. 

Message from the Kogi

-Kristen Eovaldi

DSC00146

kristen and benjamin with kogi shaman

Rincon

An example of globalization making something worse.

Additionally, zebra mussels in Lake Michigan (originally from the lakes of southern Russia and Ukraine) continue to cause significant economic burden.  Not to mention the goby fish (originally from the Caspian and Black Seas), known to carry a strain of botulism responsible for killing thousands of shorebirds along Lake Michigan.  Internationally, Korea has the same problem with bluegill, bass (originally from the United States).

Adult bighead carp, underwater image of an adult bighead carp, photo by Ryan Hagerty/USFWS.

B4E3A80A-F37C-4E95-9092-A784042B6C17Adult bighead carp Underwater image of an adult bighead carp. Photo by Ryan Hagerty/USFWS

the smaller breakdown of little plastic 

The biodiversity had no fighting chance 

Zooplankton their first day of life 

cosiup to a likable food plastic 

What if a bucket of bleach 

could kill them all they contaminate

They are small enough to be 

To be eaten by a zooplankton 

A colossal mistake 

There are 39 species of zooplankton 

There are 39 species of zooplankton 

There are 39 species of zooplankton 

39 species of zooplankton eat microplastic

World war z world war z

I’m screaming bloody murder

It was encountered in their natural environment 

Environmental encounter el natural 

We still have to believe they will go away 

Now we can still believe that they will go away

To be continued...

CarmelCarmel, big sur coast line.

Kwon-devilstower1

Kwon-monumentvalley

Kwon-devilstower2

Kwon-meteorcrater

Kwon-horseshoebend

Kwon-arches

Kwon-moab_utah

There was a strange sound at night. It was a rattlesnake under the tripod! 
Anyway i could finish this whole night time-lapse without subtraction.
-Kwon, O Chul AstroPhotography

Benjamin J. Eovaldi, D.O.

November 1, 2018

To be continued...

White Birch Photo: Robert J. Eovaldi

Benjamin J. Eovaldi, D.O.

October 1, 2018

To be continued... JAMES STREET BEACH SUNSET

Photo: Robert J. Eovaldi

pass port sized photo

Photo of Benjamin J Eovaldi, D.O.

A pictorial journey through the piercing gazes and lines etched on the faces of men who have spent their lives on and in the waves, legends that written history with their deeds. This project is intended to represent the passing of time for a one-off viewing, a series of pictorial works that contain the fear, the adrenaline, the enthusiasm, the passion and the tenacity in every glance, the awareness of having chosen to live the life of the surfer’s wildest dream. www.surfartganadu.com

-French Columnist

MINERS FALLS

Global Warming is not the most imminent threat, and besides, species can adapt to it.

Extinction of Homo Sapiens due to wars over dwindling energy sources is the imminent threat!

Technology itself may even be an evolutionary dead end to extinction!

That could be why we haven't made any contact out there in space with other intelligent beings (?)

Are we just deluding ourselves with "sustainable initiatives?"

It's sort of like Occam's Razor.

Haven't we lost nothing in believing in the "Homo Sapiens Extinction Mitigation Initiative" If it all was destined to fail anyway!

But you gotta believe in something. (If God didn't exist (that is, there has to be a future for our species, and Intelligent Species elsewhere like ours) man, Homo Sapiens would have to invent one!

-The French Columnist

0002 PIGEON CREEK RAINBOW 2

To be honest I do not know a ton about shark repellents.   Maybe the best solution is to not swim or stay out of shark infested waters if one has a fear of sharks.  There has been an increasing number of shark sightings in Malibu and surrounding areas due to warmer water temperatures.  However, I feel sharks are a key part of our ecosystem in the ocean and humans should not be interfering with their habitat.  

051611bankok1141 Skylar Peak

City of Malibu, CA

Councilmember

Response 

I do not believe shark behavior has changed, I think we are in the water more and shark numbers are recovering. We are not a prey item or we would be bitten far more frequently. We will see what this year's numbers say, but one year does not make a trend. The Media is reporting almost every incident now, so reporting is putting it out there far more than in the past. I think what has changed is perception and not really the numbers. Typical psychological bias. There may be local differences or changes like Reunion, but I am not sure even there. Of course, the discussion is pointless unless we look at species specific information as well. As you know that not all sharks behave the same way and not all incidents are created equal.

A lot of incidents in the US are fishing related and that is pretty much left out in the media. For me, those do not count as it is like saying oh look a lion on the savanna eating something someone killed or came in to investigate a slaughtered animal.

Grant W. Graves

Marine Biologist

Response

Sharks are a top predator in our marine (and estuarine) systems. The role that these species play is critical to proper ecosystem function. As humans have developed an increasing (and sometimes irrational) fear of sharks, these species have in some cases faced threats that have caused possibly irreversible damage to their populations. As many shark species are migratory, utilizing a variety of habitats over their life cycles, understanding just their basic demography and behavior is a logistic challenge for scientists. Given the gaps in knowledge related to many shark species, I am hesitant to support any type of shark "repellent" that might have direct impacts to how these species function within their habitats. Additionally, the use of acoustic transmissions (e.g. orca vocalizations) or altering the electromagnetic field of a geographic location may have consequences beyond the targeted shark species. Many marine organisms rely on acoustic and sonar information to assess their environments. The use of and sensitivity to electromagnetic fields is not limited to sharks. Marine turtles, spiny lobsters, sea slugs, and other species have been demonstrated to use magnetic field for orientation and navigation. Elasmobranch species (sharks, rays, and skates) and other marine species rely on electromagentic fields to detect their prey. Disrupting these fields could have devastating consequences to important habitats for these species. Dr. A. Peter Klimley used wet suits designed to replicate the color pattern of orca whales while conducting field work in the Pacific. I think this latter approach is far more innocuous and with less consequences for unintended species. 

Sheila V. Madrak, M.S.
Doctoral Candidate
Joint Doctoral Program in Ecology
San Diego State University/UC Davis
Department of Biology

Response

All of the expert responses bring up excellent points and I whole heartedly agree with most of it. To add my personal, non-scientific, opinion. I think most shark repellent products are a fairly crude attempt at affecting a complex animal in a complex environment.  Most devices I have seen or heard of will only work on certain species, during certain circumstances and under specific conditions. It is a simplified idea to think all species of sharks will respond to a color pattern or electric field at all times when there is other stimulation in the water. How strong a deterrent has to be largely depends on how motivated the shark is. Most of the time sharks are not even interested in humans, so keeping them out of the area is not necessary. The slightest sound, movement or sight can either attract or spook a shark, depending on what they are used to, why they are in a particular location and what they may or may not fear. How often do sharks have to fear being hunted by Orcas if they live in a place where you never see Orcas? Small amounts of electric current can attract sharks. So does sound. How can you dose it considering the density of the water? Sound travels incredibly far. Electricity disperses quickly. To use electricity or sound to protect a whole area would require such a high dose that surely it would be damaging to a lot of other ocean life in the area. Trying to tag and track ALL Great whites, tiger sharks and bull sharks is simply impossible. 

It really worries me that there seems to be this attitude that the sharks are encroaching on human's swimming areas or surf spots and that there is an increase in sharks. First of all - when seen in relation to how many people are entering the ocean, there is no increase in attacks. It has been proven that shark populations are decreasing all around the globe. Creating panic over the fact that sharks come closer due to climate change is also pointless. It is a natural reaction that predators will go where they find prey. That does not mean that there is automatically an increase in danger. We cannot expect fish to stay in their neatly designated areas that make it easy for us to keep track of them. That is not how it works. And secondly, sharks contribute to the health and balance of the ocean. Surfers and swimmers are there for recreation - what is more important?

The real problem is that sharks are being wiped out and that sightings have become quite rare, except in certain locations. It is unfortunate that sometimes these locations coincide with some of the popular surf spots. Maybe choosing locations for surf competitions should consider the wildlife as much as the perfect wave. Most surfers I know are perfectly happy to be in an environment that is still wild. Extreme sports have an element of danger, so sometimes I wonder who shark repellents are made for? Is it more hype than necessity? Are we trying to sanitize the ocean so more people can enjoy it without worry? Is that what we should strive for? People are more and more removed from the natural world and feel entitled to safely use the wild places as their playground. We have managed to wipe out nearly ever "slightly" dangerous predator on land, and now this attitude is extending into the oceans. We do not need shark or bear repellents. We need to be willing to learn about our environment and enter the wild with some knowledge and acceptance that we are only one of the animals that use that space and that we need to coexist.

Stefanie Brendl

President

Shark Allies

A Snippet from Aloah Tech Writers Article-

Shark Deterrent and Detection Technology Demystified: What Works, What Doesn’t and Why.

October 26th 2015 by Purna Nemani of Aloha Tech Writers (collaborator, Stefanie Brendl of Shark Allies).

http://alohatechwriters.com/shark-deterrent-detection-technology-demystified-what-works-what-doesnt-why/

We end this article with the opinion of Hawaii Institute of Marine Biology, Shark Research Group’s Dr. Kim Holland. Holland and his team research the behavior, physiology and ecology of sharks and other fish.

“I and my students have quite a bit of experience and have done research looking at what sharks can detect, both magnetically and electrically. The short answer is they are extremely sensitive to electric fields and magnetic fields, and they’ve got very good hearing, as well. Most of the devices tend to dissuade sharks by using electric current, and that’s been tried by a number of companies over the years. We actually got some money by an oil company whose gear was being damaged by shark bites, and they wanted to know if there was some way of deterring sharks, so we did quite a lot of work trying to find some sort of electrical signature that would be aversive to sharks and turn them away, which is exactly what these other companies have tried to do with various products. And the short answer to your question is that there is no known device- either commercially available or scientifically being tested- that works to deter sharks when they are motivated to attack. It’s not there.

“We’ve casually tested a couple of the commercially-available products over the years and have had sharks swim right through it. The problem is- in order to deter a shark, reliably- you need to have a current that is not just aversive but ispainful. If we were listening to someone scrape their fingers on a chalkboard, that’s aversive, and it might be enough to get us to stop what we were doing; If they gave us an electric shock in a chair, that’s something that would be painful. So, it’s a difference between being aversive and being painful, and most of the devices that have come up over the years- because you can’t have a huge amount of electricity being used (either because you need a very large power source, or because you would shock the person wearing the system)- you need to come up with something that’s aversive, not painful, and nobody has been able to find that for sharks. So, really, the short answer to all of these questions is- and probably one of the reasons these companies are not returning your inquiries- is because none of them have really shown that they work.”

Purna Nemani  

Aloha Tech Writers

Response

The ocean attracts people to it for many reasons, one of which is that it remains one of the last readily accessible places for most people to have a true adventure in a world that has become increasingly tamed and modified for the purposes of human progress and the ‘greater good’. The intersection of human and shark in the coastal/oceanic realm is one of the things that makes life more interesting and adds a bit of mystery and unpredictability back into the lives of those who choose to spend time in, on, or under the water. This is, of course, despite the fact that there are unfortunate instances where it does not go as planned (occasional shark-attacks). Those who chose to make a living or recreate in the ocean must be aware that once they set foot in the water they are entering an environment that is home to creatures that have evolved over millions of years to be very successful and efficient at what they do, whereas we (humans) have not. This humble realization should not serve as deterrence, but rather as a reality check and a healthy dose of respect that helps people make informed decisions about where they pursue their activities and the manner in which they go about them. And, at the risk of sounding spacey, this humble realization and respect can also be used as a way to find a deeper connection with the ocean and ultimately add to the context of how we view our own place in the world and the other creatures that are riding around the sun with us.

This may come across as an unpopular or inflammatory statement to some, but perhaps the presence of sharks and the occasional shark attack can help to keep the oceans from being completely overcrowded and saturated with weekend warriors and thrill seekers out to conquer the ocean on their own terms. If the oceans are somehow made completely safe for everyone that would likely mean that an even greater percentage of our ever-growing population would end up spending time in the water, equating to more surfers crowding popular surf breaks, more scuba divers spearfishing and depleting limited fish stocks or damaging sensitive habitats, more crowded beaches, and so on.  I certainly do not want to suggest that we should not strive to make our coastal areas safe and accessible for all to enjoy, but we should be careful what we wish for.

Orca/zebra patterned boards or suits: Sharks hunt for their prey using a combination of sight, smell, and electro-receptive abilities. Smell and electro-reception are used for long-distance detection and location of food resources, whereas sight is used in the approach and final moments leading up to capture and consumption of a prey item. The effectiveness of disruptive coloration or patterns applied to the underside of a surfboard or a wetsuit could potentially be affected by several things: the time of day/angle of the sun/cloudiness, underwater visibility/turbidity, and whether it is choppy or calm. For example, on a calm day with the sun overhead, the dark shape of a surfboard will be silhouetted against the contrasting lighter sea surface regardless of what pattern is underneath. And on other occasions where water clarity is an issue it is quite possible that the pattern might not be visible to a shark until it gets very close. And even then, the shark might not lock in on the uniqueness of the pattern in the moments leading up to an attack. Sharks roll their eyes back and/or protect their eyes with a nictitating membrane to protect them from damage during feeding, effectively and temporarily blinding them during the actual moment of attack. However, disruptive coloration/camouflage is used with great success by both predators and prey in the marine environment, and the idea could still hold great potential. The basic concept is that the animal employing the disruptive pattern is attempting to either blend in to its surroundings and/or to break up its outline to make it less distinct. One thing is certain, utilization of patterns such at these is much cheaper and simpler to employ than an elaborate electromagnetic field.

Tagging Great Whites: In recent years much has been learned about the movements and long-distance migrations of this and many other shark species. Numerous individual sharks have been documented as traveling hundreds to thousands of miles in a relatively short period of time. There are sharks that are sometimes considered as residents of a particular area and those that are transient that may only be associated with a specific location on a temporary basis. It is likely that during a shark’s lifecycle it may lean more heavily towards one or the other at different times depending on its age, its dependence on a particular food source, and/or its reproductive state. To place tags on enough of the population to be relevant to the purpose of protecting people in the water at any one location, or for multiple locations for that matter, would be quite an ambitious undertaking. In addition, any tag that has an electrical component to it, whether it is a GPS tracking tag or something designed to apply a deterrent stimulus, will be limited by the finite life span of its power source. Even the most advanced satellite tags used to track sharks over great distances have a limit to how long they are useful. Therefore, unless better batteries are developed, the tags would need to be replaced too frequently to be useful on a long-term basis. Furthermore, even if this hurdle were to be overcome, there could still be a problem with how the shark reacts to the deterrent stimulus. Suppose a shark has been fitted with a tag that delivers an electrical shock when it approaches a strategically placed safety beacon. Assuming the shark reacts with an immediate escape response, what guarantee is there that the shark would reverse course and head away from the beacon? In its panicked flight, it might end up swimming closer to the beacon unless the stimulus is strong enough and continuous enough for the shark to sense that things are becoming increasingly uncomfortable if it continues traveling in a certain direction. And even then, if it does decide to turn around and head in another direction, if it is still within range of the beacon it will still be receiving the shock, which could further confuse its direction of travel.

Electromagnetic Fields: Our lab has recently been involved in a project assessing the effects of EMFs on the marine community in southeast Florida. A system of cables that have been in place on the sea floor for many years was used as our experimental test range. The focus was on the reaction of reef fishes that live in the immediate vicinity of the cables to EMF fields of varying intensities. Field strengths tested were on par with those produced by existing and possible future marine hydrokinetic devices (MHKs), such as offshore wind turbines, solar farms, ocean thermal energy conversion devices, or anything else that uses submarine cables to transmit electrical power. Sharks and rays were encountered occasionally during this project, although in numbers too small to be relevant for a robust statistical analysis. However, anecdotally, our observations indicate that they were neither attracted nor repelled by the EMFs we were evaluating. However, it is entirely possible that utilization of EMFs of specifically enhanced/selected strength and/or frequency could be used as an effective shark deterrent on a small-scale basis. As Tom Garrison pointed out already (inverse square law), the strength of the field dissipates significantly as you move away from the source. I also agree with Claude Zanetti (response above), in that anything that is strong enough to deter an apex predator will likely have undesirable effects on the surrounding environment and other animals, including humans. But perhaps there is a “magic number” out there somewhere…an EMF of sufficient strength to deter the electro-sensitive sharks that is innocuous enough to be used in close proximity to human activity. The inverse square law could be quite useful here - the EMF producing cable (or cables – perhaps a curtain of multiple suspended cables hanging from buoys) could be located far enough offshore to prevent its effects from reaching the surfers in the lineup. More research is needed, but this idea has potential.       

Kirk Kilfoyle, M.S.
Research Assistant, PhD Candidate
Nova Southeastern University Oceanographic Center

I’ve never seen or tested a shark repellent that I would bet my life on.   I just don’t think that we know enough about shark behavior to develop repellents that would be successful under a wide enough range of conditions and across a wide range of species.  In addition, I’ve seen people exhibit more risky behavior because they believe the devices are 100% foolproof – and that is, in my opinion, a disaster in the making.  The ocean’s a dangerous place, if you want to play or work in it, accept the risks.  However, you can reduce those risks by being smart about what you do and how you do it when out on or in the water.

Christopher G. Lowe, Ph.D.

Professor and Director of the CSULB Shark Lab

Dept. of Biological Sciences

California State University Long Beach

Response

Sharks are endangered already.  We know the electromagnetic field exposure increases risk of leukemia and maybe other cancers in people that are excessively exposed, and brain cancer if they spend too much time on their cell phone.  Will use of electromagnetic shark repellents increase risk of shark cancer?   Perhaps we need to balance protecting the sharks verses protecting the surfers!

David O. Carpenter, M.D.

Director, Institute for Health and the Environment University at Albany

Response 

Most of the ideas you propose look OK, with the exception of these:

"2) Would emitting orca sounds from surfboards, swimsuits, or the bottom of the ocean at surf breaks provide any additional benefit?"

First, because sharks lack a swim bladder, they do not appear to have a very good sense of long distance hearing.  And they certainly are very unlikely to be able to hear the high frequency "orca sounds".  More importantly, there is the very real possibility that these sounds would adversely impact the behavior of marine mammal species (e.g., California grey whales) that are regularly preyed upon by orca.  So it's very likely that the adverse unintended impacts of playing "orca sounds" would have to be thoroughly researched and the technique would need to be approved by state and federal governmental agencies involved with marine mammal issues, both of which can be lengthy and costly procedures.

"We believe a safe method would be to tag all great whites with a sensor/transmitter capable of interacting with strategically placed shark safety beacons dialed into the same frequency of the great white tags. When the tagged shark gets too close to the beacon they get a shock and leave the area – similar to an underground electric dog fence."

I'm very skeptical that you would be able to "tag all great whites with a sensor/transmitter..." because of the expenses and difficulties associated with doing so.  Plus I doubt that you'd be allowed to do so, given the very real possibility of seriously injuring or killing great white sharks, and other species.
 

Richard Brill
Fishery Biologist
NMFS, NOAA & Adjunct Faculty VIMS

Response 

In short, the sea belongs to its denizens and we are ecotourists when we enter it.  Our venturing there comes with associated risks – drowning, jellyfishes, stingrays, and – yes – occasionally sharks.  Sharks kill on average six humans a year (only a fraction of those are surfers) but thousands die by drowning.

A central tenet of ecotourism is not to leave behind any footprints and we should endeavor to do the same.  We need to be smarter than the animals that inhabit the alien environment we choose to visit and avoid times and places where a negative interaction might take place.  It’s common sense.

This may necessitate us abandoning a great break because sea lions haul out there, drawing white sharks. Or we may choose to continue to go there at our own risk, but we can’t blame the critters if a bite occurs because our playground is their dining room.  Most surfers are already of that mindset, i.e. “Surfing is a wilderness experience that comes with risks that I’m willing to accept.”

Can I have an “Amen,” brothers and sisters…

George H. Burgess

Director, Florida Program for Shark Research

Curator, International Shark Attack File

Response 

The thought that we can engineer nature to make it safer for humans sends a chill to my heart. People need to take responsibility for their actions, which includes being aware of and accepting the risks of entering the ocean. There is something unique in our fear of sharks that make many compelled to try to engineer ways of preventing them. Many more people die each year by drowning in rip-currents then by sharks, yet they do not spark the controversy and outrage that a shark attack does. If a surfer drowns politicians and communities do not close the beach or build a break-wall to stop the waves or currents. Yet, driven by our fear of sharks we invest millions into the design and implementation of shark culls, shark shields, and patterned wet suites and surf boards.  I believe that the best way for us to protect sharks is to better understand Galeophobia (fear of sharks) and why humans respond to shark attacks in the way they do, and most importantly to change our cultural views of sharks. In my opinion engineering equipment, such as electric fences, to reduce shark attacks is unlikely to be met with any level of success. Our biggest investments should be in rewiring society’s views of sharks.   

Trisha Atwood

Assistant Professor

Watershed Sciences and Ecology Center, Utah State University

(The views expressed above are those of Dr. Atwood’s and do not represent the position or views of Utah State University)

Response 

I read through the responses, which are quite varied. I have no professional opinion about the efficacy of shark repellents, but I have an ethical view that sharks should not be killed as a precaution. 

The little I can add, personally, is that some years ago while briefly living in Hawaii, I did daily swins across a wide bay mouth in Kauai. As the days went by I was increasing spooked about looking down, quite far, into the fading deep and imagining something come up from below. Finally I decided I was not comfortable swimming in deep water and gave it up. 

Jim McWilliams 

Dept of Atmospheric and Oceanic Sciences 

University of California, Los Angeles (UCLA)

Response 

First off I’d like to make it clear that I am a 4th year PhD student with research interests in physical oceanography.  So I work mostly with fluid dynamical concepts and problems, and am not necessarily qualified to confidently give insight on behavioral patterns of sharks as they respond to temperature or fish stock changes.  That being said, there is a rather obvious intuitive inference that marine life will have a response to environmental conditions (water temperature, nutrient levels).  The only confident claim I would make is that this response will temporarily shift patterns away from what is statistically normal.  Maybe that is obvious, but without doing an actual quantitative assessment (potentially a couple of years of work) I do not know what the nature of that response would be from a statistical standpoint (e.g. what is the probability that you run into a shark while surfing during an El Nino vs La Nina year at the same location).

The ENSO (El Nino Southern Oscillation) event this year has already brought much warmer water along the California coast via the collapse of upwelling in the eastern equatorial Pacific and maintained by the eastward propagation of oceanic Kelvin waves along the equator and up/down the west coasts of North/South America.  The California Current System has been shown to respond to an El Nino event with reduced upwelling.  This essentially means warmer waters and less nutrients brought up from depth, thus lower primary productivity (i.e. plankton blooms).  Lower primary productivity means less food in the water for larger organisms, so it is probably a safe assumption that there would be some migrations of California Current marine life in search of food due to the lower local food supply.   Again, without giving a quantitative assessment, I would think it is reasonable to assume that marine life (starting from plankton all the way up to sharks) will show a transient response to these increases in water temperature and decreases in nutrients/primary production; the normal geographical patterns of where sharks are found could be influenced (and thus changed) by the trophic system’s response to ENSO.

I think the most feasible shark deterrent system presently in place is Shark Shield (https://sharkshield.com/).  Orca patterns on the bottom of a surfboard are easy and cheap, but a surfboard is nowhere near the size of an actual orca, so I have a hard time imagining why a 15ft Great White would back away from a ~6’1 x 19’ x 2.5’ orca.  From what I read, the orca pattern is only meant to disrupt the shark’s vision in the final phase of an attack (when the prey is near), so my interpretation is that this will not necessarily prevent collisions/onset of attack (it may change a bite to a bump).  Also, attempting to tag every shark out there just strikes me as way to laborious with no guarantee that every shark is accounted for; it seems like a very costly way to go about solving the problem, with the constant need to update the system (i.e. find and tag new sharks).

To my eye, Shark Shield has shown the most promise in testing with actual quantitative results indicating less probability of attack with the Shark Shield turned on (https://sharkshield.com/scientific-research/)  From a an non-scientific standpoint it is also apparently endorsed by some professional surfers (http://stabmag.com/shark-repellents-are-so-hot-right-now/) who give anecdotal testimony to its efficacy (I would take the published papers more seriously, but the anecdotal evidence can be interpreted as promising).  

I think there are two ways to think about the extrapolation of the single unit Shark Shield to cover a larger area.  The first, I would guess would be heavily endorsed by the Shark Shield people: if most of the surfers in a crowded break have Shark Shields, you already have an array of units all sending signals out, thus protecting most of the surf-zone.  The other, is some form of the idea mentioned in the article, in which the same technology used in Shark Shield is somehow retrofitted to a surf-break.  I think I share the same thoughts with most of the other people responding, that testing would definitely need to be done to see what the fundamental effects on all marine life are before that is implemented.

daniel

Daniel Dauhajre, PhD Student

UCLA Department of Atmospheric and Oceanic Sciences

Response 

Response 

Patterns on the bottom of a board as a potential repellant does make some sort of sense.  A surfer with appendages dangling over the edge of his board does look rather seal/sea lion like, and anything capable of changing that pattern might be a positive development.  The electromagnetic idea might work, but sadly its effectiveness would probably be limited to very close quarters (unless vast amounts of power were used – inverse square law and all that).  Tagging with beacons any significant percentage of Great Whites in this area would be a near-impossible task.  Good idea, though.

Meanwhile, there is a sort of backward-positive bit of good news about this temporary inundation of sharks:  Folks are beginning to think climate change is real, and about its effects on the ocean. 

-Tom Garrison

Orange Coast College

Response 

Shark Repellent Strategies:

In light of the success of mimicry strategies in deterring predators in the wild (Viceroy butterflies versus Monarch butterflies or scarlet king snakes versus coral snakes), Orca patterns on surfboards, or devices to emit Orca sounds from surfboards, swimsuits, or the ocean floor would seem to be the most promising.

Strategies to tag white sharks with a sensor/transmitter capable of interacting with safety beacons seems to be a good strategy, although the challenge is to make sure that all sharks that might appear in the area are tagged.  The main concern in this respect is the huge range of great white sharks tagged and tracked in the wild.

The electromagnetic field strategy would have to be tested. Location strategies in electric fish work well in navigation and for locating prey, and involve very low voltage. The safety of higher voltages and the effectiveness of specific electromagnetic fields to repel sharks would need to be tested.  I expect that insufficient information is available on the safety effects of the proposed voltage ranges on humans (and marine life).

Julian H. Lombard, Ph.D.

Professor—Department of Physiology

Medical College of Wisconsin

Response

As to mutagenesis or carcinogenesis from electromagnetic fields, while I'm not qualified to speak authoritatively, I harbor doubts about any significant effect. Every news note or study I ever heard reported on the subject came back negative or (in rare cases) a small trend effect "worthy of further study" (but perhaps not even statistically significant) was seen. Given the pervasiveness of such fields in modern society and their absence in remote environs, we're not seeing the difference in cancer rates among city and wilderness residents to suppose any strong effect. (Also, unlike "ionizing radiation" at the highest end of the EM spectrum, EM fields are not ionizing, and it's therefore a little harder to imagine how they would significantly prompt mutations or other chemical changes predisposing to cancer (or other major disease). An MRI is still safer than a CT...

Case Ketting, MD

Response

Human nature is designed to focus on the threats even when the statistical likelihood is low. For example. Most folks way overestimate the risk of dying from terrorist attack or plane crash. In fact the risk of dying from road accident is orders of magnitude greater. Ditto, sharks.

Paul D.

Response

It appears that my concern and opinion are pretty consistent with those more directly involved with the field of study...I think that products or ideas such as this feed the fear and seek to profit in some manner than to really help...the magnetic anklets are a good example...you have a higher risk of getting speared through the leg, gut or head with your or someone else's surfboard. Pura vida.

Robb Havassy

Robb Havassy

Artist

Response 

I'm an avid surfer and spearfisher which puts me in the highest risk groups for shark bites, but I don't use shark repellents because I'm skeptical about their effectiveness in reducing the already very low risk of a shark bite.

Commercially-available shark repellents run the gamut from absurd to potentially-effective, but none are likely to be 100% reliable.  Nonsensical repellents include wetsuits and surfboards with stripes and other disruptive patterns.  The rationale behind these patterns is that they mimic the appearance of highly-venomous sea snakes and hence will be avoided by sharks.  The genius who came up with this notion apparently overlooked the fact that sea snakes are a regular component of the tiger shark diet in many regions, plus when viewed from below against a brightly-illuminated sea surface, objects decorated with patterns still appear as dark silhouettes!

Electrical repellents, such as Shark Shield, have a more scientific foundation, and I've actually tested one in a very basic experiment with wild sharks.  I attached the Shark Shield below a floating PVC frame at the site of a Galapagos shark aggregation off Hawaii.  I first deployed the Shark Shield with the power off, and dropped chunks of fish next to it.  Galapagos sharks approached to within 30 cm of the Shark Shield to consume the fish.  I then switched on the Shark Shield and repeated the experiment.  Guess what!?  Galapagos sharks approached to within 30 cm of the active Shark Shield to consume the fish!  I was actually very surprised by this result, because the manufacturer’s website has videos of huge sharks flinching and turning away when the Shark Shield is turned on. However, I was unable to produce this response in Galapagos sharks.

I still believe electrical repellents may deter sharks under certain circumstances but I certainly wouldn't bet my life on one.  More experimental work is needed to understand the limitations of these devices.

Carl Meyer, Ph.D.,
The Hawai'i Institute of Marine Biology

Response 

While the pursuit of shark repellents is a worthwhile one, I am afraid most of the products on the market or in development are not based on rigorous scientific testing and their effectiveness is inconclusive at best.  At worst, they may provide surfers and other ocean enthusiasts with a false sense of security that could lead to them to engage in risky behavior, like being in the ocean alone, at night, near sea lion haul-outs etc.  

Electromagnetic repellent devices may be the most promising, but these need more independent testing.  The orca pattern on the bottom side of a surf board may or may not do anything.  The same could be said for the striped pattern or even striped wetsuits.  These may offer some camouflage effect, but animals are also attracted to novelty and if it is something the shark has not seen before, it may investigate (with its mouth).  Orca sounds may or may not be a deterrent, if the sharks can even hear the sounds.  Sharks hear very low frequencies and the machines needed to generate low frequency noise that travels far distances are large and expensive.

Lastly, tagging all the white sharks in the ocean is not feasible and very costly.  It would also require a constant effort because newborn sharks would have to be constantly tagged as they grew as well as new sharks that enter from other areas.   Even if you could tag most of the white sharks, how would the public respond when one was detected nearshore?  Would they not enter the water?  White sharks are all over, so there would be detections all the time.  If there were no detections, would people assume there are no sharks in the water?  That would also be incorrect because there would obviously be untagged sharks out there.  Given how few people are injured by white sharks every year off California, I'm not sure that the investment in time and money could be justified.  

I think what is most important is that we keep things in perspective.  The chances of being injured or killed by a shark are vanishingly small.  Perhaps that small risk is just something we have to accept when we enter the water for any purpose?  This does not mean we shouldn't think about ways of further minimizing risk.  After all, that's why we have seat belts in cars and why there is a growing push for self-driving vehicles.  That is also why hikers carry bear spray in the woods.  However, at this point, the best way to minimize risk of a shark bite is to always have a buddy nearby who can help in the event of a shark encounter (or other much more likely medical emergency), minimize water activities at dusk, night, and dawn, when sharks are most active, and to avoid places with lots of food like bait, marine mammals, and river outflows.

Andy

Andrew Nosal, Ph.D.

Postdoctoral Researcher, Scripps Institution of Oceanography

Response 

My thought is this, if it's strong enough to drive away Great Whites how good can it be for humans, and "everybody knows" you can get cancer from cell phones, and living near power lines (cancer cluster debate).  The practical issue is the liability issue for the device's risk real or imagined and public perception.

We all know irradiating food would save thousands of lives from food borne epidemics, and how about nuclear power to save hundreds of thousands of lives each year from air pollution deaths alone. Gosh no!!! We can't have nuclear, or electromagnetic or cosmic rays!!! Don't the astronauts and flight attendants get more cancer over a lifetime???? But wait, there's hope to market this device!!! The earth's magnetic field holds all that bad stuff at bay in the Van Allen Belt!! There you go, that's the ticket!!! I'm sold!  Great piece dude!

Claude Zanetti, MD

Response 

Shark & Ray Sensory Biologist & Ocean Educator
World Below the Waves

Response 

I believe that the ocean should not be a big safe bathtub.

We are seeing globally the consequences of human activity that is changing and threatening all life and future life in our planet. One aspect is the loss of the top predators in our ecosystems, on land and in the ocean.  I refer you to this study. https://scripps.ucsd.edu/news/1925

"The decline of apex consumers has been most pronounced among the big predators, such as wolves and lions on land, whales and sharks in the oceans and large fish in freshwater ecosystems. But there have also been dramatic declines in populations of many large herbivores, such as elephants and bison. The loss of apex consumers from an ecosystem triggers an ecological phenomenon known as a "trophic cascade," a chain of effects moving down through lower levels of the food web."
 

We Humans need to temper our needs and desires for unbridled consumerism with consideration for these consequences. That is the challenge of our times, to preserve the world for future generations of life. 
 

Carmen Ramírez

Mayor Pro Tem,

City of Oxnard, CA

Response 

Surfing is an inherently dangerous sport. Anyone that decides to pursue this undertaking has to accept responsibility for personal injury and any potential environmental effects. The only action I would consider are measures that are paid for by the responsible human parties, and have zero impacts on shark populations, that are already threatened due to human related activities such as habitat encroachment, overfishing, and pollution. 

Karen Crow-Sanchez

Associate Professor

Department of Biology

San Francisco State University

Response 

My personal opinion is that we (humans) are entering the shark's home. 

ryan scuba

Ryan K Walter

Dept of Physics, Cal Poly

New Zealand

Regarding sharks. I have never really considered using a repellant due to the fact that attacks here in Aotearoa are uncommon. In saying that, I am very aware that when I am shooting at dusk or dawn (when the light is optimal for creating images) and especially when I am shooting flash images in the water, there is always a chance that I will have an encounter with a shark. I guess I try to put it out of my mind and focus on enjoying being in the ocean and doing what I'm doing. The ocean is a shark’s home; it's their environment and we are guests. I met a guy who worked for Sharkdiver Magazine and was shooting a feature on sharks at the bottom of the South Island for the Discovery Channel a few years back. You get some enormous Great Whites down in those waters and the interactions he is able to have with them blew my mind. I guess if a repellant was proven to minimize the risk of an attack while not harming the creature I would be all for it. Overfishing appears to be having the biggest impact on where sharks are looking for food, so I think getting this under control would be the optimal means of limiting future attacks.

Punis Farm, Jim Culley

Jim Culley

Photographer

Response

This discussion is timely given the recent attention shark populations are receiving from both shark attacks and increasing regulations on the shark fin trade. While even the most skilled water person is not immune to the power of the ocean, I find the risk to be part of the allure. As a surfer, the idea of shark deterrent technology is compelling; and as a mother, I would likely encourage my children to use shark deterrent technology that has been shown to decrease the risk of an unwanted shark encounter. However, as a conservationist, I question the ethics of invasive technologies, such as shark nets or electric fences. Among others, this paper discusses the use of shark tags as triggers for an electric fence-type technology. Instead of “zapping” sharks, I would like to see this or similar technology used to improve more passive measures designed to reduce encounters between sharks and ocean users (e.g., shark spotting technologies).

brooke

Dr. Brooke Porter

New Zealand Tourism Research Institute

Auckland University of Technology, New Zealand

Scotland

My comments come from research on sharks and from being an avid diver having spent a lot of time underwater with a wide range of species. The problem with the majority of shark repellents is that they come with the manufacturers claims of working, but they have not been rigorously tested and published through peer-review.  That is starting to change but it’s important to stress how difficult it will be to test repellents under the scenarios by which a shark may attack a human. For example, attracting sharks with bait while testing may still not elicit the same response as an animal that is naturally trying to forage on large prey on the surface. My own personal experience has been using a shark shield with bait experiments in Hawaii, which I was not impressed with. Other methods such as electric / magnetic / chemical / visual repellents may work in some situations but their effectiveness in other locations/situations are less clear.

There are some methods currently being tested that show promise, but I certainly would not bet my life on them working and have not seen nearly enough to say that they will work. I would personally not bother using any devices currently on the market, at least when it comes to diving.

tigerrestraint

Dr Yannis P. Papastamatiou

Scottish Oceans Institute

University of St Andrews

South Africa

knowledge on behavior (that of both sharks and humans). Of course, for any rigorous scientific approach, the proof of the pudding is in the eating, in other words the results of shark repellent studies should wherever possible be validated by independent data. Shark repellents are better than “culling devices” that intend to minimize shark-human encounters through death of an animal in its natural environment, at least in my view.

Simo

Simo N. Maduna, M.Sc. cum laude

Ph.D. candidate

Department of Genetics

Stellenbosch University

Spain

I fully agree with Lindy Weilgart and Sebastian Biton Porsmoguer.  Any system that uses electromagnetic radiation to scare away sharks particularly affect species with low mobility who live in the area (bivalves, algae, corals, small fishes, crabs ...) and affect much less to highly mobile species who often travel long distances and spend little time in the same place (like sharks…), because the effects of these radiations normally are long- term and the exposure time is an important variable to consider.

Alfonso Balmori

Biologist, Spain

Responses are organized by country (countries presented in alphabetical order) spanning five continents. 

Australia – Brazil - Canada - France & Reunion Island - New Zealand - Scotland  – South Africa – United State of America.

AUSTRALIA

Well done on getting the discussion going. I think we’ve taken a rather piecemeal approach to the testing of shark repellents and it’s hard for consumers to know what to believe. Being a scientist I naturally gravitate towards the need for robust, empirical, peer-reviewed testing of the various options. As was concluded from the shark summit in Sydney last week, the technology still has a long way to go. I’ve worn shark deterrent devices (’shark shields’) a lot while working on the east coast of Australia, but I only wore them because it was EH&S policy of my University - not because I trusted them. Funnily, we used to work a lot with State Government and their EH&S policy banned the use of shark shields because their shark scientists believed it actually increased your chances of being attacked! From my reading of the various scientific testing that has been done on shark shields and other similar deterrent devices, their effectiveness really context specific and depends on the motivational state of the sharks. For example, a sharks shield may be effective for a curious a great white that approaches a surfer with curiosity, but not for a great white that is charging from below in full attack mode. 

Dr Peter I. Macreadie

Senior Lecturer | Australian Research Council DECRA Fellow

Plant Functional Biology and Climate Change Cluster - UTS; & 

Centre for Integrative Ecology, School of Life and Environmental Sciences 

Faculty of Science Engineering & Built Environment, Burwood, Deakin University

Response 

The potential threat that sharks pose to ocean users has led to the adoption of a range of shark control programs around the world that often involve the removal of sharks to reduce risk. These programs are at odds with the important ecological role that large predatory sharks play in ocean ecosystems, as they do not discriminate by species or size, so they place increased pressure on non-target and potentially vulnerable species. The effects of removing sharks from our oceans, although complex and rather unpredictable, can be ecologically and economically damaging. There is, therefore, a clear need for alternative non-lethal shark mitigation solutions that will allow humans and sharks to safely co-exist.

Research has shown that certain low-voltage electric fields can be effective at deterring a range of shark species, but questions still remain about the effectiveness of this type of stimulus over a prolonged period.  My own previous research has shown that shark embryos will habituate to electric fields resulting in a reduced response to the stimulus over time. Now, my current research is investigating this effect in a range of wild sharks, including white sharks, to see if they will also habituate to an electric stimulus, and if so, determine how their behaviour may change over time. Once this information is published, we will be in a better position to develop new effective electric deterrents, and also provide advice on how we can improve current technologies. However, it is important to remember that no deterrent is ever going to be 100% effective. We must always take precautions to reduce our own risk of injury, and although a deterrent may well be part of the solution, it is unlikely to be the whole solution.

Dr_Ryan_Kempster

Dr. Ryan M. Kempster 
Shark Biologist & Founder of Support Our Shark
The UWA Neuroecology Group
School of Animal Biology
University of Western Australia

Response 

As a professional surf photographer based in Margaret River Western Australia which over years has had a number of fatal shark attacks around the area and with all the over the top press it was certainly in the back of my mind when swimming out to sea on my own.  The only time I have ever used a so called shark repellent is when I swim at a place called the “Right”, being the only one in the water a mile out to sea where we have seen a number of Great Whites and been bumped on the ski is the only time I have to overcome a mental hurdle, to be honest I don’t even think the shark shield would even work on a Great White (I wear it only for peace of mind), I rely more on the feel of the situation and then I make my decision to swim or not swim. I would love to see an amazing scientific study on everything to do with sharks; amazing creatures and I look forward to swimming with them in the future to gain more knowledge on the subject.

image1

Russell Ord

Photographer

Response 

I love the ocean. I grew up in the water on the West Coast of Australia (where shark attacks are not uncommon). Sure, there's always that slight fear about what I can't see, but in reality, I'm probably surfing with sharks every day I go out without even realising. 

I think people get wound up in the hysteria and forget that we are humans entering their environment. I am by no means a shark expert. have opinions, but they're not educated and could perhaps contradict views from experts in fields related to this topic, however there's no doubt that Sharks play a vital role to the ecosystem of the ocean, and definitely shouldn't be culled just because they have teeth and occasionally bite humans.  I feel that an issue which should be addressed, is the over fishing of our oceans. The fact that there are less and less fish in the ocean would surely be a reason as to why sharks are coming in closer to shore looking for food? 

I think it's tragic when we lose another fellow ocean lover to a shark, but at the same time, we all take the risk when we enter the water. I've watched a few talks and read articles on ideas such as visually confusing sharks (whether it be via painted patterns on the underside of boards, patterned wetsuits etc) but I think sharks generally have pretty poor vision- they work off smell and vibrations rather than sight- so I'm not entirely sure if these visual distractions would work (again like I said, I'm no shark expert- so perhaps I'm completely wrong). 

I'm totally keen on the idea of tagging sharks that continually enter an area- I think that is a relatively non-invasive way of tracking sharks, and ensuring the public know if a shark may be in the area...again, I'm not sure how viable the idea is- financially, and practically- but I feel like this would be the best way to combat the rising number of shark attacks.

LUCKYBAY

Sharma Heylen-Silvia

Design and Illustration

Artist

Response 

Given that I have surfed (Frequently) at very shark infested breaks –

South Africa (Cape Town), East Coast of RSA (Nahoon Reef), and now in SW WA, Margaret River region, I feel that common sense should prevail!

Also, now if you check on the situation on the Island of Reunion – where surfing is basically banned!!

It appears that sharks movements and behaviours have changed quite radically over the last few years.

Causes: Multi-factorial (Global warming, over –fishing, cage – diving, plastic pollutants, noise pollution etc)

Added to this we have many more humans on the Planet, and now many more surfers.

We are on their turf, and even when all the above is taken into account the Great White, and Bull Shark spottings are still rare.

After a run of attacks in WA last year, we had Drum Lines, and Baiting to draw the GW’s in for culling:

Guess What – Over a whole summer season, not One sighting.

So in the interim – striped boards and wetsuits Might be part of the solution.

Electro-magentic fields might also help.

But, If the GW is hungry, or in a bad mood, and you are nearby – best you have your best game on to escape!!

Life will never be without risks, and I feel that it’s a good thing to step outside one’s comfort zone at times.

Keep the research flowing (tagging / monitoring)

But in the interim, enjoy the ocean and embrace the risk!!

As I said before: Relax, Assess and React!

My 20 cents worth.

phil wave

Phil Chapman, MD

Emergency Medicine Attending (Specialist)

Surfingdoctors.com

Response

I am not a shark expert, and have no experience with any shark repellent. Nor am I a surfer.  What I am is a marine biologist, who has spent a lot of time SCUBA diving in blue water studying larval fishes.  Most of my diving has been in the tropics, and in many hundreds of hours doing this sort of work, we have only rarely even seen sharks (that is not to say that sharks have not seen us when we have been unaware of it!). I have had a lot more encounters with sharks diving on reefs, and the only time I have ever been threatened by a shark was while snorkeling on a reef. 

The sharks we saw in blue water were almost always species of the genus Carcharhinus, and usually were only slightly to moderately interested in us.  The exception was during an experiment on the Great Barrier Reef when we were observing the behaviour of fish larvae while we were broadcasting underwater for about 30 minutes sounds recorded over a coral reef, and alternating with similar periods of no broadcast.  A species of Carcharhinus appeared, and aggressively approached our dive team in the classic threat posture (back arched, and pectoral fins spread).  The divers immediately exited the water. We think this was either a bull shark or the closely-related pig-eye shark.  Nothing similar happened when we were continuously broadcasting the same sounds over several days, so it seems that the changing sounds were the thing that attracted the shark, and initiated its aggression.

We have done similar studies (but without the underwater sounds) in temperate waters off New South Wales, and never saw sharks, even though it has subsequently been shown that we were working near Stockton Beach where juvenile Great White Sharks are common.

So, my only real experience in manipulating shark behaviour, was unplanned, and attracted them rather than repelled them.  Therefore, my experience does not really add anything helpful to the discussion.  I would add, however, that no one should rely on aerial surveys to accurately assess the presence or absence of sharks.  Studies off both the east and west coasts of Australia have shown that aerial surveys miss most of the sharks that are present, and can actually mislead the public, giving them a false sense of security when no sharks are reported.  A final word – given how unpredictable sharks are, and the multiple senses that they possess, I would not be optimistic about finding a ‘silver bullet’ repellent.

Jeff Leis

Senior Fellow, Australian Museum Research Institute, Sydney

and

Adjunct Professor, Institute for Marine and Antarctic Studies, University of Tasmania, Hobart

Response

Historically, our interaction with the environment has often reflected an anthropocentric and domineering perspective. Thankfully, there appears to be an emerging paradigm that not only questions this perspective, but offers a more compassionate and altruistic alternative (Bekoff 2013). Our biological dependence on nature means that nature’s survival is integral for our own. Thus, environmental conservation and management that is based on compassionate philosophies, could provide the new model we need to ensure our survival on this planet.

The public are challenging shark management policies that reflect an assumption that humans’ right to the marine world, trumps that of sharks’. For instance, a lethal shark management policy that was implemented in Western Australia generated a lot of controversy (McCagh et. al. 2015). While some of our interaction with sharks has resulted in injury and deaths (on both sides), people are becoming less convinced that our reaction should be lethal. Instead, increasingly, there is a call for alternative strategies that encourage the co-existence of sharks and humans. Fortunately, there have been responses to this call including studies that investigate the effectiveness of shark repellents. Studies such as these, will help maintain our intrinsic bond with the marine environment, without destroying it.

I believe that the paradigm from which we decide to interact with our natural world will largely dictate how compassionately or oppressively we will manage our environment, which will ultimately affect our own survival.

Christine McCagh (Dip. Biological Sciences)

University of Western Australia

References

Bekoff M. (Ed.). 2013. Ignoring nature no more: The case for compassionate conservation. University of Chicago Press. USA.

McCagh CM, Sneddon J and Blache, D. 2015. Killing sharks: The media’s role in public and political response to fatal human–shark interactions. Marine Policy 62: 271-278.

Brazil

I do not believe that shark repellents are effective. Sharks are unpredictable and these repellents can bring confidence for people to get in the water considering "without risks of shark attack". I believe that the more reasonable solution may be to just keep people out of the water in areas prone to shark attacks, and the government needs to invest more funds in educational awareness programs and research on how to avoid encounters with sharks.

Logically, with fewer people in waters, the probability of a shark attack is concomitantly reduced. In Brazil, for instance, the sum of the two actions: Shark Monitoring Program (Hazin F.H.V. & Afonso A.S. 2014. Animal Conservation, 17: 287-296) and environmental education campaigns (Liberal C.N. et al. 2006. Tropical Oceanography, 34: 85-97) has been responsible for reduction of the rate of shark attacks by 97% in Recife, northeastern Brazil.  The "formula" cited above used by a developing country can serve as example of how to reduce shark attacks in other countries of the world, without resorting to capturing and culling sharks.

hugo

Dr. Hugo Bornatowski

postdoctoral - Instituto de Pesca, Santos, Brazil.

References 

Hazin, F.H.V. & Afonso, A.S. 2014. A green strategy for shark attack mitigation off Recife, Brazil. Animal Conservation 17: 287-296.

Liberal, C.N., Santos, G.K.N., Demétrio, K.M., Morimura, M.M. & Vasconcelos, S,D. 2006. Shark attacks in Pernambuco, Brazil: analysis of bather’s perceptions and environmental factors. Tropical Oceanography 34: 85-97.

Response

In Brazil a recent study published in Fernando de Noronha Archipelago found tourists exhibited positive attitudes toward sharks while local people were less aware of the potential for shark watching on the island (Garla et al., 2015). The Archipelago belongs to the state of Pernambuco, whose capital, Recife, has been experiencing a problem with shark attacks since 1992 (Hazin et al 2008), as well as recent shark culling retaliation organized by local NGOs (Bornatowski et al. 2014). Under this scenario, the use of shark repellents would be desirable instead of extermination, as claimed by some groups. However, the efficiency of these shark culling programs has not been clearly proven (or approved) by scientists. Beyond the discussion on the effectiveness of any shark repellent to really deter sharks, there are additional ecological concerns to be pondered. Do we really need to ban sharks from certain areas? What would the effects to the local ecosystem be if shark were repelled? What effect would restricting the access of sharks to certain areas have upon the overall shark populations? As large apex predators sharks require extensive areas for feeding, reproducing or simply living. Restraining their use of the ocean does not sounds fair and may result in undesirable effects on the local marine ecosystem and on shark populations.

dono do dt fóssil SA

Dr. Adriana Carvalho

Department of Ecology Federal University of Rio Grande do Norte

Natal, Brazil

References

BORNATOWSKI, H., R. R. BRAGA and J. R. S. VITULE. 2014. Threats to Sharks in a Developing Country: The Need for Effective and Simple Conservation Measures. Natureza & Conservação 12(1):11-18.

FREITAS, RENATO H.A. ; CALADO, JANAINA F. ; PATERNO, GUSTAVO B.C. ; CARVALHO, ADRIANA R. . Public awareness of the economic potential and threats to sharks of a tropical oceanic archipelago in the western South Atlantic. Marine Policy, v. 60, p. 128-133, 2015.

HAZIN, F. H. V. ; G. H. Burgess ; CARVALHO, Felipe Correa de . A Shark Attack Outbreak off Recife, Pernambuco, Brazil: 1992 2006. Bulletin of Marine Science, v. 82, p. 199-212, 2008.

CANADA

I don't have much expertise when it comes to shark repellents and would echo those responses that suggest that we need to accept the usually small risk that sharks represent to humans.  I would not be in favor of killing sharks, especially given how low shark numbers have dropped worldwide.  I would be leery of EMF repellents and acoustic repellents because of the unintended consequences and low predictability to both sharks and other marine life.  They would have to be thoroughly studied long-term in terms of effectiveness and impacts to all components of the marine ecosystem, which is quite an undertaking.

Lindy Weilgart, Ph.D.
Adjunct, Department of Biology
Dalhousie University
Halifax, Nova Scotia, Canada

Response

My name is Scott Seamone, and I am a PhD student at the University of Calgary exploring how morphology influences locomotor behaviours in fishes. My experience with sharks extends from scuba diving with 15 species of sharks around the globe, in addition to academic and personal research.

I do not support any safety measures that involve the killing of sharks. I also do not advocate for shark barriers that are potentially harmful to these animals via entanglement, yet I have been rather impressed by the Eco Shark Barrier (http://www.ecosharkbarrier.com.au), and I have read nothing but positive reviews thus far (see Case study: Coogee Beach, https://www.dpc.wa.gov.au/science/SiteCollectionDocuments/Review%20of%20the%20Dunsborough%20Beach%20Enclosure%20Trial.pdf)

In addition to exploring the Eco Shark Barrier further, in areas of high risk for unwanted shark-human interactions, I believe attention should be focused on increasing lifeguard/shark watch on land, on water (by watercraft), and in air (by aircraft), pending on finances. Consequently, this helps prevent an even greater coastal threat - drowning. Further, raising public awareness about sharks, including how to behave in the presence of a shark that has not yet attacked (both aggressive and non-aggressive), in addition to how to respond to an attack (personal or to another individual) is necessary. I would also advocate to ban swimming/surfing activities and beach/pier fishing from occurring in same location, designating separate zones for both activities that are strictly enforced. I agree with cage diving, or chumming the water to scuba dive with sharks, but I would encourage banning shark-feeding activities where a scuba diver is directly feeding a shark outside of a cage. I believe this changes the behaviour of sharks, like a stray animal that is timid at first, but then becomes more comfortable the more it is fed. We do not feed wolves, cougars and bears at National Parks for this very reason.

Tagging research is very important (to understand times that one may be more prone to a shark encounter, in addition to many other reasons), yet the idea of tagging all of the great white sharks in the ocean just does not seem possible because of how much it would cost, the lifespan of tags, and the notion that you just are not going to get your hands on “every shark”. Also, from my understanding bull sharks, tiger sharks, and possibly others pose more threat to humans than great whites.

There are currently no shark-deterring devices that I would trust for all of the reasons that have been discussed throughout this forum, but I will reinforce a few main reasons. Research, especially the paper by Gardiner and Motta 2012 (http://scholarcommons.usf.edu/etd/4046/), has revealed that predatory behaviors in sharks differ from species to species, and thus, I agree that a device that may work on one species is not necessarily going to work another. Also, I too would worry that a device sending electric signals strong enough to deter a shark may cause biological damage to myself. In terms of devices that send out sound signals, from my understanding very little is known regarding the capabilities of hearing in sharks, and how this changes from species to species. Thus, I would not be confident in the orca-sounding device that has been mentioned, and it would be unfair to the consumer to sell this product without proper testing. With regards to colourful wetsuits or surfboards, any visual pattern will become a silhouette when viewed from below and into the sun. Also as mentioned, orcas are massive, and the thought keeping a shark away by painting an orca design on a small surfboard just does not seem very effective.

Finally, I too believe that we should enter the ocean accepting of the risks that may come.

Most people who grew up around the ocean seem to think this way. My condolences to those who have been affected by an unwanted shark-human interaction. 

Screen Shot 2013-06-19 at 2.49.01 PM

Scott Seamone 

PhD student, University of Calgary

Calgary, Alberta, Canada

FRANCE & REUNION ISLAND

I´m a surfer and I agree with Dr Christopher Lowe.  The ocean´s a dangerous place.  It is very difficult to predict shark attacks.  We tested electromagnetic waves in longline fishing vessel (Biton Porsmoguer et al., 2015). The results showed that electromagnetic waves were ineffective to reduce catches of blue shark (Prionace glauca) and with others pelagic species (shortfin mako). I also agree with Dr Marc Soria. The mixing of caution (local knowledge, scientific studies) could be a good solution. The better solution: we are only privileged visitors, so we need to respect the oceans.

DSC_0029

Photo Caption: Biometric data. Shortfin mako (Isurus oxyrinchus) caught by a Spanish longliner in Vigo, Spain (march 2012). SBP.

Sebastian Biton Porsmoguer
Ocean Engineer - Shark Researcher
Aix-Marseille University - Mediterranean Institute of Oceanography (MIO)

Biton Porsmoguer, S. Banaru, D. Boudouresque, C-F. Dekeyser, I. Almarcha, C. 2015. Hooks equipped with magnets do not reduce by-catch of blue sharks (Prionace glauca) by long-line fishery. Fisheries Research, 172: 345-351

Response 

Whatever the repellent type used it seems that none of them can offer a full protection.  Patterns on suits or surfboards need to be tested on lures before to be sure they are effective.  From my knowledge these tests have never be done. The same goes for orca sounds and electromagnetic emission, although preliminary tests on sounds were negative (sounds could not be heard by sharks at very long distances and electromagnetic fields seemed to actually be attractive at low intensity or worse induce frenzy behaviors.)

I have seen barriers of artificial kelp beds to be effective against sharks. From my point of view the success will be in the mixing of caution and wariness (by taking into account the knowledge of scientists and local people to avoid risky behaviors) with alarming systems (by tagging sharks), avoiding systems (for example by trans-locating sharks as it was done at Recife) and repelling or protecting systems (as with experienced underwater divers for example).

Marc Soria

Coordinator of CHARC Program in Reunion Island

Research Engineer at IRD (UMR Marbec)

Response 

It is common knowledge that the regular practice of water sports & water based activities provides wellbeing to many people across the globe, thus benefitting their mental & physical state and helping them to balance their life. Therefore, not being able to access the ocean while living on a tropical island is a real torment, especially when you’ve been born & raised by the sea.

With each new attack, a choir of so called “experts” implicates and pinpoints “careless” or "risky" human manners, but in some places (such as Reunion Island and Recife in Brazil) there are no more “safe conducts”: the simple fact of entering the water is a risky behavior,  where you are putting your life on the line!!

In many places, water sports & activities were able to be developed and thrive thanks to the fishing pressure exerted on sharks, but here, the lack of foresight & consideration from the authorities about this extreme danger led to the imposed total ban on surfing and swimming.

You have to understand that we do not try and fight the shark conservation effort of the past 15 years (which naturally led to the increased numbers of predators) but we do protest about the implementation of marine reserves right in the middle of recreational seaside areas, as it is the case in Reunion Island. Protecting potentially dangerous sharks in an aquatic kindergarten is pure madness and should incur responsibilities.

It is important to note that sharks are neither evil nor good, they are just wild animals that do not experience mercy, and which consider humans as much of a danger as a mere prey. The problem with shark attacks is that modern society refuses to accept our ancestral common sense: when faced with a predator, humans have no choice but to act as a predator also. This basic principle is the very reason which has enabled us to survive as a species since the dawn of humanity, and it is astonishing that some modern conception of “romantic ecology” would have us to believe in pacific cohabitation, even though it’s impossible.

In this context, shark attacks appear like a powerful symbol of nature fighting back and taking it on to its main enemy, us...This symbol is exacerbated with surfing (a “useless” hobby) – surfing -- a symbol of leisure and free time, the culmination of industrialization’s progress. Therefore, any security steps toward a regulation will be resented as a “massacre” of those “pillars of the marine ecosystem” to the sole benefit of an egoistic leisure, thus leading to mass (media) hysteria.

Ocean analysts base their opinions on a basic principle: "We do not belong there, so it is for us to adapt." Unfortunately, reducing prevention to a mere compliance with safety rules cannot be generalized. The risk in Hawaii for example (where almost only tiger sharks are incriminated), is extremely low with only 6 deaths over the last 35 years, despite an extremely widespread practice of surfing among its 1.4 million inhabitants and also among the 7 million annual tourists!

On Reunion Island on the other hand (where mostly bull sharks are incriminated), we had 7 deaths between 2011 and 2015, for only 800,000 inhabitants, 400,000 tourists, and fewer than 1000 practitioners subjected to a shark attack risk since 2012!  It’s thus obvious that you cannot compare situations & dangers which are so different in nature.

There are places where sharks represent a very small risk, and where a simple “risk assessment & education” might be sufficient indeed, like in the USA where you had only 3 deaths to shark attacks between 2011 and 2015 for a population of 330 millions (Hawaii, Bahamas & Porto Rico included), with 3.1 million surfers, and tens of millions of bathers.

Since the beginning of 2015, while our ocean is banned & virtually deserted, we’ve had 2 deaths already, and 0 for the entire USA. This means that the risk of a shark attack in Reunion Island is several thousand times higher than elsewhere else. Proportionally if the United States were subjected to the same risk, there would be thousands of deaths each year. In this case, would “specialists” still try and justify shark attacks through a simple problem of "bad risk assessment" and “wrongful behavior”?

Moreover, it is unfair to compare a shark attack with drowning, jellyfish sting, injury by a falling coconut or injury due to a “selfie”. These kinds of comparisons (used solely to discredit & marginalize the media coverage surrounding shark attacks) are, according to communication experts, a "manipulation of statistics".

 Furthermore, after each and every shark attack, it has become a routine for “specialists” and/or NGOs to intervene and to lecture us about the "100 million sharks which are killed every year by humans", thus diverting the public attention from the attack and reversing the roles with the shark then becoming the victim.

There is also some exaggeration about shark populations waning. Indeed, preservation actions conducted for the past 15 years are bearing their fruits, and shark population seems to be on track to recovery. Unfortunately, this kind of data is not "politically correct" and goes against vested interests about oceans resources grabbing and is helped by context of ultra alarmism.

We have to remain vigilant about the fact that the preservation & the protection of the oceans (and of their inhabitants) does not hide more “sinister” plans about the potential exploitation of  natural resources (fishing stocks, minerals, etc..) and does not turn into a moneymaking business.

Our position is that we are for science but against dogma, and some “specialists” theories that are littered with contradictions. For example, how can they say that overfishing could lead sharks to come closer to shores, when speaking about species such as bull sharks (which are known to be living in coastal biotopes anyway) fully adapted to fresh water and therefore not impacted by overfishing?

Similarly, linking shark attacks with global warming or El Nino, beg the question about the credibility of the so called “experts”, who do not hesitate to use “apocalyptic fears” to divert the opinion from the evidence: a direct correlation between increased populations of sharks and increased attacks.

The failure of the scientific program CHARC (€ 800,000 over 2 years with 80 tagged sharks) for risk reduction purposes should be an example for the entire planet.  As foresaw in the initial evaluation report (“Rapport d’évaluation du projet CHARC, mars/avril 2012, F. Gerlotto) : "It is absolutely certain that if these results (in terms of governance) did not appear, it is because of the chaotic nature (in the sense of deterministic chaos) of the system which prohibits any prediction. Therefore, we can give up any hope of risk management through an environment study, and it will be useless to try any other scientific activities in that way. "

Simply put, it is absolutely unrealistic to seek to establish sufficiently reliable patterns to risk human lives in such a difficult area to understand such as the ocean and the unpredictable wildlife’s individual behaviors.

There is also a real ethical issue regarding the tagging programs of many potentially lethal sharks and their monitoring in the heart of a seaside area full of ​​human activities...

Marking dangerous predators and releasing them right in front of the most popular beaches of the island, and latter on being able to study the attacks.  Wouldn’t that be similar to a "scientific experimentation” with “human guinea pigs"?

All those dogmas and manipulations will lead to an increasing number of attacks worldwide and to an increasingly problematic access to the ocean. The “return to wilderness” policies, with the reintroduction of all sorts of harmless or dangerous beasts will lead to a gradual disappearance of human activities in many places. Our ocean here is already on its way to returning to its “wilderness state”, whatever the social, human and economical toll.

To that regard, Reunion Island is following the path of Recife in Brazil, which I visited in April 2014, only to find out that 20 years of “research” and ban had led to the permanent closure of the ocean. Some local actors there made me understand that the bull shark, a prolific species, is a plague, some kind of "opportunistic ocean rat." Whenever an area of ​​human activity constitutes a suitable habitat, with plenty of fresh water and a lack of territorial pressure (through fishing), it leads to a tragedy.

This means that for us, the "hotspots" of the planet, the only effective methods in 2015 are still the implementation of fishing gear (nets and drum lines) in the areas to be protected. Those methods’ effectiveness has been proven in Australia and South Africa for the past 20 years by significantly dropping the risk on protected beaches. Sharks are intelligent animals that have crossed ages, and like all wild animals, they learn to avoid areas that are dangerous to their survival.

No one wishes to empty the ocean of all sharks; this is just about preserving a part of coastal areas for human activities, applying territorial pressure through fishing.

Any other non lethal methods either lack of perspective or have shown their limitation.

We consider the zebra patterns logic to have limited effectiveness because often when there are waves, the water is cloudy and sharks won’t use their sight to hunt in those situations. It is also illusory to imagine preventing attacks with real-time detection of tagged sharks via satellite. In addition to capture & marking difficulties along with the limited lifespan of the tags and the often too low percentage of tagged sharks, the main problem will be about spreading the alert and the immediate evacuation scheme.

The method (invented in Reunion Island) of employing underwater lookouts may be considered but only in clear water (and thus in small waves conditions) as visibility will be insufficient in bigger waves. Furthermore, while seeking a "scientific validation/approval", this method has become too complicated and costly to expect a broader deployment. Indeed, it now necessitates a heavy protocol, with a total of 35 peoples involved, 2 boats, cameras etc... just to secure a group of surfers!

Regarding the so called “innovative” devices, especially the semi-rigid and the electromagnetic barriers, they could be of interest and we have met almost all their inventors/developers in the past three years here in Reunion Island.

Unfortunately, all of these methods are still experimental and their standardization is impossible due to prohibitive implementation and maintenance costs

That is the recent conclusion (August 2015) supported by the town of Saint-Pierre, which has just abandoned the idea of securing its beaches through innovative measures after three years of feasibility studies!

We should also ensure that this trend of "nonlethal innovations”, greatly supported by the animalists do not become a money making scheme cashing on our fears and feeding the controversy by maintaining the illusion of a "magic solution" that would preserve both predators and humans.

Nativel

Jean François Nativel
Ocean Prevention Reunion Association Secretary

http://www.opr.re/
(author of a forthcoming book on the "shark crisis" in Réunion)

Rincon Surf

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