Friday, July 20, 2018

Thursday, July 19, 2018

President Obama Era Wetlands Protection Rule Under Review

Environmental & Science Education
STEM
Water & Watersheds
Edward Hessler


The U.S. Environmental Protection Agency and the U.S. Army Corps of Engineers are proposing to repeal the Clean Water Rule. The basis of the repeal is that the Obama administration's wetlands rule placed "too much emphasis on science" and not enough on statutory text and legal history.

Science republished an article from E&E News by Ariel Wittenberg explaining this argument. The Clean Water Act applies to "navigable waters of the United States." This phrase has been the subject of three U.S. Supreme Court cases. Wittenberg notes that the most recent case (2006) ended in an unusual 4-1-4 split decision. Interestingly, the stand alone opinion was written by recently resigned Justice,Anthony Kennedy.

The Obama administration made use of Kennedy's opinion in their so-called Connectivity Report. In his opinion, Kennedy wrote that wetlands deserved protection if they, "alone or in combination with similarly situated lands in the region, significantly affect the chemical, physical and biological integrity of other covered words." He referred to this as a "significant nexus." These are the five major conclusions of the "Connectivity Report.".

--The scientific literature unequivocally demonstrates that streams, regardless of their size or frequency of flow, are connected to downstream waters and strongly influence their function. 

--The scientific literature clearly shows that wetlands and open waters in riparian areas (transitional areas between terrestrial and aquatic ecosystems) and floodplains are physically, chemically, and biologically integrated with rivers via functions that improve downstream water quality. These systems act as effective buffers to protect downstream waters from pollution and are essential components of river food webs. 

--There is ample evidence that many wetlands and open waters located outside of riparian areas and floodplains, even when lacking surface water connections, provide physical, chemical, and biological functions that could affect the integrity of downstream waters. Some potential benefits of these wetlands are due to their isolation rather than their connectivity. Evaluations of the connectivity and effects of individual wetlands or groups of wetlands are possible through case-by-case analysis. 

--Variations in the degree of connectivity are determined by the physical, chemical and biological environment, and by human activities. These variations support a range of stream and wetland functions that affect the integrity and sustainability of downstream waters. 

--The literature strongly supports the conclusion that the incremental contributions of individual streams and wetlands are cumulative across entire watersheds, and their effects on downstream waters should be evaluated within the context of other streams and wetlands in that watershed.

The current agencies, according to Wittenberg's report, believe that the Obama administration's approach was "an expansive reading" of the Kennedy opinion, that the regulation "does not give sufficient effect to the term 'navigable'," and that not enough attention was paid to a part of the Clean Water Act that "says states and tribes should retain authority over their land and water resources."

Wittenberg ends with a discussion of the "continuum of connectivity" and the issue that Justice Kennedy raised in his opinion, one that the Trump administration has not addressed, namely the balance of science and law.

Please read Wittenberg's report on this complicated issue here.

Wednesday, July 18, 2018

Pigeons


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Environmental & Science Education
STEM
Biodiversity
Culture
Society
Edward Hessler

Do you think pigeons are beautiful or not?

Take a look at these photographs from The New York Pigeon: Behind the Feathers by Andrew Gam, Emily Rueb, and Rita McMahon.

The authors are biased in favor of their beauty and with reason, I think.


Monday, July 16, 2018

Dust Analysis for Household Hazardous Contaminants


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Environmental & Science Education
STEM
Health
Miscellaneous
Solid Waste
Edward Hessler

If you are interested in an analysis of possible hazardous contaminants found in the dust in your home, then you may be interested in the 360 Dust Analysis Project at IUPUI. The project's main focus is on lead and chromium but will look for a few other contaminants.

This press release explains the details as well as how to participate. It includes a video in which the director of the IUPUI Center for Urban Health Gabriel Filippeli explains.

The researchers will run an analysis on each sample and send back a report that includes suggestions on how to handle any contaminants found in the dust.

IUPUI = Indiana University-Purdue University Indianapolis.

Sunday, July 15, 2018

An Origami T. Rex


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Environmental & Science Education
STEM
Earth Science
Paleontology
Art and Environment
Edward Hessler

The Natural History Museum, London provides instructions on how to make an origami Tyrannosaurus rex.

"It even has those famous tiny arms."

There are PDFs for the patterned paper used in the original.

Saturday, July 14, 2018

Bear Cam




Image result for bear salmon

Environmental & Science Education
STEM
Biodiversity
Behavior
Nature
Edward Hessler

I hope you have looked at the Brooks Falls brown bear camera (Katmai National Park, Alaska) this season. There is a short list of facts about the park, the salmon and the bears, e.g., there are about 2000 brown bears in Katmai, 80 to 100 bears in the vicinity of the falls, and on a good day, all 24 hours of it, a bear can catch about 40 salmon (~100 pounds,100,000 calories).

This is the time of the salmon run and the featured fishers are skilled brown bears who use a variety of techniques (and occasionally you will see some humans fishing, too). Young bears practice and also are adept at snarfing up left overs. They also do a fair amount of play wrestling. The site offers several viewing options, including an underwater camera. More than once I have seen the legs and lower body of a paddling bear. The rangers also provide talks about the biology of the bears from time-to-time. These are announced in advance

I've seen a Mama with young charge a male who was way too interested in the cubs and also seen cubs swept over the falls and rescued by their Mother.  They, all three of them, bobbed like corks with one going over the falls backwards. I once watched a sleeping bear who slept for nearly a day.

A couple of weeks ago a male killed one of two cubs (not recorded but heard and witnessed by park visitors. It was near the river cameras). The second cub rushed up a tree as the mother ran off and remained there for about two hours, expressing considerable discomfort throughout, before reuniting with its mother. Cub killing by males has a basis in evolution for it brings the lactating female into breeding condition. If she is impregnated by a male, his genes are forwarded to the next generation.

Image result for bear salmonThe death of the cub and the behavior of the mother were the subject of an extensive report on the Brooks Falls blog (very active with many of the commenters who have watched enough to identify individuals) Ranger Mike closed his report by noting,  "Brown bears live in a fierce and competitive world, and spring cubs are the most vulnerable of all bears. Through luck, skill, and the guidance of their mothers, cubs can grow into healthy independent bears. It’s a risky and challenging world though, one in which cubs, their mothers, and the river’s most dominant bears all compete to survive within."

Friday, July 13, 2018

Friday Poem


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Environmental & Science Education
Poetry
Art and Environment
Edward Hessler

Today's poem, My Standard Response, is by Karenne Wood.

You may learn more about her as well as link to an interview with her here.

Thursday, July 12, 2018

Aging


Image result for cat and dog

Environmental & Science Education
STEM
Behavior
Biological Evolution
Edward Hessler

Lifespans vary with smaller critters living shorter lives (on average) and bigger critters living longer (on average). NPR's Robert Krulwich did a nice report more than a decade ago on the matter of size and longevity. A technical account published in 2005 may be found here.

Take domesticated cats and dogs. Cats are generally smaller and dogs generally larger but moggies tend to live longer than doggies. So what's up?

This Science (AAAS) video discusses this difference.

Tuesday, July 10, 2018

How to Measure a Foot


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Environmental & Science Education
STEM
Mathematics Education
History of Science
Edward Hessler

The time when it took a village to measure a foot.

Here is a great book by Rolf Myller on another solution to this problem.

And here is an animation of the story by Rolf Myller.

h/t Aeon

Monday, July 9, 2018

Anatomical Knowledge: A Research Project


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Environmental & Science Education
STEM
Health
Medicine
Literacy
Edward Hessler

What do you know about the location of organs and structures in the human body?

Zooniverse's aim is to undertake the largest project to date to understand the anatomical knowledge of the general public, we have a number of specific questions that we are looking to answer:
  • What is the extent of anatomical knowledge of the global population?
  • Are there any observable differences between the ages and gender of the respondents?
  • Will individuals that work in a health care facility/profession perform well?
  • Will individuals that recently (within a week) went for a consultation with a healthcare professional perform well?
  • Is there geographic/regional differences in performances?
If you would like more information and also participate in this study check it out. This is not a quiz but a request for what humans know about their bodies. There are a couple of reports on the site, information about Zooniverse and a FAQ.

Sunday, July 8, 2018

The Art of Fighting Climate Change: Miami, Florida


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Environmental & Science Education
STEM
Climate Change
Sustainability
Edward Hessler

In Miami there is a culture around murals that are found everywhere. 

Linda, an artist in Miami, believes that "climate change requires an injection of empathy and inspiration." So she and other artists make murals, drawings, and augmented-reality piecess to raise awareness of the imminent threat that climate change poses to the habitability of Miami.

This 5 minute video from the New Yorker shows some of the work she and others are doing.


Saturday, July 7, 2018

Women in Science and Engineering


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Environmental & Science Education
Women in Science
STEM
Society
Culture
Nature of Science
History of Science
Edward Hessler

A few days ago I received my weekly notice on new publications and news from the National Academies Press. At the top of the list was the report Sexual Harassment of Women: Climate, Culture, and Consequences in Academic Sciences, Engineering, and Medicine.

It is a large report and not inexpensive ($59) although certainly in line with the cost of books but like all NAP publications it is available as a PDF. It can be read on-line and also downloaded.

Meredith Wadman wrote a summary for Science and notes that "the report describes persistent and damaging 'gender harassment'--behavior that belittles women and makes them feel they don't belong, including sexist jokes and demeaning jokes." Here are two numbers that made my eyes snap to attention: "Between 17% and 50% of female science and medical students reported this kind of harassment in large surveys conducted by two major university systems across 36 campuses."

You will find a link to the full report in Wadman's column.

Friday, July 6, 2018

Wednesday, July 4, 2018

Young Minds at Work


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Environmental & Science Education
STEM
Early Childhood
Medicine
Health
Edward Hessler

I've watched and listened to the reactions of quite a few young children, infants or toddlers to Elmo and the Italian opera singer/songwriter Andrea Bocelli, singing a rendition of Con te partero (Time to Say Goodbye).  Perhaps you have as well.

Each one is deeply moving and make my heart sing.

All of the clips I've watched quickly become favorites but the one I've viewed most is infant Abriel. There is so much to see and hear as he watches and listens as well as to wonder about. All of the videos make me think that there must be many building blocks in place for infant knowing, feeling and expressiveness.

I'm slow on the uptake and had never heard of the "Still Face Experiment," a classic as it turns out. It was first presented by Edward Tronick at a professional meeting in 1975! What Tronick and colleagues did was have a mother and her infant interact and then have the mother turn away and then turn her face back to the infant but this time her face is non-responsive and expressionless.

The infant is at first sober-sided and confused, trying hard to figure out what is going on but soon attempts in a variety of ways to restore the obviously satisfying interaction with the mother. Ultimately all attempts fail and the infant withdraws emotionally and also physically, turning away from the mother and becoming angry as well as screams loudly in frustration and pain.

This response has been replicated many times to explore differences such as gender, culture, infants who are deaf or have been exposed to drugs, etc. It may be viewed here. Dr. Tronick discusses it here.

Tronick directs the Child Development Unit, University of Massachusetts. Its work includes child development, parenting research and infant-parent therapeutic programs.























Tuesday, July 3, 2018

The Biological Life


Image result for checkermallow


Environmental & Science Education
STEM
Nature
Nature of Science
Biodiversity
Edward Hessler

What is it like to be a biologist whose passion is the conservation of rare plants?

First, please take a look at the Botany Photo of the Day's entry on Sidalcea hendersonii, a checkermallow. The entry notes that it is native to British Columbia (where it is blue-listed), Washington, and Oregon (extremely rare). Once common in tidal marshes and meadows where it did occur, it is now estimated that fewer than 100 populations remain.

Hendeerson's checkermallow belongs to the plant family known as the Malvaceae. Some of its members include okra, cotton, cacao and a plant you may have in your backyard or is found in your neighborhood, the hollyhock. It is a personal favorite. I don't think I remember a farmhouse where I grew up without at least one plant on a house or barn corner. You will likely notice similarities with Henderson's checkermallow and hollyhock.

A list of some of the plants found in this family is found here.  The root of one of them, the marsh mallow, is the source of the confection known as the marshmallow.

BPOD includes a link to a paper on the natural, botanical and conservation history of Henderson's checkermallow. On page 7 you will find a photograph of  conservation biologist Melanie Gisler at work.

There is no other life!

Monday, July 2, 2018

Being Smart: A Probe


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Environmental & Science Education
STEM
Behavior
Biodiversity
Biological Evolution
Nature of Science
Edward Hessler

The puzzle solving abilities of social and solitary animals can help us understand what it means to be smart.

In this short video from Science (AAAS), behavioral biologists pose a challenge to two social and two solitary animals. They are confronted with a box in which there is a treat. The box has a "handle" that opens the box when it is tugged.

A simple experimental set-up designed to opens the door, if only a crack, to cognition.

The film includes a brief essay which includes another study with a larger sample of critters that draws the opposite conclusion!

This is the way science works--in fits and starts, tentative probes, new experiments and evidence that sometimes corroborates and other times contradicts. The puzzle is complex and the pieces are small and not so easily fit together to probide an explanation.

Sunday, July 1, 2018

The Weight of Life Presented in a Tower


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Environmental & Science Education
STEM
Biodiversity
Edward Hessler

A census by Yinon Bar-On, Rob Phillips, and Ron Milo that sorted all life on earth by weight in gigatons of carbon was reported in the Proceedings of the National Academy of Sciences (PNAS).

The authors note that they use biomass as a measure of abundance, which allows us to compare taxa whose members are of very different sizes. Biomass is also a useful metric for quantifying stocks of elements sequestered in living organisms. We report biomass using the mass of carbon, as this measure is independent of water content and has been used extensively in the literature.

Over at Vox, Brian Resnick and Javier Zarracina used these data to help us visualize the impressive numbers. They present the data in what they describe as a kind of tower of weight. You may recall pyramids of biomass from a biology or ecology course. The tower visual has a different purpose. It is, in the words of the PNAS authors, a global, quantitative view of how the biomass of different taxa compare with one another.

Taxa are populations of organisms that form a unit. In the case of this paper think of them as broad kingdoms of organisms. Resnick and Zarracina explain this very nicely. There are the protists (think microscopic life like amoebae), archaea (single-celled organisms somewhat similar to bacteria), fungi (mushrooms and other types of fungus), bacteria (you’re familiar with these, right?), plants, and animals.

First, a definition. A gigaton is equal to a billion metric tons. A metric ton is equal to a 1000 kilograms or about 2200 pounds. As you can see these numbers add up into some very large numbers.

Of course the census is not perfect and the authors of the original paper discuss various deficiencies. It also makes you think about what life is missing, especially as humans have come to dominate the planet.

The chart and the article by Resnick and Zarracina are found here.

h/t 3QuarksDaily
 

Friday, June 29, 2018

Friday Poem


Image result for bird

Environmental & Science Education
Poetry
Art and Environment
Edward Hessler

Today's poem is by Robin Becker.

I like this open letter from one Robin Becker to Robin Becker "the better," as one Robin Becker calls Robin Becker "the better,: so I choose to send it instead of a traditional biography.

Wednesday, June 27, 2018

What's Up?


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Environmental & Science Education
STEM
Astronomy
Edward Hessler

Two aides to viewing what's overhead at night.

Astronomy Picture of the Day (APOD) highlights the summer sky for its June 27, 2018 entry.  If, when you click on the link, it doesn't take you there, go to the archive (bottom of the page) where you can find it for this date.

And NPR's Skunkbear provides a tutorial on finding the constellations.

Wikiversity provides all kinds of information on stargazing.

Monday, June 25, 2018

The Next Big Thing: Theranos




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Environmental & Science Education
STEM
Society
Culture
Medicine
Health
Edward Hessler

60 Minutes recently did a story on the quick rise of the Silicon Valley company Theranos and its fall.

The company was the idea of Elizabeth Holmes who dropped out of the Stanford University biology program to found a company that would revolutionize blood testing. It would use a fingerstick sample of blood and from that dozens of blood tests could be accurately performed. Well this was the idea.

Theranos resulted from research Ms. Holmes did while an undergraduate at Stanford University. The Wiki entry on Theranos describes it as follows: (She) created a wearable patch to adjust the dosage of drug delivery and notify doctors wirelessly of variables in patient's blood. She started developing lab-on-a-chip technology for blood tests and the idea for a company that would make testing cheaper, more convenient and accessible to consumers  Holmes used the education trust from her parents for Stanford to found the company that would later be called Theranos, which is a combination of the words "therapy" and "diagnosis".

Holmes was able to attract the imagination and the money of venture capitalists as well as very distinguished board members, real heavy hitters, among them, former United States Secretary of State (1982-1989) George Schultz. Walgreen's, for example, bought into Theranos. She became the youngest female, self-made billionaire in the world with many of the trappings, e.g., bullet-proof glass for her office and traveling with a security detail.

Norah O'Donnell reported the story of this deception (and greed)--I'm tempted to say a story of several deceptions. For additional perspective here is the New Yorker article on the rise of Theranos written only three years ago.

Image result for theranosSilicon Valley investors are routinely described as extremely cautious and bright.  The Theranos story is an exception. I think scientific publications and peer-reviewed data were missing from the beginning.

Whenever I see Ms. Holmes I notice a similarity in dress between her and the late Steve Jobs: black. Did she think she was the next Steve Jobs? Maybe a blond Steve Jobs. It is clear that she is bright and charismatic.

Holmes and the former president of the company have been indicted for wire fraud.  Here is a video of an interview with Wall Street Journal reporter John Careyrou whose painstaking detective work fully exposed the deception.

Sunday, June 24, 2018

Free as a Bird


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Environmental & Science Education
STEM
Paleontology
Earth Science
Behavior
Edward Hessler

This short video of a Pterosaur in flight is from the Natural History Museum, London.

See here for information about this pterosaur known as Anhanguera. The name means "Old Devil."

It is NOT a pterodactyl.

h/t Jerry Coyne, Why Evolution is True

Saturday, June 23, 2018

Hansen's Claim 30 Years Later


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Environmental & Science Education
STEM
Climate Change
Society
History of Science
Edward Hessler

Global warming has reached a level such that we can ascribe with a high degree of confidence a cause and effect relationship between the greenhouse effect and observed warming.'It is already happening now.--James Hansen, 23 June 1988, Senate Testimony.

So, how has his claim held up?

He got it right according to climate scientists. If you are interested in the technical response of climate scientists see RealClimate. Definitely worth scanning because of the insights it provides into their thinking.


Friday, June 22, 2018

Friday Poem


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Environmental & Science Education
Poetry
Art and Environment
Edward Hessler

Friday's poem and information about its author Stephen Kuuisto.

Thursday, June 21, 2018

Koko Has Died


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Environmental & Science Education
STEM
Biodiversity
Behavior
Edward Hessler

Koko has died at age 46.

One memory I will always have of her is when she and her friend All Ball were playing or when she was holding All Ball.  What a friendship.

If you need your memory refreshed and would like to know more about her, NPR posted an essay by Bill Chappell.

Scholastic's Koko's Kitten may be seen here where you can take a look inside.

And this essay, added later, from the NYT which includes a clip with Mr. Rogers.

Tuesday, June 19, 2018

Facing Mortality


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Environmental & Science Education
Death
Medicine
Health
STEM
Edward Hessler

In March 2016, Stanford University Paul Kalanithi, MD, an eloquent writer about facing mortality died of lung cancer. He was 37 years old.

Kalanithi had only recently completed his neurosurgery residency at the Stanford University of Medicine. He was also a first-time father.

Kalanithi did his undergraduate work in English and biology at Stanford, graduating in 2000 with three degrees: a bachelor's in biology, and a bachelor's and a master's in English literature. While still in high school his career goal was to be a writer.

The Stanford School of Medicine announcement of his death has several links, one  to a short video (roughly 8 minutes) where Dr. Kalanithi reflects on being a physician and a patient. The film is titled Days are Long Long, Years are Short. Kalanithi is the author of the widely acclaimed memoir When Breath Becomes Air, published posthumously.

Nora Krug reporting in the Washington Post (January 5, 2018) writes about what has happened since his death.. Lisa Kalanithi, an assistant professor of internal medicine at Stanford Medical School, has fallen in love with Nina Rigg's widower, lawyer John Duberstein. His wife, Nina Rigg died of breast cancer.

It was Nina Rigg who first put the two in contact. As she was facing death, she was concerned with how her husband John Duberstein was going to deal with the focus. She suggested that he contact Dr. Kalanithi. The reason, as reported by Nora Krug, was that "She (Lisa Kalanithi) has experience with this, she told him; she’ll know what to do." She did. Nina and Lisa became fast friends and John found someone to help him safely to the other shore.

Nora Krug's column also links to the video mentioned above. No guarantees on this link but I think an infrequent user will be granted permission to read it, otherwise it may be available only by subsciption.






Monday, June 18, 2018

Saturday, June 16, 2018

CRISPR


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Environmental & Science Education
STEM
History of Science
Nature of Science
Medicine.
Edward Hessler

CRISPR is a powerful gene-editing technique.

Analogies are often used to help in understanding the impact and potential power of this technique. Among the most used are these, ranked from worst to best: a knock-out punch (#10), the hand of Gog, a bomb removal squad, a handyman at work, an eraser, a surgeon's scalpel, a pair of scissors, "search and replace" in MSWord, photoshop, and a Swiss army knife (#1).

These are from a critical essay in STAT by Rebecca Robbins (December 8 2017). She and Sharon Begley, the senior science writer at STAT, evaluated each analogy based on three criteria: creativity, clarity, and accuracy. You may read the results here.

STAT's Jeffrey Del Viscio and Dominic Smith recently published a visual attempt to show the genetic complexities involved in making the invisible visible and they hope understandable. Take two minutes to view their animation.

CRISPR is short-hand for Clustered Regularly Interspersed Short Palindrome Repeats. There is a history of CRISPR at the Broad Institute website.

Friday, June 15, 2018

Thursday, June 14, 2018

U. S. Department of State Science Envoy Program


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Environmental & Science Education
STEM
Society
Culture
Medicine
Health
Edward Hessler

Epidemiologist Michael Osterholm is director of the University of Minnesota's Center for Infectious Disease Research and Policy (CIDRAP).  He is also a Regents Professor at the University of Minnesota.

On June 11, Dr. Osterholm was one of five scientists chosen by the U. S. Department of State to serve as a science envoy, a year-long appointment.

The other four scientists are chemical engineer Robert Langer (MIT), bioengineer Rebecca Richards-Kortum (Rice University), environmental engineer James Schauer (University of Wisconsin) and NASA Administrator (retired) Charles Bolden.

There is a short interview with Professor Osterholm in Science by Jon Cohen which includes a link to the science envoy program.

Congratulations, Dr. Osterholm.

Tuesday, June 12, 2018

Reading a Dog's Mind


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Environmental & Science Education
STEM
Behavior
Edward Hessler

This video on animal consciousness comes from the point-of-view of a neuroscientist. The project is known as the "Dog Project."

It is from Science Friday's The Macroscope (May).

What I like about this website is that it includes the video as well as some still shots and text.

Sunday, June 10, 2018

Leeches: Beyond Fishing


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Environmental & Science Education
STEM
Medicine
Health
Edward Hessler

This video from KQED Science describes the use of leeches in medical treatment. The accompanying essay by Emma Hiolski notes that "the humble leech is making a comeback. Contrary to the typical derogatory definition of a human 'leech,' this critter is increasingly playing a key role as a sidekick to scientists and doctors, simply by being its bloodthirsty self."

I hadn't known that leeches can be used--a low tech method--for assessing local biodiversty. Leeches retain the blood they remove while feeding and that blood can be used through the analysis of the DNA to identify the donor.

Some basic biological research on leech behavior and neurobiology is also described.  An advantage of studying such a small nervous system is that it is easier to understand basic mechanisms on how information from the environment is used in decision-making.

The video shows a bandaged hand after reconstructive surgery and here is where leeches enter the treatment regimen. They remove stale blood from damaged veins that are too small to repair. There is another benefit, too. The enzymes found in leech saliva prevents blood clotting.









Friday, June 8, 2018

Friday Poem


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Environmental & Science Education
Poetry
Art and Environment
Edward Hessler

Today's poem is by Tony Hoagland.

I add a thoughtful essay about children's poetry by Imogen Russell Williams that I've long intended to include.  She writes about the narrowing of education in an examination based system, referring to the "GCSE behemoth" grinding "over the horizon," which often has the effect for many students "that poetry exists for one purpose alone: to be broken down into techniques and terminology for the optimal acquisition of marks."

The GCSE is the acronym for the General Certificate of Secondary Education, a set of examinations taken by students aged 15-16 in England, Wales and Northern Ireland.

The poems Williams discusses put paid to the analytic, not that analysis is unimportant but the joy or poetry and nourishment poetry provides are not to be lost. To give you a taste of her aim in this essay about liking poetry, she includes a few lines from Roger McGough's Apostrophe.

'twould be nice to be
an apostrophe
floating
above an s
hovering
like a paper kite
in between the its ... 

There is more and you may read her comments here.

Thursday, June 7, 2018

The Apgar Score


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Environmental & Science Education
STEM
Medicine
Health
Edward Hessler

Today's Google Doodle honors Dr. Virginia Apgar, who invented what became the standard test for assessing the health of a newborn infant within a few minutes of birth. She would have been 109 years old.

This quick diagnostic measures infant health using five dimensions: Appearance, Pulse, Grimace, Activity, and Respiration.

Dr. Apgar's career also included work in genetics. She became a public health advocate for congenital birth defects.

You may read about her and see the Google Doodle at Quartz.

When it Is Brain Surgery

Environmental & Science Education
STEM
Medicine
Health
Edward Hessler
Image result for surgeon

After reading Joshua Rothman's essay in the New Yorker on the eminent London neurosurgeon Dr. Henry Marsh, I put the Marsh's memoir on my "want to read" list. One reason was this searing quote from Marsh's memoir. "'As I approach the end of my career I feel an increasing obligation to bear witness to past mistakes I have made.'"

Rothman noted that "Marsh isn't interested in the usefulness of error. He is the Knausgaard of neurosurgery: he writes about his errors because he wants to confess them, and because he's interested in his inner life and how it's been changed, over time, by the making of mistakes."

Long after reading Rothman's essay I found Marsh's memoir Do No Harm: Studies of Life, Death and Brain Surgery, in the new books section of Hamline University's Bush Memorial Library. The title is from the Latin, Primum non nocere, "first, do no harm," one of medicine's most fundamental and difficult precepts. It means that attending physicians are first to weigh uncertainties regarding risks and benefits with their patients before proceeding. It does not mean or imply that the way forward is clear or without risk or without the possibility of a mistake but it means that these have been considered and that the treatment chosen is the best in the physician's and patient's judgment.

The memoir is organized by compelling and brutally honest case studies, 25 total. The cases consist of neurological disorders, strokes, spinal cord problems and, of course, cancers. Marsh was among the pioneers of anesthesia free brain surgeries. He also worked for years with neurosurgeons in Ukraine, after the fall of the Soviet Union who had at best second-hand and antiquated equipment. This work was funded by a charity Marsh established. And, of course, he trained residents, including some from the United States who came to study and practice with him for a year. 

Marsh is also a fierce and relentless critic of the British National Health Service. His comments will make you both laugh (first) and cry/wince (second). You are likely to recall similar experiences from your own life experiences --"trainings," as they are called.

Image result for bike surgeon
A fragment from the BBC documentary, The English Surgeon, shows Marsh's work in the Ukraine. You may want to bark, "Henry, wear a helmet!" when you see him riding to work without any head protection, his standard almost daily practice. There is a lovely scene of Marsh and a Ukrainian colleague sliding, just like kids, across an icy pond using their shoes as skates.
In his memoir Marsh comments on the use of technology in brain surgery, e.g., infrared cameras which allow him to "see" where his instruments are on a brain scan taken shortly before the surgery but neurosurgery remains fraught with danger, measured in a millimeter or two.  
Dominic Smith, who writes for STAT describes a new technology being developed by neurosurgeon Dr. Alexendra Golby and her colleagues at Brigham and Women's Hospital in Boston which uses magnetic resonance imaging technology coupled with powerful computing technology to create personalized 3-D models of the brain in near real-time so that the surgeon can know where s/he is throughout the surgery.
Smith's essay includes a short video explaining the new technology. If you'd like to see a day in the life of Henry Marsh, the BBC produced a film (~10 minutes) is about the problems Dr. Marsh finds with the British National Health Service.

Marsh is the author of Admissions: Life as a Brain Surgeon which is on my reading list.