Pharmacology, Toxicology and Environmental Health Commons^™

Improving Care For Patients With Atrial Fibrillation Through The Use Of A Personal Electrocardiogram, Teresa Praus, Jonathan Li, Svetlana Barbarash, Manuel Proenza, Mary D. Bondmass

Nursing Faculty Publications

Background: Atrial fibrillation (AF) is the most common arrhythmia affecting more than six million people in the United States. The economic burden is estimated to be >$6 billion annually with catastrophic events dramatically increasing expenditure. When patients experience symptoms, they commonly present to an acute care facility; this can be costly and anxiety provoking. Local problem: Same-day access issues prohibit patients from communicating directly with their cardiology provider, forcing them to use resources and increasing psychological burden.Methods:A convenience sample, made up of 43 patients, was given a KardiaMobile device. Eligible patients had ≥2 AF-related emergency department (ED) or urgent care …

Combining Community Wastewater Genomic Surveillance With State Clinical Surveillance: A Framework For Sars-Cov-2 Public Health Practice, Ted Smith, Rochelle H. Holm, Ray Yeager, Joseph B. Moore Iv, Eric C. Rouchka, Kevin J. Sokoloski, Daymond Talley, Vaneet Arora, Sarah Moyer, Aruni Bhatnagar

Faculty Scholarship

Study objective: To garner a framework for combining community wastewater surveillance with state clinical surveillance that influence confirmation of SARS-CoV-2 variants within the community, and recommend how the flow of such research evidence could be expanded and employed for public health response. Design, setting, and participants: This work involved analyzing wastewater samples collected weekly from 17 geographically resolved locations in Louisville/Jefferson County, Kentucky from February 10 to November 29, 2021. Genomic surveillance and RT-qPCR platforms were used as screening to identify SARS-CoV-2 in wastewater, and state clinical surveillance was used for confirmation. Main results: The results demonstrate increased epidemiological value …

Cardenolide, Potassium, And Pyrethroid Insecticide Combinations Reduce Growth And Survival Of Monarch Butterfly Caterpillars (Lepidoptera: Nymphalidae), Annie J. Krueger, Emily A. Robinson, Thomas J. Weissling, Ana M. Vélez, Troy D. Anderson

Department of Entomology: Faculty Publications

The monarch butterfly, Danaus plexippus L., has evolved to be insensitive to milkweed cardenolides via genetic modifications of Na⁺/K⁺-ATPase. There is concern for insecticide exposures near agriculture, with little information on monarch caterpillar toxicology. It is unclear how cardenolide insensitivity may affect the sensitivity of monarch caterpillars to pyrethroid insecticides. Additionally, potassium fertilizers may affect monarch caterpillar physiology and cardenolide sequestration. Here, we investigated the growth, survival, and development of caterpillars exposed to the cardenolide ouabain, bifenthrin, and potassium chloride (KCl) alone and in combination. Caterpillars were either exposed to (1) ouabain from third- to fifth-instar …

Public Awareness And Support For Use Of Wastewater For Sars-Cov-2 Monitoring: A Community Survey In Louisville, Kentucky, Rochelle H. Holm, J. Michael Brick, Alok R. Amraotkar, Joy L. Hart, Anish Mukherjee, Jacob Zeigler, Adrienne M. Bushau-Sprinkle, Lauren B. Anderson, Kandi L. Walker, Daymond Talley, Rachel J. Keith, Shesh N. Rai, Kenneth E. Palmer, Aruni Bhatnagar, Ted Smith

Faculty Scholarship

The majority of sewer systems in the United States and other countries, are operated by public utilities. In the absence of any regulation, public perception of monitoring wastewater for population health biomarkers is an important consideration for a public utility commission when allocating resources for this purpose. In August 2021, we conducted a survey as part of an ongoing COVID-19 community prevalence study in Louisville/Jefferson County, KY. The survey comprised of seven questions about awareness of and privacy concerns and was sent to 32,000 households randomly distributed within the county. A total of 1,220 sampled adults participated in the probability …

High-Throughput Sequencing Of Sars-Cov-2 In Wastewater Provides Insights Into Circulating Variants, Rafaela S. Fontenele, Simona Kraberger, James Hadfield, Erin M. Driver, Devin Bowes, La Rinda A. Holland, Temitope O.C. Faleye, Sangeet Adhikari, Rahul Kumar, Rosa Inchausti, Wydale K. Holmes, Stephanie Deitrick, Philip Brown, Darrell Duty, Ted Smith, Aruni Bhatnagar, Ray A. Yeager, Rochelle H. Holm, Natalia Hoogesteijn Von Reitzenstein, Elliott Wheeler, Kevin Dixon, Tim Constantine, Melissa A. Wilson, Efrem S. Lim, Xiaofang Jiang, Rolf U. Halden, Matthew Scotch, Arvind Varsani

Faculty Scholarship

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) likely emerged from a zoonotic spill-over event and has led to a global pandemic. The public health response has been predominantly informed by surveillance of symptomatic individuals and contact tracing, with quarantine, and other preventive measures have then been applied to mitigate further spread. Non-traditional methods of surveillance such as genomic epidemiology and wastewater-based epidemiology (WBE) have also been leveraged during this pandemic. Genomic epidemiology uses high-throughput sequencing of SARS-CoV-2 genomes to inform local and international transmission events, as well as the diversity of circulating variants. WBE uses wastewater to analyse community spread, …

Technical Memo: Incorporating Mixture Toxicity Into Bayesian Networks To Calculate Risk To Pesticides In The Upper San Francisco Estuary., Eric J. Lawrence, Skyler R. Elmstrom, Emma E. Sharpe, Wayne G. Landis

Institute of Environmental Toxicology & Chemistry Publications

This memo presents the methods we have developed to calculate risk of mixtures of pesticides for the Upper San Francisco Estuary (USFE). We used curve fitting to estimate the exposure-response curves for each individual chemical and then the mixture. For the mixture the models were normalized for specific ECx values. In that way the curve fitting was optimized for effects that are similar to most threshold values. A Bayesian network was then built that incorporated four different pesticides and a specific mode of action. The input distributions of the pesticides were measured amounts from each of the six risk regions. …

The Rapid Assessment Of Aggregated Wastewater Samples For Genomic Surveillance Of Sars-Cov-2 On A City-Wide Scale, Eric C. Rouchka, Julia H. Chariker, Kumar Saurabh, Sabine Waigel, Wolfgang Zacharias, Mei Zhang, Daymond Talley, Ian Santisteban, Madeline Puccio, Sarah Moyer, Rochelle H. Holm, Ray A. Yeager, Kevin J. Sokoloski, Joshua Fuqua, Aruni Bhatnagar, Ted Smith

Faculty Scholarship

Throughout the course of the ongoing SARS-CoV-2 pandemic there has been a need for approaches that enable rapid monitoring of public health using an unbiased and minimally invasive means. A major way this has been accomplished is through the regular assessment of wastewater samples by qRT-PCR to detect the prevalence of viral nucleic acid with respect to time and location. Further expansion of SARS-CoV-2 wastewater monitoring efforts to include the detection of variants of interest/concern through next-generation sequencing has enhanced the understanding of the SARS-CoV-2 outbreak. In this report, we detail the results of a collaborative effort between public health …

Standardizing Data Reporting In The Research Community To Enhance The Utility Of Open Data For Sars-Cov-2 Wastewater Surveillance, Jill S. Mcclary-Gutierrez, Zachary T. Aanderud, Mitham Al-Faliti, Claire Duvallet, Raul Gonzalez, Joe Guzman, Rochelle H. Holm, Michael A. Jahne, Rose S. Kantor, Panagis Katsivelis, Katrin Gaardbo Kuhn, Laura M. Langan, Cresten Mansfeldt, Sandra L. Mclellan, Lorelay M. Mendoza Grijalva, Kevin S. Murnane, Colleen C. Naughton, Aaron I. Packman, Sotirios Paraskevopoulos, Tyler S. Radniecki, Fernando A. Roman, Abhilasha Shrestha, Lauren B. Stadler, Joshua A. Steele, Brian M. Swalla, Peter Vikesland, Brian Wartell, Carol J. Wilusz, Judith Chui Ching Wong, Alexandria B. Boehm, Rolf U. Halden, Kyle Bibby, Jeseth Delgado Vela

Faculty Scholarship

SARS-CoV-2 RNA detection in wastewater is being rapidly developed and adopted as a public health monitoring tool worldwide. With wastewater surveillance programs being implemented across many different scales and by many different stakeholders, it is critical that data collected and shared are accompanied by an appropriate minimal amount of meta-information to enable meaningful interpretation and use of this new information source and intercomparison across datasets. While some databases are being developed for specific surveillance programs locally, regionally, nationally, and internationally, common globally-adopted data standards have not yet been established within the research community. Establishing such standards will require national and …

Dependence On Humidity And Aerosol Composition Of The Gas-Particle Partitioning Of Weakly And Moderately Polar Vocs, Jeonghyeon Ahn, Guiying Rao, Eric P. Vejerano

Faculty Publications

Volatile organic compounds (VOCs) dominate the class of pollutants that accumulate in the atmosphere and indoors. Assessing the gas-particle partitioning of VOCs is important to determine their fate, transport, and adverse health impacts. This work is a companion to our earlier study on the temperature dependence of VOC partitioning. Here, we report our measurement of the gas-particle partition coefficient (Kp) for weakly polar (trichloroethylene, TCE) and moderately polar (n-butanol, n-BuOH) VOCs under varying relative humidity (RH) levels onto organic and inorganic aerosols. Kp of TCE was four to five orders of magnitude lower than those …

Sars-Cov-2 Impairs Dendritic Cells And Regulates Dc-Sign Gene Expression In Tissues, Guoshuai Cai, Mulong Du, Yohan Bossé, Helmut Albrecht, Fei Qin, Xizhi Luo, Xiao Michelle Androulakis, Chao Cheng, Mitzi Nagarkatti, Prakash Nagarkatti, David C. Christiani, Michael L. Whitfield, Christopher I. Amos, Feifei Xiao

Faculty Publications

The current spreading coronavirus SARS-CoV-2 is highly infectious and pathogenic. In this study, we screened the gene expression of three host receptors (ACE2, DC-SIGN and L-SIGN) of SARS coronaviruses and dendritic cells (DCs) status in bulk and single cell transcriptomic datasets of upper airway, lung or blood of COVID-19 patients and healthy controls. In COVID-19 patients, DC-SIGN gene expression was interestingly decreased in lung DCs but increased in blood DCs. Within DCs, conventional DCs (cDCs) were depleted while plasmacytoid DCs (pDCs) were augmented in the lungs of mild COVID-19. In severe cases, we identified augmented types of immature DCs (CD22+ …

Toxicology Of Chemical Stress To Monarch Butterflies (Danaus Plexippus L.), Annie Krueger

Department of Entomology: Dissertations, Theses, and Student Research

Monarch butterfly (Danaus plexippus L.) population declines have caught the attention of the country and prompted nationwide conservation initiatives. The United States Fish and Wildlife Service has identified insecticide exposure and loss of milkweed (Asclepias spp.) reproductive habitat as primary threats to the monarch. In the Midwestern US, milkweed largely occurs around cropland borders where there may be a spatial and temporal overlap of monarch larvae, insecticide usage, and fertilizer applications. In this study, the acute toxicity and sub-lethal effects on growth and diet consumption of two commonly used pyrethroid insecticides, bifenthrin and beta-cyfluthrin, were characterized …

Geographic And Occupational Mobility Of Small-Scale Fishers Of Lake Malawi: An Exploratory Study Of Water, Sanitation, And Hygiene Access, Malawi, Rochelle H. Holm, Tikhala Chakalamba, Bwighane Ngasama, Fanuel Kapute

Faculty Scholarship

The livelihood of small-scale fishers on the world’s freshwater lakes cuts across the Sustainable Development Goal (SDG) 6, which covers water and sanitation, and SDG 8 on economic growth. The aim of this study was to examine the nature and extent of fishers’ mobility patterns and access to improved sanitation facilities, safe drinking water, and handwashing practices while at work and home for two fishing camps in Malawi. The study used key informant interviews, questionnaires, water quality testing, and an observational checklist, followed by interviews on fishers’ occupational migration. Many fishers (85%; 51/60) live and work in fishing camps with …

Associations Between Physiological Biomarkers And Psychosocial Measures Of Pregnancy-Specific Anxiety And Depression With Support Intervention, Karen L Weis, Tony T Yuan, Katherine C Walker, Thomas F Gibbons, Wenyaw Chan

Journal Articles

Stress and anxiety significantly impact the hypothalamic-pituitary axis, and in pregnancy, the subsequent maternal-fetal response can lead to poor outcomes. The objective of this study was to assess the association between psychosocial measures of pregnancy-specific anxiety and physiologic inflammatory responses. Specifically, to determine the effectiveness of the Mentors Offering Maternal Support (M-O-M-S

Andrographolide Attenuates Gut-Brain-Axis Associated Pathology In Gulf War Illness By Modulating Bacteriome-Virome Associated Inflammation And Microglia-Neuron Proinflammatory Crosstalk, Punnag Saha, Peter T. Skidmore, Larinda A. Holland, Ayan Mondal, Dipro Bose, Ratanesh K. Seth, Kimberly Sullivan, Patricia A. Janulewicz, Ronnie Horner, Nancy Klimas, Mitzi Nagarkatti, Prakash Nagarkatti, Efrem S. Lim, Saurabh Chatterjee

Faculty Publications

Gulf War Illness (GWI) is a chronic multi-symptomatic illness that is associated with fatigue, pain, cognitive deficits, and gastrointestinal disturbances and presents a significant challenge to treat in clinics. Our previous studies show a role of an altered Gut-Brain axis pathology in disease development and symptom persistence in GWI. The present study utilizes a mouse model of GWI to study the role of a labdane diterpenoid andrographolide (AG) to attenuate the Gut-Brain axis-linked pathology. Results showed that AG treatment in mice (100 mg/kg) via oral gavage restored bacteriome alterations, significantly increased probiotic bacteria , , and , the genera that …

Afterschool Sustainability Club, Ethan Halman Gonzalez

Honors Expanded Learning Clubs

In-depth lesson plans used at Riley Elementary to educate students about the environment around them and how to preserve it.

Wastewater Sample Site Selection To Estimate Geographically Resolved Community Prevalence Of Covid-19: A Sampling Protocol Perspective, R. Yeager, R. H. Holm, K. Saurabh, J. L. Fuqua, D. Talley, A. Bhatnagar, T. Smith

Faculty Scholarship

Wastewater monitoring for virus infections within communities can complement conventional clinical surveillance. Currently, most SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) clinical testing is voluntary and inconsistently available, except for a few occupational and educational settings, and therefore likely underrepresents actual population prevalence. Randomized testing on a regular basis to estimate accurate population-level infection rates is prohibitively costly and is hampered by a range of limitations and barriers associated with participation in clinical research. In comparison, community-level fecal monitoring can be performed through wastewater surveillance to effectively surveil communities. However, epidemiologically defined protocols for wastewater sample site selection are lacking. …

High And Low Toxin Producing Strains Of Karenia Brevis Differ Significantly In The Redox Proteome, Lipid Profiles, And Xanthophyll Cycle Pigments, Ricardo Colon

FIU Electronic Theses and Dissertations

The dinoflagellate Karenia brevis, blooms annually in the Gulf of Mexico, producing a suite of neurotoxins known as the brevetoxins. The cellular toxin content of K. brevis, however, is highly variable between or even within strains. I investigated biochemical differences between high (KbHT) and low (KbLT) toxin producing cultures both derived from the Wilson strain, related to energy-dependent quenching (qE) by photosystem II, and the content of reduced thiols of the proteome. By characterizing the xanthophyll content of the two strains I was able to determine that KbLT performs qE inconsistently. To investigate the …

In Situ Arsenic Speciation Using Surface-Enhanced Raman Spectroscopy And The Coffee Ring Effect, Valery Liamtsau

FIU Electronic Theses and Dissertations

The coffee ring effect (CRE) phenomenon is originated from the nonuniform solvent evaporation of a sessile droplet deposited onto the flat substrate. Once the evaporation starts, the droplet suspended particles move outwards by the radial flow and concentrate in the edge region of the evaporating droplet, resulting in the formation of the so-called CRE stains. In this work we have expanded the applications of the CRE from separation of particles and macromolecules to small molecules, in particular, coupled to surface-enhanced Raman spectroscopy (SERS). Herein, we have developed a theoretical framework to describe the CRE-driven separation process of small molecules, using …

Sustainability And The Post-Covid Normal, Tuck Lye Koh, Michael P. Liwanag, Hong Minh Le

Perspectives@SMU

Governance and flexibility will be key to addressing challenges climate change and the next pandemic will bring

Carbon Dioxide Emissions And The Macroeconomy: Evidence From The Asean Region, Mari Joy M. Buenavista, Rosalina Palanca-Tan

Economics Department Faculty Publications

This paper examined the effects of income, trade, and foreign direct investments (FDI) on carbon dioxide (CO2) emissions in the Association of Southeast Asian Nations (ASEAN) member countries for the period of 1970–2011 using the panel corrected standard errors (PCSE) estimation method. The results of the study were consistent with the environmental Kuznet’s curve (EKC) hypothesis – CO2 emissions increase as per capita GDP increases up to a certain income threshold, beyond which further increase in income is accompanied by lower emissions. However, the threshold per capita GDP (estimated to be USD 20,017) is way above the income levels of …

Environmentally Persistent Free Radicals As Sources Of Pops, Eric P. Vejerano, Jeonghyeon Ahn, Junaid Latif, Mustafa Mamun

Faculty Publications

Environmentally persistent free radicals (EPFRs) are a new class organic pollutant sharing some of the attributes of persistent organic pollutants (POPs). This opinion/short review aims to describe the properties of EPFRs that merit their recognition as an additional and potentially significant source of POPs. EPFRs are ubiquitous in diverse environments because of multiple factors: (1) organic precursors from anthropogenic, biogenic, and other natural emission sources are abundant; multiple mechanisms in PM and soils form (2) EPFRs; and (3) EPFRs are stable and persist for a long time, thereby, accumulate in the environment and potentially transported long range. The hazards of …

Nanoantibiotics: Functions And Properties At The Nanoscale To Combat Antibiotic Resistance, M. Mustafa Mamun, Adeola Julian Sorinolu, Mariya Munir, Eric P. Vejerano

Faculty Publications

One primary mechanism for bacteria developing resistance is frequent exposure to antibiotics. Nanoantibiotics (nAbts) is one of the strategies being explored to counteract the surge of antibiotic resistant bacteria. nAbts are antibiotic molecules encapsulated with engineered nanoparticles (NPs) or artificially synthesized pure antibiotics with a size range of ≤100 nm in at least one dimension. NPs may restore drug efficacy because of their nanoscale functionalities. As carriers and delivery agents, nAbts can reach target sites inside a bacterium by crossing the cell membrane, interfering with cellular components, and damaging metabolic machinery. Nanoscale systems deliver antibiotics at enormous particle number concentrations. …

Joint Effects Of Ethnic Enclave Residence And Ambient Volatile Organic Compounds Exposure On Risk Of Gestational Diabetes Mellitus Among Asian/Pacific Islander Women In The United States, Andrew D. Williams, Sandie Ha, Edmond Shenassa, Lynne C. Messer, Jenna Kanner, Pauline Mendola

OHSU-PSU School of Public Health Faculty Publications and Presentations

Background: Asian/Pacific Islander (API) communities in the United States often reside in metropolitan areas with distinct social and environmental attributes. Residence in an ethnic enclave, a socially distinct area, is associated with lower gestational diabetes mellitus (GDM) risk, yet exposure to high levels of air pollution, including volatile organic compounds (VOCS), is associated with increased GDM risk. We examined the joint effects of ethnic enclaves and VOCs to better understand GDM risk among API women, the group with the highest prevalence of GDM.

Methods:

We examined 9069 API births in the Consortium on Safe Labor (19 hospitals, 2002–2008). API ethnic …

Chemical Exposure From Manufactured Gas Plants: Public Health Risks?, Aneeza Hussain

Publications and Research

This project aims at identifying the chemicals and their risk factors to public health, which were found underneath Public Place, a brownfield next to the Gowanus Canal. The site is heavily contaminated with coal tar — a toxic chemical by-product of gas manufacturing, which happened at the site for 100 years until the gas plant closed down in the 1960s and the land was seized by the city. Recently, the city has planned to develop Public Place into “Gowanus Green” and which will be comprised of a school and low-income housing units on this site. The aim of this research …

Vignette 16: Vulnerability And Climate Change Adaptation, Northwest Indian Fisheries Commission, Jamestown S'Klallam Tribe

Institute Publications

The 2013 Jamestown Climate Vulnerability Assessment and Adaptation Plan provides an assessment of vulnerabilities of tribal resources to the negative impacts of climate change. The plan also identifies adaptation measures that the tribe is working to complete. Sea level rise, ocean acidification and climate models show potential for increased risks to critical habitats, tribal infrastructure and tribal health. As one of the first tribes in western Washington to complete a climate adaptation plan and vulnerability assessment, the Jamestown S’Klallam Tribe has identified and prioritized areas where changing climate conditions will leave tribal resources, infrastructure, economy and health most vulnerable, Climate …

Evaluating Urban Parks Accessibility And Equity: A Case Study Of Hartford, Ct And New Haven, Ct, Natalie Roach, Mara Tu

Honors Scholar Theses

Public parks provide cities with environmental benefits, positive health effects, recreational opportunities, community building, educational spaces, and public amenities. However, certain populations have been systematically denied their fair share of these benefits because of unjust practices in the creation and maintenance of urban parks. With a lens of environmental justice, the goal of this research was to assess park quality and accessibility of two Connecticut cities, Hartford and New Haven, by gathering publicly available information as well as using GIS tools.

The Trust for Public Land (TPL) has an existing ParkScore rating system that evaluates the quality of a city’s …

Acute Mountain Sickness, Efrain De Leon Angon

Student Publications

Overview of Acute Mountain Sickness including Diagnosis, risk factors and treatment/prevention, as well as the pathophysiology effects of AMS.

Impact Of Sampling Depth On Pathogen Detection In Pit Latrines, Drew Capone, Petros Chigwechokha, Francis L. De Los Reyes, Rochelle H. Holm, Benjamin B. Risk, Elizabeth Tilley, Joe Brown

Faculty Scholarship

Wastewater based epidemiology (WBE) is increasingly used to provide decision makers with actionable data about community health. WBE efforts to date have primarily focused on sewer-transported wastewater in high-income countries, but at least 1.8 billion people in low-and middle-income countries (LMIC) use onsite sanitation systems such as pit latrines and septic tanks. Like wastewater, fecal sludges from such systems offer similar advantages in community pathogen monitoring and other epidemiological applications. To evaluate the distribution of enteric pathogens inside pit latrines–which could inform sampling methods for WBE in LMIC settings unserved by sewers–we collected fecal sludges from the surface, mid-point, and …

Evaluating A Commercially Available In-Duct Bipolar Ionization Device For Pollutant Removal And Potential Byproduct Formation, Yicheng Zeng, Prashik Manwatkar, Aurelie Laguerre, Marina Beke, Insung Kang, Akram S. Ali, Delphine K. Farmer, Elliott T. Gall, Mohammad Heidarinejad, Brent Stephens

Mechanical and Materials Engineering Faculty Publications and Presentations

We conducted a series of experiments to evaluate the gas and particle removal effectiveness and potential for byproduct formation resulting from the operation of a commercially available in-duct bipolar ionization device. Laboratory tests were conducted with the ionizer installed in a small air handler serving a large semi-furnished chamber. Chamber experiments were conducted under (i) normal operating conditions to characterize the impact of the ionizer on concentrations of particles (0.01–10 μm), ozone (O3), nitrogen dioxide (NO2), volatile organic compounds (VOCs), and aldehydes, and (ii) particle injection and decay conditions to characterize the impact of the ionizer operation on particle loss …

Ambient Air Quality And The Risk For Chronic Obstructive Pulmonary Disease Among Metro Manila Development Authority Traffic Enforcers In Metro Manila: An Exploratory Study, Xerxes Seposo, Audrey Lynn A. Arcilla, Jose Guillermo N. De Guzman Iii, Enrico Miguel S. Dizon, Andrea Nova R. Figuracion, Christina Micaela M. Morales, Pauleenaa Katriona A. Tugonon, Geminn Louis C. Apostol

Ateneo School of Medicine and Public Health Publications

Background

Air pollution and poor ambient air quality are significantly related to multiple health risks. One associated disease is chronic obstructive pulmonary disease (COPD), a preventable disease with several contributing factors and one of the leading causes of morbidity/mortality locally and globally. A potentially high-risk population are traffic enforcers who are constantly exposed to air pollution. In the Philippines, the MMDA has the widest coverage in traffic management. The study determined the risk of COPD among Metro Manila Development Authority (MMDA) traffic enforcers in relation to ambient air quality level, as well as identified other factors that increase the risk …