Usha Satish

Associations of Cognitive Function Scores with Carbon Dioxide, Ventilation, and Volatile Organic Compound Exposures in Office Workers: A Controlled Exposure Study of Green and Conventional Office Environments.

Background: The indoor built environment plays a critical role in our overall well-being because of both the amount of time we spend indoors (~90%) and the ability of buildings to positively or negatively influence our health. The advent of sustainable design or green building strategies reinvigorated questions regarding the specific factors in buildings that lead to optimized conditions for health and productivity. Objective: We simulated indoor environmental quality (IEQ) conditions in “Green” and “Conventional” buildings and evaluated the impacts on an objective measure of human performance: higher-order cognitive function. Methods: Twenty-four participants spent 6 full work days (0900–1700 hours) in an environmentally controlled office space, blinded to test conditions. On different days, they were exposed to IEQ conditions representative of Conventional [high concentrations of volatile organic compounds (VOCs)] and Green (low concentrations of VOCs) office buildings in the United States. Additional conditions simulated a Green building with a high outdoor air ventilation rate (labeled Green+) and artificially elevated carbon dioxide (CO2) levels independent of ventilation. Results: On average, cognitive scores were 61% higher on the Green building day and 101% higher on the two Green+ building days than on the Conventional building day (p < 0.0001). VOCs and CO2 were independently associated with cognitive scores. Conclusions: Cognitive function scores were significantly better under Green+ building conditions than in the Conventional building conditions for all nine functional domains. These findings have wide-ranging implications because this study was designed to reflect conditions that are commonly encountered every day in many indoor environments. Citation: Allen JG, MacNaughton P, Satish U, Santanam S, Vallarino J, Spengler JD. 2016. Associations of cognitive function scores with carbon dioxide, ventilation, and volatile organic compound exposures in office workers: a controlled exposure study of green and conventional office environments. Environ Health Perspect 124:805–812; http://dx.doi.org/10.1289/ehp.1510037

Simulation-based executive cognitive assessment and rehabilitation after traumatic frontal lobe injury: A case report

Purpose. To investigate whether identifying specific deficits after brain injury can lead to a more focused and potentially effective cognitive rehabilitation technology. Method. Cognitive simulation assessment was undertaken in a 47-year-old man with trauma-related prefrontal damage and persisting occupational and cognitive-behavioral difficulties at 15 months post brain injury. Results. Results revealed significant difficulties in measured levels of activity, initiative, information utilization, response flexibility, and effective decision-making strategies which accorded well with his real-life complaints despite normal neuropsychological test scores. This profile of findings was then used to design a two-stage intervention program. The first stage focused on participant education and awareness about his simulation-based problem solving difficulties. In the second stage specific goals were formulated to improve problem solving impairments that were then the target of weekly training sessions using pertinent decision-making and problem-solving vignettes. A parallel version of the cognitive simulation assessment was undertaken post-cognitive training (3 months after initial assessment) and revealed significant improvements in targeted executive cognitive-behavioral areas. Conclusion. Results of this cognitive rehabilitation probe supported the feasibility and validity of undertaking a cognitive simulation approach to identify residual executive function deficits after traumatic brain injury, even with a normal neuropsychological test profile. Further studies are needed to establish the reliability, generalizability and maintenance of such gains.

Economic, Environmental and Health Implications of Enhanced Ventilation in Office Buildings

Introduction: Current building ventilation standards are based on acceptable minimums. Three decades of research demonstrates the human health benefits of increased ventilation above these minimums. Recent research also shows the benefits on human decision-making performance in office workers, which translates to increased productivity. However, adoption of enhanced ventilation strategies is lagging. We sought to evaluate two of the perceived potential barriers to more widespread adoption—Economic and environmental costs. Methods: We estimated the energy consumption and associated per building occupant costs for office buildings in seven U.S. cities, representing different climate zones for three ventilation scenarios (standard practice (20 cfm/person), 30% enhanced ventilation, and 40 cfm/person) and four different heating, ventilation and air conditioning (HVAC) system strategies (Variable Air Volume (VAV) with reheat and a Fan Coil Unit (FCU), both with and without an energy recovery ventilator). We also estimated emissions of greenhouse gases associated with this increased energy usage, and, for comparison, converted this to the equivalent number of vehicles using greenhouse gas equivalencies. Lastly, we paired results from our previous research on cognitive function and ventilation with labor statistics to estimate the economic benefit of increased productivity associated with increasing ventilation rates. Results: Doubling the ventilation rate from the American Society of Heating, Refrigeration and Air-Conditioning Engineers minimum cost less than

Measuring Executive Function Deficits Following Head Injury: An Application of SMS Simulation Technology

40 per person per year in all climate zones investigated. Using an energy recovery ventilation system significantly reduced energy costs, and in some scenarios led to a net savings. At the highest ventilation rate, adding an ERV essentially neutralized the environmental impact of enhanced ventilation (0.03 additional cars on the road per building across all cities). The same change in ventilation improved the performance of workers by 8%, equivalent to a

Impact of VOCs on decision making and productivity

6500 increase in employee productivity each year. Reduced absenteeism and improved health are also seen with enhanced ventilation. Conclusions: The health benefits associated with enhanced ventilation rates far exceed the per-person energy costs relative to salary costs. Environmental impacts can be mitigated at regional, building, and individual-level scales through the transition to renewable energy sources, adoption of energy efficient systems and ventilation strategies, and promotion of other sustainable policies.

Using Meaningful Outcomes to Differentiate Change from Innovation in Medical Education

Neuropsychological tests have limited sensitivity in identifying subtle residual cognitive impairments in patients with good medical recovery from head injury and post-concussive syndrome. Detecting and characterizing residual ‘real life’ cognitive difficulties can be problematic for treatment purposes. This study investigated the usefulness of a well-standardized and validated cognitive simulation procedure that is based on complexity theory (The Strategic Management Simulation or SMS) for detecting such impairments. Twenty adults who had suffered moderate closed head injury (CHI) but now generated normal or close to normal neuropsychological test scores, yet continued to experience family, work, or other problems, were compared with matched controls. Comparisons of the patient and control group on simulation scores indicated no significant differences for single, well-structured task components or for information search activity. In contrast, the CHI sample was impaired on numerous tasks that require intermediate or complex cognitive efforts. The CHI sample generated significantly lower performance scores for strategic functioning, activity levels, information utilization, emergency responsiveness, planning, and breadth of decision-making. These findings suggest that SMS may provide a highly sensitive assessment tool for the assessment of subtle cognitive deficits after CHI.

Environmental Perceptions and Health before and after Relocation to a Green Building.

Environmental conditions can affect the productivity of workers performing a variety of tasks including manufacturing assembly, data entry and management. These factors might include physical, chemical, biological and social agents, but the relative effect of individual factors is not known. A pilot project was conducted to assess the relationship between productivity and exposure to latex paint in indoor environments. This was achieved by utilizing a sophisticated Strategic Management Simulation (SMS) tool that has been proven to accurately measure decrements and improvements in human effectiveness across a wide range of chemical and environmental exposure scenarios. Prior research with the SMS simulation technique shows considerable differences in human functioning when drug treatments are compared with placebo treatments, when drugs are compared with each other and when dose levels of specific drugs are compared. Among others, the SMS has been used to measure the effects of beta-blockers, caffeine, antihistamines, alcohol, marijuana and tranquillizers. Latex paint was chosen as the exposure for this pilot study because of (1) Institutional Review Board considerations and (2) the fact that latex paints contain volatile organic compounds (VOCs), known factors affecting indoor environmental quality. For this project the decision making and productivity abilities of study participants were assessed using the SMS after exposure to two different and well-characterized environmental conditions. One condition was the ‘control’ or when a participant is not painting and has not been for the previous 48 hours. The second condition was an ‘exposure’ and will occur when the participant has been painting for a two-hour period. For both conditions, air samples were collected and analysed for VOCs.

The impact of working in a green certified building on cognitive function and health

Major changes are being advocated and implemented in order to transform medical education. For instance, the influential Carnegie report [1] to mark the 100th anniversary of the 1910 Flexner Report calls for sweeping changes to both undergraduate and graduate education with an emphasis on increasing professionalism and replacing “seat time”with competence-based standards; the MCAT has been revised to include behavioral and social sciences and public health strategies in order to make “better doctors” [2]; reductions in the length ofmedical education have been instituted at some schools by either structuring it within 3 years or by competence-based evaluations that will allow students to graduate at their own pace [1, 3]. The AMA’s Innovation grants aim to accelerate this transformation [4]. The goal is to make better doctors. How will we know if we are succeeding? As with clinical practice with its firm embrace of evidence-based medicine, it is critical to define meaningful outcomes. Some outcomes like patient mortality are more meaningful than others such as patient satisfaction [5]. This is regularly captured in Patient-Oriented Evidence that Matters (POEMs) [6], which ask “With this intervention, did more patients improve? Have fewer complications? Live longer? Have a better quality of life?” In contrast, the medical education literature fails to distinguish among outcomes. Norcini et al. write: “Much of the research on the competence of ...graduates has focused largely on educational measures of quality” [7] such as multiple-choice examinations. “A more fundamental question is: Are there differences in clinical outcomes for patients cared for by these physicians?” [7, p. 1462]. Ideally, we need to show that teachers teach well, learners learn and apply this effectively, and patients get better. In reality, there is little evidence to show whether repeated changes in educational requirements and curricula have been effective or destructive [1–3]. To address this, we utilize a long-established hierarchy for evaluating systems of training which gauges the level and sophistication of attempts at medical education reform. This model highlights gaps and illuminates steps that must be taken to move forward in a meaningful way. More importantly, it allows us to present the first models of how to structure the Psychiatry clerkship and residency (using the learning of psychotherapy and psychopharmacology as examples) to obtain evaluations with the most meaningful outcomes.