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Environmental Public Health Surveillance for Exposure to Respiratory Health Hazards: A Joint NASA/CDC Project to Use Remote Sensing Data for Estimating Airborne Particulate Matter Over the Atlanta, Georgia Metropolitan Area

As part of the National Environmental Public Health Tracking Network (EPHTN) the National Center for Environmental Health (NCEH) at the Centers for Disease Control and Prevention (CDC) is leading a project called Health and Environment Linked for Information Exchange (HELiX-Atlanta). The goal of developing the National Environmental Public Health Tracking Network is to improve the health of communities. Currently, few systems exist at the state or national level to concurrently track many of the exposures and health effects that might be associated with environmental hazards. An additional challenge is estimating exposure to environmental hazards such as particulate matter whose aerodynamic diameter is less than or equal to 2.5 micrometers (PM2.5). HELIX-Atlanta's goal is to examine the feasibility of building an integrated electronic health and environmental data network in five counties of Metropolitan Atlanta, GA. NASA Marshall Space Flight Center (NASA/MSFC) is collaborating with CDC to combine NASA earth science satellite observations related to air quality and environmental monitoring data to model surface estimates of PM2.5 concentrations that can be linked with clinic visits for asthma. While use of the Air Quality System (AQS) PM2.5 data alone could meet HELIX-Atlanta specifications, there are only five AQS sites in the Atlanta area, thus the spatial coverage is not ideal. We are using NASA Moderate Resolution Imaging Spectroradiometer (MODIS) satellite Aerosol Optical Depth (AOD) data for estimating daily ground level PM2.5 at 10 km resolution over the metropolitan Atlanta area supplementing the AQS ground observations and filling their spatial and temporal gaps.

Quattrochi, Dale A.↗

Global Estimates of Average Ground-Level Fine Particulate Matter Concentrations from Satellite-Based Aerosol Optical Depth

Exposure to airborne particles can cause acute or chronic respiratory disease and can exacerbate heart disease, some cancers, and other conditions in susceptible populations. Ground stations that monitor fine particulate matter in the air (smaller than 2.5 microns, called PM2.5) are positioned primarily to observe severe pollution events in areas of high population density; coverage is very limited, even in developed countries, and is not well designed to capture long-term, lower-level exposure that is increasingly linked to chronic health effects. In many parts of the developing world, air quality observation is absent entirely. Instruments aboard NASA Earth Observing System satellites, such as the MODerate resolution Imaging Spectroradiometer (MODIS) and the Multi-angle Imaging SpectroRadiometer (MISR), monitor aerosols from space, providing once daily and about once-weekly coverage, respectively. However, these data are only rarely used for health applications, in part because the can retrieve the amount of aerosols only summed over the entire atmospheric column, rather than focusing just on the near-surface component, in the airspace humans actually breathe. In addition, air quality monitoring often includes detailed analysis of particle chemical composition, impossible from space. In this paper, near-surface aerosol concentrations are derived globally from the total-column aerosol amounts retrieved by MODIS and MISR. Here a computer aerosol simulation is used to determine how much of the satellite-retrieved total column aerosol amount is near the surface. The five-year average (2001-2006) global near-surface aerosol concentration shows that World Health Organization Air Quality standards are exceeded over parts of central and eastern Asia for nearly half the year.

Van Donkelaar, A.↗

Filovirus Research: The Need for an Integrated Approach in Time and Space

The episodic appearance of Ebola virus (EBOV) and Marburg virus (MARV) across central Africa over the last 15 years not only underscores the importance of filoviruses as uniquely virulent agents to both human and wildlife communities but also implies a very complex transmission scenario that must be understood if we are to prevent or mitigate filovirus outbreaks in the future. Efforts of a global network of scientists and healthcare workers have expanded our knowledge of filoviruses to meet the growing threat of Ebola and Marburg hemorrhagic fevers in Africa. In recent decades, several newly emerging diseases have resulted in major threats to both affected communities and global public health. Viruses from wildlife hosts in particular, have exhibited a capability for cross-species transmission (CST), and have caused high-impact diseases in humans Such as Ebola and Marburg hemorrhagic fevers, Nipah and severe acute respiratory syndrome (SAILS). It has been estimated that about 60.3% (Jones et al. 2008) of human infectious diseases are of animal origin (zoonoses) and even some important viral diseases that are traditionally considered of human origin, for example measles and smallpox, may very well have their prehistoric origins in wildlife (Wolfe et al 2007). It maybe logical and prudent therefore, to anticipate that there are other, new filoviruses out there that will cross into humans at some point in time. If we anticipate that these will happen and wish to be prepared for and mitigate this potential, then an understanding of filoviruses as a biologic system in the environment will be essential to that process. We will need to know how the ecological dynamic of CST interacts with a 'new' viruse's evolutionary factors to overcome environmental, demographic and host-specific barriers to transmission and infectivity to humans.

Pinzon, Jorge E.↗

A Hypothesis on Biological Protection from Space Radiation Through the Use of New Therapeutic Gases as Medical Counter Measures

Exposure to astronauts could be a significant obstacle for long duration manned space exploration because of current uncertainties regarding the extent of biological effects. Furthermore, concepts for protective shielding also pose a technically challenging issue due to the nature of cosmic radiation and current mass and power constraints with modern exploration technology. As biological damage from exposure is associated with increased oxidative stress, it would be enabling to mitigate and/or prevent stress prior to the development of clinical symptoms and disease. This paper hypothesizes a "systems biology" approach in which a combination of chemical and biological mitigation techniques are used conjunctively. It proposes using new, therapeutic, medical gases as both chemical radioprotectors for radical scavenging and biological promoters for management of the body s response to exposure. From reviewing radiochemistry of water, biological effects of CO, H2, NO, and H2S gas, and mechanisms of radiation biology, it is concluded that this approach may have great therapeutic potential for exposure. Furthermore, it also appears to have potential for curtailing the pathogenesis of other diseases in which oxidative stress has been implicated including cardiovascular disease, cancer, chronic inflammatory disease, hypertension, ischemia/reperfusion injury, acute respiratory distress syndrome, Parkinson s and Alzheimer s disease, cataracts, and aging.

Schoenfeld, Michael P.↗

Environmental Public Health Survelliance for Exposure to Respiratory Health Hazards: A Joint NASA/CDC Project to Use Remote Sensing Data for Estimating Airborne Particulate Matter Over the Atlanta, Georgia Metropolitan Area

Describes the public health surveillance efforts of NASA, in a joint effort with the Center for Disease Control (CDC). NASA/MSFC and the CDC are partners in linking nvironmental and health data to enhance public health surveillance. The use of NASA technology creates value - added geospatial products from existing environmental data sources to facilitate public health linkages. The venture sought to provide remote sensing data for the 5-country Metro-Atlanta area and to integrate this environmental data with public health data into a local network, in an effort to prevent and control environmentally related health effects. Remote sensing data used environmental data (Environmental Protection Agency [EPA] Air Quality System [AQS] ground measurements and MODIS Aerosol Optical Depth [AOD]) to estimate airborne particulate matter over Atlanta, and linked this data with health data related to asthma. The study proved the feasibility of linking environmental data (MODIS particular matter estimates and AQS) with health data (asthma). Algorithms were developed for QC, bias removal, merging MODIS and AQS particulate matter data, as well as for other applications. Additionally, a Business Associate Agreement was negotiated for a health care provider to enable sharing of Protected Health Information.

Quattrochi, Dale A.↗

A Hypothesis on Biological Protection from Space Radiation Through the Use of New Therapeutic Gases

Radiation exposure to astronauts could be a significant obstacle for long duration manned space exploration because of current uncertainties regarding the extent of biological effects. Furthermore, concepts for protective shielding also pose a technically challenging issue due to the nature of cosmic radiation and current mass and power constraints with modern exploration technology. The concern regarding exposure to cosmic radiation is the biological damage it induces. As damage is associated with increased oxidative stress, it is important and would be enabling to mitigate and/or prevent oxidative stress prior to the development of clinical symptoms and disease. This paper hypothesizes a "systems biology" approach in which a combination of chemical and biological mitigation techniques are used conjunctively. It proposes using new, therapeutic, medical gases as both chemical radioprotectors for radical scavenging and biological signaling molecules for management of the body s response to exposure. From reviewing radiochemistry of water, biological effects of CO, H2, NO, and H2S gas, and mechanisms of radiation biology, it is concluded that this approach may have great therapeutic potential for radiation exposure. Furthermore, it also appears to have similar potential for curtailing the pathogenesis of other diseases in which oxidative stress has been implicated including, cardiovascular disease, cancer, chronic inflammatory disease, hypertension, ischemia/reperfusion injury, acute respiratory distress syndrome, parkinson s and alzheimer s disease, cataracts, and aging

Schoenfeld, Michael P.↗

A Hypothesis on Biological Protection from Space Radiation Through the Use of New Therapeutic Gases as Medical Counter Measures

Radiation exposure to astronauts could be a significant obstacle for long duration manned space exploration because of current uncertainties regarding the extent of biological effects. Furthermore, concepts for protective shielding also pose a technically challenging issue due to the nature of cosmic radiation and current mass and power constraints with modern exploration technology. The concern regarding exposure to cosmic radiation is the biological damage it induces. As damage is associated with increased oxidative stress, it is important and would be enabling to mitigate and/or prevent oxidative stress prior to the development of clinical symptoms and disease. This paper hypothesizes a "systems biology" approach in which a combination of chemical and biological mitigation techniques are used conjunctively. It proposes using new, therapeutic, medical gases as both chemical radioprotectors for radical scavenging and biological signaling molecules for management of the body s response to exposure. From reviewing radiochemistry of water, biological effects of CO, H2, NO, and H2S gas, and mechanisms of radiation biology, it is concluded that this approach may have great therapeutic potential for radiation exposure. Furthermore, it also appears to have similar potential for curtailing the pathogenesis of other diseases in which oxidative stress has been implicated including cardiovascular disease, cancer, chronic inflammatory disease, hypertension, ischemia/reperfusion injury, acute respiratory distress syndrome, Parkinson s and Alzheimer s disease, cataracts, and aging.

Schoenfeld, Michael P.↗

A Hypothesis on Biological Protection from Space Radiation Through the Use of New Therapeutic Gases

Radiation exposure to astronauts could be a significant obstacle for long duration manned space exploration because of current uncertainties regarding the extent of biological effects. Furthermore, concepts for protective shielding also pose a technically challenging issue due to the nature of cosmic radiation and current mass and power constraints with modern exploration technology. The concern regarding exposure to cosmic radiation is the biological damage it induces. As damage is associated with increased oxidative stress, it is important and would be enabling to mitigate and/or prevent oxidative stress prior to the development of clinical symptoms and disease. This paper hypothesizes a "systems biology" approach in which a combination of chemical and biological mitigation techniques are used conjunctively. It proposes using new, therapeutic, medical gases as both chemical radioprotectors for radical scavenging and biological signaling molecules for management of the body s response to exposure. From reviewing radiochemistry of water, biological effects of CO, H2, NO, and H2S gas, and mechanisms of radiation biology, it is concluded that this approach may have great therapeutic potential for radiation exposure. Furthermore, it also appears to have similar potential for curtailing the pathogenesis of other diseases in which oxidative stress has been implicated including cardiovascular disease, cancer, chronic inflammatory disease, hypertension, ischemia/reperfusion injury, acute respiratory distress syndrome, Parkinson s and Alzheimer s disease, cataracts, and aging.

Schoenfeld, Michael P.↗

Environmental Public Health Tracking: Health and Environment Linked for Information Exchange-Atlanta (HEXIX-Atlanta: A cooperative Program Between CDC and NASA for Development of an Environmental Public Health Tracking Network in the Atlanta Metropolitan Area

The Centers for Disease Control and Prevention (CDC) is coordinating HELIX- Atlanta to provide information regarding the five-county Metropolitan Atlanta Area (Clayton, Cobb, DeKalb, Fulton, and Gwinett) via a network of integrated environmental monitoring and public health data systems so that all sectors can take action to prevent and control environmentally related health effects. The HELIX-Atlanta Network is a tool to access interoperable information systems with optional information technology linkage functionality driven by scientific rationale. HELIX-Atlanta is a collaborative effort with local, state, federal, and academic partners, including the NASA Marshall Space Flight Center. The HELIX-Atlanta Partners identified the following HELIX-Atlanta initial focus areas: childhood lead poisoning, short-latency cancers, developmental disabilities, birth defects, vital records, respiratory health, age of housing, remote sensing data, and environmental monitoring, HELIX-Atlanta Partners identified and evaluated information systems containing information on the above focus areas. The information system evaluations resulted in recommendations for what resources would be needed to interoperate selected information systems in compliance with the CDC Public Health Information Network (PHIN). This presentation will discuss the collaborative process of building a network that links health and environment data for information exchange, including NASA remote sensing data, for use in HELIX-Atlanta.

Quattrochi, Dale A.↗

Human physiology in space

The universality of gravity (1 g) in our daily lives makes it difficult to appreciate its importance in morphology and physiology. Bone and muscle support systems were created, cellular pumps developed, neurons organised and receptors and transducers of gravitational force to biologically relevant signals evolved under 1g gravity. Spaceflight provides the only microgravity environment where systematic experimentation can expand our basic understanding of gravitational physiology and perhaps provide new insights into normal physiology and disease processes. These include the surprising extent of our body's dependence on perceptual information, and understanding the effect and importance of forces generated within the body's weightbearing structures such as muscle and bones. Beyond this exciting prospect is the importance of this work towards opening the solar system for human exploration. Although both appear promising, we are only just beginning to taste what lies ahead.

NASA Center HQS↗

Pacific Northwest Health & Air Quality - Utilizing NASA Earth Observations to Analyze Air Quality Impacts from Wildfires in the Pacific Northwest

The Pacific Northwest region of the United States and Canada has become more vulnerable to intense wildfire regimes due to years of fire suppression and climatic changes. Smoke from fires exposes communities to hazardous aerosols and pollutants known to trigger asthma symptoms and exacerbate other respiratory and cardiovascular diseases. In partnership with The Nature Conservancy’s Washington Chapter and the Puget Sound Clean Air Agency, NASA DEVELOP investigated the impacts of wildfire smoke on air quality from 2008 to 2020 using NASA Earth observations. To explore the various dimensions of smoke and its relation to air quality, the team looked at the vertical extent of smoke plumes and the resulting changes in air quality. The team evaluated the potential relationship between plume height of wildfire smoke and fire radiative power using the Moderate Resolution Imaging Spectroradiometer (MODIS) aboard the Aqua and Terra satellites and Terra’s Multi-angle Imaging SpectroRadiometer (MISR) using the MISR INteractive eXplorer (MINX). The team determined that there was no regional relationship between fire radiative power and smoke plume height. To investigate changes in air quality resulting from wildfire smoke, the team utilized data from NASA’s Fire Information for Resource Management System, from the European Space Agency’s Sentinel-5P Tropospheric Monitoring Instrument (TROPOMI), and true color imagery from Landsat 8 Operational Land Imager (OLI). The team created a Google Earth Engine-based (GEE) web tool to visualize changes in atmospheric pollutants and aerosol optical depth. Results of case study fires showed varying increases in pollutant concentrations when compared to a baseline map. The end products provided the partners with tools to quantify plume height using MINX and to visualize recent air quality patterns relating to variations in wildfire extent and severity in the Pacific Northwest

Ani Matevosian↗

Allowable exposure limits for carbon dioxide during extravehicular activity

The intent was to review the research pertaining to human exposure to carbon dioxide (CO2) and to recommend allowable exposure limits for extravehicular activity (EVA). Respiratory, renal, and gastrointestinal systems may be adversely affected by chronic low dose CO2 exposure. Ventilation was increased 15 percent with 1 percent CO2 and 50 percent with 2 percent CO2. Chronic exposure to less than 2 percent CO2 led to 20 day cycles of uncompensated and compensated respiratory acidosis. Acid-base changes were small. Histopathologic changes in guinea pig lungs have been noted with long term exposure to 1 percent CO2. No changes were seen with exposure to 0.5 percent CO2. Cycling of bone calcium stores with associated changes in blood and urinary calcium levels occurs with long term CO2 exposure. Histologic changes in bone have been noted in guinea pigs exposed to 1 percent CO2. Renal calcification has been noted in guinea pigs with exposure to as low as 0.5 percent CO2. An increase in gastric acidity was noted in subjects with long term exposure to 1 percent CO2. Cardiovascular and neurologic function were largely unaffected. A decrease in the incidence of respiratory, renal, and gastrointestinal disease was noted in submariners coincident with a decrease in ambient CO2 from 1.2 percent to 0.8-0.9 percent. Oxygen (O2) and CO2 stimulate respiration independently and cumulatively. The addition of CO2 to high dose O2 led to the faster onset of seizure activity in mice. Experiments evaluating the physiologic responses to intermittent, repetitive exposures to low dose CO2 and 100 percent O2 mixtures should be performed. A reduction in the current NASA standard for CO2 exposure during EVA of 1 percent (7.6 mmHg) for nominal and 2 percent (15.2 mmHg) for heavy exertion to 0.5 percent (3.8 mmHg) for nominal and 1 percent (7.6 mmHg) for heavy exertion may be prudent. At a minimum, the current NASA standard should not be liberalized.

Seter, Andrew J.↗

A Comprehensive Assessment of Biologicals Contained Within Commercial Airliner Cabin Air

Both culture-based and culture-independent, biomarker-targeted microbial enumeration and identification technologies were employed to estimate total microbial and viral burden and diversity within the cabin air of commercial airliners. Samples from each of twenty flights spanning three commercial carriers were collected via air-impingement. When the total viable microbial population was estimated by assaying relative concentrations of the universal energy carrier ATP, values ranged from below detection limits (BDL) to 4.1 x 106 cells/cubic m of air. The total viable microbial population was extremely low in both of Airline A (approximately 10% samples) and C (approximately 18% samples) compared to the samples collected aboard flights on Airline A and B (approximately 70% samples). When samples were collected as a function of time over the course of flights, a gradual accumulation of microbes was observed from the time of passenger boarding through mid-flight, followed by a sharp decline in microbial abundance and viability from the initiation of descent through landing. It is concluded in this study that only 10% of the viable microbes of the cabin air were cultivable and suggested a need to employ state-of-the art molecular assay that measures both cultivable and viable-but-non-cultivable microbes. Among the cultivable bacteria, colonies of Acinetobacter sp. were by far the most profuse in Phase I, and Gram-positive bacteria of the genera Staphylococcus and Bacillus were the most abundant during Phase II. The isolation of the human pathogens Acinetobacter johnsonii, A. calcoaceticus, Janibacter melonis, Microbacterium trichotecenolyticum, Massilia timonae, Staphylococcus saprophyticus, Corynebacterium lipophiloflavum is concerning, as these bacteria can cause meningitis, septicemia, and a handful of sometimes fatal diseases and infections. Molecular microbial community analyses exhibited presence of the alpha-, beta-, gamma-, and delta- proteobacteria, as well as Gram-positive bacteria, Fusobacteria, Cyanobacteria, Deinococci, Bacterioidetes, Spirochetes, and Planctomyces in varying abundance. Neisseria meningitidis rDNA sequences were retrieved in great abundance from Airline A followed by Streptococcus oralis/mitis sequences. Pseudomonas synxantha sequences dominated Airline B clone libraries, followed by those of N. meningitidis and S. oralis/mitis. In Phase II, Airline C, sequences representative of more than 113 species, enveloping 12 classes of bacteria, were retrieved. Proteobacterial sequences were retrieved in greatest frequency (58% of all clone sequences), followed in short order by those stemming from Gram-positives bacteria (31% of all clone sequences). As for overall phylogenetic breadth, Gram-positive and alpha-proteobacteria seem to have a higher affinity for international flights, whereas beta-and gamma-proteobacteria are far more common about domestic cabin air parcels in Airline C samples. Ultimately, the majority of microbial species circulating throughout the cabin airs of commercial airliners are commensal, infrequently pathogenic normal flora of the human nasopharynx and respiratory system. Many of these microbes likely originate from the oral and nasal cavities, and lungs of passengers and flight crew and are disseminated unknowingly via routine conversation, coughing, sneezing, and stochastic passing of fomites. The data documented in this study will be useful to generate a baseline microbial population database and can be utilized to develop biosensor instrumentation for monitoring microbial quality of cabin or urban air.

microbial diversity↗

Integration of Dust Prediction Systems and Vegetation Phenology to Track Pollen for Asthma Alerts in Public Health

Pollen can be transported great distances. Van de Water et. al., 2003 reported Juniperus pollen, a significant aeroallergen was transported 200-600 km. Hence local observations of plant phenology may not be consistent with the timing and source of pollen collected by pollen sampling instruments. The DREAM (Dust REgional Atmospheric Model, Yin 2007) is a verified model for atmospheric dust transport modeling using MODIS data products to identify source regions and quantities of dust (Yin 2007). The use of satellite data products for studying phenology is well documented (White and Nemani 2006). We are modifying the DREAM model to incorporate pollen transport. The linkages already exist with DREAM through PHAiRS (Public Health Applications in remote Sensing) to the public health community. This linkage has the potential to fill this data gap so that health effects of pollen can better be tracked for linkage with health outcome data including asthma, respiratory effects, myocardial infarction, and lost work days. DREAM is based on the SKIRON/Eta modeling system and the Eta/NCEP regional atmospheric model. The dust modules of the entire system incorporate the state of the art parameterizations of all the major phases of the atmospheric dust life such as production, diffusion, advection, and removal. These modules also include effects of the particle size distribution on aerosol dispersion. The dust production mechanism is based on the viscous/turbulent mixing, shear-free convection diffusion, and soil moisture. In addition to these sophisticated mechanisms, very high resolution databases, including elevation, soil properties, and vegetation cover are utilized. The DREAM model was modified to use pollen sources instead of dust (PREAM). Pollen release will be estimated based on satellite-derived phenology of Juniperus spp. communities. The MODIS surface reflectance product (MOD09) will provide information on the start of the plant growing season, growth stage, peak greenness, dry-down and pollen release. Ground based observational records of pollen release timing and quantities will be used as verification. Techniques developed using MOD09 surface reflectance products will be directly applicable to the next generation sensors such as VIIRS. The resulting deterministic model for predicting and simulating pollen emission and downwind concentration to study details of phenology and meteorology and their dependencies. This information will be used to support the Centers for Disease Control and Prevention (CDC)'s National Environmental Public Health Tracking Program (EPHT) and the State of New Mexico environmental public health decision support for asthma and allergies alerts

Luvall, Jeffrey C.↗

Exploiting Satellite Remote-Sensing Data in Fine Particulate Matter Characterization for Serving the Environmental Public Health Tracking Network (EPHTN): The HELIX-Atlanta Experience and NPOESS Implications

As part of the U.S. National Environmental Public Health Tracking Network (EPHTN), the National Center for Environmental Health (NCEH) at the U.S. Centers for Disease Control and Prevention (CDC) led a project in collaboration with the National Aeronautics and Space Administration (NASA) Marshall Space Flight Center (MSFC) called Health and Environment Linked for Information Exchange (HELIX-Atlanta). Under HELIX-Atlanta, pilot projects were conducted to develop methods to better characterize exposure; link health and environmental datasets; and analyze spatial/temporal relationships. This paper describes and demonstrates different techniques for surfacing daily environmental hazards data of particulate matter with aerodynamic diameter less than or equal to 2.5 micrometers (PM(sub 2.5) for the purpose of integrating respiratory health and environmental data for the CDC's pilot study of HELIX-Atlanta. It describes a methodology for estimating ground-level continuous PM(sub 2.5) concentrations using spatial surfacing techniques and leveraging NASA Moderate Resolution Imaging Spectrometer (MODIS) data to complement the U.S. Environmental Protection Agency (EPA) ground observation data. The study used measurements of ambient PM(sub 2.5) from the EPA database for the year 2003 as well as PM(sub 2.5) estimates derived from NASA's MODIS data. Hazard data have been processed to derive the surrogate exposure PM(sub 2.5) estimates. The paper has shown that merging MODIS remote sensing data with surface observations of PM(sub 2.5), may provide a more complete daily representation of PM(sub 2.5), than either data set alone would allow, and can reduce the errors in the PM(sub 2.5) estimated surfaces. Future work in this area should focus on combining MODIS column measurements with profile information provided by satellites like the National Polar-orbiting Operational Environmental Satellite System (NPOESS). The Visible Infrared Imager/Radiometer Suite (VIIRS) and the Aerosol Polarimeter Sensor (APS) NPOESS sensors will provide first-order information on aerosol particle size and are anticipated to provide information on aerosol products at higher resolution and accuracy than MODIS. Use of the NPOESS remote sensing data should result in more robust remotely sensed data that can be coupled with the methods discussed in this paper to generate surface concentrations of PM(2.5) for linkage with health data in Environmental Public Health Tracking.

Al-Hamdan, Mohammad Z.↗

Asthma and Air Quality in the Presence of Fires - A Foundation for Public Health Policy in Florida

Outdoor air quality and its associated impacts on respiratory problems in Florida are of public health significance. Air quality in Florida can be poor during the extended wildfire season, threatening persons with compromised respiratory systems each year. Studies have demonstrated that particulate matter, which is generally elevated in the vicinity of wildfires, is associated with increases in hospital admissions and occurrences of acute asthma exacerbations. However, few studies have examined the modifying effect of socio-demographic characteristics of cities or regional areas on the relationship between air quality and health outcomes. In an ongoing university/multi-agency project, asthma hospital/emergency room (patient) data are being used to create a health outcome indicator of human response to environmental air quality. Environmental data are derived from satellite measurements, with special attention being given to the effect of wildfires and prescribed burns on air quality. This presentation will focus on the environmental data sets particulate matter, location of fires, smoke plumes that are being collected and processed for linkage with health data. After this linkage has been performed, space-time models of asthma rates as a function of air quality data and socio-demographic variables will be developed and validated. The Florida Department of Health (FDOH) will work with county health department staff and representatives from the medical community to establish a protocol with triggers for issuing public health advisories/alerts based on the developed and validated health outcome indicators. From this effort, a science-based policy for issuing public health advisories/alerts for asthma relating to air quality will be developed, giving FDOH the ability to (1) predict, with stated levels of uncertainty, case load of hospital admissions based on air quality, (2) reduce asthma exacerbations by forewarning asthmatics to limit outside activities on poor air quality days, (3) apply management practices on the rates of hospital/emergency room visits for asthma, and (4) provide information that would help translate interventions into policy decisions, thereby reducing the economic burden and increasing well being of asthmatics. Further, the results of the study will be incorporated into Florida s Environmental Public Health Tracking (EPHT) program, which is part of the Centers for Disease Control and Prevention's (CDC's) EPHT network.

Crosson, William↗

Hypercapnic ventilatory response in humans before, during, and after 23 days of low level CO2 exposure

Alterations in ventilation and the chemoreceptor response to CO2 during 23 d of 1.2% inspired CO2 were studied in four male subjects. Resting ventilation (VE), tidal volume (VT), respiratory frequency (fR), inspired and end tidal O2 and CO2 and the hypercapnic ventilatory response (HCVR) measured by CO2 rebreathing were measured once before entering the chamber, on days 2, 5, 11, and 22 of CO2 exposure, and one day after. Resting VE slightly increased (5%) on day 2 of exposure and significantly increased (22%) by day 5 followed by a progressive decrease to pre-chamber levels by day 22 and on the first day of recovery. Tidal volume and fR were not statistically different. During the exposure PetCO2 was significantly elevated with day 2 having the largest increase (19.6%). PetCO2 returned to normal within 24 h post exposure. The HCVR was characterized by the slope (SHCVR), intercept at zero ventilation (B), and the ventilation at a PCO2 = 60 mmHg (VE60). The SHCVR decreased (14%) on day 2, but was not significant; the SHCVR on the other exposure days were also not different. The SHCVR on the first recovery day significantly increased (37%). The HCVR B was shifted to the right on day 2 by 5.2 mmHg, then progressively returned to the pre-exposure position. On recovery the B significantly shifted 6.9 mmHg to the right of pre-exposure B. The VE60 decreased by approximately 32% and 16% on day 2 and 5, respectively, then returned within pre-exposure range for the remainder of the exposure and during recovery. During the early phase and one day after the exposure the HCVR was right shifted. One day after exposure chemoreceptor sensitivity to elevated CO2 was increased but, the B was right shifted resulting in a reduced HCVR below PCO2 of 60 mmHg and a greater HCVR above 60 mmHg.

NASA Discipline Cardiopulmonary↗