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In many regions globally, buildings designed for harnessing heat during the cold exacerbate thermal exposures during heat waves (HWs) by maintaining elevated indoor temperatures even when high ambient temperatures have subdued. While previous experimental studies have documented the effects of ambient temperatures on cognitive function, few have observed HW effects on indoor temperatures following subjects' habitual conditions. The objective was to evaluate the differential impact of having air conditioning (AC) on cognitive function during a HW among residents of AC and non-AC buildings using a prospective observational cohort study. We followed 44 students (mean age = 20.2 years; SD = 1.8 years) from a university in the Greater Boston area, Massachusetts in the United States living in AC (n = 24) and non-AC (n = 20) buildings before, during, and after a HW. Two cognition tests were self-administered daily for a period of 12 days (July 9-July 20, 2016), the Stroop color-word test (STROOP) to assess selective attention/processing speed and a 2-digit, visual addition/subtraction test (ADD) to evaluate cognitive speed and working memory. The effect of the HW on cognitive function was evaluated using difference-in-differences (DiD) modelling. Mean indoor temperatures in the non-AC group (mean = 26.3°C; SD = 2.5°C; range = 19.6-30.4°C) were significantly higher (p < 0.001) than in the AC group (mean = 21.4°C; SD = 1.9°C; range = 17.5-25.0°C). DiD estimates show an increase in reaction time (STROOP = 13.4%, p < 0001; ADD = 13.3%, p < 0.001) and reduction in throughput (STROOP = -9.9%, p < 0.001; ADD = -6.3%, p = 0.08) during HWs among non-AC residents relative to AC residents at baseline. While ADD showed a linear relationship with indoor temperatures, STROOP was described by a U-shaped curve with linear effects below and above an optimum range (indoor temperature = 22°C-23°C), with an increase in reaction time of 16 ms/°C and 24 ms/°C for STROOP and ADD, respectively. Cognitive tests occurred right after waking, so the study is limited in that it cannot assess whether the observed effects extended during the rest of the day. Although the range of students' ages also represents a limitation of the study, the consistent findings in this young, healthy population might indicate that greater portions of the population are susceptible to the effects of extreme heat. Cognitive function deficits resulting from indoor thermal conditions during HWs extend beyond vulnerable populations. Our findings highlight the importance of incorporating sustainable adaptation measures in buildings to preserve educational attainment, economic productivity, and safety in light of a changing climate.

Decades of air pollution regulation have yielded enormous benefits in the United States, but vehicle emissions remain a climate and public health issue. Studies have quantified the vehicle-related fine particulate matter (PM2.5)-attributable mortality but lack the combination of proper counterfactual scenarios, latest epidemiological evidence, and detailed spatial resolution; all needed to assess the benefits of recent emission reductions. We use this combination to assess PM2.5-attributable health benefits and also assess the climate benefits of on-road emission reductions between 2008 and 2017. We estimate total benefits of $270 (190 to 480) billion in 2017. Vehicle-related PM2.5-attributable deaths decreased from 27,700 in 2008 to 19,800 in 2017; however, had per-mile emission factors remained at 2008 levels, 48,200 deaths would have occurred in 2017. The 74% increase from 27,700 to 48,200 PM2.5-attributable deaths with the same emission factors is due to lower baseline PM2.5 concentrations (+26%), more vehicle miles and fleet composition changes (+22%), higher baseline mortality (+13%), and interactions among these (+12%). Climate benefits were small (3 to 19% of the total). The percent reductions in emissions and PM2.5-attributable deaths were similar despite an opportunity to achieve disproportionately large health benefits by reducing high-impact emissions of passenger light-duty vehicles in urban areas. Increasingly large vehicles and an aging population, increasing mortality, suggest large health benefits in urban areas require more stringent policies. Local policies can be effective because high-impact primary PM2.5 and NH₃ emissions disperse little outside metropolitan areas. Complementary national-level policies for NOₓ are merited because of its substantial impacts—with little spatial variability—and dispersion across states and metropolitan areas.

Energy efficiency (EE) and renewable energy (RE) can benefit public health and the climate by displacing emissions from fossil-fuelled electrical generating units (EGUs). Benefits can vary substantially by EE/RE installation type and location, due to differing electricity generation or savings by location, characteristics of the electrical grid and displaced power plants, along with population patterns. However, previous studies have not formally examined how these dimensions individually and jointly contribute to variability in benefits across locations or EE/RE types. Here, we develop and demonstrate a high-resolution model to simulate and compare the monetized public health and climate benefits of four different illustrative EE/RE installation types in six different locations within the Mid-Atlantic and Lower Great Lakes of the United States. Annual benefits using central estimates for all pathways ranged from US$5.7–US$210 million (US$14–US$170 MWh −1 ), emphasizing the importance of site-specific information in accurately estimating public health and climate benefits of EE/RE efforts. Clean energy can provide different health and environmental benefits depending on location. Modelling shows that renewable energy and energy-saving projects could deliver annual benefits of up to US$210 million across six locations in the USA.

Unconventional oil and natural gas development (UOGD) expanded extensively in the United States from the early 2000s. However, the influence of UOGD on the radioactivity of ambient particulate is not well understood. We collected the ambient particle radioactivity (PR) measurements of RadNet, a nationwide environmental radiation monitoring network. We obtained the information of over 1.5 million wells from the Enverus database. We investigated the association between the upwind UOGD well count and the downwind gross-beta radiation with adjustment for environmental factors governing the natural emission and transport of radioactivity. Our statistical analysis found that an additional 100 upwind UOGD wells within 20 km is associated with an increase of 0.024 mBq/m 3 (95% confidence interval [CI], 0.020, 0.028 mBq/m 3 ) in the gross-beta particle radiation downwind. Based on the published health analysis of PR, the widespread UOGD could induce adverse health effects to residents living close to UOGD by elevating PR. Unconventional oil and gas production has increased drastically in the US, but its environmental impacts are not well known. Here, the authors show that these wells can be associated with elevated levels of airborne particle radioactivity in downwind locations.

Participants in mass gathering events are at risk of acquiring imported and locally endemic infectious diseases. The 2014 dengue outbreak in Tokyo gathered attention since it was the first time in 70 years for Japan to experience an autochthonous transmission. Preparation for emerging infectious threats is essential even in places where these outbreaks have been largely unknown. The aim of this study is to identify strategies for early detection and prevention of dengue infection during the 2020 summer Olympics and Paralympics in Tokyo. We modified and adapted the failure mode and effect analysis (FMEA) methodology, generally used in industrial manufacturing, to examine the current controls for dengue detection and assessment. Information on existing controls were obtained from publicly available resources. Our analysis revealed that the national infectious disease control system to detect dengue in Japan is robust. However, in the case of large assemblies of international visitors for special events when the spread of communicable and vector-borne diseases increases, there are three main gaps that could be reinforced. First, cyclical training or a certification program on tropical disease management is warranted for physicians, especially those working in non-infectious disease-designated hospitals or clinics. Second, multi-language communication methods need to be strengthened especially in the health and hospitality sector. Third, owners of accommodations should consider incorporating a formal tropical disease-training program for their staff members and have a contingency plan for infectious disease-suspected travelers. Our findings may facilitate physicians and public health officials where new controls would be beneficial for the 2020 summer Olympics and Paralympics. The FMEA framework has the potential to be applied to other infectious diseases, not just dengue.

Various studies have reported the physical and mental health benefits from exposure to \"green\" neighborhoods, such as proximity to neighborhoods with trees and vegetation. However, no studies have explicitly assessed the association between exposure to \"green\" surroundings and cognitive function in terms of student academic performance. This study investigated the association between the \"greenness\" of the area surrounding a Massachusetts public elementary school and the academic achievement of the school's student body based on standardized tests with an ecological setting. Researchers used the composite school-based performance scores generated by the Massachusetts Comprehensive Assessment System (MCAS) to measure the percentage of 3rd-grade students (the first year of standardized testing for 8-9 years-old children in public school), who scored \"Above Proficient\" (AP) in English and Mathematics tests (Note: Individual student scores are not publically available). The MCAS results are comparable year to year thanks to an equating process. Researchers included test results from 2006 through 2012 in 905 public schools and adjusted for differences between schools in the final analysis according to race, gender, English as a second language (proxy for ethnicity and language facility), parent income, student-teacher ratio, and school attendance. Surrounding greenness of each school was measured using satellite images converted into the Normalized Difference Vegetation Index (NDVI) in March, July and October of each year according to a 250-meter, 500-meter, 1,000-meter, and 2000-meter circular buffer around each school. Spatial Generalized Linear Mixed Models (GLMMs) estimated the impacts of surrounding greenness on school-based performance. Overall the study results supported a relationship between the \"greenness\" of the school area and the school-wide academic performance. Interestingly, the results showed a consistently positive significant association between the greenness of the school in the Spring (when most Massachusetts students take the MCAS tests) and school-wide performance on both English and Math tests, even after adjustment for socio-economic factors and urban residency.

BackgroundRecent studies suggest that carbon dioxide has an impact on cognitive function performance of office workers at concentrations previously thought to be benign (1000–2500 ppm). The only available data for CO2 on the flight deck indicate that the average CO2 concentrations are typically <1000 ppm, but the 95th percentile concentration can be as high as 1400 ppm, depending on airplane type.MethodsWe recruited 30 active commercial airline pilots to fly three 3-h flight segments in an FAA-approved flight simulator with each segment at a different CO2 concentration on the flight deck (700, 1500, 2500 ppm). CO2 concentrations were modified by introducing ultra-pure CO2 into the simulator; ventilation rates remained the same for each segment. The pilots performed a range of predefined maneuvers of varying difficulty without the aid of autopilot, and were assessed by a FAA Designated Pilot Examiner according to FAA Practical Test Standards. Pilots and the Examiner were blinded to test conditions and the order of exposures was randomized.ResultsCompared to segments at a CO2 concentration of 2500 ppm, the odds of passing a maneuver as rated by the Examiner in the simulator were 1.52 (95% CI: 1.02–2.25) times higher when pilots were exposed to 1500 ppm and 1.69 (95% CI: 1.11–2.55) times higher when exposed to 700 ppm, controlling for maneuver difficulty, Examiner and order of maneuvers.DiscussionExaminer rating captured a wider range of performance indicators than output from the flight simulator, which can characterize only a few quantitative aspects of the flight performance. More broadly, these findings suggest that there is a direct effect of carbon dioxide on performance, independent of ventilation, with implications for many other indoor environments that routinely experience CO2 concentrations above 1000 ppm.

Antecedent factors which influence adult engagement with nature are underexplored given the human health benefits strongly associated with nature exposure. Formative pathways and impediments to nature contact merit understanding as they may contribute to later-life health disparities. We probed experiential pathways and attitudes toward nature engagement among adults purposefully sampled across U.S. regions, age, race/ethnicity, and urbanicity through semi-structured focus group discussions. The research aims were to explore entryways and barriers to experiencing nature and learn how natured and built environments compete in influencing human-nature relationships. Sessions were recorded, transcribed, and analyzed following Braun and Clarke’s phases of thematic analysis. Qualitative content analysis of discussions identified three principal themes: 1) formative influences promoting adult nature engagement (i.e., persons/organizations and places of origin), 2) detractors from nature engagement (i.e., perceptual, material, and physical barriers), and 3) role of current setting (i.e., natural and built environments) shaping nature-seeking relationships. We found experiential factors that included early life exposures outdoors, personal mentorship, and organizational affiliation to be highly influential in socializing individuals to nature and in soldering attachment to nature which manifests into adulthood. In contrast, changing demographics and childhood, inequity, social dynamics, metropolitan growth, urban renewal explained alienation from nature. These findings emphasize the importance of efforts to expand opportunities for nature contact, especially for youth living in economically challenged urban areas, which go beyond increasing greenspace to encompass mentoring partnerships for gaining skills and comfort outdoors and redesign of safe natured spaces within cities for hands-on learning and discovery.

Pilots undergo a variety of stressors that may affect their performance during all phases of flight. Heart rate variability (HRV) has been considered as a reliable indicator of the parasympathetic and sympathetic activities of human autonomic nervous system, which can be used to characterize the sympathetic stress response of pilots during flight. In this study, thirty active commercial airline pilots were recruited to fly three flight segments in a Federal Aviation Administration (FAA)-certified A320 flight simulator with each segment at a different carbon dioxide (CO2) concentration on the flight deck. The pilots performed a series of maneuvers of varying difficulty, and their performance was evaluated by FAA designated pilot examiners. The HRV metrics (SDNN, RMSSD and LF/HF ratio) of each pilot both before and during flight simulations were measured with a Movisens EcgMove3 sensor. The average SDNN, RMSSD and LF/HF ratio of the pilots during flight simulations were 34.1 ± 12.7 ms, 23.8 ± 10.2 ms and 5.7 ± 2.8 respectively. Decreased HRV was associated with aging, obesity and performing difficult maneuvers. Both CO2 exposure and HRV had an independent effect on the pilot performance, while their interaction was not significant. The generalized additive mixed effect model results showed that a pilot performed better on a maneuver when his stress response was lower, as indicated by higher SDNN and RMSSD and lower LF/HF ratio. An interquartile range (IQR) increase in SDNN (21.97 ms) and RMSSD (16.00 ms) and an IQR decrease in LF/HF ratio (4.69) was associated with an increase in the odds of passing a maneuver by 37%, 22% and 20%, respectively.

Although the entire duration of fetal development is generally considered a highly susceptible period, it is of public health interest to determine a narrower window of heightened vulnerability to polycyclic aromatic hydrocarbons (PAHs) in humans. We posited that exposure to PAHs during the first trimester impairs fetal growth more severely than a similar level of exposure during the subsequent trimesters. In a group of healthy, non-smoking pregnant women with no known risks of adverse birth outcomes, personal exposure to eight airborne PAHs was monitored once during the second trimester for the entire cohort (n = 344), and once each trimester within a subset (n = 77). Both air monitoring and self-reported PAH exposure data were used in order to statistically estimate PAH exposure during the entire gestational period for each individual newborn. One natural-log unit increase in prenatal exposure to the eight summed PAHs during the first trimester was associated with the largest decrement in the Fetal Growth Ratio (FGR) (-3%, 95% Confidence Interval (CI), -5 to -0%), birthweight (-105 g, 95% CI, -188 to -22 g), and birth length (-0.78 cm, 95% CI, -1.30 to -0.26 cm), compared to the unit effects of PAHs during the subsequent trimesters, after accounting for confounders. Furthermore, a unit exposure during the first trimester was associated with the largest elevation in Cephalization Index (head to weight ratio) (3 μm/g, 95% CI, 1 to 5 μm/g). PAH exposure was not associated with evidence of asymmetric growth restriction in this cohort. PAH exposure appears to exert the greatest adverse effect on fetal growth during the first trimester. The present data support the need for the protection of pregnant women and the embryo/fetus, particularly during the earliest stage of pregnancy.