SCIENCES IN THE DIVISION OF
TRANSLATIONAL TOXICOLOGY.
HIS RESEARCH IS FUNDAMENTALLY
FOCUSSED ON SPATIAL AND SPATIAL
TEMPORAL METHODOLOGICAL IN
POPULATION LEVEL EXPOSURE AND
RISK ASSESSMENT AND AN
INVESTIGATOR IN THE DIVISION OF
TRANSLATIONAL TOXICOLOGY,
RESEARCH HAS BEEN TO INCLUDE THE
INTEGRATION OF METHODS TO REDUCE
SPATIAL EXPOSURE AND RISK
METHODS.
TODAY HE'S GOING TO TALK TO US
ABOUT THE GEOSTATISTICAL METHODS
FOR MECHANISTICALLY-INFORMED
CLIMATE RISK ASSESSMENT AND THIS
IS RIGHT ON TIME WITH THE
CLIMATE ISSUES WITH FLOODING AND
SNOW STORMS AND FLIGHT
CANCELLATIONS.
I THINK IT'S A TIMELY TALK.
WITHOUT FURTHER ADO, I'M GOING
TURN IT OVER TO DR. MESSIER.
>> THANK YOU.
I APPRECIATE IT.
THANK YOU ALL FOR INVITING ME.
IT'S A PLEASURE TO BE HERE.
I'M A TENURE-TRACK INVESTIGATOR
AT NIEHS AND HAVE BE AN ADJUNCT
APPOINTMENT AND BELIEVE
INHERENTLY ENVIRONMENT PROBLEMS
AND HEALTH DISPARITY PROBLEMS
INEXTRICABLY LINKED AND WE LOOK
AT HEALTH DISPARITIES IN OUR
GROUP.
THE NAME OF MY RESEARCH GROUP IS
THE SPATIAL EXPOSURES TOXICOLOGY
PSYCH GROUP AND MY PRESENTATION
TODAY WILL INTRODUCE SOME OF THE
TOXICOLOGICAL OR MECHANISTIC
APPROACHES WE'RE THINKING ABOUT
THAT INCLUDE THAT TOX PORTION OF
THE GROUP NAME.
I CHANGED UP THE TITLE A LITTLE
BIT FROM WHAT INITIALLY PROVIDED
TO THE ANNOUNCEMENT.
I WANTED TO DISCUSS A RECENT
PAPER WE HAD ON CLIMATE AND
HEALTH IMPACTS ASSESSMENTS.
ALSO MAKE IT MORE RELEVANT TO
THE NIMHD AUDIENCE.
SO, THIS IS A LITTLE BIT OF AN
OVERVIEW OF MY GROUP, THE SPA
SPACEO -- SPATIOTEMPORAL
EXPOSURE TOXICOLOGY GROUP AND
THIS CAN BE USED IN ANALYSES FOR
HEALTH STUDIES.
ADDITIONALLY, I'M INTERESTED IN
THE COMBINED EFFECT OF
EXPOSURES.
MULTIPLE CHEMICAL AND STRESSOR
MIXTURES.
ADDITIONALLY, MIXERS PREDICTION.
SO THIS IS A TOPIC THAT CUTS
ACROSS BOTH EPIDEMIC AND
TOXICOLOGY.
AND THEN THE NEWEST AREA OF MY
RESEARCH IS THINKING ABOUT HOW
WE COULD INCORPORATE MECHANISMS
INTO RISK ASSESSMENT.
I'LL EXPLAIN THAT FURTHER SOON.
I JUST WANTED TO SHOW YOU MY
CURRENT RESEARCH GROUP.
NOT JUST TO SHOW YOU A BUNCH OF
BEAUTIFUL PEOPLE BUT TO
HIGHLIGHT THE DIVERSITY OF
EXPERIENCE AND TALENT IN THE
GROUP.
WE HAVE SOME PEOPLE THAT ARE
TRAINED STATISTICIANS AND
TRAINED ENGINEERS AND
CLIMATOLOGISTS AS WELL.
I'M VERY THANKFUL AND I'LL GET
INTO THE END TO DISCUSS FUNDING
BUT IT WAS PART OF AN NIEHS
GROUP WE RECEIVED A CLIMATE AND
HEALTH YOU BACKGROUND ON
EXPOSOMICS.
THE CONCEPT THAT'S IMPORTANT TO
MY GROUP AND IMPORTANT TO NIEHS.
SOMETHING HIGHLIGHTED IN THEIR
CURRENT STRATEGIC PLAN AND IN
THE NEXT FIVE-YEAR STRATEGIC
PLAN.
RELATED TO THAT IS AOPs OR
ADVERSE OUTCOME PATHWAYS OR WHAT
NORMAL SCIENTISTS CALL
MECHANISTIC PATHWAYS.
I'LL DISCUSS GEOTOX WHICH IS EYE
FRAMEWORK DEVELOPED IN A RECENT
PUBLICATION FROM A PREVIOUS
POSTDOC IN MY GROUP AND WE'LL
DISCUSS THE CASE STUDY WITH AIR
POLLUTANT MIXTURES AND THEN I'LL
DRASTICALLY SWITCH FRAMES FOR A
MOMENT TO DISCUSS A RECENT PAPER
ON CLASSIC SPATIAL EPIDEMIC
ANALYSIS LOOKING AT FLOOD RISK
AND HEALTH AFFECTS IN THE UNITED
STATES.
SO THAT SPATIAL EPI SECTION IS
SANDWICHED IN THE MIDDLE OF
EXPLAINING WHAT GEOTOX IS.AND
EXAMPLE ON FLOOD RISK AND GOING
TO END WITH
RESULTS IN OUR HEALTH OUTCOMES
FOR OBSERVED PHENOTYPE OR THE
PHENO.
SO WE HAVE A LOT OF ENDOGENOUS
PROCESSES THAT ARE DISEASE STATE
SO OF COURSE WE HAVE OUR GENOME
AND TRANSCRIPTOME AND LEARNING
MORE AND MORE ABOUT THE OTHER
OMS, PROTEOME AND EPIGENOME AND
METABOLOME THEY ALL HAVE
IMPORTANT ENDOGENOUS FUNCTION
RESULT FROM THINGS HOW WE LOOKED
TO DISEASES WE MIGHT GET.
BUT OF COURSE WE KNOW THAT'S
ONLY A ROUGHLY AH ENDOGENOUS OM
PLUS THE EXPOSOME.
IT WAS INTRODUCED IN A PAPER IN
2005 IN THE ENVIRONMENTAL HEALTH
WORLD THIS HAS TAKEN ON
TRACTION.
AND THE BASIC PREMISE IS WE
CAN'T JUST STUDY ONE EXPOSURE
AND ONE HEALTH IMPACT BECAUSE
YOU'RE JUST GOING TO MISS WAY
TOO MUCH AND REALLY IT'S A
MULTITUDE OF FACTORS THAT
COMBINE IN COMPLEX WAYS TO
RESULT IN OUR OBSERVED HEALTH
OUTCOMES.
SO WHEN WE TALK ABOUT EXPOSOME
WE TRY TO BE ALL ENCOMPASS AG
FROM CLASSIC CHEMICAL FROM AIR
POLLUTION AND OTHER MODELLING IN
GROUND WATER AND OF COURSE NEED
TO INCLUDE LIFESTYLE FACTORS
FROM PHYSICAL ACTIVITY, SLEEP,
DIET, DRUG USE, THOSE KINDS OF
THINGS.
THE ECHO -- ECO SYSTEM AND WALK
ACT TO GREEN SPACE AND HEALTH
CARE.
AND
[AUDIO DIGITIZING]
AND THEY ACCOUNT FOR ALL THESE
FACTORS TO DELETERIOUS HEALTH
AFFECTS.
THIS IS GOING TO BE AN IMPORTANT
PART OF THE MECHANISTIC APPROACH
AND WANTED TO GIVE A BACKGROUND
ON AOPs.
IT'S A TOXICOLOGY TERM ADVERSE
OUTCOME PATHWAY BUT THERE'S
OTHER SCIENTIFIC DISCIPLINES
HAVE SIMILAR CONSTRUCTS.
I THINK MECHANISTIC PATHWAYS OR
PATHWAYS AND AOP TRIES TO BE
EXPLICIT WITH THE KEY STEPS THAT
LEAD FROM THE MOLECULAR
INTERACTION AT THE VERY
BEGINNING THROUGH A SERIES OF
CASCADING EVENTS THAT LEAD TO
ORGANISM AND POPULATION ARE
RESPONSES.
SO SOME OF THE KEY THINGS IS
THIS MACRO MOLECULAR INTERACTION
SO WHEN A CHEMICAL OR STRESSOR,
LIKE WHAT IS THE FIRST THING IT
INTERACTS WITH BIO LOGICALLY
WHETHER IT'S RECEPTOR LIGAND AND
THAT CREATES CELLULAR RESPONSES
FROM CHANGES IN GENE EXPRESSION
OR SOME ALTERED SIGNALLING
PATHWAY AND THAT CAN RESULT IN
CELLS AND ORGANS AND THERE'S
ORGAN RESPONSES ON ALTERED
PHYSIOLOGY OR DEVELOPMENT AND
THE ORGAN RESULTS.
YOU CAN SEE MOVING UP TO THE
CASCADE STEP TO ORGANISM
RESPONSES AND PHENOTYPE IN AN
INDIVIDUAL OR LETHALITY AND OF
COURSE POPULATION RESPONSES
RESULT IN CHANGES IN POPULATION
STRUCTURE OR DISEASE PREVALENCE
AND THINGS LIKE THAT.
THE AOP AND THE ORGANIZATION OF
ACD MAINTAINS AOPs.
IT'S REALLY ABOUT TRYING TO
ARTICULATE WHERE EACH PIECE CAN
BE TESTED VERY EXPLICITLY AND
THAT THE END ORGANISM OR
POPULATION RESPONSE IS RELEVANT
FOR ARE RISK ASSESSMENT.
SO AOPs CAN BE SIMPLE LINEAR
THINGS WHERE WE HAVE THE
MOLECULAR INITIATING EVENT.
THE FIRST INTERACTION, THE FIRST
BIOLOGICAL INTERACTION OF A
CHEMICAL AND THEN YOU HAVE WHAT
YOU CALL KEY EVENTS WHICH ARE
ANY STEP IN THE MECHANISM AND IT
CAN BE ONE OR MANY THAT LEADS TO
AN ADVERSE OUTCOME OUR CAN HAVE
MORE COMPLEX ONES LIKE THIS
WHERE YOU HAVE AND THIS WOULD BE
AN EXAMPLE OF LIKE A GOOD
APPROACH FOR MIXTURES BECAUSE
YOU CAN HAVE MIXTURES OR
EXPOSOMES OR AN ADVERSE OUTCOMES
AND HAVE CHEMICAL A,
B AND C THAT ALL HAVE DIFFERENT
INITIAL MOLECULAR EVENTS WHERE
THEY INTERACT WITH THE BODY AND
AT SOME POINT THEY CONVERGE INTO
THE PATHWAY THAT LEADS TO THIS
OUTCOME.
ESSENTIALLY YOU HAVE MULTIPLE
WAYS FOR CHEMICALS TO EVENT TO
LEAD TO AN ADVERSE OUTCOME AND
MAYBE THIS DIVERGES AND A KEY
EVENT CAN LEAD TO MULTIPLE
ADVERSE OUTCOMES.
SO IN MY GROUP I LIKE TO THEN
TAKE THIS MECHANISTIC APPROACH
AND FRAME IT WITHIN GEOSPATIAL
EXPOSURE AND THE GEO TOX
CONCEPT.
SIMILAR TO A PATHWAY THAT THESE
EVENTS MUST OCCUR FOR THE NEXT
THING TO HAPPEN, IF WE TAKE THIS
BACK TO EXPOSURES THEN YOU CAN
SEE HOW THESE EVENTS MUST OCCUR
FOR US TO GET TO SOME INDIVIDUAL
POPULATION OUTCOME.
FOR INSTANCE, THERE'S NO
EXTERNAL EXPOSURE WITHOUT A
SOURCE.
TYPICALLY WE'RE LOOKING AT
ANTHOPOGENIC THOUGH THERE'S
OTHER SOURCES IF YOU START THINK
OF THINGS LIKE ARSENIC OR
ANOTHER NATURALLY OCCURRING
METALS.
YOU HAVE TO HAVE A SOURCE FOR
THE EXPOSURE FOR THERE TO BE
SOME TARGET DOSE TO AN ORGAN,
THERE'S GOT TO BE SOMETHING
HAPPENING EXTERNALLY.
AND SO ON AND HERE WE'RE KIND OF
IN THE PATHWAY I WAS JUST
EXPLAINING.
SPATIAL EPIDEMIOLOGY OFTEN TAKES
MEASURES BE AN EXTERNAL OR
INTERNAL EXPOSURE AND POPULATION
OUTCOMES AROUND DOES AN ANALYSIS
HERE.
IN A SENSE IT OFTEN BYPASSES THE
MECHANISM.
AND SO WHAT WE'RE TRYING TO DO
WITH GEO TOX IS GO THROUGH THE
ENTIRE MECHANISTIC PROCESS TO
GET A MORE COMPLETE
UNDERSTANDING OF THE RISK.
THANKFULLY THERE'S TWO
FRAMEWORKS THAT HAVE BEEN
OUTLINED THAT ENCOMPASS THIS
WHOLE CASCADE OF EVENTS.
I DISCUSSED THE ADVERSE OUTCOME
PATHWAY.
ACTUALLY, SOCIETY OR SOCIETY FOR
THE ADVERSE OUTCOME PATHWAYS AND
IF YOU GO TO RECENTLY STARTED
ATTENDING THE SOCIETY OF
TOXICOLOGY AND I'M A MEMBER
THERE AND IT'S A VERY POPULAR
AND VERY ACTIVE RESEARCH SPACE
FOR AOP.
WE HAVE A VERY LARGE RESEARCH
COMMUNITY WORKING ON AOPs.
AND EXPOSURE PATHWAY IS A WAY TO
ARTICULATE MULTIPLE EXPOSURES IN
A SPATIAL SENSE AND HOW THEY
MIGHT TRANSFORM AND CROSS MEDIA
AND THINGS LIKE THAT.
BUT REALLY THE KEY THING IS WE
TALK ABOUT EXPOSURES IN A
GEOSPATIAL SENSE.
WHERE GEOSPATIAL EXPOSURE MIGHT
END IS WHERE THE AOP BEGINS.
SO WE CAN LINK THAT TOGETHER AND
ARE ABLE TO USE VARIOUS VOWELS
AND TOOLS TO COMPLETE THE WHOLE
SEQUENCE THE CONTINUUM FROM
ENVIRONMENTAL SOURCES TO
INDIVIDUAL AND POPULATION
OUTCOMES.
SO THIS IS A SUMMARY OF WHAT I
WAS SAYING.
AOP IS AN EXTERNAL ANALYSIS OF
SOURCE MEDIA AND TRANSFORMATIONS
AND PROVIDE A TARGET OR PROCESS
AND OUTCOME CONSIDERED RELEVANT
TO RISK ASSESSMENT.
THAT'S A KEY POINT THERE.
GEO TOX EXPLICITLY COMBINES
THOSE.
NOW WE'LL GET INTO OUR FIRST
PAPER ON GEO TOX GEOSPATIAL
MOTIONING APPROACH TO
QUANTIFYING THE RISK OF EXPOSURE
TO ENVIRONMENTAL CHEM A MULTI-G
INSTITUTION GOING ON MORE THAN A
DECADE THAT HAS TESTED MORE THAN
10,000 CHEMICALS ACROSS HUNDREDS
OF DIFFERENT ASSAYS.
SO, IT'S A GOLD MINE FOR
UNDERSTANDING HAZARDOUS RESPONSE
FOR CHEMICALS.
ADDITIONALLY, ONCE WE HAVE
EXTERNAL EXPOSURE WE USE WHAT'S
CALLED TOXICO KINETICS OR YOU
MAY BE FAMILIAR WITH PHARMACO
KINETICS FROM MODELS THAT ALLOWS
US TO MODEL THE ABSORPTION,
DISTRIBUTION AND
MORE -- THIS IS EARLY ON THE
PATHWAY OF WHAT MIGHT EVENTUALLY
BECOME ADVERSE OUTCOMES.
SO IT'S INHERENTLY PROTECTIVE.
THIS WOULD BE EXTREMELY SCARY IF
THIS WERE A MAP OF LUNG CANCER
OR SOMETHING AND IT'S NOT IT'S
PERHAPS ON THE PATHWAY TO LUNG
CANCER OR OTHER HEALTH EFFECTS
BUT IT'S MUCH EARLIER ON.
WE'RE ABLE TO MAP THESE AOP
EVENTS THE EARLY STAGES OF
MECHANISTIC PATHWAY.
YOU CAN IMAGINE WHAT WE COULD
USE THIS FOR CURRENTLY THERE
MIGHT BE FOLKS INTERESTED IN
DOING THAT THROUGH THIS IS LARGE
SCALE MOLECULAR EPIDEMIOLOGY AND
MOLECULAR EPI PEOPLE TAKE BLOOD
OR OTHER TISSUE MEASUREMENTS AND
USE THAT AS A BIOMARKER FOR
EXPOSURE.
WELL, WE CAN POTENTIALLY GET AT
SOME OF THOSE BIOMARKERS IF THE
RIGHT IN VITRO DATA EXISTS BUT
THERE'S TIME AND MONEY
CONSTRAINTS WITH MOLECULAR
APPROACHES AND THEN WE CAN OF
COURSE QUANTIFY THE RISK OF
COMBINED EXPOSURES GIVEN ALL
THESE CHEMICALS IMPACT THE SAME
PATHWAY AND WE HAVE MIXTURES
THEORY FOR PREDICTING THIS.
SO THERE'S OF COURSE MANY MANY
LIMITATIONS AND THIS REPRESENTS
AN IMPORTANT ASPECT OF MY
RESEARCH.
ONE OF THEM IS THE INFINITE
MEASURES PROBLEM AND I HAVE A
POSTDOC THAT'S BEEN WORKING ON
THAT.
THE IDEA IS THAT WE CAN'T
FEASIBLY DO EXPERIMENTS ON THE
COMBINED DOSE RESPONSE FOR
MIXTURES BECAUSE THERE'S TOO
MANY COMBINATIONS OF CHEMICALS
AND YOU CHANGE THE PROPORTION OF
CHEMICALS AND IT'S A DIFFERENT
MIXTURE.
IT'S A LAMP-POST PROBLEM FOR
EXPOSURES AND WE HAVE DATA ON
2.5 BUT NOT FOR VOCs AND SURFACE
WATER AND THERE IS A FRACTION OF
WHAT IS AVAILABLE FOR AIR
POLLUTION SO WE REALLY NEED TO
CONTINUE WORKING ON EXPOSURE
MODELS WHICH WE'VE ALSO DONE IN
OUR GROUP.
IT'S A BIG DATA INTEGRATION
PROBLEM WHICH INTRODUCES
UNCERTAINLY AT EACH STEP OF THE
FRAMEWORK.
WE DID DO A MONTE CARLO
ASSESSMENT IN THE PAPER AND
FOUND THEY CONTRIBUTED TO THE
PROCESS.
THERE WAS NOTHING GLARING THAT
WAS FOCUS YOUR EFFORT HERE AND
YOU'LL BE GOOD.
EACH PART CONTRIBUTED ROUGHLY
EQUALLY TO THE OVER ALL
UNCERTAINTY AND PATHWAYS THAT
ARE COMPLEX.
THANKFULLY THERE'S ENTIRE FIELD
OF RESEARCHERS THAT ARE WORKING
ON MECHANISTIC PATHWAYS WE KCAN
ACT ON.
SWITCHING GEARS FROM THE SPATIAL
EPI PIECE AND BACKING UP FROM
THE MECHANISTIC FOR A MOMENT AND
THEN I'LL DISCUSS HOW WE MIGHT
BRING MECHANISTIC INTO CLIMATE
AND HEALTH RISK.
THIS PAPER OR THIS WORK WAS
RECENTLY ACCEPTED AND IN THE
AMERICAN JOURNAL OF EPIDEMIOLOGY
WITH A SUMMER INTERN OF MINE AND
WE KEPT WORK ON IT AND THE TITLE
IS ASSOCIATIONS FLOOD RISK AND
THE UNITED STATES CENSUS TRACK
LEVEL OUTCOMES.
AS BACKGROUND, CLIMATE CHANGE IS
CAUSING THINGS LIKE INCREASED
SEVERITY OF FLOOD AND FAIRLY
HETEROGENOUS AND SOME PLACES
WILL EXPERIENCE MORE DROUGHT AND
SOME WILL EXPERIENCE FLOOD.
PLACES THAT HISTORICALLY HAVE
NOT HAD MAJOR FLOODING HAVE
BECOME EPICENTER FOR FLOOD RISK.
THERE'S FEW STUDIES ON THE
LONG-TERM IMPACTS OF FLOODING.
WE CONSIDER IT'S A NATURAL
DISASTER.
YOU HAVE TO DEAL WITH IT IN THE
MOMENT BUT THEN WHAT ARE THE
LONG-TERM IMPACTS OF THAT?
OUR OBJECTIVES WERE TO EVALUATE
THE ASSOCIATIONS BETWEEN
LONG-TERM FLOOD RISK AND
MULTIPLE HEALTH OUTCOMES.
WE'RE LOOKING AT CORONARY HEART
DISEASE, HIGH FLOOD PRESSURE AND
ASTHMA AND POOR MENTAL HEALTH
AND LOOK AT SOCIAL
VULNERABILITY.
SO OUR OVER ALL APPROACH IS TO
USE U.S.-WIDE CENSUS TRACK LEVEL
PREVALENCE ASSESSMENT.
WE HAVE FLOOD DATA FROM THE
FIRST STREET FOUNDATION AND
WE'RE UTILIZING A SPATIAL
BAYESIAN REGRESSIVE MODEL AND
GOING TO STRATIFY BY THE SDI.
THE FLOOD RISK DATA COMES FROM
FLOOD RISK FOUNDATION.
I'VE BEEN WORKING WITH THEM A
WHILE AND IN THEIR EARLY
MEETINGS BEFORE THEY WERE EVEN
CALLED FIRST READ BUT THEIR DATA
IS IN A LOT OF PLACES NOW AND
RECOMMEND GOING TO THEIR WEBSITE
IF YOU CAN.
THEY QUANTIFIED FLOOD RISK FOR
EVERY PARCEL IN THE ENTIRE
UNITED STATES.
I TRUST THEIR MODEL.
THEY DEVELOPED FLOOD RISK
ESTIMATES FOR THE ENTIRE UNITED
STATES AND THEN THEY DEVELOPED
THEM FOR CURRENT DATE AND THEN
REALLY THE KEY THING IS THEY
INTEGRATED THEM INTO CLIMATE
MODELS AND HAVE FLOOD RISK
ESTIMATES FOR THE NEXT 800
YEARS.
THEY HAVE LIKE A 50-YEAR
ESTIMATE AND 100-YEAR ESTIMATE.
THIS IS DOWN TO LIKE WHAT WOULD
BE THE DEPTH OF FLOOD INUNDATION
AND DEVELOPED THE FLOOD FACTOR A
METRIC FROM 1 TO 10, 1 BEING NO
RISK TO 10 BEING SEVERE RISK.
AND THAT INCORPORATES BOTH
EXPECTED FREQUENCY AND SEVERITY.
SO YOU COULD IMAGINE YOU COULD
GET LIKE A MEDIUM RISK FROM
BEING NOT SEVERE BUT FREQUENT
FLOOD OR A RISK FROM A VERY
CATASTROPHIC FLOOD.
AND THIS INCLUDES BOTH COASTAL
FLOODING AND INLAND PERUVIAL
FLOODING AND I WENT TO MY
NEIGHBORHOOD IN DURHAM, NORTH
CAROLINA AND THERE'S PONDS.
OUR NEIGHBORHOOD HAS A DECENT
SIZED POND IN IT.
IT'S AN URBAN DAM.
AND WE'VE BEEN HAVING ISSUES ON
THE URBAN DAM WHERE IT NEEDS TO
BE ACTIVELY MANAGED AND IF YOU
LOOK AT THEIR FLOOD SCORES, THE
HOUSES DIRECTLY BENEATH THE DAM
HAVE A HIGH FLOOD RISK.
THEY'RE LIKE BASICALLY SAYING
OH, THIS IS A SMALL URBAN DAM
AND ACROSS THE ENTIRE UNITED
STATES THOSE DAMS ARE MANAGED
AND AT RISK FOR CATASTROPHIC
FAILURE AND THAT WOULD FLOOD THE
AREAS DIRECTLY BELOW IT.
SO THOSE HOUSES ON THAT SEGMENT
OF THE STREET BELOW IT ALL HAVE
FLOOD RISK SCORES, 6, 7, 8, 9.
AND MY HOUSE THAT SITS IN
ANOTHER SECTION OF THE
NEIGHBORHOOD RELATIVELY THE TOP
OF A HILL IS 1.
SO, IT WAS AN ANECDOTAL CHECK OF
THEIR HYPERLOCAL CLASSIFICATION
OF FLOOD RISK BY PARCEL.
THIS IS AN AERIAL ANALYSIS AND
HE TOOK THINGS TO THE CENSUS
TRACK LEVEL AND LOOKED AT
VARIOUS MEASURES ACROSS THE
CENSUS TRACKS.
SO WE HAVE MANY MANY MEASURES OF
FLOOD RISK THERE.
AND SO WE HAVE FLOOD FACTOR
SCORES AGAIN THAT'S THE 1-10 AND
THEN THERE'S ALSO THESE OTHER
QUANTITATIVE MEASURES WHICH ARE
THE PERCENTAGE OF PROPERTIES
WITH GREATER THAN A 2% CHANCE OF
FLOODING AT VARIOUS TIME FRAMES
SO CURRENT VERSUS LIKE 20 OR 50
ASSUMED FUTURE RISK.
WE'RE TAKE BAYESIAN APPROACH.
WE DID EXPLORE KEEPING THESE IN
THE NATIVE FORMAT BUT IT WAS A
LITTLE INTRACTABLE FOR THE
BAYESIAN PURPOSE AND WE
CALCULATED PRINCIPLE COMPONENTS
OF ALL THESE AND YOU CAN SEE THE
LOADINGS ON THE RIGHT AND WE
DEVELOPED BASED ON THE LOADINGS
WE MADE AN ASSESSMENT OF WHAT
THEY OVER ALL REPRESENT.
THE PC1 IS A CONSISTENT FLOOD
RISK.
YOU CAN SEE IT'S SMALL BUT
POSITIVE CONTRIBUTIONS OF THESE
FLOODING PROBABILITIES HERE
WHEREAS SOMETHING LIKE SEVERE
FLOOD RISK, PC3 WAS A 20% CHANCE
OR FLOOD FACTOR SCORE OF 10
WHICH IS THE HIGHEST FACTOR
SCORE THERE.
SO OUR DISEASE PREVALENCE DATA
COMES FROM THE DISEASE
PREVAL -- CDC
BEHAVIORAL RISK FACTOR
SURVEILLANCE SYSTEM AND LOOKS AT
HIGH BLOOD PRESSURE, ASTHMA AND
POOR MENTAL HEALTH.
HERE'S THE BASICS.
IT'S A CONDITIONAL AUTO
REGRESSIVE MODEL BAYESIAN
FRAMEWORK AND SAID IT'S
DISTRIBUTED WITH SPATIAL AND
RANDOM EFFECTS AND IID ERROR.
SO THE I-CAR MODEL ACCOUNTS FOR
SMOOTHS THINGS OUT A LITTLE BIT
AND SAYS THERE'S SOME ERROR
BASED ON A LOCAL NEIGHBORHOOD.
YOU IMAGINE IT'S WEIGHTING
THINGS BY IF WE'RE LOOKING HERE
IT'S EVERYTHING OUTSIDE THE DARK
GREEN NEIGHBORHOOD.
SO WHAT DOES IT DO?
WHY WOULD WE GO THROUGH THE
EFFORT?
IT REDUCES BIAS AND FIXED
AFFECTS AND PRECISION IN THE
FORM OF BETTER STANDARD ERROR.
WHAT IT DOES NOT DO, STANDARD
MISCONCEPTION IS MEASURE FOR
CONFOUNDING.
SO WE THEN STRATIFIED BY THE
SOCIAL VULNERABILITY INDEX.
I THINK MOST PEOPLE IN THE
AUDIENCE ARE FAMILIAR WITH THE
SVI.
IT HAS FOUR DIFFERENT THEMES AND
THEN THERE'S THREE TO FIVE
CATEGORIES IN EACH THEME.
SO WE STICK WITH THE THEME
LEVEL.
WE CERTIFY ABOVE AND BELOW THE
MEDIAN AND WE ALSO HAVE A
POVERTY ESTIMATE.
AND THEN SO THEN WE DO TOTAL
SVI.
BETWEEN THE SIX WITH THE FOUR
OUTCOMES WE HAVE 24 MODELS WE'RE
LOOKING AT.
SO HERE'S THE RESULTS.
FIRST I'M SHOWING YOU ALL THE
FACTORS TOGETHER INCLUDING
SOCIAL VULNERABILITY, WE ALSO
HAVE AIR POLLUTION AND OTHER
THINGS LIKE TEMPERATURE,
HUMIDITY AND SMOKING.
SO THIS IS CORONARY HEART
DISEASE, STRATIFIED POVERTY AND
SV IS A RISK FACTOR AND MAKES
THE FLOOD VARIABLES UNREADABLE
HERE BUT I WANTED TO SHOW YOU
THINGS LIKE SOCIAL VULNERABILITY
LIKE BEING OLD AGE.
OF COURSE IT'S A WELL KNOWN AND
MASSIVE RISK FACTOR FOR FLOOD
RISK.
IT'S A VULNERABLE POPULATION FOR
NATURAL DISASTER EVENTS.
IN A WAY IT'S A GOOD GUT CHECK
SAYING OKAY, THESE ARE THINGS WE
EXPECT TO HAVE A MASSIVE RISK.
BUT WHEN WE WANT TO LOOK AT
FLOOD RISK WE NEED TO JUST --
THESE ARE STILL IN THE MODEL OF
COURSE BUT WE'RE JUST
FOCUSSING -- WE REMOVED THAT
FROM THE PLOTS SO WE CAN LOOK AT
THE FLOOD RISK VARIABLES.
THESE ARE A FEW EXAMPLES OF THE
CORONARY HEART DISEASE
STRATIFIED ACROSS ALL STRATA.
THESE ARE PCs AND IT'S A LOT TO
LOOK AT AND LOW SOCIAL
VULNERABILITY AND HIGH SOCIAL
VULNERABILITY.
IT'S A HIGH SVI SCORE.
PEOPLE PARTICULARLY VULNERABLE.
AND IN GENERAL WHAT WE SEE FOR
THINGS LIKE CORONARY HEART
DISEASE CONSISTENT FLOOD RISK IS
HIGHER AND THE HIGH POVERTY.
THIS IS THIS PC1 IS CONSISTENTLY
HIGHER AND THEY BOTH HAVE HIGH
RISK THERE.
INTERESTINGLY THE ALL OF THIS
THEME THE RESULTS THE RESULTS
ARE LESS CONCLUSIVE AND THERE'S
TOO MUCH WRAPPED UP FOR IT BE AN
EFFECTIVE MODIFIER WE SAW THAT
ACROSS ALL THE PCs AND DISEASES
THAT ALL THEMES STRATA WERE JUST
TOO ALL OVER THE PLACE TO
INTERPRET.
THE THEME LEVEL PROVIDES A
LITTLE MORE INTER VA-VARIABILIT
AND MORE CONSISTENT RESULTS AND
WE SAW ASTHMA RESULT WHERE'S WE
SEE CONSISTENT AVERAGE FLOOD
RISK IS HIGHER SO NATURAL
EXPECTATION THERE'S WITH
VULNERABLE POPULATIONS.
ONE THING WE'RE ABLE TO DO IS
THEN TAKE THESE RESULTS AND MAKE
PREDICTIONS AND SO THESE
ESSENTIALLY ARE SMOOTH
PREDICTIONS OF CORONARY HEART
DISEASE AFTER THE MODEL.
YOU CAN SEE THE CORONARY HEART
DISEASE GIVEN THE FLOOD RISK
VARIABLES AND OTHER THINGS LIKE
THAT.
YOU CAN SEE THE HIGH HEART
DISEASE IN THESE COASTAL
POPULATIONS AND I WANTED TO SHOW
YOU THIS IS A MODELLING CHECK
THE SPATIAL RANDOM EFFECT PIECE
AND YOU CAN SEE WHY IT'S
IMPORTANT TO ACCOUNT FOR THIS
BECAUSE THERE ARE CLEAR SPATIAL
PATTERNS IN THIS HERE.
IF THIS WAS NOT INCLUDED, THIS
VARIABILITY WOULD GET WRAPPED UP
INTO THE STANDARD ERRORS OF YOUR
FIXED EFFECTS AND MAKE THEM LESS
RELIABLE.
SO DISCUSSION POINTS HERE.
FLOOD RISK IS ASSOCIATED WITH
LOW MAGNITUDE AFTER CONTROLLING
FOR THE CONFOUNDING AND SPATIAL
RANDOM EFFECT.
NOT AS BIG AS THE MAJOR SOCIAL
STRUCTURES AND SOCIAL
VULNERABILITY FACTORS BUT LOW
MAGNITUDE CONSISTENT WE MIGHT
EXPECT WITH FEATURE AND CHRONIC
RISK.
AND WE DID PROVIDE THESE
CONTINUOUS ESTIMATES SHOWING
EVIDENCE OF SOCIAL VULNERABILITY
AND SIGNIFICANT EFFECT MODIFIER
THE FLOOD RISK.
OKAY.
SO NOW IS THE SPATIAL EPIMEAT OF
THE SANDWICH AND KNOW I WANT TO
COME BACK TO THE MECHANISTIC
THINKING EARLY EXTENDING THE
STUDY ON FLOOD RISK AND HEALTH
EFFECTS AND JUST DISCUSS
HIGH-LEVEL IDEAS OF HOW WE MIGHT
START INTEGRATING MECHANISMS
INTO CLIMATE CHANGE, HEALTH
IMPACTS.
SO LOOKING FORWARD, HOW MIGHT A
MECHANISTIC APPROACH WHETHER IT
BE GEO TOX OR OTHER MECHANISTIC
FRAMEWORKS OUT THERE TO INFORM
AND MITIGATE THE HEALTH IMPACTS
FROM CLIMATE CHANGE.
SO BRINGING BACK THE FIGURE HERE
THE CASCADE OF EVENTS, REALLY
WHAT I WANT TO TARGET IS THIS
PIECE.
WHAT ARE THE MOLECULAR TARGETS
THAT FLOODING OR OTHER CLIMATE
EXPOSURES ARE HIDING.
ONE THING THERE'S THE CLIMATE
AND HEALTH RESEARCH IS REALLY --
THERE'S A LOT GOING ON RIGHT NOW
AND WHEN YOU LOOK AT IT IT'S
LOOKING AT THE EXPOSURE AND THEN
THE POPULATION OUTCOME AND THERE
MAY BE SOME HEALTH IMPACT
ASSESSMENT AND ONE THING THAT
BOTHERS ME A LITTLE BIT ABOUT IT
IS I FEEL LIKE THE NUMBERS DON'T
QUITE ADD UP.
IF YOU TOOK ALL THESE NATURAL
DISASTERS FROM WILD FIRES AND
FLOODING AND EARTHQUAKES AND
THESE KINDS OF THINGS, THE
NUMBER OF PEOPLE THAT ARE DYING
OR HEALTH EFFECTS ARE KIND OF
SUP
SUPERCEDING THE POPULATION AND
UNMEASURED CONFOUNDING.
MY HOPE IS IF WE'RE MORE
EXPLICIT WHAT IN PARTICULAR
NATURAL DISASTER OR CLIMATE
EFFECT IS IMPACTING AT THE
BIOLOGICAL LEVEL WE CAN BE MORE
SELF-CONSISTENT WHEN WE'RE
TALKING ABOUT THEIR RISKS.
SO YOU CAN TAKE A HIERARCHICAL
APPROACH WITH MECHANISMS.
YOU CAN GO TO THE CELLULAR LEVEL
AND ALSO THINK ABOUT MODE OF
ACTION OR TIME TO OR AFTER EVENT
AS WELL.
THIS WAS A PAPER IN CLINICAL
INFECTIOUS DISEASES LOOKING AT
HEALTH RISK OF FLOODING
CERTIFIED BY TIME.
SO AS I MENTIONED BEFORE WHEN
YOU THINK ABOUT FLOOD YOU THINK
TYPICALLY ABOUT IMMEDIATE AND
ACUTE EVENTS.
THINGS THAT ARE PERSONAL INJURY
AND DROWNING ELECTROCUTION AND
CARBON MONOXIDE POISONING ARE A
MAJOR RISK FROM DESTROYING
INFRASTRUCTURE AND THINGS LIKE
THAT.
THEN YOU HAVE VERY EARLY THINGS
AS WELL IF YOU THINK ABOUT G.I.
ISSUES AND OTHER VIRUSES AND
OTHER INFECTIOUS DISEASES THAT
DROP OFF AFTER MAJOR FLOODING.
BUT I WANT TO FOCUS ON THE
LONG-TERM IMPLICATIONS OF FLOOD
RISK.
THEY CLEARLY HAVE A VERY
INFECTIOUS DISEASE BIAS HERE AND
THERE'S MANAGEMENT OF CHRONIC
DISEASE AND MENTAL HEALTH
DISORDERS THAT MAY BE IMPORTANT.
I WANT TO PAUSE OR HIGHLIGHT
THREE POTENTIAL EXAMPLES AND I'M
JUST GOING TO GET ONE LEVEL OF
DETAIL FURTHER IN THESE.
SO THE FIRST BEING FLOODS
LEADING TO A DECREASED
COMPLIANCE AND ESSENTIAL
MEDICATION.
SO WHEN PEOPLE LOSE ACCESS TO
HEALTH CARE THEY MIGHT STOP
TAKING MEDICATION AND THAT'S FOR
MANY POPULATIONS THE OLDER
POPULATION OR PEOPLE PEOPLE WITH
CHRONIC DISEASE COULD BE AN
ISSUE AND FLOOD CAN RELEASE
ADDITIONAL TOXIC CHEMICALS INTO
THE AIR OR WATER.
THERE WAS A RECENT PUBLICATION
OUT SHOWING THINGS LIKE
HURRICANE HARVEY IS IN TEXAS AND
LOUISIANA CAUSED THE WATER AND
GAS FACILITIES TO GOOD INTO
EMERGENCY MODES OR THERE WAS
DAMAGE AND ADDITIONAL VOCs AND
OTHER POLLUTAPOLLUTANTS.
FLOODING HAS BEEN SHOWN TO
INCREASE MICRO BACTEBACTERIA LI
NON-TUBERCULOSIS BACTERIA AND A
WAY FLOODS CAN READ TO
MEDICATION DISRUPTION AND
THERE'S MEDICATION
NON-COMPLIANCE THE DRUGS ARE
MADE TO INTERACTION WITH A
TARGET AND THROUGH SOME
PERTURBATION IF YOU TAKE AWAY
THE DRUG YOU HAVE A DECREASE.
YOU GET ADVERSE OUTCOMES.
I WAS TRYING TO FIND A SPECIFIC
EXAMPLE OF THIS BUT I NEED TO DO
MORE MINING OF THE DATABASES TO
SEE ONCE WE GET TO SOME
PERTURBATION OF A DRUG TARGET
AND THINK OF SOMETHING LIKE
MANAGING CHRONIC DIABETES OR
VARIOUS CARDIOVASCULAR DISEASE
WOULD BE INTERESTING ONES TO
LOOK AT HERE.
AND FLOODS LEAD TO RELEASE OF
TOXIC VOCs IN AIR AND WATER.
THIS WOULD BE AN ADDITION ON TO
WHAT THE FIRST PART OF MY
PRESENTATION DOES.
WE MAPPED VOCs ACROSS THE UNITED
STATES AND LOOKED AT THE CYP101
PATHWAY AND YOU CAN COMBINE
THESE INTO A MULTIPLE AOP.
THERE'S CYP101 AND 1A 2 AND LEAD
TO INCREASED PERTURBATION OF THE
RELATED AOPs.
AND THEN INFECTIOUS DISEASE
LEADING TO NON-TUBERCULOSIS
MICROBACTERIA AND THERE'S
EVIDENCE AFTER MAJOR FLOOD
EVENTS MTM INCREASES AND THE
FLOODING STANDING WATER MAKES IT
MORE AEROSOLIZABLE AND EASIER TO
INHALE.
AND A PAPER TALKED ABOUT THE
SUSCEPTIBILITY FOLLOWING A
NATURAL DISASTER INDIVIDUALS ARE
AT HEIGHTENED STRESS WITH
INCREASE EXPOSURE POTENTIAL
REALLY AND WHAT THAT WOULD
EFFECT IS THE PORTION OF THE GEO
TOX FRAMEWORK.
IT MIGHT BASICALLY DECREASE THE
EFFECTIVENESS OF YOUR BODY FOR
FILTERING OUT THE CHEMICAL.
THE HIGH THROUGHPUT IN VIVO
ASSAYS THERE ARE NOT ANY
CURRENTLY FOR BIOLOGICAL FACTORS
THEY'RE ALL CHEMICAL BASED.
THERE'S MICROBIAL BASED STUDIES.
I'M CURRENTLY EXPLORING AND
TALKING WITH FOLKS MORE IN THE
MICROBIAL RISK ASSESSMENT SPACE
ABOUT OPTIONS FOR UNDERSTANDING
THINGS LIKE NTM OR OTHER
INFECTIOUS DISEASE PATHWAYS
BETTER.
IF OF THESE STRIKE YOUR
INTEREST, I'M WORK WITH A STAFF
SCIENTIST TO TAKE THIS PIPELINE
AND CREATE AN R PACKAGE OUT OF
IT.
AND WE HAVE ON SCHEDULE FOR THE
MEETING FOR MARCH OF THIS YEAR
AND IT WILL BE AN ACCESSIBLE AND
EXTENSIBLE PACKAGE TO UTILIZE
THE GEO TOX FRAMEWORK AND WE'LL
HAVE MANY VIGNETTES FROM
POPULATION INDIVIDUAL LEVEL
APPLICATIONS FOR THE GEO TOX
FRAMEWORK.
TRYING TO MAKE IT SUCH THAT
PEOPLE BESIDES MYSELF AND MY
PREVIOUS POSTDOC CAN RUN THIS
GEO TOX FRAMEWORK.
THE TERM GEOPOSSIBILITIES IS
LOOKING AT EXPOSURE ASSESSMENTS
AND THINGS LIKE BRINGING
ENVIRONMENTAL MEDICINE TO A
LARGER SCALE.
IF YOU HAVE A COHORT WHERE YOU
HAVE INDIVIDUAL BIOLOGICAL DATA
TO INFORM YOU'LL GET BETTER PRE
VISION BY WRINGING THAT ADME
INTO YOUR EXPOSURE INFORMATION
AND WE HAVE THE PIPELINE SET UP
TO DO THAT.
LONG-TERM POSSIBILITIES?
GEOSPATIAL RISK ASSESSMENT WITH
EPIDATA.
HIGH THROUGHPUT METHODS ALLOW
CHARACTERIZATI
CHARACTERIZATION VIA THE
NON-ANIMAL METHODS SURPASS THE
EPIDEMIOLOGY.
IT'S THE NATURE OF THE BEAST
THERE.
AND THERE'S MAJOR ADVANTAGES BUT
IT'S TIME CONSUMING AND MORE
TARGETED.
AND GET AT COMPREHENSIVE
EXPOSOMIC RISK ASSESSMENT.
IN SUMMARY, I'VE DISCUSSED THE
SERIES OF STUDIES AND APPROACHES
THAT WE'RE WORKING ON IN MY
GROUP FOR MECHANISTICALLY
AFORKED RISK ASSESSMENT START
WITH THE CONCEPT AND THE GENOME
AND EXPOSOME AND GEO TOX IS
EQUAL TO THE EXPOSOME AND
PATHWAYS AND LOOK AT THE STUDY
FOR FLOOD RISK AND DISCUSSING
WAYS HOW WE CAN INCORPORATE
MECHAN
MECHANISMS TO GET A MORE
COMPLETE WAY TO LOOK AT CLIMATE
RISK.
WITH THAT I'D LIKE TO THANK YOU
ALL AGAIN FOR ATTENDING AND
WOULD LIKE TO ACKNOWLEDGE MY
GROUP MEMBERS AND SUPERVISORS
AND OTHER PEOPLE WORKING ON THE
PROJECT AND NC STATE
COLLABORATORS THE AUTHORS ON THE
AG ARTICLE AND THANKFUL FOR
FUNDING AND NIEHS AND NIMHD AS
THANKFUL AS AN ADJUNCT THEY
SUPPORT A POSTDOC IN MY GROUP
THE ADDITIONAL FUNDING WE HAD
FOR TWO POSTDOCS COMES THROUGH
THE OFFICE OF SECRETARY FOR THE
PATIENT-CENTERED OUTCOME TRUST
FUND AND INVOLVED WITH GITHUB.
>> THANK YOU, KYLE FOR A VERY
INFORMATIVE AND INTERESTING
PRESENTATION.
SOME OF THE THINGS I'VE NEVER
HEARD OF AND ALWAYS WONDERED
ABOUT SO THIS IS A TREAT.
I WANT TO GO FROM SOME OF THE
MORE SPECIFIC FINDINGS IN THE
STUDIES I'VE DONE AND TO A
LARGER DISCUSSION.
WE HAVE ABOUT FIVE MINUTES TO
GET AT THAT.
>> OKAY.
GOOD.
AND AS SOME OF THE HYPOTHESIS
YOUR DATA SUGGESTS THERE'S A
MODIFICATION IN CARDIOVASCULAR
OUTCOME BY THE NEIGHBORHOOD THE
REVISION INDEX.
WHAT DO YOU THINK IS THE
MECHANISTIC OR
OLD, MINORITY AND THE AMOUNT OF
NON-U.S. CITIZENS OR IMMIGRANTS,
THINGS LIKE THAT.
MECHANISTICALLY IT DEPENDS ON
WHAT LEVEL YOU WANT TO TALK
ABOUT.
YOU CAN TALK ABOUT THE HIGHER
LEVEL OF WHAT I WAS DIFFERENCESN
HOW CERTAIN RACE AND ETHNICITIES
MIGHT LEAD TO THE ADME PORTION
OF THINGS AND THAT'S WHERE
HAVING DATA ON GENE EXPRESSION
OR OTHER OMICS MIGHT BE ABLE TO
INFORM MECHANISTIC AND
SUBPOPULATION THAT'S
PARTICULARLY WELL
PERHAPS BEHAVIORAL LEVEL AS
WELL.
>> I'M THINKING ALONG THE
SIMILAR LINE FOR FOLKS AND
PEOPLE BUYING A HOUSE AND
GETTING A MORTGAGE AND WE KNOW
THE HISTORY OF RACIALIZED
MINORITIES ARE NOT GIVEN THEIR
FAIR SHARE OF LOANS AND BEING
FORCED IT AREAS AND STAYING
THERE AND LONG-TERM EXPOSURE TO
CONSEQUENCES OF REPEATED
FLOODING AND THEN YOU MENTIONED
THE IDEA OF HOW MUCH THEY CAN
CLEAN UP AFTER EACH FLOOD
HAPPENS AND THE REMNANTS OF THE
DAMAGE IN TERM OF MOLD IN THE
WALL AND THAT KIND OF THING.
THAT COULD HAVE EXPOSURE
>> THERE'S DATA ON THE
HISTORICAL RED LINING AND SO WE
COULD LOOK AT SOME OF THOSE AS
EFFECT MODIFIERS AS WELL OR
EXPLANATORY FACTORS.
I IMAGINE YOU SEE SIMILAR TO
WHAT WE'VE SEEN WITH AIR
POLLUTION AND BASICALLY IT'S A
STRAIGHT LAYER EFFECT OF THE
WORSE THE NEIGHBORHOOD WAS RED
LINED BACK IN THE '30s AND '40s
AND MAINTAINED STRUCTURALLY IN
OUR CURRENT SOCIETY.
THERE'S HIGHER LEVELS OF AIR
POLLUTION ON AVERAGE.
WE MIGHT SEE FLOOD RISK WITH
THAT.
NOW, FLOODING IS AN INTERESTING
ONE BECAUSE THERE IS SOME
U-SHAPE BECAUSE THERE'S VERY
VULNERABLE POPULATIONS AND THEN
THERE'S EXTREMELY WEALTHY PEOPLE
AND HIGH FLOOD RISK INTERACTION
AT TO SEE HOW THAT MIGHT
MANIFEST WITH THE FLOOD
INUNDATION WITH THE WEALTHY
VERSUS VULNERABLE POPULATIONS SO
THERE'S OTHER FACTORS LIKE
ACCESS TO CARE AND RESOURCES AND
THINGS LIKE THAT THAT MAY BE
DRIVING THE IMPACT.
>> IT'S POSSIBLE.
WE'RE RUNNING OUT OF TIME SO
I'LL SAVE THE OTHER QUESTIONS I
HAVE FOR WHEN WE MEET AND
DISCUSS THEM.
>> I APOLOGIZE FOR GOING A FEW
MINUTES LONGER THAN I HAD HOPED.
BUT LET ME JUST GO BACK TO MY
E-MAIL.
OBVIOUSLY, I'M DEVELOPING WILL
MORE USABLE AND OPEN UP THE
SPACE FOR COLLABORATIONS IN THIS
WORK.
>> WITH THAT, THANK YOU,
DR. MESSIER FOR YOUR
PRESENTATIONS AND THE Q&A
PORTION AND THANK YOU EVERYONE
FOR ATTEND.
WE WISH YOU THE BEST FOR THE
REST OF THE YEAR AND WE'LL SEE
YOU ALL NEXT MONTH.
CARE. 1079 01:02:35,118 >> THANK YOU.