Source-Receptor Relationships Between Precursor Emissions and O3 and PM2.5 Air Pollution Impacts.

Reduced complexity tools that provide a representation of both primarily emitted particulate matter with an aerodynamic diameter less than 2.5 µm (PM2.5), secondarily formed PM2.5, and ozone (O3) allow for a quick assessment of many iterations of pollution control scenarios. Here, a new reduced complexity tool, Pattern Constructed Air Pollution Surfaces (PCAPS), that estimates annual average PM2.5 and seasonal average maximum daily average 8 h (MDA8) O3 for any source location in the United States is described and evaluated. Typically, reduced complexity tools are not evaluated for skill in predicting change in air pollution by comparison with more sophisticated modeling systems. Here, PCAPS was compared against multiple types of emission control scenarios predicted with state-of-the-science photochemical grid models to provide confidence that the model is realistically capturing the change in air pollution due to changing emissions. PCAPS was also applied with all anthropogenic emissions sources for multiple retrospective years to predict PM2.5 chemical components for comparison against routine surface measurements. PCAPS predicted similar magnitudes and regional variations in spatial gradients of measured chemical components of PM2.5. Model performance for capturing ambient measurements was consistent with other reduced complexity tools. PCAPS also did well at capturing the magnitude and spatial features of changes predicted by photochemical transport models for multiple emissions scenarios for both O3 and PM2.5. PCAPS is a flexible tool that provides source-receptor relationships using patterns of air quality gradients from a training data set of generic modeled sources to create interpolated air pollution gradients for new locations not part of the training database. The flexibility provided for both sources and receptors makes this tool ideal for integration into larger frameworks that provide emissions changes and need estimates of air quality to inform downstream analytics, which often includes an estimate of monetized health effects.

ZIP Code-Level Estimation of Air Quality and Health Risk Due to Particulate Matter Pollution in New York City.

Exposure to PM2.5 is associated with hundreds of premature mortalities every year in New York City (NYC). Current air quality and health impact assessment tools provide county-wide estimates but are inadequate for assessing health benefits at neighborhood scales, especially for evaluating policy options related to energy efficiency or climate goals. We developed a new ZIP Code-Level Air Pollution Policy Assessment (ZAPPA) tool for NYC by integrating two reduced form models─Community Air Quality Tools (C-TOOLS) and the Co-Benefits Risk Assessment Health Impacts Screening and Mapping Tool (COBRA)─that propagate emissions changes to estimate air pollution exposures and health benefits. ZAPPA leverages custom higher resolution inputs for emissions, health incidences, and population. It, then, enables rapid policy evaluation with localized ZIP code tabulation area (ZCTA)-level analysis of potential health and monetary benefits stemming from air quality management decisions. We evaluated the modeled 2016 PM2.5 values against observed values at EPA and NYCCAS monitors, finding good model performance (FAC2, 1; NMSE, 0.05). We, then, applied ZAPPA to assess PM2.5 reduction-related health benefits from five illustrative policy scenarios in NYC focused on (1) commercial cooking, (2) residential and commercial building fuel regulations, (3) fleet electrification, (4) congestion pricing in Manhattan, and (5) these four combined as a "citywide sustainable policy implementation" scenario. The citywide scenario estimates an average reduction in PM2.5 of 0.9 µg/m3. This change translates to avoiding 210-475 deaths, 340 asthma emergency department visits, and monetized health benefits worth $2B to $5B annually, with significant variation across NYC's 192 ZCTAs. ZCTA-level assessments can help prioritize interventions in neighborhoods that would see the most health benefits from air pollution reduction. ZAPPA can provide quantitative insights on health and monetary benefits for future sustainability policy development in NYC.

Potential health benefits of sustained air quality improvements in New York City: A simulation based on air pollution levels during the COVID-19 shutdown.

New York City (NYC) experienced a sharp decline in air pollution during the COVID-19 shutdown period (March 15, 2020 to May 15, 2020)-albeit at high social and economic costs. It provided a unique opportunity to simulate a scenario in which the city-wide air quality improvement during the shutdown were sustained over the five-year period, 2021 through 2025, allowing us to estimate the potential public health benefits to children and adults and their associated economic benefits. We focused on fine particulate matter (PM2.5) and modeled potential future health benefits to children and adults. The analysis considered outcomes in children that have not generally been accounted for in clean air benefits assessments, including preterm birth, term low birthweight, infant mortality, child asthma incidence, child asthma hospital admissions and emergency department visits, autism spectrum disorder, as well as adult mortality. We estimated a city-wide 23% improvement in PM2.5 levels during the COVID-19 shutdown months compared to the average level for those months in 2015-2018 (the business as usual period). Based on the data for 2020, we extrapolated the ambient levels of PM2.5 for the following five-year period. The estimated cumulative benefits for 2021-2025 included thousands of avoided cases of illness and death, with associated economic benefits from $31.8 billion to $77 billion. This "natural experiment," tragic though the cause, has provided a hypothetical clean air scenario that can be considered aspirational-one that could be achieved through transportation, climate, and environmental policies that support robust economic recovery with similarly reduced emissions.

TNF inhibitor induced alopecia: an unusual form of psoriasiform alopecia that breaks the Renbök mold.

TNF-α-inhibitors are known to induce skin adverseeffects including psoriasis and alopecia areata. Here, wedescribe a unique pattern of hair loss that has psoriaticand alopecia areata-like features. Diagnosis requiresclinical-pathologic correlation and is supportedby increased catagen/telogen hairs, psoriasiformepidermal hyperplasia, perifollicular lymphocyticinfiltrate, and the presence of eosinophils and plasmacells. Although there are no treatment consensusguidelines, management options include stoppingtherapy, switching to a different TNF-α inhibitor orustekinumab (in severe cases), or continuing TNF-αinhibitor therapy with addition of topical, intralesional,or systemic immunosuppressants.

Anthropogenic Secondary Organic Aerosol and Ozone Production from Asphalt-Related Emissions.

Liquid asphalt is a petroleum-derived substance commonly used in construction activities. Recent work has identified lower volatility, reactive organic carbon from asphalt as an overlooked source of secondary organic aerosol (SOA) precursor emissions. Here, we leverage potential emission estimates and usage data to construct a bottom-up inventory of asphalt-related emissions in the United States. In 2018, we estimate that hot-mix, warm-mix, emulsified, cutback, and roofing asphalt generated ~380 Gg (317 Gg - 447 Gg) of organic compound emissions. The impacts of these emissions on anthropogenic SOA and ozone throughout the contiguous United States are estimated using photochemical modeling. In several major cities, asphalt-related emissions can increase modeled summertime SOA, on average, by 0.1 - 0.2 µg m-3 (2-4% of SOA) and may reach up to 0.5 µg m-3 at noontime on select days. The influence of asphalt-related emissions on modeled ozone are generally small (~0.1 ppb). We estimate that asphalt paving-related emissions are half of what they were nearly 50 years ago, largely due to the concerted efforts to reduce emissions from cutback asphalts. If on-road mobile emissions continue their multidecadal decline, contributions of urban SOA from evaporative and non-road mobile sources will continue to grow in relative importance.

Analysis of the production and transaction costs of forest carbon offset projects in the USA.

Forest carbon offset project implementation costs, comprised of both production and transaction costs, could present an important barrier to private landowner participation in carbon offset markets. These costs likewise represent a largely undocumented component of forest carbon offset potential. Using a custom spreadsheet model and accounting tool, this study examines the implementation costs of different forest offset project types operating in different forest types under different accounting and sampling methodologies. Sensitivity results are summarized concisely through response surface regression analysis to illustrate the relative effect of project-specific variables on total implementation costs. Results suggest that transaction costs may represent a relatively small percentage of total project implementation costs - generally less than 25% of the total. Results also show that carbon accounting methods, specifically the method used to establish project baseline, may be among the most important factors in driving implementation costs on a per-ton-of-carbon-sequestered basis, dramatically increasing variability in both transaction and production costs. This suggests that accounting could be a large driver in the financial viability of forest offset projects, with transaction costs likely being of largest concern to those projects at the margin.

The potential role for management of U.S. public lands in greenhouse gas mitigation and climate policy.

Management of forests, rangelands, and wetlands on public lands, including the restoration of degraded lands, has the potential to increase carbon sequestration or reduce greenhouse gas (GHG) emissions beyond what is occurring today. In this paper we discuss several policy options for increasing GHG mitigation on public lands. These range from an extension of current policy by generating supplemental mitigation on public lands in an effort to meet national emissions reduction goals, to full participation in an offsets market by allowing GHG mitigation on public lands to be sold as offsets either by the overseeing agency or by private contractors. To help place these policy options in context, we briefly review the literature on GHG mitigation and public lands to examine the potential for enhanced mitigation on federal and state public lands in the United States. This potential will be tempered by consideration of the tradeoffs with other uses of public lands, the needs for climate change adaptation, and the effects on other ecosystem services.

Co-Benefits to Children's Health of the U.S. Regional Greenhouse Gas Initiative.

BACKGROUND: While various policies have been implemented globally to mitigate climate change and reduce exposure to toxic air pollutants, policy assessments have considered few if any of the benefits to children. OBJECTIVE: To comprehensively assess the co-benefits of climate change mitigation to children, we expanded the suite of adverse health outcomes in the U.S. Environmental Protection Agency's Benefits Mapping and Analysis Program (BenMAP) to include additional outcomes associated with prenatal and childhood exposure to ambient fine particulate matter (PM2.5). We applied this newly expanded program to an assessment of the U.S. Regional Greenhouse Gas Initiative (RGGI), the United States' first regional market-based regulatory program designed to reduce greenhouse gas emissions from the electric power sector within the Northeast. METHODS: We used calculated changes in ambient PM2.5 concentrations for the period 2009-2014, with newly incorporated concentration-response (C-R) functions to quantify changes in the incidence of preterm birth (PTB), term low birth weight (TLBW), autism spectrum disorder (ASD), and asthma. These outcomes are causally or likely to be causally related to PM2.5 exposure. Cost per case estimates were incorporated to monetize those changes in incidence. RESULTS: The estimated avoided cases of adverse child health outcomes included 537 asthma cases, 112 preterm births, 98 cases of ASD, and 56 cases of TLBW, with an associated avoided cost estimate ranging from $191 to $350 million. In a previous analysis of health benefits of RGGI, the only benefits accruing to children were limited to prevented cases of infant mortality and respiratory illnesses, with a monetized impact of $8.1 million-only 2-4% of the new results attributable to RGGI. CONCLUSION: The results of this innovative analysis indicate that RGGI has provided substantial child health benefits beyond those initially considered. Moreover, those health benefits had significant estimated economic value. https://doi.org/10.1289/EHP6706.

An Introduction to Software Tools, Data, and Services for Geospatial Analysis of Stroke Services.

Background: There is interest in the use geospatial data for development of acute stroke services given the importance of timely access to acute reperfusion therapy. This paper aims to introduce clinicians and citizen scientists to the possibilities offered by open source softwares (R and Python) for analyzing geospatial data. It is hoped that this introduction will stimulate interest in the field as well as generate ideas for improving stroke services. Method: Instructions on installation of libraries for R and Python, source codes and links to census data are provided in a notebook format to enhance experience with running the software. The code illustrates different aspects of using geospatial analysis: (1) creation of choropleth (thematic) map which depicts estimate of stroke cases per post codes; (2) use of map to help define service regions for rehabilitation after stroke. Results: Choropleth map showing estimate of stroke per post codes and service boundary map for rehabilitation after stroke. Conclusions The examples in this article illustrate the use of a range of components that underpin geospatial analysis. By providing an accessible introduction to these areas, clinicians and researchers can create code to answer clinically relevant questions on topics such as service delivery and service demand.

Comparing guideline-based care quality for inflammatory bowel disease and rheumatoid arthritis patients within a medical home.

BACKGROUND: Rheumatoid arthritis (RA) and inflammatory bowel disease (IBD) patient populations face similar risks of chronic immunosuppression including corticosteroid use. We compared the receipt of preventive services between IBD and RA populations according to published quality metrics. METHODS: We defined a single-center cohort of patients with IBD or RA receiving specialty and primary care. Electronic health record abstraction assessed quality metrics, sociodemographics, comorbidity, and utilization. Comparisons used multivariate odds ratios and Student's t-tests. RESULTS: 218 RA and 190 IBD patients were included. In multivariate analysis, IBD patients were less likely to receive pneumococcal vaccination (OR=0.29, 95% CI: 0.11-0.85), while RA patients underwent glucocorticoid-induced osteoporosis screening more often (100% vs. 82.5%, p = 0.023). CONCLUSIONS: Gastroenterologists can improve care quality for IBD patients by assuming greater responsibility for preventive care in IBD patients and/or collaborating with primary care and health systems to improve preventive care delivery.

The efficacy of switching from etanercept to infliximab in patients with rheumatoid arthritis.

OBJECTIVE: To describe the degree of clinical benefit in patients with rheumatoid arthritis (RA) who receive infliximab therapy after lack of efficacy with etanercept. METHODS: In a retrospective study among 6 centers primarily designed to assess the safety of infliximab in combination with leflunomide, a standardized chart review form was used to collect data on 93 patients with RA. During that study, it was noted that some of these patients had switched from etanercept to infliximab. In this study, we compared the response of subjects switching from etanercept to infliximab (n = 20) to that of subjects receiving infliximab with no prior tumor necrosis factor (TNF) therapy (n = 73). RESULTS: The swollen and tender joint count, patient and physician global assessments, morning stiffness, and C-reactive protein all improved substantially in both groups, with no statistical difference in the degree of benefit between the groups. At the time of chart review, switchers had received a statistically higher dose of infliximab than controls (4.4 vs 3.19 mg/kg; p = 0.006) with a total of 5.7 and 5 infusions, respectively. CONCLUSION: In this retrospective study, previous lack of efficacy with etanercept did not predict lack of efficacy with infliximab. Indeed, the degree of clinical improvement was similar in both groups, although switchers were receiving a higher dose of infliximab at the time of chart review. Our findings suggest that clinical response may differ between anti-TNF agents, and lack of response to one agent may not predict a lack of response to another.

Open label study to assess infliximab safety and timing of onset of clinical benefit among patients with rheumatoid arthritis.

OBJECTIVE: To assess the timing of onset of clinical benefit following the initial infusion of infliximab and to obtain additional safety experience of infliximab when given in an office setting to patients with rheumatoid arthritis (RA). In addition, the safety of reducing the infusion time from 2 hours to 1 hour was evaluated. METHODS: Patients (n = 553) with active RA despite receiving methotrexate (MTX) were treated with infliximab 3 mg/kg given over 2 h at baseline (Week 0), and Weeks 2, 6, and 14 in this multicenter open-label trial. Patients continued to receive a stable dose of MTX (> or = 7.5 mg/wk). At selected sites, patients tolerating the first 4 infusions were eligible to receive 2 additional infusions at twice the usual infusion rate (given over 1 h). Patients returned for efficacy assessments at 48 h following the initial infusion and several times throughout study participation. RESULTS: By 48 h following the first infusion, significant (p < 0.001) improvements were observed in duration of morning stiffness (34% mean improvement), physician's global disease assessment scores (30%), patient's global disease assessment scores (25%), and patient's pain assessment scores (30%). By Week 16, 52 to 63% mean improvements in these efficacy variables were observed (p < 0.001), the significant improvement was maintained through the end of study participation in the subset of patients who received the additional 1 h infliximab infusions. Through 16 weeks, 10% (54/553) of patients reported an adverse event associated with at least 1 of the 4 infusion procedures; the majority were mild and transient in nature. In the subset of 197 patients who received 2 additional infusions over 1 h, no increase in the frequency or severity of infusion-related adverse events was observed compared to the 2 h infusion. CONCLUSION: Infliximab administered to patients with RA in an outpatient setting resulted in significant clinical improvement within 48 h that was sustained with additional infusions. Approximately 10% of patients experienced an infusion reaction, highlighting the need for direct supervision over patient treatment. Patients who tolerated infliximab infusions given over 2 h also tolerated a 1 h infusion.