BOSTON -- This holiday season, consumer advocates are urging Commonwealth residents to consider giving gifts that don't require purchasing anything. Or, if you have to purchase something, shop for refurbished items.

Janet Domenitz, executive director of the Massachusetts Public Interest Research Group (MASSPIRG), said while Black Friday and Cyber Monday deals on electronics and other items may look appealing, there are great deals on refurbished items year-round.

"There's a shortage of goods and supply-chain problems, so you may well find yourself having more options for purchasing gifts by considering refurbished items," Domenitz explained. "Good for the environment, good for your pocketbook, good for options."

She noted MASSPIRG has two guides, one called "Buy Less Give More," which ideas for experiences, pre-loved gifts, classes, chores and tasks and baked goods, among other things. The other is called "Fixed for the Holidays," which gives recommendations on where to shop for refurbished items.

Domenitz noted many people do not realize the impact throwing out electronics and other items after just a few years can have on the environment and the nation's waste.

"If we could all keep our smartphones for one year more than we do, we would reduce the demand for manufacturing materials by 42 million pounds a day," Domenitz asserted.

Domenitz added when you buy refurbished items, there are some things to remember. She said it's important to make sure the manufacturer has a track record of durability and repairability, and to know what you want when you shop.

During the first year of the global pandemic, medical consumers in Colorado received more than one million low-value healthcare services - diagnostic tests, screenings and treatments where the risk of harm outweighs any likely benefit to the patient.

Cari Frank, vice president for communications with the Center for Improving Value in HealthCare - the group behind a new report, said consumers and insurers paid $134 million for these services in 2020.

"Even in spite of COVID, when people weren't accessing health-care services the same way," said Frank, "we still saw high numbers of these low-value care services. And they cost a lot of money, both to the health plans and to the patient, and actually can cause harm to patients."

The most obvious example of low-value care is when providers prescribe opioids for acute back pain without first trying alternative medication - a remedy that comes with significant risk of addiction and even death.

Health providers across the nation, working with medical boards and other professional associations, have created a list and guidelines for low-value services through an initiative called Choosing Wisely.

Frank said getting the word out can help bring down overall health costs. She said many services now considered low-value care were considered best practices at one time.

"A lot of things are just, historically, the way the provider has treated patients," said Frank. "And it takes a while when the guidelines change, for there to be an actual adoption of the guidelines."

The average cost for low-value services is $130 - but some, including peripheral catheters for patients with late-stage kidney disease, cost more than $14,000 per incidence.

Frank noted that every patient is different, and some procedures flagged as low-value may actually be the right course for patients.

"There might be family history, or there might be medical history where they have tried some other alternative," said Frank. "So there still needs to be that kind of communication between the provider and the patient."

The baby-formula shortage is hitting Michigan families hard, especially those who live in rural areas, are low-income or have kids with digestive or other health issues.

Because of supply problems and a massive safety recall by the Michigan Abbott factory in February, the Food and Drug Administration says it is working with manufacturers to increase their output and trying to import more formula.

Data released this week revealed out-of-stock rates jumped to 40% at the end of April. Elyssa Schmier, vice president for government relations with Moms Rising, said she has been dealing with the shortage herself in Michigan.

"Anyone who has a child with medical issues or digestive issues, a lot of them use a particular type of formula that they've found works along with their doctors," said Schmier. "And switching formula is not only incredibly hard, but could be detrimental to their child's health."

She said some moms are driving hours and even crossing state lines to find specialized formula, or buying online for prices far higher than normal. She added that for folks living in rural areas, if their regular store is out of formula, they might not have another nearby option.

Schmier said folks who are struggling to afford formula should reach out to WIC - the Women, Infants and Children special supplemental nutrition program. But she added that the shortage is hitting WIC recipients particularly hard, because they are limited to purchasing certain brands.

"They've been able to get waivers and work in some flexibility for WIC recipients," said Schmier. "But these are people who are low-income. They don't have the ability to stockpile."

Schmier said while it may be tempting to water down formula to conserve it, try to make homemade formula or use cow's milk, it's really important to consult your pediatrician.

"I know from personal experience," said Schmier. "My son didn't switch very easily. He had some digestive issues when we originally switched him. And so your health-care provider can provide you with a lot of good advice of how to slowly do that, how to safely do that."

Moms Rising is circulating a petition calling on President Joe Biden to use the Defense Production Act to get formula on the shelves as soon as possible.

The calendar indicates it is early May, but many Minnesotans are experiencing summerlike temperatures this week. As residents crank up the air conditioning, clean energy nonprofits hope more people give thought to installing systems providing more efficiency.

The industry said air source heat pumps are equipped with improved technology and now work better in colder climates. Beyond brutal Minnesota winters, experts say they are a reliable cooling source in the summer.

Emily McPherson, program development manager at the Center for Energy and Environment, said advancements with dual systems can really help reduce a home's carbon footprint.

"Rather than generating heat directly, it moves heat from the outside of the home into the home," McPherson explained. "And then it does the reverse in cooling. So, it can be 300% efficient, whereas typical heating systems are 80%, 90% or 100% efficient."

The U.S. Department of Energy backs up those claims. However, while the systems now work better in colder regions, their effectiveness starts to wane when temperatures approach zero, meaning a secondary source is still needed. And federal officials suggest connecting with knowledgeable technicians to avoid performance issues.

Shaylyn Bernhardt, communications and engagement manager for Clean Energy Resource Teams, said the systems can especially help with homes currently using propane or electrical heating systems. She noted it is becoming easier to explore options.

"Many utilities are offering rebates now, too, that make it a lot more cost-effective to put in a system," Bernhardt pointed out. "More and more contractors are familiar with the technology. "

Brent Hartwig of Saginaw has adopted the technology for his home. He feels it provides more stability in energy usage, especially when transitioning from one season to another.

"Heating the home, seems like they run a little bit more," Hartwig observed. "But like in those transitional parts of the year, like we are in, they have produced."