Victor Agbafe was watching the address on TV. The University of Michigan Medical School student, who is also studying law at Yale, immediately texted a few mentors, including Michigan Medicine integrated plastic surgery resident Nicholas Berlin, M.D., M.P.H., M.S.

The question that emerged from their messages was a crucial one: What role can the medical community, which accounts for about 8.5% of America’s greenhouse gas emissions, play in these climate change reduction efforts?

A year later, research that Agbafe and Berlin led outlines some answers. Their paper describes how surgery, particularly cancer surgery, contributes to climate change and suggests some solutions to combat the problem, from reducing waste to rethinking how surgical care is delivered.

“In general, these ideas are good for our planet,” Agbafe said. “But also, surgery unfortunately plays a disproportionate role in the carbon output and the waste we produce in medicine.”

Operating rooms are a massive source of greenhouse gas production for hospitals, representing 70% of their waste and generating three to six times as much carbon as the rest of health systems.

Cancer care is an obvious target for greener efforts within surgery, Berlin notes, because it often involves intense levels of care over a short period of time.

Plus, minimally invasive surgeries that require a lot of energy, including robotic-assisted operations, have become common treatments for cancers ranging from colorectal and uterine cancer to head and neck cancer. A robotic-assisted hysterectomy, for example, produces as much carbon as driving more than 2,200 miles in a car — the equivalent of a road trip from Ann Arbor, Mich., to Los Angeles.

“If we can lower our greenhouse gas output, we have a chance to extend the lifespan of our patients and expand access to timely care,” Agbafe said. “And we think it’s really important that the surgical community is proactive at being at that table.”

What to do differently

One of the most feasible changes to make in this space would be around waste reduction, Agbafe said.

This might be as simple as making sure that anything thrown away before or during surgery is properly categorized and labeled since it’s estimated that over 90% of OR waste does not meet the necessary standards for the type of trash it ends up in. (The red waste bags in ORs are intended only for items that have been exposed to bodily fluids and are much more expensive to dispose of than clear disposal bags.)

Hospitals could also consider switching to some reusable or reprocessed devices and surgical gowns since there is no link between reused tools and hospital-acquired infections.

Some of the pair’s other suggestions involve optimizing ORs’ energy use. Agbafe and Berlin point to the American Society of Healthcare Engineering’s recommendations to install energy-efficient lighting, schedule preventive maintenance and minimize air flow into rooms that aren’t being used as easy ways to green the systems.

The surgical supply chain could be more efficient, too, they write. Estimates suggest that 87% of the surgical instruments laid out for an operation are rarely used, so coming up with standardized lists of the necessary tools for surgeries that occur regularly could cut down on cost, waste and the energy needed to sterilize and repackage those instruments.

Moving more manufacturing of surgical supplies closer to hospitals — or choosing to source from suppliers that are locally based — could also reduce the OR’s carbon footprint.

“Given some of the geopolitical events that have been going on right now in Ukraine and with China and the competition there along with the effects of pandemic is creating an increasing emphasis on resiliency within supply chains,” Agbafe said. “So this idea of localizing our operating room supply chains is something that there’s a lot of political energy and momentum within the public to move towards.”

Reimagining care delivery

But perhaps the broadest way the oncology space could cut down on its greenhouse gas emissions is to change how surgical care is delivered, starting with permanently offering telemedicine.

“We think telemedicine is a great opportunity for us to lower the climate impact and improve the quality of care by doing so,” Agbafe said. “During the pandemic, we’ve been using virtual care and if we could make that a routine aspect of cancer care for pre-op and post-op, that’s a way we can reduce the climate impact of delivering care and make it more convenient for patients.”

Reducing low-value care is another way to eliminate carbon-producing activities associated with unnecessary scans, testing and procedures.

This has been a priority for U-M, thanks to the Michigan Program on Value Enhancement — a collaboration of Michigan Medicine and the University of Michigan Institute for Healthcare Policy that aims to improve the quality of care at the institution — and a partnership with the similarly oriented Michigan Value Collaborative, also referred to as MVC, a collaborative quality initiative that serves the entire state.

Last year, the two organizations collaborated on a study that highlighted how much routine testing was still done before surgeries despite its low value. Berlin was the first author.

“U-M is considered one of the leading institutions studying low-value care and efforts to limit that type of care,” Berlin said. “But like a lot of other centers, we are really just at the precipice of these initiatives. I would anticipate big changes in the next 10 years.”

From gas to (more sustainable) gas

Some sustainability shifts may come even sooner at Michigan Medicine.

For instance, the Department of Anesthesiology recently launched the Green Anesthesia Initiative, or GAIA for short. Its mission: become more environmentally conscious about the types and rates of anesthesia its providers use, another area Agbafe and Berlin say is ripe for improvement.

“This is a topic of fairly intense discussion right now in the field, and I’ve been thinking about it for a while,” said George Mashour, M.D., Ph.D., the chair of the Department of Anesthesiology and the Robert B. Sweet Professor of Anesthesiology at the University of Michigan Medical School. “Unlike other industries, I don’t think that we require massive disruption in order to make progress because, fortunately, we have options.”

Several inhaled gases regularly used for anesthesia are A-list offenders when it comes to greenhouse gas production. Nitrous oxide, commonly known as laughing gas, is a greenhouse gas, a direct ozone depleter and does not dissipate from the atmosphere for more than a century after it’s produced.

However, the inhaled anesthetic sevoflurane has much less of an environmental impact than nitrous oxide and other common inhaled agents, so Mashour says it would be a good alternative.

“The overall goal is to shift away from some of these egregious culprits and start making better choices about which drug we use and then also how we use it,” Mashour said.

“The contributions in terms of greenhouse gas effect or ozone-depleting action partly relate to how much is getting pumped out into the atmosphere and that relates directly to how high we have our fresh gas flow,” he added. “If we have, for example, 10 liters going, we’re blowing a lot of anesthetic into the scavenging and waste and atmospheric systems that doesn’t need to be there.”

To that end, Mashour’s colleagues in the Department of Anesthesiology are already leading a national initiative to try to reduce anesthetic gas flow rates through the Multicenter Perioperative Outcomes Group, another quality initiative that includes health centers from across the country.

Mashour plans to roll out other elements of GAIA over a three- to- five-year period.

“We could be doing better,” he said. “Right now, we’re starting the conversations, getting people on board and making structural choices in the department to help make it easy for people to do the right thing.”

Led by Michael Naguib, an assistant professor in the Department of Physics and Engineering Physics, the study has been published in the journal Advanced Materials.

“Two-dimensional materials are nanomaterials with thickness in the nanometer size (nanometer is one millionth of a millimeter) and lateral dimensions thousands of times the thickness,” Naguib said. “Their flatness offers unique set of properties compared to bulk materials.”

The name of the new family of 2D materials is transition metal carbo-chalcogenides, or TMCC. It combines the characteristics of two families of 2D materials — transition metal carbides and transition metal dichalcogenides.

Naguib, the Ken & Ruth Arnold Early Career Professor in Science and Engineering, said the latter is a large family of materials that has been explored extensively and found to be very promising, especially for electrochemical energy storage and conversion. But he said one of the challenges in utilizing them is their low electrical conductivity and stability.

On the other hand, he said, transition metal carbides are excellent electrical conductors with much more powerful conductivity. Merging the two families into one is anticipated to have great potential for many applications such as batteries and supercapacitors, catalysis, sensors and electronics.

“Instead of stacking the two different materials like Lego building blocks with many problematic interfaces, here we develop a new 2D material that has the combination of both compositions without any interface,” he said.

“We used an electrochemical-assisted exfoliation process by inserting lithium ions in-between the layers of bulk transition metals carbo-chalcogenides followed by agitation in water,” said Ahmad Majed, the first author of the article and a doctoral candidate in Materials Physics and Engineering at Tulane working in Naguib’s group.

Unlike other exotic nanomaterials, Majed said, the process of making these 2D TMCC nanomaterials is simple and scalable.

In addition to Naguib and Majed, the team includes Jiang Wei, an associate professor in physics and engineering physics; Jianwei Sun, an assistant professor in physics and engineering physics; PhD candidates Kaitlyn Prenger, Manish Kothakonda and Fei Wang at Tulane; and Dr Eric N. Tseng and professor Per O.A. Persson of Linkoping University in Sweden.

This study was supported by Naguib’s National Science Foundation Career Award that he received less than a year ago.

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Materials provided by Tulane University. Note: Content may be edited for style and length.

“It’s hard to fathom that a landform the size of the Netherlands and with a comparable population might disappear by the end of the century,” said study co-lead author Matt Kondolf, a Professor of Landscape Architecture & Environmental Planning at the University of California, Berkeley.

“The Mekong Delta is truly outstanding in terms of agro-economic value and regional importance for food security and livelihoods,” said study co-lead author Rafael Schmitt, a senior scientist at the Stanford Natural Capital Project. “Without rapid action, the delta and its livelihoods could become victims of global and regional environmental change.”

On its journey from skyscraping Tibetan peaks to the sea, the Mekong River picks up sediment from eroding uplands in China, Myanmar, Laos Cambodia, Thailand and Vietnam. The nutrient-rich sediment has accumulated in the Mekong Delta and enabled the lower Mekong region to produce up to 10% of all rice traded internationally. It has also fed fisheries that feed tens of millions of people. Like any river delta, the Mekong Delta can only exist if it receives a constant sediment supply from its upstream basin, and if water flows can spread that sediment across the low-lying delta surface to build land at a rate that is equal to or greater than global sea level rise.

Hungry for renewable energy, countries in the basin have built numerous hydropower dams that block fish migrations, trap sediment and reduce downstream flows. If all planned dams are built, they will trap 96% of the sediment formerly reaching the delta. Additionally, sediment supply from tropical cyclones, which deliver about 32% of the suspended sediment load reaching the delta, is decreasing as cyclone tracks shift north.

Sediment that manages to reach the lower Mekong is mined for sand used in construction and land reclamation. Over pumping of groundwater and high dikes built to control floods and enable high intensity agriculture exacerbate the problem.

To slow and reverse damages, the researchers recommend that policymakers:

• Design dams to enable better sediment sediment passage, place them strategically to reduce their downstream impacts, or replace them with wind and solar farms, where possible.
• Strictly regulate sediment mining and reduce use of Mekong sand through sustainable building materials and recycling.
• Allow floodwaters to spread out over the Delta and deposit their sediments
• Limit groundwater pumping in the Mekong Delta
• Reevaluate intensive agriculture in the Mekong Delta for sustainability.
• Implement natural solutions for coastal protections on a large scale along the delta’s coast

Most efforts to rehabilitate the delta have involved individual countries approaching isolated engineering challenges, and proposing solutions on local scales, according to the researchers. Making meaningful progress will require coordination among countries, development banks development agencies and other private and civil society stakeholders, the researchers write.

“We are seeing signs that governments and nongovernmental actors are beginning to work together on these issues,” said Schmitt. “We hope our commentary will elevate the topic on the regional policy agenda, empower conservation in the basin, and act as a wake-up call to address key drivers for land loss on a system scale.”

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Materials provided by Stanford Woods Institute for the Environment. Original written by Rob Jordan. Note: Content may be edited for style and length.

In the race for what may become a key future technology, tech giants like IBM and Google are investing enormous resources into the development of quantum computing hardware. However, current platforms are not yet ready for practical applications. There remain multiple challenges, among them the control of device imperfections (‘disorder’).

It’s an old stability precaution: When large groups of people cross bridges, they need to avoid marching in step to prevent the formation of resonances destabilizing the construction. Perhaps counterintuitively, the superconducting transmon qubit processor — a technologically advanced platform for quantum computing favoured by IBM, Google, and other consortia — relies on the same principle: intentionally introduced disorder blocks the formation of resonant chaotic fluctuations, thus becoming an essential part of the production of multi-qubit processors.

To understand this seemingly paradoxical point, one should think of a transmon qubit as a kind of pendulum. Qubits interlinked to form a computing structure define a system of coupled pendulums — a system that, like classical pendulums, can easily be excited to uncontrollably large oscillations with disastrous consequences. In the quantum world, such uncontrollable oscillations lead to the destruction of quantum information; the computer becomes unusable. Intentionally introduced local ‘detunings’ of single pendulums keep such phenomena at bay.

‘The transmon chip not only tolerates but actually requires effectively random qubit-to-qubit device imperfections,’ explained Christoph Berke, final-year doctoral student in the group of Simon Trebst at the University of Cologne and first author of the paper. ‘In our study, we ask just how reliable the “stability by randomness” principle is in practice. By applying state-of-the-art diagnostics of the theory of disordered systems, we were able to find that at least some of the industrially pursued system architectures are dangerously close to instability.’

From the point of view of fundamental quantum physics, a transmon processor is a many-body quantum system with quantized energy levels. State-of-the-art numerical tools allow one to compute these discrete levels as a function of relevant system parameters, to obtain patterns superficially resembling a tangle of cooked spaghetti. A careful analysis of such structures for realistically modelled Google and IBM chips was one out of several diagnostic tools applied in the paper to map out a stability diagram for transmon quantum computing.

‘When we compared the Google to the IBM chips, we found that in the latter case qubit states may be coupled to a degree that controlled gate operations may be compromised,’ said Simon Trebst, head of the Computational Condensed Matter Physics group at the University of Cologne. In order to secure controlled gate operations, one thus needs to strike the subtle balance between stabilizing qubit integrity and enabling inter-qubit coupling. In the parlance of pasta preparation, one needs to prepare the quantum computer processor into perfection, keeping the energy states ‘al dente’ and avoiding their tangling by overcooking.

The study of disorder in transmon hardware was performed as part of the Cluster of Excellence ML4Q in a collaborative work among the research groups of Simon Trebst and Alexander Altland at the University of Cologne and the group of David DiVincenzo at RWTH Aachen University and Forschungszentrum Jülich. “This collaborative project is quite unique,” says Alexander Altland from the Institute for Theoretical Physics in Cologne. “Our complementary knowledge of transmon hardware, numerical simulation of complex many-body systems, and quantum chaos was the perfect prerequisite to understand how quantum information with disorder can be protected. It also indicates how insights obtained for small reference systems can be transferred to application-relevant design scales.”

David DiVincenzo, founding director of the JARA-Institute for Quantum Information at RWTH Aachen University, draws the following conclusion: ‘Our study demonstrates how important it is for hardware developers to combine device modelling with state-of-the-art quantum randomness methodology and to integrate “chaos diagnostics” as a routine part of qubit processor design in the superconducting platform.’

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Materials provided by University of Cologne. Note: Content may be edited for style and length.

Now, researchers from the Harvard John A. Paulson School of Engineering and Applied Sciences (SEAS) have developed a single-material, single-stimuli microstructure that can outmaneuver even living cilia. These programmable, micron-scale structures could be used for a range of applications, including soft robotics, biocompatible medical devices, and even dynamic information encryption.

The research is published in Nature.

“Innovations in adaptive self-regulated materials that are capable of a diverse set of programmed motions represent a very active field, which is being tackled by interdisciplinary teams of scientists and engineers,” said Joanna Aizenberg, the Amy Smith Berylson Professor of Materials Science and Professor of Chemistry & Chemical Biology at SEAS and senior author of the paper. “Advances achieved in this field may significantly impact the ways we design materials and devices for a variety of applications, including robotics, medicine and information technologies.”

Unlike previous research, which relied mostly on complex multi-component materials to achieve programmable movement of reconfigurable structural elements, Aizenberg and her team designed a microstructure pillar made of a single material — a photoresponsive liquid crystal elastomer. Because of the way the fundamental building blocks of the liquid crystal elastomer are aligned, when light hits the microstructure, those building blocks realign and the structure changes shape.

As this shape change occurs, two things happen. First, the spot where the light hits becomes transparent, allowing the light to penetrate further into the material, causing additional deformations. Second, as the material deforms and the shape moves, a new spot on the pillar is exposed to light, causing that area to also change shape.

This feedback loop propels the microstructure into a stroke-like cycle of motion.

“This internal and external feedback loop gives us a self-regulating material. Once you turn the light on, it does all its own work,” said Shucong Li, a graduate student in the Department of Chemistry and Chemical Biology at Harvard and co-first author of the paper.

When the light turns off, the material snaps back to its original shape.

The material’s specific twists and motions change with its shape, making these simple structures endlessly reconfigurable and tunable. Using a model and experiments, the researchers demonstrated the movements of round, square, L- and T-shaped, and palm-tree-shaped structures and laid out all the other ways the material can be tuned.

“We showed that we can program the choreography of this dynamic dance by tailoring a range of parameters, including illumination angle, light intensity, molecular alignment, microstructure geometry, temperature, and irradiation intervals and duration,” said Michael M. Lerch, a postdoctoral fellow in the Aizenberg Lab and co-first author of the paper.

To add another layer of complexity and functionality, the research team also demonstrated how these pillars interact with each other as part of an array.

“When these pillars are grouped together, they interact in very complex ways because each deforming pillar casts a shadow on its neighbor, which changes throughout the deformation process,” said Li. “Programming how these shadow-mediated self-exposures change and interact dynamically with each other could be useful for such applications as dynamic information encryption.”

“The vast design space for individual and collective motions is potentially transformative for soft robotics, micro-walkers, sensors, and robust information encryption systems,” said Aizenberg.

The paper was co-authored by James T. Waters, Bolei Deng, Reese S. Martens, Yuxing Yao, Do Yoon Kim, Katia Bertoldi, Alison Grinthal and Anna C. Balazs. It was supported in part by the U.S. Army Research Office, under grant number W911NF-17-1-0351 and the National Science Foundation through the Harvard University Materials Research Science and Engineering Center under award DMR-2011754.