Faculty Bibliography

INTRODUCTION:Environmental Health in a Global World at New York University was re-designed as a class participatory effort, challenging undergraduate students to understand environmental hazards and the resultant adverse health outcomes by embracing the inherent complexity of environmental risks and proposing solutions. METHODS:Following introductory lectures, students are placed into teams and assigned a specific perspective, or avatar, which includes learning to see the challenge from the perspective of a technical expert such as a biologist, an engineer, or an anthropologist. The teams then design specific systems maps to visualize the complex interactions that lead to adverse health outcomes after a given environmental exposure. The maps highlight potential leverage points where relatively minor interventions can provide a disproportionate benefit in health outcomes. The teams then explore potential interventions and identify the potential unintended consequences of those actions, develop and advocate for innovative new strategies to mitigate risk and improve outcomes. RESULTS AND DISCUSSION:Over the past 5 years, we have taught this methodology to over 680 students with strong, student-oriented results. The teams created and presented more than 100 strategies, addressing a diverse set of environmental challenges that include water contamination, gun violence, air pollution, environmental justice, health security, and climate change. Developing the strategies helped the students understand environmental threats in a more holistic way, provided them with some agency in finding solutions, and offered an opportunity for them to improve their presentation skills. The responses in course evaluations have been enthusiastic, with many students reporting a deep impact on their college experience.

The climate crisis is a health emergency: breaking temperature records every successive month, increasing mortality from hurricanes/cyclones resulting in >USD150 billion/year in damages, and mounting global loss of life from floods, droughts, and food insecurity. An entire course on climate change and global public health was envisioned, designed for students in public health, and delivered to Masters level students. The course content included the physical science behind global heating, heat waves, extreme weather disasters, arthropod-related diseases, allergies, air pollution epidemiology, melting ice and sea level rise, climate denialism, renewable energy and economics, social cost of carbon, and public policy. The methods included student engagement in presenting two air pollution epidemiological or experimental papers on fossil fuel air pollution. Second, they authored a mid-term paper on a specific topic in the climate crisis facing their locale, e.g., New York City. Third, they focused on a State, evaluating their climate change laws and their plans to harness renewable wind, solar, storage, nuclear, and geothermal energy. Students elsewhere covered regional entities' approach to renewable energy. Fourth, the global impact was presented by student teams presenting a country's nationally determined contribution to the Paris Climate Agreement. Over 200 Master's students completed the course; the participation and feedback demonstrated markedly improved knowledge and evaluation of the course over time.

A tribute to Dr. Irving J. Selikoff MD, the founder of this journal, is indeed welcome now more than two decades after his passing. He was known during his lifetime as the US Father of Environmental Medicine which at the time encompassed occupational medicine and much more as industry also polluted the general environment. The 1970s were a busy time as OSHA and the EPA were newly formed and high exposures to workers were no exception. Dr. Selikoff was a brave pioneer examining workers throughout the country and Canada, publicizing their exposures, and writing and presenting the scientific results. Industry was not always receptive and controlled an astounding amount of narrative, with the creation of the American Journal of Industrial Medicine filling a void of scientific need. We four authors write about the ethics of occupational health, the plight of nuclear energy workers, the climate crisis and opportunity for unions to engage workers, and the global march toward educating medical students on workers' health and safety. All four of us interacted with Dr. Selikoff during his tenure at Mount Sinai, and over the years joined each other in promoting his legacy. Toward that end we have written articles honoring his memory.

In lung cancer, enrichment of the lower airway microbiota with oral commensals commonly occurs and ex vivo models support that some of these bacteria can trigger host transcriptomic signatures associated with carcinogenesis. Here, we show that this lower airway dysbiotic signature was more prevalent in group IIIB-IV TNM stage lung cancer and is associated with poor prognosis, as shown by decreased survival among subjects with early stage disease (I-IIIA) and worse tumor progression as measured by RECIST scores among subjects with IIIB-IV stage disease. In addition, this lower airway microbiota signature was associated with upregulation of IL-17, PI3K, MAPK and ERK pathways in airway transcriptome, and we identified Veillonella parvula as the most abundant taxon driving this association. In a KP lung cancer model, lower airway dysbiosis with V. parvula led to decreased survival, increased tumor burden, IL-17 inflammatory phenotype and activation of checkpoint inhibitor markers.

BACKGROUND:Emphysema in asymptomatic heavy smokers can be detected during CT-scan screening for lung cancer. Metalloproteinases (MMPs) have been found to play a role in the pathogenesis of chronic obstructive pulmonary disease and to possibly serve as biomarkers for emphysema. METHODS:The NYU Lung Cancer Biomarker Center enrolled study subjects over 50 years of age with lung cancer risk factors from January 1, 2010, to December 31, 2015. These subjects received chest multi-detector computed tomography, spirometry, and provided serum for immunoassays for metalloproteinases (MMP) -1, -2, -7, -9, -10 and tissue inhibitor of metalloproteinases (TIMP) -1 and -2. RESULTS:/FVC percent compared to smokers without emphysema (68 ± 11 (mean ± sd) versus 75 ± 8; p < 0.0001). Increased age and pack-years of smoking were associated with increased odds of emphysema. None of the metalloproteinases or tissue inhibitors of metalloproteinases were useful to predict the presence of emphysema in smokers. CONCLUSION/CONCLUSIONS:/FVC ratio).

: Low-dose CT (LDCT) is widely accepted as the preferred method for detecting pulmonary nodules. However, the determination of whether a nodule is benign or malignant involves either repeated scans or invasive procedures that sample the lung tissue. Noninvasive methods to assess these nodules are needed to reduce unnecessary invasive tests. In this study, we have developed a pulmonary nodule classifier (PNC) using RNA from whole blood collected in RNA-stabilizing PAXgene tubes that addresses this need. Samples were prospectively collected from high-risk and incidental subjects with a positive lung CT scan. A total of 821 samples from 5 clinical sites were analyzed. Malignant samples were predominantly stage 1 by pathologic diagnosis and 97% of the benign samples were confirmed by 4 years of follow-up. A panel of diagnostic biomarkers was selected from a subset of the samples assayed on Illumina microarrays that achieved a ROC-AUC of 0.847 on independent validation. The microarray data were then used to design a biomarker panel of 559 gene probes to be validated on the clinically tested NanoString nCounter platform. RNA from 583 patients was used to assess and refine the NanoString PNC (nPNC), which was then validated on 158 independent samples (ROC-AUC = 0.825). The nPNC outperformed three clinical algorithms in discriminating malignant from benign pulmonary nodules ranging from 6-20 mm using just 41 diagnostic biomarkers. Overall, this platform provides an accurate, noninvasive method for the diagnosis of pulmonary nodules in patients with non-small cell lung cancer. SIGNIFICANCE: These findings describe a minimally invasive and clinically practical pulmonary nodule classifier that has good diagnostic ability at distinguishing benign from malignant pulmonary nodules.