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The Human Disease Ontology (DO) (www.disease-ontology.org) database, has significantly expanded the disease content and enhanced our userbase and website since the DO’s 2018 Nucleic Acids Research DATABASE issue paper. Conservatively, based on available resource statistics, terms from the DO have been annotated to over 1.5 million biomedical data elements and citations, a 10× increase in the past 5 years. The DO, funded as a NHGRI Genomic Resource, plays a key role in disease knowledge organization, representation, and standardization, serving as a reference framework for multiscale biomedical data integration and analysis across thousands of clinical, biomedical and computational research projects and genomic resources around the world. This update reports on the addition of 1,793 new disease terms, a 14% increase of textual definitions and the integration of 22 137 new SubClassOf axioms defining disease to disease connections representing the DO’s complex disease classification. The DO’s updated website provides multifaceted etiology searching, enhanced documentation and educational resources., Graphical Abstract Graphical AbstractThe Human Disease Ontology (DO) integrates disease features and etiological factors to describe disease complexity. The DO is extensively cited and integrated into highly cited databases.

To promote safe and positive health outcomes by utilizing culturally relevant evidence-based interventions for immigrant and refugee women survivors of intimate partner violence, their active participation in research is critical. With 43.6 million immigrants and refugees living in the United States, there is a need for research studies to eliminate health disparities in these populations. However, barriers to recruiting and retaining these populations in research prevent the provision of quality and culturally informed services to meet their needs. The aim of this article is to discuss the recruitment and retention strategies employed and analyze the methodological and ethical challenges in the context of the weWomen Study. The use of a multifaceted approach informed by best practices maximized recruitment efforts and active participation that generated high numbers of immigrant and refugee women participants. The study also substantiated the need for more community-based participatory approaches to engage community members in the development of culturally appropriate approaches that instill a sense of ownership over the research process. Active research participation of immigrant and refugee survivors will help investigators understand their unique needs and facilitate the implementation of targeted evidence-based interventions.

As the coronavirus disease 2019 (COVID-19) pandemic slowly begins to resolve, preparations are being made to re-open businesses and schools across the USA, and individuals who have recovered from COVID-19 will need to return to work with appropriate modifications. Patients and clinicians are currently faced with conflicting information and recommendations about when it is safe for patients who have had COVID-19 to terminate their quarantine and return to work. This article presents the case of a patient trying to return to work after having COVID-19, and then discusses the challenges posed by current clinical guidelines.

While hospitals, sustainable healthcare organizations, and recent peer-reviewed publications have assessed the sustainability of medical products and services, the healthcare industry lacks a framework to effectively inform environmental decision making and quantitatively assess the success of sustainability initiatives for medical products and services. Several recent publications have even expressed a need for better ways to quantify sustainable healthcare practices. To address these needs, this research compared the cradle-to-grave environmental and economic impacts of some of the most common recommendations from checklists: reusable versus disposable medical products, and changes to common medical services. Salient results and conclusions from recent studies focusing on the environmental and economic impacts of various reusable versus disposable medical products and different medical services were synthesized and prioritized. All relevant results related to environmental and economic impacts of reusable versus disposable medical products and the analyzed medical services were also correlated with existing sustainable checklists. The results showed that reusable products were less expensive their single-use disposable alternatives. The dental bur also required the least amount of water for its associated cleaning processes, had the lowest total embodied energy, and had the lowest associated greenhouse gas emissions. These outcomes were likely due to the fact the burs were, by far, the smallest examined product. Based on the results derived from the study, healthcare checklists should be updated to include: optimizing the reusability of medical products; reduce products utilized in custom packs; and evaluating energy recovery potential of utilized products. The results of this study indicate that sustainable healthcare checklists be further validated with more environmental and economic life-cycle analyses related to medical products and services. The primary aim of this paper is to assist hospital employees and administrators with making more informed decisions about the sustainability of their products and services. The scientific value of this paper is underscored by a novel aggregation of life cycle assessment studies pertaining to medical devices and services in order to draw conclusions regarding the overall sustainability of those medical devices and services.

The Human Disease Ontology (DO) (http://www.disease-ontology.org), database has undergone significant expansion in the past three years. The DO disease classification includes specific formal semantic rules to express meaningful disease models and has expanded from a single asserted classification to include multiple-inferred mechanistic disease classifications, thus providing novel perspectives on related diseases. Expansion of disease terms, alternative anatomy, cell type and genetic disease classifications and workflow automation highlight the updates for the DO since 2015. The enhanced breadth and depth of the DO’s knowledgebase has expanded the DO’s utility for exploring the multi-etiology of human disease, thus improving the capture and communication of health-related data across biomedical databases, bioinformatics tools, genomic and cancer resources and demonstrated by a 6.6× growth in DO’s user community since 2015. The DO’s continual integration of human disease knowledge, evidenced by the more than 200 SVN/GitHub releases/revisions, since previously reported in our DO 2015 NAR paper, includes the addition of 2650 new disease terms, a 30% increase of textual definitions, and an expanding suite of disease classification hierarchies constructed through defined logical axioms.

Disposable materials contribute to healthcare's estimated production of 33 pounds of waste per patient bed per day or approximately 5.9 million tons of waste each year. The shift toward disposable materials was initially driven by a variety of factors including the potential for infection control, convenience, and cost. The current use of single-use disposables in healthcare, however, has become costly, wasteful, and to some extent, unnecessary. Disposable custom packs, a set of products prepackaged for a specific procedure to reduce time and error, are utilized in nearly every medical procedure performed in the US and internationally. This study analyzed 15 custom packs from geographically diverse hospitals using life cycle assessment and design for the environment. Polypropylene, the material used to make gowns and drapes, was the most prominent material by weight, followed by cotton. However, the life cycle assessment results show that cotton composed the largest portion of environmental impacts in every category. Finally, a new green custom pack was designed. By using tools and strategies such as life cycle assessment and design for the environment, healthcare institutions can make educated streamlining efforts for their disposable custom packs.

The development of green building rating systems (GBRS) and sustainability metrics for buildings, including building products, is reviewed from a North American perspective. The Leadership in Energy and Environmental Design (LEED) system and the Living Building Challenge (LBC) are highlighted as primary examples of different levels of GBRS. Life cycle assessment (LCA) is introduced as a preferred method of quantifying sustainability, and its integration into current GBRS is examined a prominent building example. Two example applications of LCA to building products associated with GBRS – carpet and roof membranes – are provided. In the first example, conventional carpet was compared with carpet meeting the standards of the LBC's materials exclusion criteria (Red List, via the Declare product labeling system). In the second example, LCA was applied to both the manufacture and use phases of roof membrane alternatives for a building retrofit project, one of which would have aided in achieving LEED certification. The Declare-listed products did not perform better in every LCA impact category, and the GBRS-preferred roof system performed more poorly in all LCA impact categories, while suggesting the need for additional LCA categories. Both examples help to illustrate the complexity and tradeoffs encountered while integrating the quantitative perspective of LCA and the qualitative perspective of GBRS.

Background While petroleum-based plastics are extensively used in health care, recent developments in biopolymer manufacturing have created new opportunities for increased integration of biopolymers into medical products, devices and services. This study compared the environmental impacts of single-use disposable devices with increased biopolymer content versus typically manufactured devices in hysterectomy. Methods A comparative life cycle assessment of single-use disposable medical products containing plastic(s) versus the same single-use medical devices with biopolymers substituted for plastic(s) at Magee-Women’s Hospital (Magee) in Pittsburgh, PA and the products used in four types of hysterectomies that contained plastics potentially suitable for biopolymer substitution. Magee is a 360-bed teaching hospital, which performs approximately 1400 hysterectomies annually. Results There are life cycle environmental impact tradeoffs when substituting biopolymers for petroplastics in procedures such as hysterectomies. The substitution of biopolymers for petroleum-based plastics increased smog-related impacts by approximately 900% for laparoscopic and robotic hysterectomies, and increased ozone depletion-related impacts by approximately 125% for laparoscopic and robotic hysterectomies. Conversely, biopolymers reduced life cycle human health impacts, acidification and cumulative energy demand for the four hysterectomy procedures. The integration of biopolymers into medical products is correlated with reductions in carcinogenic impacts, non-carcinogenic impacts and respiratory effects. However, the significant agricultural inputs associated with manufacturing biopolymers exacerbate environmental impacts of products and devices made using biopolymers. Conclusions The integration of biopolymers into medical products is correlated with reductions in carcinogenic impacts, non-carcinogenic impacts and respiratory effects; however, the significant agricultural inputs associated with manufacturing biopolymers exacerbate environmental impacts.

This study introduces life cycle assessment as a tool to analyze one aspect of sustainability in healthcare: the birth of a baby. The process life cycle assessment case study presented evaluates two common procedures in a hospital, a cesarean section and a vaginal birth. This case study was conducted at Magee-Womens Hospital of the University of Pittsburgh Medical Center, which delivers over 10,000 infants per year. The results show that heating, ventilation, and air conditioning (HVAC), waste disposal, and the production of the disposable custom packs comprise a large percentage of the environmental impacts. Applying the life cycle assessment tool to medical procedures allows hospital decision makers to target and guide efforts to reduce the environmental impacts of healthcare procedures.

Despite being a heavily regulated industry and one in which patient safety and wellbeing trumps many other concerns, healthcare's environmental impacts can be improved. Using Life Cycle Assessment (LCA) to quantify the environmental impacts associated with cesarean section and vaginal births at a US hospital, this study identifies aspects of birthing procedures upon which hospitals should focus to maximize efforts related to sustainability. This case study hospital, which delivers about 10,000 babies a year, emits about 227,000 kg of CO 2 equivalents annually from birth procedures alone. Results show that for both cesarean section and vaginal births, impacts related to the production and disposal of single-use items, as well as the impacts related to the heating, ventilation, and air conditioning contribute the most to the impact categories analyzed.

ONE of the principle rules of medical ethics is the oath, “First, do no harm.” Nearly everyone in the developed world is impacted by healthcare. In 2008, US hospitals employed over 5.3 million people and spent nearly $320 billion on goods and services from other businesses [1]. In 2009, healthcare represented about 17% of the total US GDP. The healthcare sector consumes 73 trillion kWh of electricity annually, and its hospital facilities are the second most energy intensive facility type in the US [2]. The health industry also generates large quantities of waste.

The authors regret an error in ‘Fig. 2: Environmental impacts of cesarean section and vaginal births’ of the original publication. The wasteimpacts in the non-carcinogenic category of Fig. 2 were shown as the same (88%) for both the cesarean section and vaginal births.Non-carcinogenic impacts (kg toluene eq) for the waste portion of the vaginal birth column in Fig. 2 should read 20%, not 88%, as shown inthe updated Fig. 2, as this figure normalizes to cesarean sections. The authors found no errors in any other impact categories and would liketo apologize for any inconvenience caused.