Long-term exposure to PM2.5 major components and mortality in the southeastern United States
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Yifan Wang↗
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Results for “mortality”
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Projections of Temperature-Attributable Premature Deaths in 209 U.S. Cities Using a Cluster-Based Poisson Approach
Background: A warming climate will affect future temperature-attributable premature deaths. This analysis is the first to project these deaths at a near national scale for the United States using city and month-specific temperature-mortality relationships. Methods: We used Poisson regressions to model temperature-attributable premature mortality as a function of daily average temperature in 209 U.S. cities by month. We used climate data to group cities into clusters and applied an Empirical Bayes adjustment to improve model stability and calculate cluster-based month-specific temperature-mortality functions. Using data from two climate models, we calculated future daily average temperatures in each city under Representative Concentration Pathway 6.0. Holding population constant at 2010 levels, we combined the temperature data and cluster-based temperature-mortality functions to project city-specific temperature-attributable premature deaths for multiple future years which correspond to a single reporting year. Results within the reporting periods are then averaged to account for potential climate variability and reported as a change from a 1990 baseline in the future reporting years of 2030, 2050 and 2100. Results: We found temperature-mortality relationships that vary by location and time of year. In general, the largest mortality response during hotter months (April - September) was in July in cities with cooler average conditions. The largest mortality response during colder months (October-March) was at the beginning (October) and end (March) of the period. Using data from two global climate models, we projected a net increase in premature deaths, aggregated across all 209 cities, in all future periods compared to 1990. However, the magnitude and sign of the change varied by cluster and city. Conclusions: We found increasing future premature deaths across the 209 modeled U.S. cities using two climate model projections, based on constant temperature-mortality relationships from 1997 to 2006 without any future adaptation. However, results varied by location, with some locations showing net reductions in premature temperature-attributable deaths with climate change.
Schwartz, Joel D.↗
Projections of Seasonal Patterns in Temperature- Related Deaths for Manhattan, New York
Global average temperatures have been rising for the past half-century, and the warming trend has accelerated in recent decades. Further warming is expected over the next few decades, with significant regional variations. These warming trends will probably result in more frequent, intense and persistent periods of hot temperatures in summer, and generally higher temperatures in winter. Daily death counts in cities increase markedly when temperatures reach levels that are very high relative to what is normal in a given location. Relatively cold temperatures also seem to carry risk. Rising temperatures may result in more heat-related mortality but may also reduce cold-related mortality, and the net impact on annual mortality remains uncertain. Here we use 16 downscaled global climate models and two emissions scenarios to estimate present and future seasonal patterns in temperature-related mortality in Manhattan, New York. All 32 projections yielded warm-season increases and cold-season decreases in temperature-related mortality, with positive net annual temperature-related deaths in all cases. Monthly analyses showed that the largest percentage increases may occur in May and September. These results suggest that, over a range of models and scenarios of future greenhouse gas emissions, increases in heat-related mortality could outweigh reductions in cold-related mortality, with shifting seasonal patterns.
Trends↗
Risk analysis: divergent models and convergent interpretations
Material presented at a NASA-sponsored workshop on risk models for exposure conditions relevant to prolonged space flight are described in this paper. Analyses used mortality data from experiments conducted at Argonne National Laboratory on the long-term effects of external whole-body irradiation on B6CF1 mice by 60Co gamma rays and fission neutrons delivered as a single exposure or protracted over either 24 or 60 once-weekly exposures. The maximum dose considered was restricted to 1 Gy for neutrons and 10 Gy for gamma rays. Proportional hazard models were used to investigate the shape of the dose response at these lower doses for deaths caused by solid-tissue tumors and tumors of either connective or epithelial tissue origin. For protracted exposures, a significant mortality effect was detected at a neutron dose of 14 cGy and a gamma-ray dose of 3 Gy. For single exposures, radiation-induced mortality for neutrons also occurred within the range of 10-20 cGy, but dropped to 86 cGy for gamma rays. Plots of risk relative to control estimated for each observed dose gave a visual impression of nonlinearity for both neutrons and gamma rays. At least for solid-tissue tumors, male and female mortality was nearly identical for gamma-ray exposures, but mortality risks for females were higher than for males for neutron exposures. As expected, protracting the gamma-ray dose reduced mortality risks. Although curvature consistent with that observed visually could be detected by a model parameterized to detect curvature, a relative risk term containing only a simple term for total dose was usually sufficient to describe the dose response. Although detectable mortality for the three pathology end points considered typically occurred at the same level of dose, the highest risks were almost always associated with deaths caused by tumors of epithelial tissue origin.
Non-NASA Center↗
Watching Without Seeing a Tool to Surveil Astronaut Health Outcomes While Maintaining Astronaut Medical Privacy
BACKGROUND The Privacy Act of 1974 regulates the use a nd disclosure of personally identifiable information by US Federal agencies. The Act applies to biographical, financial, a nd other identity-linked information, a s well a s personal health information (PHI). As such, the use of astronaut PHI is limited to authorized personnel for preapproved uses, with data reporting often limited to aggregated information about groups. These limitations on the use a nd reporting of astronaut PHI complicates surveillance efforts, wherein epidemiologists a t the National Aeronautics and Space Administration (NASA)monitor the incidence of targeted health conditions in the astronaut population, or to discover emerging trends of aging and disease. Stratification on one or more covariates –particularly time-period, sex, a nd mission participation –can lead to extremely small datasets such that the reporting of results is potentially attributable to individuals. An additional challenge is the small size of the astronaut population, both in terms of numbers of individuals a s well a s in terms of density of exposure time. Such small datasets yield volatile rate estimates that are difficult to interpret. To a id the epidemiological surveillance efforts, a surveillance tool is required that can (a) satisfy the need for rapid computation of condition-specific incidence and mortality rates; (b) improve the statistical estimates of these estimated rates; and (c) maintain astronaut privacy. Here we describe a nd demonstrate such a tool. METHODS We devised a system that models incidence a nd mortality rates rather than calculating them directly. This ha s the advantage of using all the available data to derive the estimates, lea ding to rates that a re not attributable to any one individual, a nd a re a s numerically stable a s they can be given the extremely limited data. The system models disease endpoints using a Poisson regression model with exposure density (measured in person-years) a s a n offset term. By doing so the model is estimating event counts per person-year, equivalent to modeling the rates directly. It uses a standard (pre-specified)set of covariates; the system does not engage in “model-building” as model parsimony is not the goa l. Instead, it is explicitly recognized that if a covariate is not statistically significant a nd not a confounder then it will likely have very little effect on the estimate of the incidence a nd mortality rates. Users are able to specify the disease endpoint of interest and the covariates over which they would like to stratify. The system then uses the resulting model to compute the estimated rates for the user-chosen configuration of variables as visualizes those either over an age range within a specified time-period, or over time for astronauts with a specified age range. RESULTS The first iteration of the tool computes incidence a nd mortality rates for cardiovascular conditions and cancers. Code ha s been developed to retrieve the appropriate data from the IMPALA analysis platform, compute the models for incidence a nd mortality, a nd then use those models to generate the corresponding rate curves. A companion graphical user interface allows the user to specify the curves and visualize the results. CONCLUSIONS It is important to note that the rapid surveillance tool described here is neither meant to be a definitive assessment of the incidence or mortality of any particular disease or condition in the astronaut population, nor is it meant to be used for research purposes. Rather, it is meant as an early indicator that in-depth investigation may be warranted. By automating a repetitive process and leveraging carefully curated astronaut health outcomes, the tool makes possible a rapid “first look” into known areas of concern, and, if used judiciously, may surface new areas of concern for long-term astronaut health. This work is supported in part by the Translational Research Institute for Space Health (TRISH) through NASA Cooperative Agreement NNX16AO69A.
R J Reynolds↗
Ecological study of dietary and smoking links to lymphoma
The ecological approach is used to investigate dietary and smoking links to lymphoma. International mortality rate data for 1986 and 1994 by gender and age group are compared with national dietary supply values of various food components for up to 10 years prior to the mortality data as well as per capita cigarette consumption rates 5 and 15 years earlier. The non-fat portion of milk, 3-9 years prior to the 1986 mortality data and 4 years prior to the 1994 data, was found to have the highest association with lymphoma, with r as high as 0.89. The results imply that 70 percent of lymphoma mortality may be related to this dietary component. Cigarette smoking in 1980 was found to have a weaker association with 1994 lymphoma mortality rates, being most important for younger men and statistically insignificant for younger women. The non-fat milk result is consistent with both case-control studies and a Norwegian prospective study, and with the often-observed finding that abnormal calcium metabolism, hypercalciuria, and dysregulated calcitriol production are common in normocalcemic patients with non-Hodgkin's lymphoma (NHL). It is hypothesized that excess dietary calcium from milk is a significant risk factor for lymphoma.
Calcium/adverse effects↗
Venous Gas Embolism: Review to Quantify a Safe Volume of Air in Intravenous Fluids Bags for Spaceflight Applications
INTRODUCTION: The ability to create intravenous fluids (IVF) in-situ from the potable water supply of a spaceflight vehicle or habitat is a desired capability for an exploration medical system. In order to define an acceptable volume of air in IVF bags, an understanding of the volume of venous gas embolism as it relates to negative outcomes is needed. The purpose of this study is to review the literature to determine if there is a known volume of gas that contributes to mortality and/or morbidity that could be used to define requirements for rapid IVF infusion in microgravity. METHODS: A literature review was conducted of the PubMed database using the syntax: (Venous) AND (Gas OR Air) AND (Embolism) AND (Morbidity) AND (Mortality) AND (Volume) as well as manual review of references from relevant articles. 151 articles were screened excluding partial text and pediatric articles. Studies were reviewed for identification of volume of venous gas embolism associated with morbidity and/or mortality, which identified 27 articles. RESULTS: Reviewed literature included animal studies, case reports, and review articles. A high variation of proposed volumes contributing to mortality was reported. The limited human data values ranged from 20 ml to 200 ml of infused air with mortality estimated to be 48 – 80%. No studies evaluated human morbidity in any capacity. DISCUSSION: The lack of consensus on the safe volume of infused air has potential ramifications for IVF use in spaceflight as current technologies to create IVF from potable water may introduce air in IVF bags. While current microgravity infusion protocols call for the use of inline air removal filters, commercially available options have flow rate limitations that preclude rapid infusion in a resuscitation scenario. Such filters may be used in parallel to increase flow rate, but the time required to set up such a system may exclude its use during a medical emergency. Additionally, these consumable filters drive up the overall mass and volume of the medical system. Identification of a safe volume of air in IVF would allow for guidelines for the in-situ production of IVF in future spaceflight vehicles/habitats.
Christopher R Woodard↗
Asparagine Biosynthesis as a Mechanism of Increased Host Lethality Induced by Serratia Marcescens in Simulated Microgravity Environments
While studies have shown an increase in pathogenicity in several microbes during spaceflight and after exposure to simulated microgravity, the mechanisms underlying these changes in phenotype are not understood across different pathogens, particularly in opportunistic pathogens. This study evaluates the mechanism for increased virulence of the opportunistic gram-negative bacterium, Serratia marcescens, in simulated microgravity. Low-shear modeled microgravity (LSMMG) is used in ground-based studies to simulate the effects of microgravity as experienced in spaceflight. Our previous findings showed that there was a significant increase in mortality rates of the Drosophila melanogaster host when infected with either spaceflight or LSMMG treated S. marcescens. Here, we report that LSMMG increases asparagine uptake and synthesis in S. marcescens and that the increased host lethality induced by LSMMG bacteria grown in rich media can be recapitulated in minimal media by adding only aspartate and glutamine, the substrates of asparagine biosynthesis. Interestingly, increased bacterial growth rate alone is not sufficient to contribute to maximal host lethality, since the addition of aspartate to minimal media caused an LSMMG-specific increase in bacterial growth rate that is comparable to that induced by the combination of aspartate and glutamine, but this increase in growth does not cause an equivalent rate of host mortality. However, the addition of both aspartate and glutamine cause both an increase in host mortality and an overexpression of asparagine pathway genes in a LSMMG-dependent manner. We also report that L-asparaginase-mediated breakdown of asparagine is an effective countermeasure for the increased host mortality caused by LSMMG-treated bacteria. This investigation underscores the importance of the asparagine utilization pathway by helping uncover molecular mechanisms that underlie increased mortality rates of a model host infected with microgravity-treated S.marcescens and provides a potential mitigation strategy.
simulated microgravity↗
Investigation of the detection and monitoring of forest insect infestations in the Sierra Nevada Mountains of California
The author has identified the following significant results. Due to the fact that all of the ERTS-1 imagery has not been received, evaluation of this imagery will be delayed until all of it is at hand. It has been determined that the arbitrary classification of tree mortality into dead, dying, and light damage is sound in that each class is significatly different in terms of number and volume of trees killed. It has likewise been determined that the different classes of defoliation of light, medium, and heavy are significantly different in terms of the needles per tip. It has been found that all classes of tree mortality and degrees of defoliation are readily and accurately identified from underflight photos in color and color IR in both scales of 1/5000 and 1/18,500. Evaluation of U-2 imagery is incomplete. It has been determined, however, that through the use of RC-10 color IR it is expected to be able to detect all three classes of tree mortality and probably at least two extreme levels of defoliation.
Hall, R. C.↗
Evaluation of medical treatments to increase survival of ebullism in guinea pigs
Spaceflight carriers run a constant risk of exposure to vacuum. Above 63,000 ft (47 mmHg), the ambient pressure falls below the vapor pressure of water at 37 C, and tissue vaporization (ebullism) begins. Little is know about appropriate resuscitative protocols after such an ebullism exposure. This study identified injury patterns and mortality rates associated with ebullism while verifying effectiveness of traditional pulmonary resuscitative techniques. Male Hartley guinea pigs were exposed to 87,000 ft for periods of 40 to 115 sec. After descent, those animals that did not breathe spontaneously were given artificial ventilation by bag and mask for up to 15 minutes. Those animals surviving were randomly assigned to one of three treatment groups--hyperbaric oxygen (HBO), ground-level oxygen (GLO2), and ground-level air (GLAIR). The HBO group was treated on a standard treatment table 6A while the GLO2 animals received O2 for an equivalent length of time. Those animals in the GLAIR group were observed only. All surviving animals were humanely sacrified at 48 hours. Inflation of the animal's lungs after the exposure was found to be difficult and, at times, impossible. This may be due to surfactant disruption at the alveolar lining. Electron microscopy identified a disruption of the surfactant layer in animals that did not survive initial exposure. Mortality was found to increase with exposure time: 40 sec--0 percent; 60 sec--6 percent; 70 sec--40 percent; 80 sec--13 percent; 100 sec--38 percent; 110 sec--40 percent; and 115 sec--100 percent. There was no difference in the delayed mortality among the treatment groups (HBO--15 percent, GLO2--11 percent, GLAIR--11 percent). However, since resuscitation was ineffective, the effectiveness of any post-exposure treatment was severely limited. Preliminary results indicate that reuscitation of guinea pigs following ebullism exposure is difficult, and that current techniques (such as traditional CPR) may not be appropriate.
Stegmann, Barbara J.↗
Effects of the hindlimb-unloading model of spaceflight conditions on resistance of mice to infection with Klebsiella pneumoniae
BACKGROUND: It has been well documented in several studies that many immunologic parameters are altered in experimental animals and human subjects who have flown in space. However, it is not fully known whether these immunologic changes could result in increased susceptibility to infection. Hindlimb (antiorthostatic) unloading of rodents has been used successfully to simulate some of the effects of spaceflight on physiologic systems. OBJECTIVE: The objective of this study was to determine the effect of hindlimb unloading on the outcome of Klebsiella pneumoniae infection in mice. METHODS: Hindlimb-unloaded, hindlimb-restrained, and control mice were intraperitoneally infected with one 50% lethal dose of K pneumoniae 2 days after suspension. Mortality and bacterial load in several organs were compared among the groups. RESULTS: Unloaded mice showed significantly increased mortality and reduced mean time to death compared with that seen in the control groups. Kinetics of bacterial growth with smaller infective doses revealed that control mice were able to clear bacteria from the organs after 30 hours. In contrast, unloaded mice had continued bacterial growth at the same time point. CONCLUSION: The results of this study suggest that hindlimb unloading might enhance the dissemination of K pneumoniae, leading to increased mortality. The complex physiologic changes observed during hindlimb unloading, including stress, have a key role in the pathophysiology of this infection.
NASA Discipline Regulatory Physiology↗
Biological Response to SPE Exposures
It has long been recognized that a single solar particle event (SPE) can produce, over a short period of time, exposures on the order of LD50 for humans under normal physiological conditions. It is further recognized that recovery from injury over the period of exposure would greatly increase the chances of survival (dose rate effects) although such effects were left unquantified. In the present report we use the bioresponse model derived from a broad range of animal and human exposure data for evaluation of troop readiness in tactical nuclear warfare to evaluate the biological risk posed by the solar event of 4 August 1972. The astronaut blood forming organ (BFO) exposure in deep space would have been 2.2 Sv (1.6 Gy) in a space suit, 1.8 Sv (1.3 Gy) in an aluminum pressure vessel, and 0.7 Sv (0.5 Gy) in an equipment room compared to an X-ray mortality threshold of 1.5 Gy (assuming high dose rate). We find BFO dose rate effectiveness factors for this SPE on the order of 3 to 4, greatly reducing the mortality risks for this event. There is an approximate 3 percent chance that an even larger event may occur for which exposures could be 2-4 times higher. Assured survival of the astronaut requires added shelter shielding and a warning system for this event. The required mass of the shelter shield can be greatly reduced by using hydrogenous materials such as polymers, water, food, and other biological materials in its construction. Limitations of the current bioresponse model arise from the exposures taking place in the microgravity environment wherein the immune system is already challenged and the effective mortality threshold may be reduced by a factor of two. Such microgravity effects could greatly affect astronaut risks.
Wilson, J. W.↗
Maternal reproductive experience enhances early postnatal outcome following gestation and birth of rats in hypergravity
A major goal of space life sciences research is to broaden scientific knowledge of the influence of gravity on living systems. Recent spaceflight and centrifugation studies demonstrate that reproduction and ontogenesis in mammals are amenable to study under gravitational conditions that deviate considerably from those typically experienced on Earth (1 x g). In the present study, we tested the hypothesis that maternal reproductive experience determines neonatal outcome following gestation and birth under increased (hyper) gravity. Primigravid and bigravid female rats and their offspring were exposed to 1.5 x g centrifugation from Gestational Day 11 either through birth or through the first postnatal week. On the day of birth, litter sizes were identical across gravity and parity conditions, although significantly fewer live neonates were observed among hypergravity-reared litters born to primigravid dams than among those born to bigravid dams (82% and 94%, respectively; 1.0 x g controls, 99%). Within the hypergravity groups, neonatal mortality was comparable across parity conditions from Postnatal Day 1 through Day 7, at which time litter sizes stabilized. Maternal reproductive experience ameliorated neonatal losses during the first 24 h after birth but not on subsequent days, and neonatal mortality was associated with changes in maternal care patterns. These results indicate that repeated maternal reproductive experience affords protection against neonatal losses during exposure to increased gravity. Differential mortality of neonates born to primigravid versus bigravid dams denotes gravitational load as one environmental mechanism enabling the expression of parity-related variations in birth outcome.
NASA Discipline Developmental Biology↗
An ecologic study of dietary links to prostate cancer
BACKGROUND: The etiology of prostate cancer has not been fully resolved in the scientific and medical literature, although the non-fat portion of milk and calcium are emerging as leading dietary risk factors, with lycopene (found in tomatoes) and vitamin D apparently being risk reduction factors. METHODS: The ecologic (multi-country statistical) approach is used to study dietary links to prostate cancer. Mortality data from 1986 for various age groups in 41 countries are compared with national consumer macronutrient supply values for 1983 and tomato supply values for 1985. RESULTS: For 28 countries with more than five Kcal/day of tomatoes in the consumer supply, a linear combination of non-fat milk (risk factor) and tomatoes (risk reduction factor) was found to have the highest statistical association with prostate cancer mortality rates for men over the age of 35, with the Pearson regression coefficient (R2) for those aged 65-74 years = 0.67 and p < 0.001. For the 13 countries with fewer than six Kcal/day of tomatoes, non-fat milk had the highest association (R2 = 0.92, p < 0.001 for men aged 65-74 years). For 41 countries combined, the non-fat portion of milk had the highest association with prostate cancer mortality rates (R2 = 0.73, p < 0.001 for men aged 65-74 years). CONCLUSIONS: These results support the results of several cohort studies which found the non-fat portion of milk to have the highest association with prostate cancer, likely due to the calcium, and tomatoes to reduce the risk of prostate cancer, most likely due to lycopene.
Diet/adverse effects↗
Risk cross sections and their application to risk estimation in the galactic cosmic-ray environment
Radiation risk cross sections (i.e. risks per particle fluence) are discussed in the context of estimating the risk of radiation-induced cancer on long-term space flights from the galactic cosmic radiation outside the confines of the earth's magnetic field. Such quantities are useful for handling effects not seen after low-LET radiation. Since appropriate cross-section functions for cancer induction for each particle species are not yet available, the conventional quality factor is used as an approximation to obtain numerical results for risks of excess cancer mortality. Risks are obtained for seven of the most radiosensitive organs as determined by the ICRP [stomach, colon, lung, bone marrow (BFO), bladder, esophagus and breast], beneath 10 g/cm2 aluminum shielding at solar minimum. Spectra are obtained for excess relative risk for each cancer per LET interval by calculating the average fluence-LET spectrum for the organ and converting to risk by multiplying by a factor proportional to R gamma L Q(L) before integrating over L, the unrestricted LET. Here R gamma is the risk coefficient for low-LET radiation (excess relative mortality per Sv) for the particular organ in question. The total risks of excess cancer mortality obtained are 1.3 and 1.1% to female and male crew, respectively, for a 1-year exposure at solar minimum. Uncertainties in these values are estimated to range between factors of 4 and 15 and are dominated by the biological uncertainties in the risk coefficients for low-LET radiation and in the LET (or energy) dependence of the risk cross sections (as approximated by the quality factor). The direct substitution of appropriate risk cross sections will eventually circumvent entirely the need to calculate, measure or use absorbed dose, equivalent dose and quality factor for such a high-energy charged-particle environment.
NASA Discipline Radiation Health↗
Strategies for Small Volume Resuscitation: Hyperosmotic-Hyperoncotic Solutions, Hemoglobin Based Oxygen Carriers and Closed-Loop Resuscitation
Introduction: Logistic constraints on combat casualty care preclude traditional resuscitation strategies which can require volumes and weights 3 fold or greater than hemorrhaged volume. We present a review of quantitative analyses of clinical and animal data on small volume strategies using 1) hypertonic-hyperosmotic solutions (HHS); 2) hemoglobin based oxygen carriers (HBOCs) and 3) closed-loop infusion regimens.Methods and Results: Literature searches and recent queries to industry and academic researchers have allowed us to evaluate the record of 81 human HHS studies (12 trauma trials), 19 human HBOCs studies (3trauma trials) and two clinical studies of closed-loop resuscitation.There are several hundreds animal studies and at least 82 clinical trials and reports evaluating small volume7.2%-7.5% hypertonic saline (HS) most often combined with colloids, e.g., dextran (HSD) or hetastarch(HSS). HSD and HSS data has been published for 1,108 and 392 patients, respectively. Human studies have documented volume sparing and hemodynamic improvements. Meta-analyses suggest improved survival for hypotensive trauma patients treated with HSD with significant reductions in mortality found for patients with blood pressure < 70 mmHg, head trauma, and penetrating injury requiring surgery. HSD and HSS have received regulatory approval in 14 and 3 countries, respectively, with 81,000+ units sold. The primary reported use was head injury and trauma resuscitation. Complications and reported adverse events are surprisingly rare and not significantly different from other solutions.HBOCs are potent volume expanders in addition to oxygen carriers with volume expansion greater than standard colloids. Several investigators have evaluated small volume hyperoncotic HBOCs or HS-HBOC formulations for hypotensive and normotensive resuscitation in animals. A consistent finding in resuscitation with HBOCs is depressed cardiac output. There is some evidence that HBOCs more efficiently unload oxygen from plasma hemoglobin as well as facilitate RBC unloading. We analyzed one volunteer study, 15 intraoperative trials, and 3 trauma studies using HBOCs. Perioperative studies generally suggest ability to deliver oxygen, but one trauma trial using HBOCs (HemAssist) for treatment of trauma resulted in a dramatic increase in mortality, while an intraoperative trauma study using Polyheme demonstrated reductions in blood use and lower mortality compared to historic controls of patients refusing blood. Transfusion reductions with HBOC use have been modest. Two HBOCs (Hemopure and Polyheme) are now in new or planned large-scale multicenter prehospital trials of trauma treatment. A new implementation of small volume resuscitation is closed-loop resuscitation (CLR), which employs microprocessors to titrate just enough fluid to reach a physiologic target . Animal studies suggest less risk of rebleeding in uncontrolled hemorrhage and a reduction in fluid needs with CLR. The first clinical application of CLR was treatment of burn shock and the US Army. Conclusions: Independently sponsored civilian trauma trials and clinical evaluations in operational combat conditions of different small volume strategies are warranted.
Kramer, George C.↗
Monitoring Regional Forest Disturbances across the US with near Real Time MODIS NDVI Products Resident to the ForWarn Forest Threat Early Warning System
Forest threats across the US have become increasingly evident in recent years. Sometimes these have resulted in regionally evident disturbance progressions (e.g., from drought, bark beetle outbreaks, and wildfires) that can occur across multiyear durations and have resulted in extensive forest overstory mortality. In addition to stand replacement disturbances, other forests are subject to ephemeral, sometimes yearly defoliation from various insects and varying types and intensities of ephemeral damage from storms. Sometimes, after prolonged severe disturbance, signs of recovery in terms of Normalized Difference Vegetation Index (NDVI) can occur. The growing prominence and threat of forest disturbances in part have led to the formation and implementation of the 2003 Healthy Forest Restoration Act which mandated that national forest threat early warning system be developed and deployed. In response, the US Forest Service collaborated with NASA, DOE Oakridge National Laboratory, and the USGS Eros Data Center to build and roll-out the near real time ForWarn early warning system for monitoring regionally evident forest disturbances. Given the diversity of disturbance types, severities, and durations, ForWarn employs multiple historical baselines that are used with current NDVI to derive a suite of six forest change products that are refreshed every 8 days. ForWarn employs daily quarter kilometer MODIS NDVI data from the Aqua and Terra satellites, including MOD13 data for deriving historical baseline NDVIs and eMODIS 7 NDVI for compiling current NDVI. In doing so, the Time Series Product Tool and the Phenological Parameters Estimation Tool are used to temporally de-noise, fuse, and aggregate current and historical MODIS NDVIs into 24 day composites refreshed every 8 days with 46 dates of products per year. The 24 day compositing interval enables disturbances to be detected, while minimizing the frequency of residual atmospheric contamination. Forest change products are computed versus the previous 1, previous 3, and all previous years in the MODIS record for a given 24 day interval. Other "weekly" forest change products include one computed using an adaptive length compositing method for quicker detection of disturbances, two others that adjust for seasonal fluctuations in normal vegetation phenology (e.g., early versus late springs). This overall approach enables forest disturbance dynamics from a variety of regionally evident biotic and abiotic forest disturbances to be viewed and assessed through the calendar year. The change products are also being utilized for forest change trend analysis and for developing regional forest overstory mortality products. ForWarn's forest change products are used to alert forest health specialists about new forest disturbances. Such alerts are also typically based on available Landsat, aerial, and ground data as well as communications with forest health specialists and previous experience. ForWarn products have been used to detect and track many types of regional disturbances to multiple forest types, including defoliation from caterpillars and severe storms, as well as mortality from both biotic and abiotic agents (e.g., bark beetles, drought, fire, anthropogenic clearing). ForWarn offers products that could be combined with other geospatial data on forest biomass to assess forest disturbance carbon impacts within the conterminous US.
Spruce, Joseph P.↗
Global Air Quality and Health Co-benefits of Mitigating Near-term Climate Change Through Methane and Black Carbon Emission Controls
Tropospheric ozone and black carbon (BC), a component of fine particulate matter (PM < or = 2.5 microns in aerodynamic diameter; PM2.5), are associated with premature mortality and they disrupt global and regional climate. Objectives: We examined the air quality and health benefits of 14 specific emission control measures targeting BC and methane, an ozone precursor, that were selected because of their potential to reduce the rate of climate change over the next 20-40 years. Methods: We simulated the impacts of mitigation measures on outdoor concentrations of PM2.5 and ozone using two composition-climate models, and calculated associated changes in premature PM2.5‑ and ozone-related deaths using epidemiologically derived concentration-response functions. Results: We estimated that, for PM2.5 and ozone, respectively, fully implementing these measures could reduce global population-weighted average surface concentrations by 23-34% and 7-17% and avoid 0.6-4.4 and 0.04-0.52 million annual premature deaths globally in 2030. More than 80% of the health benefits are estimated to occur in Asia. We estimated that BC mitigation measures would achieve approximately 98% of the deaths that would be avoided if all BC and methane mitigation measures were implemented, due to reduced BC and associated reductions of nonmethane ozone precursor and organic carbon emissions as well as stronger mortality relationships for PM2.5 relative to ozone. Although subject to large uncertainty, these estimates and conclusions are not strongly dependent on assumptions for the concentration-response function. Conclusions: In addition to climate benefits, our findings indicate that the methane and BC emission control measures would have substantial co-benefits for air quality and public health worldwide, potentially reversing trends of increasing air pollution concentrations and mortality in Africa and South, West, and Central Asia. These projected benefits are independent of carbon dioxide mitigation measures. Benefits of BC measures are underestimated because we did not account for benefits from reduced indoor exposures and because outdoor exposure estimates were limited by model spatial resolution.
air quality↗