 Hello, and welcome everyone to a really exciting workshop in day. My name is Kristen Maliki. I'm professor and division director in the of environmental and occupational health sciences here at the University of Illinois Chicago, but I'm here today as a member and chair co chair of the standing committee on the use of emerging science for environmental health decision making. And it's just an honor and really exciting for me to be introducing this workshop today titled developing wearable technologies to advance understanding of precision medicine and environmental health. In today's workshop, we will cover a number of exciting topics and opportunities. This is the first of the first day of a two day workshop. And experts will be discussing the emerging applications of wearable technologies and the latest advancements in wearable technology for capturing monitoring and predicting environmental exposures. So while there's been a rapid advancement in wearable technology, the application in this context has not yet been fully explored so it will be very exciting to think about how we can use these new technologies in areas such as disease monitoring for environmental health sciences, interventions and biomedicine and discuss how we can move from development of the technology into adoption implementation and science communication to really advance environmental health and the population health for everyone. So, to begin the standing committee for emerging science for environmental health decisions is a committee of the National Academy of Science, Engineering and medicine. And we really are a group that is charged with examining scientific advances to help with the identification and control of environmental impacts on human health, meaning we really are looking to the future and trying to identify those aspects of scientific advances that are on the cutting edge that can make the work that we do as environmental health sciences and decision makers, more accurate precise and practical and really make the most advancements and biggest impact on human health. We do this by facilitating communication amongst many different stakeholder groups including government industry, environmental advocacy groups, as well as the academic committee community. This activity and the work that we do is made possible through support through the National Institute for Environmental Health Sciences. The committee itself is made up of a fabulous group of 16 members, many of whom are here today, and will be leading this workshop. We also have a number of federal agency groups that are a part of our work that we do and we facilitate and liaison with this group this federal government liaison group, including, again, the sponsors of the program the National Institute for Environmental Health Sciences, as well as the CDC, Consumer Product Safety Commission, USGS, EPA, NIOSH, Public Health Centers, you can see the group, the host, the whole host of folks who are a part of our government liaisons here, and we're very excited to have many, if not all of them here with us today. So this standing committee on the use of environmental decision making has been in operation since about 2009, which is when the first workshop on computational toxicology was held. We have a number of different areas that we focus on within this group, including emerging research strategies and analytic methodologies. We also think a lot about emerging areas of conversion. So more recently, we've been thinking about how does environmental health sciences interplay and intersect with many of the other ongoing activities within the National Institute of Environmental Health Sciences. In the last two years, we've had work on the interplay between environmental exposures and mental health outcomes, aging and environmental health research, infectious diseases. And even today is really one of those workshops at the emerging, which is an area of convergence where we're looking at environmental, oh, this is not today, we had one recently and slides a little bit out of date. But I would say that this use of wearables to bring together biomedical research and environmental health sciences is absolutely an area of emerging convergence. And then we also have emerging advances in science and technology, which is again, where, where this particular workshop may also fall. If you are interested in any of these you can go to the standing committees website on the national academies.org and slash in viral health decisions, and all of the information about these past workshops is available to you. We are always looking for new ideas for workshops and how we can advance environmental health sciences, many of you bring incredible who are participating today bring incredible expertise to the table. So please, please share your ideas with us and if you have an idea for a future workshop please email us at esech at nas.edu. A few housekeeping rules before we get going. This is a public webcast and workshop to discuss and exchange data and ideas. Please be an active participant in the discussions we really encourage folks to participate in the chat box and the webcast. So the comments made and ideas shared during this workshop should be attributed to individual speakers their organizations and unless otherwise stated, and thoughts shared during the course of the workshop should not be interpreted as the opinions of the National Academy of Sciences engineering and medicine, except for the housekeeping rules. You can certainly add our hashtag to your social media posts so that we can get more movement and more recognition and more dissemination of the exciting work that's happening here today. And the full workshop will be recorded and posted to the workshop workshop web page and about seven business days, as well as a brief written summary of the workshop will be published within a few months. So if you really want to get the word out and these exciting ideas implemented on as soon as possible. So without further ado, we will begin our workshop, developing wearable technologies to advance understanding of precision environmental health. And this workshop was put together by this amazing group of planning committee members, many of whom are part of the standing committee. It is chaired by Rima Haber, I'm sorry, who is with the Keck School of Medicine at the University of Southern California. And I know that in pulling these workshops together there's a lot of flurry of activity and it's really exciting that the day has come but these folks have worked really really hard to put an excellent workshop together for you so we're really excited to see what comes next. And this is what we'll be discussing today we'll be looking at wearables and their potential in environmental health and biomedical research with two sessions capturing monitoring and predicting environmental exposures, followed by a second session using wearables to advance and then we'll come back tomorrow to look at wearable applications in research, including disease monitoring and intervention, and then we will have both a panel discussion and an interactive group discussion so please join us for both days we'd be excited to have everybody here to help us with that. And without further ado, I will now be introducing Rick Weitschek who will provide opening remarks on behalf of the National Institute of Environmental Health Sciences. Again, welcome, and we look forward to an exciting day. Okay, there we are. So thanks very much Kristen can you hear me okay. Great. Good. So again, I want to extend my welcome to all of you on this very exciting workshop and developing wearable technologies to advance understanding of precision environmental health. I'm really thrilled to be here today. And this is all about exploring that exciting potential of wearables and biomedical research. And I'll reinforce some of the concepts that Kristen just gave you and the aim of the workshop is to really explore how the various forms of wearable technologies can help to inform and connect environmental health and not only amongst ourselves but also with the broader biomedical biomedical community to essentially enable precision medicine, as well as precision environmental health. So I think as we know wearables have become increasingly prevalent in our society I'm wearing an apple watch. So I'm contributing to this. And I realize that they, they represent really a unique opportunity for bringing innovation and change into the technologies we use to capture data. So they can provide real time data on a wide range of environmental, as well as physiological factors. So data from these wearable technologies have the potential to open doors to new possibilities and research and health monitoring. So combining innovative new sensors with artificial intelligence machine learning will likely produce more precise and accurate data that can be collected and analyze. So again just to reinforce there are goals of this workshop where there are two falls. The first goal is to delve further into the potential of wearables to capture monitor and predict environmental explosions and risks. The second goal of the workshop is to explore the broader applications of wearables in areas such as disease monitoring interventions and biomedicine. So the workshop is designed to encourage interdisciplinary collaboration. And we're doing this by bringing together experts from various fields, and we hope that there will be a robust discussion, robust discussions around some of the latest technologies and research opportunities in wearable technologies. So at the throughout the next couple of days, there will be sessions as Kristen indicated on different facets of wearable technologies. We'll start the sessions describing how wearables can be used to capture monitor and predict environmental exposures hazard and risks. And then we will explore how wearables could be broadly used across the biomedical enterprise by enabling dynamic and real time measurements of environmental exposures. I think this is really important. It's great to think we're bringing the environment environmental exposures into the broader community. So in addition to these sessions, there will be a panel discussion. The expectation is that this panel discussion will help shed light on the crucial factors of how technology adoption, implementation and science communication, these will all be necessary to advance the use of wearables across the biomedical and environmental health sciences communities. So there is also there will also be time for a group discussion on research gaps limitations and future directions for utilizing wearables to collect data. So I personally want to encourage all of you to actively participate. One of your share your expertise and contribute actively to the collection of knowledge that will emerge from this workshop. And hopefully by collaborating across disciplines and investing in research and embracing the potential of wearables I'm convinced that we can revolutionize our understanding of the types of how different environmental exposures can influence human health and well being. So thank you for attending the workshop taking the time to attend taking the time to contribute taking the time to listen. And with that, Kristen, I think I'm going to turn the virtual podium back over to you let's get this show on the road. Okay, wonderful. So I think we have an exciting lineup and without further ado, I'm going to let our first speaker come our first session. Hello everyone, my name is Tiffany Bailey lash and I am from the National Institute of biomedical imaging and bioengineering at the National Institute of Health. I would like to present our first keynote speaker, Dr Christina Davis, who is a professor and chair of the Department of Mechanical and Aerospace Engineering of the University of California Davis, her research centers around chemical sensing for applications by both developing novel miniature gas phase chemical sensors, as well as defining relevant volatile organic compound metal, metal, but below mix biomarkers of interest in human animal and plant systems. She has been a fellow for multiple highly esteemed organizations, including the American Institute for medical and biological engineering, the American Association for the advancement of science, the National Academy of inventors and a member of the United States Air Force Research Advisory Board. In 2008, she was selected for the National Academy's Keck Futures Initiative and 2011 for National Academy of Engineering 17th annual frontiers of engineering education symposium. Since 2018, she has been an ad hoc member of the intelligence science and technology experts group, which is administered by the Intelligence Community Studies Board of the National Academies. We are honored to have Dr Christina Davis with us today as our keynote speaker and would like to invite her to begin her presentation. Thank you. Thanks Tiffany so much. It's really wonderful to be here with you today and I'm grateful for the organizers to have a chance to to showcase some of the work that we've done so I'll start sharing my slides. Okay, well, I'm going to talk today about some of the technologies that my group has developed over the last decade. And it's really been a journey where we are working towards making miniature chemical samplers and chemical sensors that can be in wearable formats. So I'll jump right in. One of the things that we're particularly interested in our volatile organic compounds that are emanating from biological systems and we do this in a bunch of ways. In humans when we exhale we have respiratory gases that we're familiar with like inhale oxygen exhale carbon dioxide and nitric oxide, but we also exhale other hundreds and hundreds of other volatile organic compounds that are very low thresholds. And yet those odors and compounds have. They represent a lot of the health outcomes that are going on in our bodies. In addition to that we also exhale aerosols. And those aerosols contain a large amount of information as well. In the pandemic, most of us became aware that aerosols can contain infectious materials and that's true. They can have bacteria like tuberculosis bacterium or they could have viruses. In addition to that they represent the interior lining of the lung that's been in contact and in equilibrium with the capillary beds that that go and circulate through the lungs. And so the aerosols that we breathe out if we sample them correctly they actually mimic the compounds that you see in blood, but at lower concentrations than we're used to seeing. We have multiple ways we can exploit breath as a way to noninvasively monitor human physiology. And so the samplers and the detection methods that I'm talking about today are, are, were developed to exploit these kinds of samples from from wearable formats. So the first compound, the first device that I'm going to talk about today is actually a condensate sampler so I mentioned that aerosols exist in breath. And if we can capture those appropriately we actually can can analyze them biochemically. So this device has a small chip on the interior of it that actually has a variety of patterned features that are at the micro scale. This is a fiduciary Marcus 250 microns so you can see these are very small features. This chip actually is super hydrophobic and it allows the condensate from exhale breath those aerosol droplets to form on the surface to nucleate and to collect together into a plug of liquid. And this chip is actually sandwiched inside of a sampler that's shown over here it's about the size of the palm of your hand, and it has a lot of different layers in it it's got a cooling system, it's got this special chip that actually condenses the exhale breath condensate that we're talking about. And then going into this patient just breathes normally normal title breathing through this mouthpiece it's disposable. And we have an aerodynamic filter here, so that aerosols that are small can continue through the device and they actually impact on to the condenser, so that we're able to sample them. And yet, large droplets that might be things like saliva are actually large enough that they don't go through this aerosol that this this aerosol filter, and they end up in a saliva trap here in the bottom. So we're able to capture this fraction of breath pretty efficiently. And that's interesting for us so we did a pilot study with a series of teenagers that were that there were a part of a pilot study that we did for an NIH s NIB IB program that we had several years ago called the prisms program. We had them take their breath samples twice a day every 12 hours over the course of two weeks in their home. And as they condensed their breath it turns into that little plug of liquid in the center of the chip and they would pour it off into a vial and stick it in their freezer. So we collected all the vials at the end of the two week period, and we actually treated the samples, we lyophilize them so that they would be in smaller volumes, then we analyze them on an LCQ TOF mass spec. And then we were able to look at the data that resulted. What's really interesting is that these teenagers were from two different demographics one were just normal healthy controls. They had asthma that was relatively well controlled but they did have asthma. And what you can see here is when we color the dots from our LC mass spec metabolomics measurements, the asthmatics subjects are here and the control subjects are over here so we see a clear location between these two types of individuals one of the questions that we were interested in is could we, could we look at non invasive diagnostics even though we knew these patients had asthma was well controlled. We still could see metabolomic differences between them and the controls. And the next question is, could we also develop technologies to understand what people are being exposed to. So this is kind of the clinical preview. We looked at the types of compounds that we found. This is a fraction of them here we actually know that there are thousands of compounds that are in exhale breath condensate and they represent the, the types of compounds that you see in blood, they're just at lower concentrations. So when we looked at these these are a variety of compounds that are actually from what's called the arachidonic path pathway, arachidonic acid pathway that's an inflammation pathway. And these, these metabolites were, were different between the control and asthmatics, and the variety of compounds are listed across the top this is just one snapshot. But what was also very interesting is that these represent pathways biochemical pathways that are intracellularly very well known. And so we can look at these pathways and what's also interesting is that my clinical collaborators noticed that these pathways have different drug actions and so for a patient you could actually potentially look at which pathway they may be most responsive to, and you could use that as a cue to be able to think about the types of medication that would be most appropriate for them. What was also interesting for us is that we noticed that most of these across the board except for in one case that was in this one over here, the controls actually had bigger variability and they had higher values. This one case was different that was in the asthmatic was larger and had more variability across that group it's in a group of individuals. What we also know was that because all of these subjects had well controlled asthma, they were on either inhaled or systemic corticosteroids. So they actually had, it makes sense that all these inflammatory biomarkers are actually reduced. That was a really interesting thing for us. What we've been working on recently is looking at those volatile organic compounds that I mentioned early on. And those are in the gas phase. So we developed this sampler this is actually about the size of a small paperback book. It's a sample and it can be used in low power situations. We've sent it to the clinic and used by relatively unskilled users, and you can either do mobile or ambulatory sampling and what we do is, we actually get patients to blow up what's called a bag, and their exhaled volatile organic compounds are captured in that bag. And then this sampler actually collects those volatile compounds and routes them onto a small sorbent tube that stabilizes them so that they can be taken back to the lab and and what we have been using this for is, of course, a variety of different diseases and conditions. But most interestingly, we were in, we were specifically working on a project for NIH and cats, and we were looking at VOCs that that are related to COVID-19 infection. And we made a really interesting discovery with this we actually found out early on that we could distinguish the compounds that were between COVID infected and COVID negative patients. We followed that over the course of the pandemic, and we continue to do that now. What was very interesting is that when we moved from the Delta wave of Omicron to the Omicron wave that occurred a little over a year ago now. We saw a shift in the volatile compounds that were present between those two infections and that was also interesting because the Delta infections and the original COVID infections were more lower respiratory and the Omicron is more upper respiratory. And we did see a slight difference in those profiles. What was interesting is when we model those separately in terms of the compounds, we actually get better identification. And then when we tried to pull those together, we actually got a little bit poorer separation. And that told us that when we have large jumps in the upper respiratory or viral infectious diseases that we are expecting to see a shift in these volatile compounds, since the Omicron lineage has passed and we actually have the now the additional Omicron lineages, we do not see that continued shift. So they still are looking like the Omicron sample. So we hypothesize that that shift was because of a very large jump. And we were able to publish this. I forgot to put the reference on here. We published this in December in Nature Communications Medicine. So for people who wanted to look that up. Let me just go to my next slide. So shifting gears a little bit. We also have wearable technologies where we've tried to understand what are the environmental exposures that were that we're all getting all day long as we go through our daily life. And this was developed under our prisms program that several years ago, we developed a micro scale chip that's shown here that actually has electrodes and thermistors and heaters that are on it and the center cavity has an inert material called 10 X that actually absorbs volatile compounds for later analysis. So these are kind of like miniature thermal distortion tubes, if you guys are familiar with those. And this just shows, you know, the compounds that we're able to sequester on these there's a microfluidic channel across it and so we draw in air on one side and it goes out the other side. The compounds are absorbed onto this 10 X. This is kept in the laboratory or taken back to the laboratory as needed. They can be stored in a freezer over long periods of time. So we can have archival samples and then we are able to put these into wearable sensors so this is a device that was concurrently developed where the chip actually fits in the front of it here. And there is a Bluetooth connection here as well as a GPS system. This is just the wearable holder this is actually meant to be pretty robust because we deployed these with teenagers as well. We wanted to make sure that the electronics and everything were stable and we didn't have any problems with that and this was also deployed over one to two week time period this is the lithium ion battery it's rechargeable. There's a simple pump in here and these are the micro electronics and the fluid systems that route the air sampling to it and you can see that this is the wearable form factor here, and it has a small outlet that comes off of it so that you can actually you're basically walking around as a personal volatile organic compound dosimeter that you can wear. This just shows that we get time stamped and GPS stamped data out of it. We can change the sorbent type if you want a broader or a more tailored volatile organic compound profile. We use 10x because it was pretty broad. They're stable over time so we actually have kept them in the freezer to be able to analyze those later and we have archival versions of that. This just shows the GPS time stamping and then this is an example of sequential samples that were taken in 24 hour increments from a subject that was wearing these around so they're able to change the chips themselves. They just fit into and out of this little part in the front and then they're self sealing and so they're able to change those on demand and then keep them wrapped in aluminum foil in their freezer and then we get them back at the end of the study deployment. This just shows some of the linearity that we found with a variety of different compounds so that that's been great as well. We have subsequently deployed these a few different ways so these are some of the compounds that we found that were actually just in normal everyday environments so this first panel is just in a kitchen while a subject was just cooking dinner. This one we had a commercial hallway that the floors were being stripped and waxed and you see these are very large environmental compounds and it was particularly odor enhanced when the subject was there. This final one, this is actually in the room that is next to an indoor cat litter box so a variety of flavors and I'm sorry fragrances that are here as well as other compounds so we know that these samplers can actually collect a kind of a personal dosimeter information of the volatile organic compounds that are being exposed for all of us over periods of time. We've also deployed these on UAVs and in California this was particularly useful because in our wildfire seasons which have now expanded to cover many months of the year. So we do worry about air quality and we worry mostly about PM 2.5 and PM 10 which are the particulate matters, but what is relatively unexplored are the impacts of the volatile organic compounds, and we do know that they are especially they're relevant, they're in high abundances, and they actually are the same things that you see from fuel combustion, which makes sense. So we do worry about some of those BTEC chemicals like benzene toluene and etc. So with that, I think, I think that's my last slide I'll have one more. We're also looking at combining these with other wearable sensors that can actually monitor other things and this would be especially important for things like heat exposure which may be concurrent with some of these chemical exposures so we've taken things like skin temperature sensors, pulse ox sensors, accelerometers to understand, you know, the activity level of the person that is being monitored, as well as looking at galvanic skin response which is a surrogate for sweating. And we have wrapped these into mobile wearable devices this shows the form factor here we're working on making that smaller right now. And then we're also in the process of coupling this with real time chemical sensors we have a current project from the NIH. And so we're underway where we're looking at skin released volatile organic compounds that can also be added into the technology is under development so that's that part is not quite finished yet but we're using micro fabricated chemical sensors like the ones that are shown here that were published by my lab a couple years ago. I do want to mention that we have some patents that we have developed over the years on these. And as a part of trying to be diligent I always do a conflict of interest disclosure we have a small startup company that has that has licensed some of these technologies I do not hold a position with the company. And I am I am a scientific advisor to it and this just lists some of the patents that that are that are represented in the work I just described. In addition to that I also do some work with Los Alamos National Laboratory and the Veterans Administration as an unpaid scientific advisor. With that, I will stop and we're grateful for support from a variety of different funders over the years the National Institutes of Health has been especially supportive of this research and we're grateful for that. So I'll stop here, and I can take any questions. So looking in the chat right now there's a question about for the personal VOC dosimeter the 24 hour interval results would indicate the time weighted average of the 24 samples can one identify individual chemicals. Yes, you can and you can actually do that. Let me just go back to that screen. The shows. So this can be desorbed and analyzed in a GC mass spec and so this is mass spec data which means that we actually can look at the chemical identity. And you can decide what type of time interval you'd like to do so in some cases, you might actually want to look at six hour time intervals if you're thinking about occupational safety. In this case, we were looking at longer intervals because we wanted to know what the integrated exposure was over a longer period of time but that can actually that can be programmed into the device. And there's a microcontroller in here that is easily adjusted so that it can actually do different time intervals, the linearity of the sample. So should I stop here and take some, some additional questions. Well Christina we do have some questions. One question that's being asked, are any wearables to month are there any of the wearables do they monitor a hormone levels. That is a great question. We have some unpublished data that we are very excited about in the exhale breath condensate we can measure cortisol. And that's one of the stress hormones that we were interested in looking at in that case we actually just looked at cortisol and and we measured it in in normal healthy adults that were that were not under any known stress. It was actually just baseline. So we hypothesized that other additional hormones are probably monitored can be monitored but we have not tried to do that. And for that answer we also have another question. One of our participants said I saw your linearity and PPM for personal VOC sampler. What types of limits of detection and have you gone to with this device. So in this case, I think the published data that we had was down to the single digit part per million, but we've subsequently gone much lower than that so we're routinely operating in the 100 part per billion range right now. And the longer that you sample the more material you're able to accumulate on the chip. And we found that within reasonable sampling times of just like a minute or so that we can get down to that 100 ppb range. And that that's in some of our other published work but I didn't have it in here today. Great. Another participant asked, have you all published the work with the EBC sampler. If so, can you share it. Yes, so we have, and the sampler itself we published and the publications are listed to the original publications are listed here. We also have several more where we've shown the utility of it over time and I think those are not all listed here but I can, if you look on my website at UC Davis all of our papers are are actually shown there with links to everything to the journals. And one of the things that we're excited about is being able to have a startup company that may be able to commercially sell these at some point. So we, we build them in our lab right now we do them in batch fabrication for these breath for these samplers. And we, we, you know, are able to build about 20 or 40 to time. We're using them in collaborative efforts. And at some point we do believe, and there's a plan for these to be able to be available commercially. Great. Thank you for that resource. Another participant asked, do those awareness use of personal care products containing the OCS interfere with data interpretation. We definitely see them. So for people who use personal products and that can include a lot of different things including skin lotions, as well as personal care, you know products like shampoo or conditioners. If there are volatile compounds in those you will, you will observe them. Usually they're not at levels that are high enough to obscure other results because we're looking at this using mass spectrometry when the chip is desorbed. But we also note that we see these sometimes with the breath condensate sampler so in this sampler. There are, we recommend that people don't use personal products at the time that they're taking the samples and mainly what we found was lip balm, lip balm that contains specific volatile compounds of interest so. Otherwise, we didn't see large effects in the, in this sampler, the one that's the personal dosimeter. If they're in the ambient environment, even if you don't personally have if the subject doesn't personally have on those personal products you will also detect them in the ambient environment. That's kind of what we want sometimes. Right. Okay, so here's another question. Do you plan any physiologic measurements of any VOCs for peptide with, or excuse me for people with diabetes who are hypoglycemic. For example, service dogs for people with diabetes seem to recognize something. Is it a VOC or some type of shivering response unrelated to any VOC. What, so there's a lot of speculation that it is likely a volatile organic compound that the dogs are alerting on that that is a really interesting area, and not just for for for diabetics but also for people with seizures that there are these alerts that dogs can recognize and it may be a combination of things. It may be volatile compounds, in addition to, you know, subthreshold tremors that we that we don't necessarily always notice. But at least with the breath monitoring. So definitely it's known that when patients are hyper glycemic or hypoglycemic that they actually have ketone changes that are in their exhale breath. So, so we're, we're pretty aware that people would be looking at it we're not specifically trying to look at that but I know other people have. Wow, several questions now. So, one participant says, I'm curious as to whether you are able to be a bit more specific as to the microbiome analysis. In particular, what about the taxonomic abundance may inform. Yeah, so that's a great question and there are breath researchers in the world that are looking at this right now trying to look at the role of diet and gut micro flora, especially the microbiome. And that I'd say is an open area but we I think the field recognizes that there that there is something to probably look at there and I don't have anything to report today, you know, but I'm watching what my colleagues are doing. I don't have any current studies on that skin micro flora, maybe a different thing so we think about the microbiome in different ways it's not always just got it it actually could be skin as well we have commensal micro organisms on us, all the time. And as we're developing that skin VOC sensor that I measured that case we very likely are measuring some things from the person and some things from the micro flora. It's still interesting though because our immune systems have, they let that micro flora commensal micro flora exist. And so, in an indirect way, it still may represent, you know, our clinical significance so we're, we're, we're looking at that now. Okay, great. So another question, have you reached out to EPA on use of wearable devices that can be used by the public to address environmental health exposures during environmental disaster events. So we have an NIH SP 30 center at the UC Davis campus, and that has been a tremendous resource for potential public engagement with with with our local communities. And in some cases we actually have looked at using some of these wearables to look at persistent organic pollutants that may be in different environments. We have, we haven't been able to, to take yet enough data to be able to analyze and publish that. But we, but we have been thinking about citizen science approaches to deploying these so that we can gain information when there could be time sensitive disasters or exposures that are around us in the community and we haven't taken that next leap, but we certainly recognize it could be very valuable. Great. Okay, so we have well so many questions but we will take one more. We're concerned with volatile toxins released from burning solid waste, particularly plastic. It will be useful to understand the types and amount of exposure that informal waste collectors experience as well as people living closer to, or farther from a dump or unsanitary landfill. Are there devices that could be worn or used to measure this. Yeah, so I think two things one is this is definitely a wearable we're working on making this even smaller right now and I think that that could be a good tool that could be used. We also have put it on to UAV so that that would be another great way, but another thing that could be useful are devices like let me just find this other one. There are devices like this one, which actually can just take air samples and put them on to thermal desorption tubes, again from mass spectrometry and these are relatively easy to to utilize. So, I think there's a variety of tools, depending on if you want them to be fixed in place, or if you want something that is more wearable and mobile, like this one. And I think that they, they all can generate some pretty useful data. Dr. Davis, we certainly appreciate your keynote address. I'll turn it back over. Thanks so much. Hi, everyone. I'm Yixiao Qi on health scientists at the ministry to treat her to the National Institute of Immortal Health Sciences. I will be moderating the next session for you. So welcome to session one capturing monitoring and predicting your mom exposures hazards and the risks to inform precision in the house. In this session, we'll hear from three speakers. Sameer Halei from we health. I'm Virginia Jaffee from Baylor College of Medicine, and that the Johnson from Texas a and m university. So our first speaker of this session will be Mr. Sameer Halei. Sameer Halei is a founder and the CEO of we health. Mr. Mr. Halei was formally the chief of product officer at giraffe, whose mission was to bring financial sophistication to all the co founder and the chief design officer at the sun founder, where Mr. was working to bring electricity to people around the world living energy poverty. And director, we use their experience at my mate, where he helped define the future of health incentive assistance. He has conducted cutting edge research with Microsoft IBM and a university of Michigan. I'm originally from Bombay, India. Mr. Halei earned a degree in computer engineering from a university of Mumbai, where he received the school, the schools entrepreneurial and innovation awards. And one of us, you have his first MSI degrees with a specialization in social computing. So it's with a warm welcome that we invite Mr. Halei to speak. Thank you so much for the introduction. Hi everyone. I'm glad to be here. I am going to try sharing my screen. Okay, let me know if you cannot see it. I'm the CEO of we health. It was started. It's a public benefit cooperation that was started at the beginning of the pandemic. And we've been working very closely with the state of Arizona, the nation of Bermuda and government and research institutions. And we have taken kind of the lessons learned from the last three years of what you've all been through and turn it into a public health platform that we use for all hazards. As I continue, it would be great if you want to download this app. It will make it a lot easier to follow along what I'm going to speak about today. It's a free app for the public. If you're any concerns about installing yet another app on your phone, this is probably the safest app you can ever install because it can access your location. It cannot. It doesn't require login and it's completely anonymous. So follow along, if you can, it's just called we have notified on place or up the store. So 2020 is when we were kind of getting started. And when we ended up with is the platform that helps with monitoring detecting and mitigating hazards. We started with covert. And now in the process of adding other hazards to the platform as well. And we connect public and public health into this feedback room, but we can all kind of do it together, which is kind of what we've learned. We need to do over the last three years. So, when I started, I was actually at a nonprofit. We were one year away from a vaccine and we're all wondering what we're going to do. And so we were looking at how can smartphones have in digital contact tracing. And there are a few different organizations looking at that. And we decided that a privacy preserving approach was going to be the only one that would be adopted worldwide. And so we already built a protocol that worked. We had an Android app that used to do expert notification using Bluetooth in a privacy preserving way and realize that what to really work. Apple also needed to support background Bluetooth, which it did not. And so that's how they got involved. And if you know about this, as of May 2020, all phones in the world now have this protocol. And I'm saying that Google Apple built and put out there that helps with expert notification. So I'm going to quickly give an overview of how the protocol works as statistically speaking at least 20% of you have used it because it's been available worldwide. So, I just kind of explain the high level concept because it's relevant to the rest of what we're trying to do. So when you turn on expert notification on your phone, your phone goes into a simultaneous broadcast and detect mode. It's broadcasting a bunch of random keys to anyone who wants to listen. And it's also detecting the same keys from others who are broadcasting them as well. So it's a bi-directional kind of exchange that's happening. So here are some keys that phone A has come up with over a 30 minute window. The keys change every 15 minutes so they are completely anonymous. They're not tied to any identity. So this phone said whispering meadow, phone B detected whispering meadow, phone says Crystal Cascade detects session numbers but just to make it easy. And so at the end of half an hour, these phones now have a list of what keys have I used in the last half an hour to broadcast, and what keys have I detected in the last half an hour from others. The phones don't know that there's just one of the phone out there. The key could be coming from multiple phones. So I just know I know three keys. I don't know where they came from. So now phone A and phone B are not next to each other. They have gone away to some other place and phone A, the owner of phone A test positive. The phone A owner decides that I want to notify anyone that may have come in contact with me. So at that point they just say hey I tested positive. What happens behind the scenes is all the keys that I have used over the last 14 days to broadcast to others are now marked as infected and uploaded to a public server. Now has basically similar uploads from every phone that has chosen to share a positive diagnosis. So it's a big list of basically 14 days worth of exposure data from anyone who has shared that information for the further word. So now phone B is periodically checking the server and checking if any of the keys that are posted are actually also something that I've detected directly. So in this case, this ring meadow was something that phony had detected yesterday, and it's is now that it's, you know, it's in this public server, which is basically I won the lottery. I had this ticket and I was one of the winners, not the lot you want to win. So that's basically how it works. So phone B finds out that I may have been exposed, because I have this key that I detected, but no one else knows that phone B found out that they were exposed. Similarly, phone A doesn't know who they actually notified. So that's how the system is decentralized. There's a proxy in between which guarantees that there's no way to find out who is notifying who. So that's the underlying protocol how it works. And what happens after that is, once I find out that I may be exposed, then the system on my phone is looking at what was the symptom onset date for the person that showed the diagnosis. What was infectiousness level based on the infectiousness curves that we know how close was I to that device based on the Bluetooth signal strength so I can understand. So there's all these waiting that goes in based on the way that we're talking about Omicron versus Delta and so on, and also the guarantee of how confident we are about the report type, and all of that is combined to create an infection risk. So that's how I find out that, hey, I have a high exposure risk based on some exposure that I had over the last three days. I don't know who exposed me. I don't know how many people expose me. I don't know if it was day one of symptom onset for one person for 10 minutes, or if it was one hour of low infectiousness with someone else but I just know that's my exposure risk. So that's basically how the things work together. Right now it's only for COVID, but this protocol can be used for any infectious disease right and that's what we're working on right now. We see flu as the next easy one to add on, especially going into fall, where we face COVID and flu as a dual risk. So that's what we're working on. The other thing we're also working on is we did this research. Actually, we didn't do this research. We only worked with them at Lincoln Labs and they did all the hard work on this. We just gave them an app to use. And they were CDC funded on this and what they did is they took the app and put them in on these mannequins and move them around to simulate a physical setting. So what's happening here is all of these robots have a phone in the pocket and as they move around this room, we can see that this person in purple is the simulated infected person and these other phones are slowly turning yellow as this person moves around. So able to see using this protocol that I just described that over time, we are able to see a simulation of what's happening in real life to the protocol as well. So at this point, number 12 just turned a high risk of exposure because they spent enough time next to this person. And then as this person moves to the room, the infectiousness spreads and more people are getting exposed. So that's basically how the protocol works. They did an amazing job of simulating it and showing what kind of signal strength, thresholds and all of those to use to best simulate best adapt for what's happening in the real world. And based on that we also found that there are some limitations to the protocol. And so we are working with them to improving that one of the things is adding stationary hardware to these built environments, so that instead of relying just on phones, detecting each other all the time. So we can actually have a Bluetooth repeater so to speak. You can see this picture is my, I have one year old sons right now. So I got to speak and they were playing with it. It's a good way to show how small and how big they are. So they're really small these are $5 Bluetooth beacons that can broadcast signals. And if you just have like five of them at a conference. So for $25 worth of senses, three years of battery life, we can basically do export detection at any event. So we're looking into how we can improve the build environment coverage to enhance how quickly we can detect these kind of exposure to pathogens, and also extend the protocol to go beyond just code and actually summarize for many other things as well. And then we also have, we also have smaller sensors and variables as well. So all of this can come together using the same privacy preserving approach so that we get more buying and everyone benefits without giving up any of the personal information. So this is a deeper kind of dive into how it could also work in a bus we see transit events conferences, any place for a lot of people come together for a short amount of time and go ahead is a great place to have this kind of coverage. So if we detect an exposure we can put the notify room. So that's kind of the detection side I want to touch upon just that, you know, we can build the best technologies that's what I've learned with background, but for to really work and have an impact we need to focus on the last mile and make it really really work. So that's what you have done a lot. We have really built out the last mile which is a very complicated thing to do. And that's why our solution has been quite effective. So we realized that we need to have a community focus. So all of the tracking reporting information sharing all of that happens at a small community level, we can have universities, centers, counties, travel nations and we work with all of them. So if you tried out the app if you installed it, you can put in your zip code and will tell you what's happening where you are right now. And that's really important to understand what's the local public health department saying about what's happening. The other thing we realized was it's very important to have a feedback loop and I'm sure everyone here is working on census knows this right you need to give feedback. So people know what's actually going on. And with COVID, that was really important as well so we built up with a lot of the groundwork to make that happen as well. So you can see here we have inbuilt surveys in the app so when people get exposure notifications they fill out a survey and we found one in 10 people filling out the survey. So based on that we see even last month, even though we're kind of going through end of emergency and all that 70% people getting notified on a platform, reporting age of 50 or higher, and 37% people have a risk of C. Well, I'm sorry we can immune system, but then COVID has not ended. Right. And so they still find value. And if you didn't have this feedback loop we wouldn't know that's actually still serving its purpose to touch upon how we're adding the other factors other hazards on the platform. We have come up with this idea of factors on a platform so you can see on the left we have some code related factors, but we can easily add flu as another factor on the platform we can even add radiation can be any environmental risk we can add that as a factor on the platform, and then the factors get set either to detection by the app or a signal from an external system or just a self report. Like if I just know hey I was like exposed to something I can just put that in the app and then the app can adapt and give me that information for that. Or I have a sensor that I use that can then signal to our app or platform, and that's how I find out all the app itself can use any detection methods to kind of set the factors to what then let's just do is population wide risk certification automatically. And that way we can then push the right mitigation strategies to the right people at the right time when they need it most. So that's targeting based on factors across all hazards makes the app way useful for the cool population. The other thing we learned was, you know, in the last three years, there were times when we know that CDC gardeners outdated. We're waiting for them to update it. There was sometimes a month before we would see it. And that gap creates a vacuum for misinformation to spread. So we make sure that once we know something needs to be updated can be updated quickly. So for the public health side, we have built a whole platform for them, where everything is real time. So any content changes, any strategy changes, any special changes, this model changes, all of that is real time. We don't need to wait to deploy something. It's just live instantaneously. We also invested in communication. Again, this was one of the reasons why information updates take so long because we want to make sure we reach everyone. Right. And so we have invested in creating a system of AI and human review and auditing to make sure that all information platform is passing real time in all languages at this point. And we're also doing some work on taking it to the next level because we anticipate a lot more misinformation coming next year and we want to meet it where it is so we want to generate content and meet people where they are. So we can continue to make sure we don't lose the messaging. So I want to add one thing. We are the only ones left right now doing this, which honestly, I'm just surprised because May 11 right. It's like to 20 days ago, suddenly it shut down all across the US. So if you were any of these states that are either blue or purple, you had this app available, and it was turned off and not because public health departments wanted to turn it off. It just happened so suddenly and they were just not prepared on how to keep it on. So, one thing I'd like to do is make sure it doesn't go away because it actually works. And it actually, both in simulated environments in real environments, we have data to show that actually works. So we'd like to make sure it doesn't die, because if it's not kept warm, we will lose it. Instead, we should be working on improving it. And that's what we're trying to do. So we're looking for collaborators to join us. And if you are in any of these states, if you are in public health, we have a document. You just sign it and it will live again, because the protocol doesn't care about where you are. It can even work on the moon and it's already live. We can have astronauts using it today on the moon. It works. So we just need public health departments to turn it back on and that's it. So that's basically the overview of what we're doing. If anyone is working on any systems that can integrate with our platform, we'd be happy to talk to you because we think that this explanation orifications platform can scale any sensors we have in the environment. So if there are some people with some sensors, they can still benefit others who are around them so that we can really create this environmental sensing system that connects public health and sensors and people together. And that's what we're trying to bring here. So with that, I'll end and I'll take any questions here. Thank you, Samir for the very interesting presentation. For our audience, if you have questions for our speaker, please use the QA function at the bottom of your screen to send them and then we'll take them at the end of the session during the QA session. So our next speaker is Dr. Bijan Najafi. Dr. Majafi is a professor of surgery at Baylor College of Medicine specializes in data health and biotechnology. He serves as the director of clinical research in muscular surgery and in the vascular therapy director of the NSF Center for Streamed Healthcare in place, also known as C2-SHIP, and a co-founder director of the interdisciplinary consortium of advanced emotion performance, also known as ICAMP. In 2014, Tucson local media recognized him as a most influential health and medical leader. Dr. Najafi has published over 250 peer-reviewed articles around the 14,000-plus citations. expert SCAPE ranked him in the top one global scholars in 2021 for work on leg ulcers and a diabetic peripheral neuropathy. In 2023, he was inducted into the prestigious American Institute for Medical and Biological Engineering College of Fellows for pioneering digital health technologies that went false and named Gong Green. Throughout his career, he has mentored over 500 students, research fellows, interns, postdocs, and young faculty members. Please, Dr. Najafi, to take the podium. Oh, thank you so much for this kind introduction. Can you hear me well? Yes, and also I'm guessing you have my slide. Good day, everyone broadcasting live from Houston Texas. I'm thrilled to be here virtually as we delve into fascinating topic at the nexus of design, health, and workplace. I express my sincere thanks to our esteemed organizers for facilitating this exchange of ideas and knowledge. The focus of my talk revolves around groundbreaking study supported by General Service Administration, or GSA, titled Well-Built or Well-Being. This research seeks to illuminate the potential effects of office design and indoor air quality on the health and well-being of those who often overlook the office workers. As we navigate through this journey, remember that you aren't talking just about walls and windows, desk and chairs, but the environments that we shape and in return shape us. Our ultimate vision is to imagine and reinvent the design of indoor office in a manner that profoundly elevates the health and well-being of office workers. Our focus here is on indoor, but tomorrow my colleague and my mentor, Dr. David Armstrong, also we talk about other digital health activity that we have to promote health and well-being of patients with chronic illness. So let's see that hopefully I can navigate this slide. So the trajectory of global workforce has witnessed a remarkable transformation over the past few decades. If you look at the 1970s, the label landscape was predominantly populated by blue-collar jobs involving hands-on physical work in fields such as construction and agriculture. However, when we shift on the horizon, in particular around late 20th century, a radical change occurred, fueled by advancement in the technological globalization and shift towards a service-based economy. The majority of workers migrated from factory floors and construction to office setting. And now we are becoming indoor species. Statistically speaking, we spend approximately 90% of our time in enclosed space and nearly a quarter of that time spent with the office environments. Therefore, if we would like to promote health and well-being, and if you would like to consider the air quality on health or well-being, probably one of the major focus should be indoor and how we can improve indoor air quality and also design. So with the concept of high-performance buildings has traditionally been associated with energy efficiency and cost-effectiveness, now we are becoming increasingly aware that through performance exchange beyond this parameter, in particular, the most advanced buildings are only truly high-performing if they also enhance the health and well-being and performance of those who inhabits them. So to achieve this goal, we need to expand our understanding from actually indoor office, how to design better the indoor office, how to change air quality to ultimately can improve on health-being of us and also work here in that office. But this is not a very simple question to answer. The health outcomes actually are interconnected well that an ultrational one can drastically impact on the others. And if you would like to have a better understanding that how the indoor air quality and design impact or health, we need to look at this reciprocal association. Let's like give you an example. This is an example from ongoing study of the study that we have done that I will briefly explain today. Here it shows that how the sleep quality can impact on the stress on the next day. And when you have a stress today, how it's impact or sleep on next day. So that is highlighting the complexity of assessing of those health metrics. Also, if you look at the stress and activity, again, this is the results from our study that shows that when we have more stress, we tend to have less activity after work over. And then the less activity after work over, overall, where stress is increasing. Again, the association always reciprocal. And we need to address all of them to gain a better understanding how the indoor design can impact on health and well-being. So to address this challenge, actually, we came up with a complex design at the beginning is looks super real, but actually it works. Basically, we use a chest for sensor that help us to avoid this sleep stress and physical activity. We use a pendant sensor that measure actually the air quality surrounding of the subject and also the noise and exposure to the light. And also we use a survey app that half an hour every half an hour every one hour we collecting some additional input from the subject. Additionally, we use a series of the nodes inside of the building that the job is reading the indoor air quality noise and also light on the different office and also act as a big weekend that it's a pair with the sensor that was on the chest and then we can track the individual inside the building so we can see that how much information from that inside door can impact on health and well-being. So for more information about the about this design please visit the gsa.gov and search for well-built for well-being so you can see more detailed information about that design. Another challenge that we have is that of course we use some of the consumer electronics available but we needed to extract clinically graded information from those sensors so we needed to design and validate the algorithm to accurately capture the stress. Evaluate the mobility not only about level of activity also identify the posture for instance we know that inside the office detection of the sitting is important sitting is like a new smoking so we needed also to detect a different posture. And also we needed to ensure that the sensor has been worn by the subject so we need to measure adherence on wearing the sensor so use the temperature sensor for that measurement. This is an example of activity data that we have we asked our participant to wear the device for three days we then we can help us to evaluate the sleep so we use our algorithm to look at the sleep quality then look at it during work over how the different indoor air environments and quality impact actually the stress and level of physical activity. Then after office hours are actually those elements can impact work after work and of course the sleep next day and then we characterize a different level of physical activity and also the stress level. For stress we use heart rate variability and we characterize them by SDNN so the details you can find out actually your publication. Because of stick up time I don't have time to go to details but one of the biggest challenge that we have in those study is to evaluate the sleep quality with very high time resolution because we were interested to see that the indoor air quality and environment that we have today. Highs impact or sleep of the same day and etc and we needed to have a simple single metric for doing so we use actually the Pittsburgh sleep quality index that usually is based off different metrics like that mainly our self report based off the sleep latency duration. If you KC sleep disturbance use of a sleep medication daytime is function but to add it the time resolution we actually replace the sleep latency duration and KC directly from the sensor that was attached and through the validated algorithm that we have to exactly identify when the person is going to the bed. How long it takes to fell asleep. What is the duration of actually sleep and also is the efficiency so that helped us to have index of the sleep quality that we did time resolution so we can track night after night. These are the some of the survey that actually we collected from the data for data collection we collected the office workers from the four federal building three of them they were in Washington DC and the other one was in Texas. We tracked the individual three different type of the office one office was open bench bench is a new design in the GSA is a traditional offices space it could be called and also private office. So that helped us to collect a very rich amount of data that I invite everyone that want to explore that database would be happy to share this data but basically we have a significant amount of the continuous data with the indoor air quality noise light and many other information to explore them. Already in the GSA it's it's you can see the current publish a study come up from this study. For the sake of time I just very quickly will overview the studies the top two study one is impact of office design and the other one the effect of the relative humidity on health and well being again for list of all other studies please visit the website of just a dot go. So this is example about the impact of the office we use the structural models on tangled association within the office design and health and well being. We find out that after controlling for all the confounding parameters including the type of the work the job description of the person the level of hierarchy. We find out that actually the people who are actually working on the open bench. They have significantly higher physical activity compared to the other office design and also they have less stress and then after work over also they have less stress and more physical activity that that highlight the impact of the office. This is some of the typical example of the of the physical activity that you can see here for some you see that on a bench data and those who are working on the bench they have a higher significant higher number of steps compared to cubicle and private office after adjusting by age sex PMI and the job description of the individual and overall they have they are walking more. So sorry I'm trying to be very fast because I know that I have a shortage of time so here also I would like to highlight another study that we have and be trying to address through or database again is highlighting the importance of using verbal technology to address some of the unanswered questions. This is a graph that was suggested by ashray to define that what is the optimum relative humidity to promote health and well being and it was recommended that relative humidity should be between 30 and 60% but later on ashray relax. Their regulation about to dry because of lack of evidence that how to drive or working in a to dry environment can impact on health and well being. Then then we look at our data we achieve to identify a series of the cohorts that actually they spend significant time in the dry environments and the cohort that spends significant time during human and also a cohort that living in the comfort zone and then we look at it that how actually the house and well being metrics are changing as functional relative humidity. This is the results interestingly find out that after adjusting by co-founder parameters working in both dry and humid environment can significantly impact on the stress if you're more stress and when we have more stress significant impact also on sleep quality. So that that is another again value of the variable technology to objectively evaluate all actually the indoor condition air condition and impact or health and well being even we achieve to identify a narrower optimum zone for relative humidity. We find out that level of stress is minimum when the relative humidity is between 40% and 50% even is a narrow range that originally was recommended by ashray. So here was of course a snapshot of highlighting the technology how the technology like variable sensor can really untangle and answer some questions that we're struggling to answer and that is including indoor air quality and office design. GSA of course previously did several studies to look at that how office design impact is stress but usually have that often they have a challenge to look at other metrics like indoor air quality, relative humidity, the light exposure and other metrics. So or study by leveraging those technology help us to explore those metrics and directly evaluate that how they are that impact on or stress on our level of physical activity and or quality of life. And to that end, I would like to highlight that this was a highly interdisciplinary project. This is the actually one of the very fun project that I have involved in it. I work on this project with psychiatric environmental scientists, the architecture designer, and obviously a very insight from GSA and the company of acne mother designs on the sensor that views in the context of this study. Thank you so much for your attention. I hope that I am on time. I hope that I didn't pass my time. You did great. Thanks for presenting a very exciting research. So the last speaker of this session but not least is Dr. Natalie Johnson. Dr. Johnson is an associate professor in the department of environmental and occupational health at Texas A&M University and vice chair of the interdisciplinary program in toxicology. Dr. Johnson obtained her PhD in toxicology from Texas A&M University and completed her postdoctoral fellowship at the Johns Hopkins University. Dr. Johnson's current research and the translational goals are to identify hazard and characterize exposures to promote solutions to combat air pollution and respiratory disease risks, especially in susceptible populations. Dr. Johnson is leading projects funded through NIHS and the Robert Wood Johnson Foundation to develop novel tools to evaluate hazard and characterize air pollution mixtures through experimental models and community-based studies. Dr. Johnson has received numerous honors including the women in toxicology world W. Hudson and it has a base key Wissenberg Scholarship Award and the Society of Toxicology, Reproductive and Development of Toxicology Specialty Section New Career Studies Award. Now, Dr. Johnson, please have your presentation. Thank you. Thank you so much. I'm really happy to be here today and follow the excellent talks that have already been presented today. I'm going to be sharing with you a study that we did in south Texas utilizing silicon wristbands as personal passive samplers to absorb chemicals from environmental air pollution exposure. As mentioned in the introduction, my research program mainly focuses on exposure to air pollution and air pollution is all around us. You can see it in the news almost daily and here's something from Tuesday morning showing the impact in Manhattan on the air quality due to transport of air pollution from Canadian wildfires. And so sources can be very diverse. As mentioned earlier from wildfires in California, or also more traditional air pollutant sources that are thought of like vehicular traffic or industrial related exposures. It does account for a really, really high number of environmentally related diseases and a large burden on mortality or death. This is some data from the state of the global air showing air pollution, following risk factors such as high blood pressure, tobacco dietary risk, and being a top environmental factor for disease and death worldwide. When you start to tease apart this burden, you can see some distinct windows of susceptibility, including those kind of later in life, which are largely attributable to exposures from COVID-19 particles are PM 2.5 household air pollution or ozone that could result in deaths related to COPD, heart disease, lung cancer or stroke, as well as low respiratory infection deaths and I think that's something that was also really highlighted during the pandemic was that exposure to air pollutants could increase your risk for COVID related deaths. Also, if you look at the other side of this plot, you can see early deaths related to neonates very early in life or even into young childhood ages one to four that are related to air pollution exposure. And this largely stems from the impact of PM 2.5 or air pollutants, very small in size ability to cause infant low birth weight premature delivery, or also increase neonatal susceptibility to respiratory infections. Myself and colleagues looked at a variety of published literature related to fine particle exposure and impact on birth weight. We used a specific systematic review technique known as the navigation guide methodology that not only looked at the data but also looked at the quality and the strength of the data. And as you can see on this plot here is a variety of individually published studies that looked at the relationship between prenatal exposure to PM 2.5 and impact on infant birth weight. This is called a force plot. What you can tell here is that there are overwhelmingly a number of studies that are showing a positive relationship between an increase in the level of air pollution and a decrease in infant birth weight on average about 20 gram decrease. What you can also see here is that there's a lot of heterogeneity, meaning there's spread in the data. And even in some cases that looks like there would be an opposite relationship. And this really highlights that there's a need for personal exposure assessment when we dug a little deeper and looked at risk of bias across different domains in the study design. Most frequently we saw that there was bias in the way that investigators actually conduct exposure assessment. And that could be due to how the data is being monitored at specific locations throughout counties or being modeled. And so being able to really account for the individual and personal activities that we know people have and the importance of the indoor air as the other speakers have mentioned today. There's a need to really quantify what a personal exposure to important air pollutants may be. There's also a need to address the unique components of particles that can come from those variety of different sources. And in fact, in one of the studies, Detrekowski at all that looked at a maternal birth cohort in Poland, where coal burning was actually quite common. They sent out small backpacks with mothers for two days during the second trimester and quantified those two days because kind of representative as the pregnancy related PM 2.5 exposure. They further looked at what the components were of that PM and looked at the pH exposure, which stands for the polycyclic aromatic hydrocarbons, which are toxic combustion products that are known to be associated with PM 2.5. And then what you can see in this short little plot here is that the pH exposure actually didn't have the same relationship as the PM 2.5 exposure and in fact even had a stronger relationship with the impact on birth weight that even the PM 2.5 did. So because of this need to quantify not only PM 2.5 but important organic chemicals that are stored to the PM. We started looking into personal strategies to quantify that exposure. Interestingly, there was a publication that came out in 2014 that's featured here by Ken Anderson's group out of Oregon State University entitled Silicon wristband as personal passive samplers. And they propose that these bracelets which were really popular in the early 2000s could actually act as a sorbent, binding chemicals that are in our ambient air, but also on her skin so could actually represent both inhalation and dermal routes of exposure. They sent these out with some asphalt roofing workers, as you can see here on the figure three a eight participants were these bands either on their wrist and a stack formation on our lapels, kind of on their shirt. And you could see that they would actually bind a variety of levels of pH is over their eight hour work shift. What's really interesting is when they looked at the rooftop work site location kind of where they would be using these kind of shingles laying them on the roof. They saw that there was a burden of pH exposure associated with that, but it was actually quite higher in the training site. And this made sense because the training site was actually indoor so you didn't have as much of the kind of dilution of this exposure. And so they really proposed and showed that this could be useful as a personal dosimeter. And we were lucky that we read this paper right before we started a pilot study in South Texas looking at maternal exposure to air pollution. And so that's really useful proof of concept for how you can take a published paper and actually see if you can replicate that in a separate laboratory setting and get sort of similar results. So a little bit of background on the study population of where we're working. So Texas A&M University is located in more central Texas, and about six hours south from our campus located in Haldogo County, and the Rio Grande Valley is the McAllen-Eddenburg Mission area, one of the fastest growing populations across the United States. There's very high prevalence of childhood asthma in this area compared to the rest of the state. And there's also been evidence of an increased rates of prematurity. So our study team wanted to ask the question, what is the risk for maternal exposure to air pollution, and could this be having an impact on maternal and children's health. Specifically at where we recruited our participants, you can see here in the center in McAllen, this is where the hospital is located where most of the women were delivering. And we were able to recruit participants at multiple satellite clinics located throughout the region. We recruited healthy women in their third trimester of pregnancy that were receiving prenatal care at these various clinics and were non-smokers and did not live with a smoker. We were able to recruit 17 participants into our study, and the study and design entailed carrying a backpack similar to the study that I mentioned, but this time on three separate occasions, spread throughout six weeks. So that kind of matched up with when women would be going in for their prenatal care appointments. We had a community health worker or promotora actually drop the backpack at the mother's house the day before their prenatal clinic exam. Others were instructed to carry the backpack or leave it nearby within their respiratory zone for a period of 24 hours and then return it alongside with the giving a hair sample at the clinic the next day, which we use for nicotine analysis, which all of the levels were below limits of detection, indicating that they were not exposed to secondhand smoke. So in the backpack, we saw that we were able to quantify both active and outside the backpack passive sampling. So, inside it contained a battery, a small pump that would emulate what's going into the lung. There's a small data RAM right here that's for the PM 2.5 analysis that was paired with GPS, and then also a PTFE filter and XAD resin tube that we were able to use for actively quantifying the polycyclic aromatic hydrocarbons are the PAHs in the backpack. We also following the Alcano et al methods deployed a pre clean silicon wristband that we had here on the outside of the backpack for passive sampling. Now to show a little bit of the types of data that we were able to receive from this personal monitoring. This right here is showing the PM 2.5 concentrations that we were able to get highly resolved over space and over time. On the Y axis you see the measurements of the PM 2.5 expressed as micrograms per cubic meter, and you can see different peaks throughout the day, often, you know, kind of lower throughout the night and then return to the clinic that matched with the different locations of where the mothers were traveling. We also were able to overlay these data for all 17 participants and three sampling periods. You can see that the higher levels indicated in kind of the orange and red did track with the major corridor of highway 83, but you had some cases where you had, you know, kind of outside of that major traffic corridor, evidence of heightened PM 2.5 levels, which kind of correlated with individual residential exposure. When we look at the individual participant data in this bar chart, you can see that this was picking up a lot of the individual variability throughout the different sampling periods so for instance participant eight and nine tended to have higher levels of PM 2.5 detected compared to some of the other participants, but within each sampling period sometimes you would also have certain days that would be higher than others. So when we looked at this by the specific micro environment based on GPS data and also a daily diary log, we saw that most of the exposure was coming from the indoors. So I liked what was mentioned earlier we really are indoor species or indoor creatures, and a variety of the peaks were associated with times related to cooking, which is shown here in the kind of purplish magenta color, and the evidence that a majority of the PM 2.5 was coming from cooking related activities, likely and maybe not as well ventilated kitchens. When we compare these individual data to the local EPA site kind of the ambient monitor for Hidalgo County, you can see frequently in red the personal monitoring data is exceeding what is picked up at the ambient monitoring site. And that's because we're also capturing what the indoor exposure is. What another major question came out of this is, you know, who in the world would want to carry a backpack for for nine months it's just not feasible. So it's really that's not what we would consider a wearable, and it'd be much nicer to could just send out something as simple as this bracelet that moms could wear perhaps that one month intervals, and you could get these sort of time weighted average chemical exposures across the duration of pregnancy. So, following the previously cited methods, we took the wristbands back to the laboratory where we're able to extract them with solvents and then run them on gas chromatography mass spectrometry to look at a variety of different chemicals. And here I'm showing data for the 16 criteria PAHs that we were able to quantify using targeted methods. For the most part, you can see, just through the three different filter media types, you have filter, you have XAZ XAD Sorbent that's going to pick up more of the volatile PAHs. And then you have the wristbands, and you can see that you have variation between the different participants, and also between the different sampling periods. You can see here, you know, one of the round two participant three periods had a very different profile than the other participants have that would indicate a different type of exposure, perhaps. By and large, though, we picked up two predominant PAH chemical species, phenanthrene and fluorine that tended to be similar for the filter and for the wristband with phenanthrene being the predominant PAH detected at the highest concentration. We also looked at eight additional semi-volatile PAHs in specifically the XAZ tubes and the wristbands, and you can again see that you get the individual level variation across each of the different media types. And over 90% of these chemicals were represented by these top four highlighted in the box here, including both one and two methyl naphthalene, biphenyl and two six dimethyl naphthalene. When we looked at a approach to see kind of the similarities between the participants and between the specific chemicals, these heat maps reveal specific patterns in each round with very high concentrations again of the one and two methyl naphthalene, biphenyl, the two six dimethyl naphthalene and phenanthrene. And we also further specifically working with a colleague of mine calculated the partition coefficients, which basically looks at the ability or the affinity of the compound to move from the air into the subpoen wristband bracelet. What's shown here on this plot is just comparisons of the partition coefficients to other published studies by the Anderson group that we showed very similar partition coefficients indicating that there could be the ability to back calculate the air concentrations after you measure what's in the wristband. We're reporting everything in the band as a mass, a nanogram analyte per band per weight of the wristband, and it would sometimes be nice to be able to calculate back to what was the concentration in the air. So then you could compare to what ambient levels are and make sort of inferences as to what regulatory limits maybe or maybe not exceeding. So conclusion, some strengths of this approach is that the silicon wristbands can bind smaller molecular weights and evolved to pH is very similar to existing active sampling techniques. We think they're very useful for determining the frequency and magnitude of inhalation exposures over time. They're low cost, and they're also really easy for participants to wear, as well as for researchers to transport so you know after we took them off. We had them in a freezer stored easy to transport back to the laboratory for analysis. And then we also further were able to show that there was an opportunity to integrate multiple exposure pathways, although we didn't do this in our own study. We have seen other publications showing where you can capture both the inhalation and the dermal exposure. Some of the limitations and existing gaps include that we actually did follow the first methods published by the Anderson group showing that there was a rinsing step for the band prior to extraction. And that's not really needed, or is it really recommended in the best practices anymore. So that might be why we didn't see as high correlation between the band and the filter because maybe we actually just washed off some of the particulates. There's also a lack of the detailed spatial information that you got with the personal data RAM. So this could be important if you do want to tease apart, you know, maybe occupational versus environmental exposures. But that's definitely something that could be incorporated into a study design, say maybe people only wearing them at home or taking off and wearing another one at work if you wanted to discriminate between different sources or locations. It's still kind of being investigated what the impact of showering or bathing is on these bands. So, while we didn't have our participants wear them, many other studies have. And so there's still ongoing investigations on if that would actually have any involvement of desorption of the chemical although it's not hypothesized that it would. And there's also still ongoing research on the ability to measure very highly volatile chemicals. However, there is an opportunity to use this very simple technology to link with potential health effects and many studies are beginning to do just that. I did a quick search this past week on publications in PubMed related to a silicon wristband, and there are 86 articles that were identified since that 2014 article, about 74 of these are relevant for personal exposure and this includes over 70 primary years that have been published over the past decade. A few of these are detailed methodological papers that can help with people are just getting started in the field, and a few are starting to link with adverse health outcomes. I'll also mention that there are four really good reviews that have recently come out in the past year or two, including a systematic review that looked at a specific focus on pH is like our study did. So another one that looked at kind of current knowledge recommendations and ongoing future directions, as well as a more comprehensive review that looked at not only the silicon bracelets but also additional passive air samplers that can be worn as wearables. But overall, if you look across the kind of 70 studies that have looked at these in a variety of populations, there's been multiple reports of the ability of these to bind many different numerous chemical classes, including the pHs, but also some of the polychlorinated biphenyls, flame retardants, plasticizers, including phthalates and non phthalates nicotine and a wide variety of pesticides. These have been especially informative in studies that have looked at susceptible populations. Again, like pregnant women or children, specifically with pesticide exposures say there's a band pesticide, and children are wearing these in a setting you can easily pick up if that pesticide is still present in the child care setting. So we've been using a variety of occupational settings, including with firefighters, agricultural workers, waste and even office workers, and then also specific environmental and even more emerging on environmental justice communities, those that are disproportionately exposed to environmental exposures. And interestingly, a couple of recent reports on animal species, including bees, frogs and cats and dogs that are showing that these maybe even could be used as sentinels, seeing tracking with the exposure of our pets with what we're exposed to as as people. Dr. Johnson. Yes. Yeah, we probably need to wrap up in probably 30 seconds, we need to go into the QA session. Sounds good. Well, I will just wrap up. You can see that review for some of the best practices and recommendations. And then this is my last slide showing some of the future applications that our group is working on looking again at some of the burden of exposure to animal species where we're working in South Dallas there's concern around exposure to asphalt chingle factory and an interest in a volatile organic compound exposure. We're also in the Houston ship channel where we're working in these communities. We're doing some air sampling I just wanted to mention some mobile air sampling, using a mass spectrometer on board mobile van to drive and do this hyper local VOC sampling at very low concentrations down to parts per billion and parts per trillion and we've also been responding some to some recent environmental disasters so please check out our Superfund Research Center Twitter page they can see some of the mobile sampling that we're doing in East Palestine and other parts of the Midwest and response to recent disasters and there's a real opportunity to partner with community groups that are interested in the personal level exposure and make some direct comparisons. So I'll just wrap up with acknowledging all of my team the study participants community health workers, collaborators and really highlight work done by each of Mendoza Chief Fanchez on the pH analysis and Kirsten Fuller on the PM analysis. And of course, thank our funding, especially in IHS for our P 30 and P 42 centers for the support. Thank you so much. I look forward to the Q&A. Thank you for the opportunity for the very wonderful presentation lots of information to take. So now we start our Q&A session I think I'm going to ask all speakers in this session to turn on their camera. Okay, so we have lots of questions, but we only have seven minutes. So, first question is for Samir. The question is, Apple and Google got together with a COVID exposure notification system similar to yours. How does your system differ from theirs? Yeah, so actually the system we have is what I talked about is what they have turned on. So we are using the same system we built it prior to Google Apple adopting it, and then they adopted it in coordination with our nonprofit and a couple of other nonprofits as well as another protocol. So it's the same protocol and was first called EN 1.0 and now we're using EN 2.0. And that's what we are using as well. But what we're doing now is extending it, because they have stopped working on it. So it needs to continue to get better from what you've learned to extending by adding on to it by adding stationary hardware and other diseases on it as well. So the next question is for Beijing. It says, actually, I think other speakers can also chime in because there's some generality there. So in low or middle income countries, levels are not easily available to analyze the verbal devices for environmental exposures or disease. What low cost tools are available to identify and quantify exposures? Sure, I can start. It's very good point. Of course, when we start our study, we didn't know what kind of metrics we should look at and what kind of metric of the health and impact by indoor air quality or the office design. And we needed to design the algorithm ourselves, but now look at the smartwatches that are measuring the stress and are measuring the sleep quality, so they become cheap and affordable. And we believe that ultimately, everywhere using those consumer electronics also can track those metrics. There's one to chime in. Oh, I can move to the next. The next one is for Natalie. So what's the mechanism of air pollution exposure? See PM 2.5 increasing the risk of diabetes and blood pressure. Yes. So there are multiple studies looking at how PM 2.5 can influence blood pressure. And a lot of the underlying mechanisms have to do with its ability to generate oxidative stress and inflammation. So not only are you influencing the lung, but you're influencing other organs like the vessels. And the same goes for diabetes risk. And so that's also some emerging literature that's showing impact on type two diabetes that really has underlying mechanisms related to the ability of the particles themselves to cause an oxidative stress reaction on the on the person. So therefore, thank you. Another question also for you. Can the city called response be used to evaluate exposure common coronated solvents like a PC and a TCE. Yes. And I know they have been extensively utilized to look at chlorinated and also brominated flame retardants. So in our own research now we're since, you know, with the train derailment there was concern around the chlorinated solvents. We're starting to see if we can test them and calibrate them in the laboratory. So a lot of the studies not only are they sending these wristbands out to be tested with personal sampling, but also in a chamber setting making sure that these will actually be able to effectively absorb the variety of different chemicals that have different chemical and physical properties. So yes, they can and there's also ongoing work in our labs and I know and others to fully calibrate this technology. Thanks. And there's a question kind of colorifying question for some year. So what are you, you mentioned that you also have sensors. What do your sensors matter. That's a quick question. So, if you've used the Google Apple technology right there are some limitations, the first one being your phone is in transmit mode, you're transmitting blue which costs a lot more energy than just receiving all phones are receiving more all the time. That's our headphones and things work, but transmitting is high energy. So that's one of the reasons that people don't use it because it drains battery life. So what we're doing is between you have two phones, and they can just stay in listen mode, and we introduce this beacon in between. And now this is the proxy where if they both hear this beacon, then they don't need to transmit to each other anymore. So that's significantly improves battery life. It also helps with situations where you had about aerosols. So when you go into a room and the person has already left, you're not going to detect their phone, but the aerosol still has code in it. So that's what the beacons have as well. So we can do for my transfer we can do a lot more accurate detection by introducing the beacons in between. But the best part is the beacons don't even have to be active. They are passive says $5 for three years of battery life just take it and you're done. And then the whole protocol just suddenly becomes a lot better. Thank you very much. Welcome to take a short question. So, it's for Natalie. Have any studies or city congress compared exposure between stationary band at home and one. The rest, I'm sorry, I think the question wasn't really clear to me, maybe you can answer quickly. Yes. Not also top of my head can I think of one most of the studies that I've read more recently have been people, you know, wearing them, or in the laboratory setting, you know, kind of keeping it within a chamber and seeing the ability of these two sort of different chemicals. And perhaps this has been done and I'm dismissing it I've got the updated literature search now to go back through since so many have been coming out in the past couple years. But that would be a good study designed to see kind of, can you pick up, maybe, you know, kind of like traditional passive sampling, just leaving in a location and making comparisons between different locations that definitely could be done. Thank you very much. We are at time at 250 we still have lots of questions. So there's lots of interest from the audience I really want to thank all our speakers for wonderful session, and we need to move to the next session. We're going to session two, which is using wearables to advance research for dynamic and real time measurements of environmental exposures so we're excited to see how these can be used to inform our exposures, you know, quickly. My name is by Loma Beamer I'm a professor in the College of Public Health here at the University of Arizona. I also direct our community engagement core and co direct the translational research support core for any just p 30, which we call the Southwest Environmental Sciences Center. And I'm also director of our new EPA Environmental Justice Technical Assistance Center. The purpose of our session this afternoon is to speak on capturing and monitoring and predicting environmental exposures hazards and risks to inform position health. But this time we're really focused on how can these be used in real time and dynamically so that we can make decisions about our health. Our speakers for this session are Anna Rappold from EPA Kevin Lanza from UT School of Public Health and David Noran and Sarah Mariani from Phillips. I'm going to go ahead and introduce Anna so we can get moving. As I know that everyone's excited to hear that. So Dr Rappold is a statistician and a clinical research branch chief at us EPA she conducts clinical and epidemiological research on health effects, air pollution and other environmental exposures and has authored several studies specific to wildfire smoke impacts on cardiopulmonary health. And I received a 2019 Arthur S Fleming award for the smoke sense project, a smartphone citizen sense project. Just lost my bio. And app that seeks to answer how people experience wildfire smoke and build community around health protective behaviors in the face of exposure. We would like to invite Dr Rappold to begin your presentation. Thank you for Loma. Just make sure first that you can hear me. Yes, I can. And I can see your slides. Yeah, okay. Good. Oh, great. Thanks. Well, thank you for. Thank you for having us here today to talk about our experiences with wearables in the context of environmental health research. Our experience are not broad, but we have been involved with this project that has led us to give us pretty good insights into how wearable technologies can make impact on the future of how we live with with our environment, how we make decisions about our environment, how we influence the future course of environmental health problems. So let me first begin by providing this vision for why we for a virtuous path of wearables in the context of environmental health. We have learned that data from wearables are in high demand. That is true. That we like gadgets right, but we also like the data that they give us the wearables can measure environment almost instantaneously right around us at the scale that is personally relevant to us. Just a few years back to measure ozone and particulate matter you really needed this big machinery but now you can measure them on this tiny little devices right, you know in your kitchen or outside your house door. We can measure our body temperature some of the wearables are implanted in our body right and they provide data every night to our doctors who decide on the best course of action for us for our health. The real time information that wearables provide can really move the needle on our decision making spectrum. When we observe changes in the environment, we start building the rationale for behavioral change. So even the hardcore skeptics of us among us can move their needle on decision making spectrum adopting new ways you know when the data is presented to them at the personally relevant scale. Others among us, you know, or in another context, we are ready to to change behavior right away. We just need the information that that that to queue us in to make that change. However, when the personal costs and barriers are involved and we require people to make that action, we need to we then start evaluating pros and cons and weighing the benefits of our actions right. So that is so information alone is not enough to motivate that behavioral change. Now when we couple wearable data with reporting and other interactive features, we really facilitate connection between changes in the environment and our health at the scale that's intuitively familiar and able to stick in our minds. Think about it like calories on the labels right in the food yeah. It's informative, but do we actually change our behavior we some of us do some of us don't because if you're anything like me I can always subtract a little bit, add a little bit, because you know who is counting right it's me that's counting. I'm only. I'm only accountable to myself, but now when you throw in like features like logging goal, the goal setting rewards sharing and all those things. You really capture people. And before you know, you know you can't you don't go to sleep before you close all of your phones on the Apple watch right or you turn around and go home because you forgot your watch or phone and your day would not have any meaning if you didn't get a credit for it right. Ultimately, this starts this information, you know, comes into a cycle of reinforcement and and it helps us build new habits and ultimately we start changing the be our own behavior behavior of others there within our sphere, and even you know at the larger scale right we shift the norm, and then we move into new new technologies new discoveries and so forth. So in the next few minutes I just want to share with you few experiences from our citizen science project and why we see why we believe this is possible. Okay. In the big picture smoke sense project was one of the project that was motivated on developing health risk communication strategies in the way that when people are being exposed to smoke. They, they take health protective action so moving them in the direction of taking on the right action. There are several behaviors that are recommended, and none of them come with specific information of how beneficial they are so it's a very confusing task. Meanwhile, we get inundated with media and this captivating images, right. So how do we respond in the absence of clear message. The information alone is not enough to motivate our actions, because we're unsure how to respond, whether responses provide benefits, and we have a lot of on our minds right we have our schedules we have our habits. So, anything new to our schedule must be weighted by benefits that we perceive sense of urgency that we perceive, or other aspects that define our perspectives on the issue. So doing nothing, or meaning nothing different from normal is the lowest cost of action that we can take. And so what we often do is that we accumulate weight, we accumulate evidence, we observe others before we respond. Meanwhile, the, the evidence suggests well the evidence is, is, I wouldn't say suggest actually, let me just say that it's a point that there's an increased risk with this type of response when we're, and it's not good for our health, right so it's beneficial to our health to learn to accommodate new behaviors in order to, to reduce our exposures. But these are just a couple of images of us how we continue our lives during welfare, welfare smokes and the captivating images that we receive from the medium. So status quo is a term, right that we use to describe why our propensity to stick with the same behaviors and not change. There's likely several reasons for that during welfare smoke, and that both the habits are both hard to form and hard to break. So we have this tricky task when we're thinking about health risk communication strategies of getting into the decision space, among us, like those shown here, right when, right when you're sitting off at the beginning of the day on your normal routine. These people recognized that the, that today is the day to wear shorts right, what made them not recognize that this day is also a smoky day, right, because there is that gap. So, what do we, what kind of things do we consider before we head out, both, both images are displaying another kind of exposure right that it's, it's summertime, that we're wearing shorts, we're exercising, but we are not responding to what's really in the picture, and that is smoke. So status quo and other biases lead us to what we have observed, and that is this widespread gap between what we know, and what we do to protect our health during welfare smoke exposure. This citizen science project is an approach to study people when and where they're experiencing welfare smoke, make resources more easily available, you know, the information they need in order to make the decisions and explore why and how these gaps exist. And why are we not bridging the gap between what we know about reducing exposure and the benefits and what we do. So, in the, in the, the primary way of interaction with the smoke sense citizen science project is through this app that provides a lot of resources to the user when they're actually experiencing smoke. They go to the app, usually when they're actually in this situation and they're invited to report their symptoms and smoke observations, and in that way contributes to the, the community that is learning from each other. The first thing that we did in this study is to learn how people interact with this information and what the risk perspectives are on the issue. Let me take a moment back because I want to talk about this image, for example. The same goes, we can't see the forest from the trees, right. Trees make up forest with smoke. The opposite is true, tiny particles and gases make up the smoke, which is not visible that what makes up the smoke is not visible, but smoke on aggregate is visible. So the fact that particles are invisible to the eye is one reason why it's really difficult to build a common perception or perspective on the risk during wildfire smoke and the variety of perceptions increase the complexity of health risk strategies. In addition to having multiple decisions that one has to make. What we learned is that this we started in back in 2017. And what we learned is that there's a high demand for understanding air quality at the very fine spatial and temporal scale. This is before a lot of sensors came on the market. So it's changing now, but the man demand was there. Right, we need, we really wanted to see those changes when and where we're experiencing them, not three days later, not across town. Health was the motivation for seeking engagement in the in the study. But the lack of recognition of personal risk influence behavior. So what I mean here is that most people recognize smoke as a health risk, but to much lower extent as a personal risk right so we, we think about it as yes this is a health risk, but it influence impacts others, not myself. When for those who have been around wildfire smoke know that it's, there's no one that really can escape the effects of smoke exposure. Now someone more severe than others. But the symptoms can be really annoying. And in some cases can be preventable. Majority of people who engaged with the study. I meant to say there is now over 50,000 users, majority responded to smoke by taking action to reduce exposure after experiencing symptoms. And this is the crux of the problem. We really want them. We really want to get to the stage where we take action to to reduce exposure so we don't experience the symptoms. So, to prevent symptoms rather than to react to symptoms. So, at the end of the first phase of the study, we had several recommendations, among which is to provide personally relevant data and information, as well as compelling evidence that benefit that changing behavioral is beneficial. But also to try to build habits around air quality is habit around air quality. Yeah, because habits are a way to to become better prepared when we are experiencing smoke. Currently, we are preparing a new phase of the study, we call it smoke sense level up. And in this phase, we are focusing on habit formation around air quality and wildfire smoke. Sorry, I didn't know these slides were interactive like this. But anyway, and to build habits, we leverage some pillars of social science and behavioral science, marketing and all other areas where we are trying to build habit. And that is social norms, establishing and changing social norms, positive reinforcement, building and removing barriers, and increasing self-efficacy. So, all of these things are true. The problem, the challenge is how to implement them in the context of air quality and wildfire smoke exposure. So this is how we are proposing to approach it. Smoke sense users become smoke sense level up users become part of a group with similar concerns and experiences by submitting their reports, their observations of smoke, of changes in the air quality and of actions they take. By sharing and seeing how others respond, it is easier to visualize impacts of behavioral change, right? Then it's easier for us to see how the herd is doing, or what's called the herd behavior, right? How the rest of the people react. When, if you can imagine the situation of smoke and you're hunkered down in your house, trying to keep your air quality clean, well then you are sheltered, right? You're protected from the rest of the world. But through digital community, such as smoke sense level up community, it gives you an insight onto what other people are doing and what they feel like is beneficial to the situation. Social norms can also be dynamic, have dynamic aspects to them, like changing in prevalence, which can be long term, you know, when we think about people who, percent of people who are wearing seat belts, right? In the 60s, it used to be very low, and a lot of resistance to it, and now we take it for granted. They can be short term. I apologize, but we are passing time. We're a few minutes past, maybe you could wrap up in the next minute. That would be great. This is such a great presentation. I hate to cut in. Okay. Okay. So, here I will just show a couple of examples then how to include positive reinforcement, which is the reward that follows and reinforces the behavior. Then, sorry. We incorporate reward building and barrier removal, and then finally, different features that are aimed to increase self-efficacy. People's own belief that they have the capacity to act. And so I'm sorry, I'm so short of time. I didn't follow this very well, my instructions. But finally, what I want to say is that ultimately, through the engagement in the citizen science, we want to help people recognize the need for behavioral change so they can make it closer to see the trees from the forest, right? Or analogously in our situations to see the particles in the smoke and react to the particles. And we believe that the key point is to try to motivate action and dependency on the variables through the interactions, by allowing users to interact in a way that is personally relevant to them so that reinforcement of desired behavior takes place. One thing that, and over time, we're changing our own decisions. We also build good habits for those around us and ultimately shift norms. What the challenge remains is how to continue building on to this type of research engagement and communication strategies, how to create a business model for it, so to speak. Okay. Thank you so much. I love the positive reinforcement. Thank you so much. And we will be moving on to our next speaker, which is Kevin Lanza from, he's an assistant professor in environmental and occupational health sciences at UT Health School of Public Health in Austin. And his research explores the relations between the environment, health behaviors and health through an equity lens with a focus on extreme heat and physical activity of children and other heat sensitive populations. And the ultimate goal of his research is to inform policies that eliminate health inequities based on race, ethnicity, class and occupation in the face of climate change. Prior to joining the faculty at UT Health, Dr. Lanza was a research fellow at the US Centers for Disease Control and Prevention, and received his doctorate in city and regional planning from Georgia Institute of Technology and completed his postdoctoral training with the Michael and Susan Dell Center for Healthy Living. His research has been funded by the National Institute of Environmental Health Sciences, NOAA and the Robert Wood Johnson Foundation and City of Austin. We would like to invite Dr. Lanza to bring to begin his presentation. Thank you, Dr. Bhima, and can you hear me all right and see my screen. Yes, I can do both. Thanks. All right, great. Well, thank you all for joining today. Kevin Lanza here, assistant professor at UT Health School of Public Health in Austin. And I'd like to share with you some of my work on how I use wearable technologies to assess the environment, physical activity relationship in youth. And here we see an image of one of the study participants wearing an elastic belt with an accelerometer and GPS device to measure to evaluate the efficacy of a safe routes to school program, whether or not these children are walking and biking to and from school. And so this project has kind of two overarching parts, or sorry, this talk. First, I'll just give a very brief overview of the exposome and health and where my research fits within it. Second, I'll dive into three of my research projects, the first two of which focus on youth physical activity, one in the school setting during the school year, the second during the summertime. And then lastly, I'll share a more general study about how different cycling routes affect ambient environment exposures, or one's dose to these exposures. And all three of these studies take place in central Texas. So first, kind of setting the table on the expo zone. So this is a concept that's defined as a measure of all exposures of an individual throughout their lifetime. And those exposures can be broken down into kind of forming categories, ecosystems, lifestyle, social and physical chemical. In my research, I focus on physical activity and its effect on health, as we know physical activity as a health behavior that lowers the risk of cardiovascular disease, cancers, diabetes. I'm also interested in temperature and humidity and its impact on health. As extreme heat leads to more deaths in the United States than all other weather related hazards. This is the same in Australia and a few other places. I'm also curious how temperature may impact physical activity behavior in that potentially extreme temperatures may serve as a barrier to people engaging in this health behavior. And then lastly, oops, I look at health equity. Are there fair access to physical activity infrastructure such as green space, and are certain communities unfairly exposed to higher temperatures than others. Okay, so what we see here is that most children across the US are not reaching recommended levels of physical activity and there are differences that exist by race ethnicity. Here are data from the research center I work at that are across the state for the percentage of Texas fourth graders reaching recommended levels of activity for health and wellbeing. We see that across the major race ethnicity categories in Texas, the majority of fourth graders are not reaching recommended levels, yet black and Latino children are less likely than white children. We've also understood in Austin and in other cities across the US that urban heat is a health inequity in that low income communities and communities of color disproportionately live in areas characterized by higher temperatures. This is a product of historical discriminatory policies and ongoing disinvestment where there are left trees and higher amounts of dark building materials in these settings. Here we did a citizen science based mapping of temperatures across the eastern portion of Austin to highlight one of these health inequities or heat inequities. This is one of the citizen scientists that did mobile monitoring where there's an air temperature relative humidity sensor on the personal vehicle along with the GPS device, which allowed us to estimate temperatures over time and space. So now with the table set. Let's dive into the first of three projects. This is the green school yards project. This was completed in 2021 in which I partnered with city of Austin Parks and Recreation Department. And we focused on a school yard settings. Here are two photos from data collection. What you can see in these photos are school park. You see children. They're under the shade. What you can't see in these photos is it was over 100 degrees when these were taken. So this begs the question, what are the relations between air temperature shade and physical activity levels of children. This project took place at 3 elementary school parks in Austin, Texas. Each of would have each of which had low access to nature as well as. We're at schools that we're serving over 85% economically disadvantaged Latino households. The project took place in September, November in 2019 as September's the historically high temperature month during the school year in November for comparison purposes. And we recruited a cohort of 213 total third and fourth grade students across the three schools. And we test these students during 20 minute recess periods during three weeks to wear these elastic belts with two devices and accelerometer and a GPS device to measure their physical activity and time and space during recess. And then to relate that to the shade and to the, the air temperatures. We measured green features such as trees and shade by drawing polygons of these features using higher resolution aerial imagery by the US Department of Agriculture's national agriculture imagery program within a GIS. And we measured temperature and melt humidity by installing 10 weather stations. Looking for even spatial distribution across each of the parks and siding based on land cover and land use. So this is a fixed site network rather than wearable monitors. So what did we find? Well, we found heat index, a combination term for air temperature and relative humidity that captures how it really feels different across sites, even within parks. Here are data for the September 2019 where the red spots the hottest spot in one of the parks. This it reached 114 degrees Fahrenheit and that's characterized by the top right image and unshaded playground. Yet just 100 feet south was the coolest spot in the park, which was 10 degrees cooler and that's the bottom right image, which is the shaded playground. So now with children having on those wearables on that elastic belt, we've understood during recess, we've understood that as temperatures rise, children decrease their physical activity and they stop shade. So looking at this graph at 91 degrees Fahrenheit, that's the inflection point where a larger percentage of recess time children worse under the shade and not engaging in physical activity. What you what is also what we also found from this project is the school with the highest amount of tree canopy. Had children spent 6% more time engaging physical activity than the school with the lowest amount of canopy. So based on these findings, we could recommend. Covering activity spaces for physical activity with tree planting tree shade as a way to potentially promote safe physical activity as our world's warming. So now that we did that project during the school year, we want to follow that up with a summertime physical activity project. And we want to not only look at the relationship between temperature and physical activity, but also air pollution and physical activity. This project, we've already recruited a sample just recently and this is 40 total rising fourth graders across three schools, two of which are serving majority Latino economically disadvantaged households, the latter, the last of which is serving white affluent households, mostly. And this is a pilot project where we're having the children this summer in July and August, where for seven consecutive days, again, that elastic belt. This time the belt has four devices on it. So two of which are measuring what we've measured before, just during a different time of year, different context. That would be the physical activity in space and time by having that accelerometer plus the GPS device, but then we're adding to ambient around exposure instruments. We're going to have a thermochron eye button, which measured air temperature, and then a 2 pro, which measures particulate matter at three sizes, ultra fine fine and course so one micrometer 2.5 and 10, and total volatile organic compounds. We're going to set each of these sampling rates to be at one minute. And so what have from time matching the understanding of where these children are moving in time in space, and what dose of exposures they're receiving. This is for the last project here, which isn't specific to children more generally looking at different doses of multiple ambient exposures when taking different cycling routes in Austin. Here you see two different routes identified, there's a trail route the red route, which is about 10 miles long. It's completely surrounded by green space, and it circumvents a ladybird lake this is in the center of Austin, over 5 million users a year. We have this orange road route, which is an analogous comparable route, which is all on streets, and that was developed from commonly used cycling routes using Strava. So with this last study what we're looking at is these 2 sites, and we're comparing them. And what we're doing is we're having cyclists, or we've already done this, we had cyclists ride these routes simultaneously 2 times per day. Once in the late afternoon, and then on a weekday and a weekend day, and this was done in September 2021. The cyclists by cycling we were measuring using 5 different instruments, 2 of which were installed on the bike itself and 3 of which were worn by the cyclists. The first 2 measuring air temperature relative to humidity and light intensity or shade. Those 2 were installed on the bicycle itself, while the other 3, the geographic location measured through the GPS device, the Atma 2 Pro, which is that their quality device. And then we added a new device. This is a zoom F2 field recorder. This measures noise as we had individuals wear this on their back. From that noise sensor, we were able to use a sound detection system in which we could categorize the noises throughout the audio files that we collected to partition them into either anthropogenic noises or natural noises. Here is a sampling of some of the results of summer statistics. I'll share this further at an upcoming conference at the International Society of Exposure Science over in Chicago this August. And what we see here are the mean and standard deviation of these different ambient around exposures on the trail route versus the road route. And what we see in the vegetated trail route is lower temperatures and higher humidity than the road route. That's what one would expect as trees can lower temperatures and they also elevate relative humidity. Yet when you calculate from these means, the heat index from those 2 variables, you actually have a lower heat index from the vegetated trail route than the road route by about 3 degrees Fahrenheit. Light intensity we see is higher on the road route than on the trail route. Just for reference 400 lux for light intensity would be more or less like a sunrise sunset amount of light, while 1000 would be a daytime more or less overcast. We did see that particulate matter and VOCs was higher on the trail than on the road. We suspect this is because the trail is a gravel path and it's kicking up dust as one is using it. And the volatile organic compounds could be a portion of biogenic or a natural based VOCs as it is in a green space. With the noises we found what we'd expect where there were more anthropogenic noises on the road than the trail and the trail had more natural noises, yet what's important to note is that the decibels, the units of noise is on a logarithmic scale. So a 17 decibel difference is almost 100 times higher sound intensity on the road than the trail of anthropogenic noises. And a three decibel difference between natural noises on trail and road is about a two times decibel two times sound intensity difference in natural noises and we've understood that anthropogenic noises are a stress inducer while natural noises can be a stress reliever. And so just wrapping up, I wanted to share that environmental exposures from this project you've seen, they can serve as either barriers or facilitators to the engagement in physical activity and exposure during physical activity can be either harmful or helpful. Data from wearables can be linked to other types of data. So data of the participants, as well as built environments just to canopy for that further analysis. And then lastly, when you're designing a study with wearables, consider including participant burden. So are these comfortable to wear? Do they have to charge these devices? How long are they wearing them for? The position of the wearables important, such as a hip worn physical activity monitor measured a different type of physical activity than a wrist worn physical activity monitor, asking in the top image. And then different Spencer says sensor specifications. How accurate are they? What's the response time in that how soon can the sensor itself collect new environmental data? The logging rate. Are you collecting data every one second, one minute, one day data storage is the data stored are the data stored on a phone or tablet, are they stored on the device itself and what's the capacity of that storage and then battery type are they rechargeable. So none of this work could happen without the collaborators. So we must thank them very much for their help with this work, along with the funding agencies that have supported these initiatives. And so thank you. And I'd be happy to answer any questions you have either now or later if you think of some. Thank you so much. That was perfect. And we will be doing the Q&A session at the end of this session. And so just to remind everybody to go ahead and post your questions if you have any. There are speakers. So I'd like to invite all of our speakers to go ahead and turn on their cameras and while they're doing that I just want to say I'm so excited about all the excitement for the ICS conference in Chicago I hope everybody here will submit and be there. Early bird registration is next week. I think that because former president I'd be remiss if I didn't put that plug in there and I think we're still missing Dr. Rappold. Are you going to join us as well for the questions. So the first question we got is actually at all the speakers so any one of you could go ahead and jump in and answer it. But what research gaps in this space of wearable sensors and environmental health research can benefit from future funding, do you think. So this is a great platform for that question. That's a that's a huge question. I think it's. I don't think there are any bounds to that specific to my own. I'd love to see a wearable monitor for measuring gaseous exposures. So that could be nitrogen oxides carbon monoxide that can be used for the researcher because oftentimes these are kind of consumer facing. But researchers need specific specs on these different devices such as are they actually logging and storing the data. Are they able to be off loaded from the device. How often do they need to be charged. And so I think in general, having more of these research great products available that are low cost and have been tested for accuracy. That's great. Anyone else want to chime in on that question. I can move on to some of the other ones. Alright, well also to all the speakers in the session. What are the key pollutants that wearables could track that provide the most. And impact lifestyle intervention. By five nitrogen dioxide so we heard gases. Anything else in there or any other plugs for a favorite pollutant we want people want to say would be great. I'm sorry I didn't hear all the the ones you listed. Those were not listed so is that something you think would be a great addition to some of these technologies. Yeah. I think that's what they were asking is what would be the key benefits of being useful for us to understand and impact our lifestyle with behavioral interventions. Somebody were listening today and designing a sense. Oh, I, I think there's some. There's a real value to be thinking about how user will be interacting with this information. And what is the potential for the user to kind of set goals achieve goals and want to be part of something bigger, because you have to motivate. It's a very big ask to ask someone to let's say, I don't know if you're talking about wallet organics to, or to abandon certain lifestyle that we are accustomed to, you know, and change our behavior and use different, different habits. You really need to know. So it's a process cannot happen just by saying to someone this chemical is bad for you. It's a process that you have to understand how we can engage in that conversation and reinforce that conversation. Right. Because, you know, we don't have, we don't have readily available information on the chemicals that we are exposed to every day. And even when you read the research papers, it's hard to believe that for an average person it's hard to believe that you're inhaling all these things, or your, you have thermal exposure to all these things. Absolutely, I would love a wearable with my total VOCs but that could be very scary for most people I would imagine if they didn't know it was in there. For Sarah, are you considering sharing your rich data publicly or under controlled access to enable reuse by other researchers. Yeah, that's, that's a great question. I think a lot depends on our on our sponsors and, and their wishes. Right. Yeah, this is a DETRA funded project so that is maybe a better question for for DETRA, but yeah that that would be wonderful like if I had my wishes to share data with other performance, other performers. And then one last question for Kevin, how do you avoid wind noise on the bicycle borne noise dosimeter they didn't see a windscreen in your pictures. That's a great question. How to avoid wind when you talking noise that a couple of strategies. One is the photo I showed in the presentation was just a stock photo. It actually comes with a windscreen so that kind of you know the fuzzy piece over a microphone. And we also put it on the very center of an individual's back while they were riding their bicycle. So that would serve as kind of a human windscreen on top of the actual windscreen. And so you kind of have to get creative at times that messes with your project needs. All right, we just got a bunch of more questions. So let's see, even how much our exposures are indoors how useful are things like city sensor networks for understanding individuals actual exposure. And I have to say I had a student look at the American time you survey and the average 30 minutes outdoors a day, which blew my mind. So, how do we use these outdoor sensor networks to form behaviors on indoor exposures. My initial response if we're talking about indoor and outdoor exposures is, you have to measure exposures both in these different settings. And so you brought you bring those appropriate sensors for indoor environments, and you do those evaluations. And I'm surprised to hear even the 30 minute level from the American time you survey. I've heard the stat that 90% of individuals time has spent indoors. During waking hours or maybe 24 hour clock. But I think we have to look at those indoor exposures and those require different sensors such as I know with temperature sensing, you require a solar radiation shield when doing outdoor measurements, which we wouldn't need for indoor measurements. And that shield actually affects the response time of the sensor itself. So there's these different consequences of different setups. So one last question we got or any of your teams looking at how to integrate the data back into the healthcare system. I'd say that I think a lot of people would like to do that. And then the last question. Since the other one didn't get too much discussion what is the cost range of these wearable air quality sensors are they low cost and how do they compare to purple air sensors. I can help with that one if it's okay. So, I know the purple air sensors. My understanding is those are meant for fixed sites. As I think the question asker knows, and therefore either indoor or outdoor, where these wearable sensors, they're comparable prices. When I've heard the word low cost added in front of the word sensor, they typically end up being around 100 to 500 dollars. The ones I've used around 200 to 300 dollar per unit. There's also some third parties like south coast, a QMD, which does evaluation of the accuracy of these different low cost sensors, and they've done quite a bit of accuracy checks on air quality sensors. I think particulate matter is the air pollution exposure that has received the most. I guess advancement so far of all the different exposures in relation to air quality. Yeah, that's a great website. I'm glad you mentioned that one. I'm going to go ahead and turn it over to Rima. She'll do our closing for today. You guys did a great job. Thank you so much for all your wonderful presentations. Thank you so much for Loma. Can you all hear me okay. Thank you. So I'm just pulling up my notes so I can also see my notes. I am delighted to close us out today. So for those who don't know me, hello first, my name is Rima Hover and I'm an associate professor in the division of environmental health and at the Spatial Sciences Institute at USC. I'm also the chair of the wearables workshop planning committee. What a fantastic way to end our first day of our workshop on developing wearable technologies to advance our understanding of precision environmental health. I would like to first start us off by thanking all our wonderful speakers for creating such rich discussion and sharing their thoughts and ideas during today's workshop. I will briefly recap our day starting with our keynote speaker, Dr. Christina Davis. Dr. Davis's presentation highlighted the potential of non-invasive monitoring techniques like breath condensate samplers and volatile organic compounds for precision environmental health. These technologies to showcase offer opportunities for diagnostics for detecting exposures, even infectious diseases and monitoring stress levels and other biological responses. Currently wearable devices with physiological and chemical sensors are being developed and advanced every day and future research areas or directions include studying the impact of BOCs from personal care products, exploring the links between diet, microbiome, skin flora and personal environmental health. And then we had our first session on capturing monitoring and predicting environmental exposures, hazards and risks to inform precision environmental health. So our session one speakers explored the utility of smartphone apps of wearable electronics of silicone wristbands to monitor exposures and impacts on health in real time in some cases. This includes using mobile apps for infectious disease surveillance and risk predictions such as COVID-19, using wearable sensors to monitor well-being and physiological responses to the indoor environment, and using silicone wristbands as personal passive samplers to detect poly-aromatic hydrocarbons or PAHs. So Samir Halai's presentation on WeHealth focused on the development of a smartphone privacy preserving app for infectious disease surveillance, initially targeting COVID-19 exposure notification, but with broad potential to be expanded to other environmental exposures to predict individualized risk without compromising privacy, which is very important as we all know. He also emphasized the importance of incorporating feedback loops and information and multiple data sources to enhance the effectiveness of these technologies. Then Dr. Bijan Najafi discussed how to better design indoor spaces and manage indoor environments to improve health for office workers through his project Well-Built for Well-Being. And he noted that people working in open benches have higher physical activity and lower stress, and their study is seeing direct relationships between indoor exposures, sleep quality and various measures and stress. Then we had Dr. Natalie Johnson discussing the many uses of silicone wristbands for detecting PAHs and personal exposures across multiple pathways. She found that most exposure peaks were indoors rather than outdoors, and this confirms the importance of all our indoor environments in affecting our day-to-day exposures. She also addressed the importance of design and wearability for getting the sustained long-term uses for exposure monitoring. And lastly, our session two, we just started from a marvelous group of presenters speaking on using wearables to advance research for dynamic and real-time measurements of environmental exposures and communications. So Dr. Anna Rappel's presentation highlighted the potential of wearables and smartphone apps in addressing air quality concerns. She emphasized the role of risk perception, of peer influence, personal motivation, and data feedback and positive reinforcement in motivating health-protective behavior change to reduce risk, especially from wildfire smoke exposures. Dr. Rappel showcased the EPA SmokeSense app, which is a citizen science initiative dedicated to understanding wildfire smoke. And in its next phase, SmokeSense is focusing on motivating habit formation to sustain very proactive health-protective behaviors that people might do to protect themselves from wildfire smoke, which is really a very complex area. Then we had Dr. Kevin Lanza present on extreme heat, and he explored the relationship between the environment, between physical activity in youth and children, and health, focusing on the exposome and health impacts. Dr. Lanza highlighted the urban heat health inequities. His work uses temperature sensors with GPS, incorporates accelerometer and high resolution GPS data for physical activity assessment. For measuring green features and shade using arrow imagery and GIS, and incorporating wearable sensors for VOCs or volatile organic compounds with an emphasis on integrating and linking all this wearable data to other types of information. And last but not least, we had Dr. Noren and Marianne's presentation on wearables for warfighters, highlighting how we can use real-time physiological data from wearables to monitor warfighters' exposures to chemical hazards, including the detection of COVID-19 or other infectious agents. They also introduced the NOTE program, which conducted a pilot study on wearable technologies potential for detecting opioid compounds. So again, thank you to all our speakers, to our moderators, to our amazing planning committee members for a fantastic first day, and to all of you online for submitting your incredible questions during the Q&A session and for engaging with us all of today. Tomorrow, we will resume with our day two, running from 1 to 4 p.m. eastern time. During day two, we will hear from leaders in the biomedical, environmental, engineering, federal and more fields, discussing wearable applications for both environmental and biomedical research. So we will begin with a session on exploring wearable applications in other research areas, such as disease monitoring, interventions and biomedicine, followed by an interactive panel discussion with speakers discussing how issues like technology adoption, implementation, science communication factor into advancing biomedical and environmental research and these wearable applications. And last, we will have a group discussion with invited speakers discussing the future of wearables and what are those big challenges and gaps to get us there. So we really look forward greatly to your participation tomorrow, starting at 1 p.m. eastern time, and I wish you all a great rest of your day. This concludes our day one of the National Academies of Sciences wearables workshop. Thank you all.