In a new study we published this week in The Journal of Clinical Investigation, our multidisciplinary team of computer scientists, physicians, and epidemiologists at the Icahn School of Medicine at Mount Sinai developed a novel machine-learning algorithm. We used this new machine learning method to identify previously unknown mixtures of toxic air pollutants that appear to be linked to poor asthma outcomes in children.  
     The issue we addressed with this investigation was that most studies assess the toxicity of pollutants one at a time. But in the real world, people are exposed to mixtures of pollutants that cause different health effects. Gaurav Pandey, PhD, Assistant Professor of Genetics and Genomic Sciences and a senior author of the study, said: "Traditionally, for technical reasons, it has been difficult to study the health effects of more than one toxic at a time. We overcame this by tapping into the power of machine learning algorithms."    
     To do this, we examined early exposure to dozens of pollutants to which 151 children with mild to severe asthma were potentially exposed early in their lives, as measured by the Environmental Protection Agency's National Air Toxics Assessment resource. We developed and applied a novel algorithm, named "Data-driven ExposurE Profile (DEEP) Extraction, to determine the possible ways that each pollutant, alone or in combination with others, could explain asthma outcomes in the children. The algorithm development was led by Yan-Chak Li, MPhil, a bioinformatician, and Hsiao-Hsien Leon Hsu, ScD, Assistant Professor of Environmental Medicine and Public Health. 
     We found that some disease cases could be linked to an individual chemical. One example of an individual chemical showing an effect was the ammonia-scented waterproofing agent trimethylamine, which raised the chances that a child with asthma would spend a night in the hospital.
     Other pollutants could act alone or in mixtures. One example was acrylic acid, a chemical used in plastics, coatings, medical products, and detergents. Exposure to acrylic acid raised the chances that a child would need daily medication. Exposure to acrylic acid combined with other chemicals further increased this possibility, and in addition, it boosted the chances of emergency room visits and overnight hospitalizations among the asthmatic children who participated in the study. (See illustration)  
     In all, 34 individual chemicals were found to be linked to poor asthma outcomes. Importantly, some asthma cases appeared to be linked to mixtures of pollutants that had never been associated with asthma.   
      "As a physician who treats children with asthma, I was struck by how many potential air toxics are not on our radar," said Supinda Bunyavanich, MD, MPH, MPhil, Professor of Pediatrics, and Genetics and Genomic Sciences, and a senior author of the study. "These results changed my view of the heightened risk some children face."  
     "Our study is an example of how machine learning has the potential to alter medical research," said Dr. Pandey. "It is allowing us to understand how a wide variety of environmental factors—or the exposome—influences our health. In the future, we plan to use DEEP and other computer science techniques to tackle environmental factors associated with other complex disorders."  
     This work was supported by the Department of Genetics and Genomic Sciences at Mount Sinai, Scientific Computing at Icahn Mount Sinai, and the National Institutes of Health (AI118833, HG011407, HL147328, OD023337, and ES023515).
Article
Citation: Li, Y.C., Hsu, H.H.L., Chun Y, Chiu PH, Arditi Z, Claudio L, Pandey G, Bunyavanich S. Machine learning-driven identification of early-life air toxic combinations associated with childhood asthma outcomes. Journal of Clinical Investigation, October 5, 2021, DOI: 10.1172/JCI152088

• A new study found that almost half of the cosmetic products tested contain potentially harmful chemicals.
• These chemicals, called per- and polyfluoroalkyl substances (PFAS), have been linked in early research to cancer, reproductive harm, and damage to the immune system.
• PFAS are often used to increase a product’s durability, spreadability, and wear.

The researchers tested 231 products purchased from retailers in the United States and Canada and found these forever chemicals in 48 percent of the products.
Two-thirds of liquid lipsticks, two-thirds of foundations, and three-fourths of waterproof mascaras contained high levels of fluorine, one of these chemicals.
In addition, another in-depth look of 29 products found that 28 of the products in which PFAS were identified did not disclose the chemicals on their product labels.
The findings were published as a group of senators introduced a bill to ban the use of PFAS in personal care products.
Though the Food and Drug Administration (FDA) regulates cosmetic products, the agency does not evaluate or approve the ingredients for safety.
In addition, the FDATrusted Source technically requires cosmetic companies to disclose all ingredients used in their products. However, many loopholes have allowed companies to not disclose all of the ingredients included on the product labels.
In the United States, “Cosmetics and personal care products are not closely regulated to ensure that they do not contain toxic chemicals,” said Luz Claudio, PhD, a professor of environmental medicine and public health at the Icahn School of Medicine at Mount Sinai.

To read the full article, click HERE.  

Juan A. Ortega-Garcia, Manuel Ruiz-Marin, Alberto Carceles-Alvarez, Ferran Campillo i Lopez, Luz Claudio. Environmental Research 189 (2020) 109957.
At one point during the global novel coronavirus pandemic, Spain was the epicenter of infection.  Yet, not all regions of the country had the same rates of hospital emergency visits during this time.  The region of Murcia flattened the curve quickly while other regions of the country had overwhelmed hospital capacity. This was attributed to a robust, community-based, social media campaign promoting tele-medicine and social distancing within health care centers. 
In this rapid communication, we describe the actions taken in Murcia that may have contributed to a more favorable outcome as compared to other regions.  One important action was the coalition of activists, community leaders, physicians and researchers working as amplifiers of an educational campaign using a variety of social media and outreach strategies. 

A successful internship can be the key to a thriving and fulfilling career. However, there are several things you need to consider before accepting any offers. 
In this article, 7 experts were asked how should candidates accept an internship.  My response:

A good acceptance letter from an intern should be informative and appreciative
Informative, because some internship programs may accept a number of interns at the same time. Make sure to include a summary of your skills in your letter. State very clearly in bulleted form what skills you will bring to the internship and how this makes you a great candidate.

If you have a good idea of the project or topic of the internship project that you’d like to do, this will also demonstrate that you have done your homework regarding the projects that will be meaningful for the organization that is offering you the internship.
Finally, the acceptance letter should be appreciative. Don’t sound like you had taken it for granted that you would be accepted to the internship. Make sure to state that you appreciate the opportunity and that you are committed to doing a great job.

Although nothing is the same after the pandemic, including summer internships for students, cancellations are lower than expected as many programs move online. But some question the value of a virtual job experience.
"At the Icahn School of Medicine at Mount Sinai in New York, internship offerings have been expanded by reallocating travel and housing funding. Professor Luz Claudio directs several medical and research internship programs funded by the National Institutes of Health. This year, the International Exchange Program for Minority Students received 400 applications for 10 positions, she said.

“There were a lot of really good applicants in that pool,” Claudio said. “I want to get more interns, not less.” Her internships are pivotal for students because they are paid, can provide required credits and allow publication of journal articles, which pave the way to graduate programs."

In these infographics and accompanying article, we gathered information from primary and secondary sources to summarize the effects of the COVID-19 pandemic and quarantine on different aspects of the environment.  We found that mother nature earned some points, but lost on others.  For example, here in New York, Columbia University measured a 50% reduction in carbon monoxide emissions.  But, medical waste quadrupled due to the increased use of disposable PPE and other contaminated biomedical solid waste. 

In the article, I was cited as follows:
"One of the things that we can learn from the pandemic’s effects on the environment is that we CAN actually have an impact if there were a global effort to do so.  It is inspiring how in cities that had extreme levels of air pollution, from Los Angeles to New Delhi, people are seeing the difference that cleaner air can make to quality of life if we could reduce the number of cars and emissions from polluting industries.  Another lesson will be the realization of how productive many workers can be while working from home when they are given the proper tools. Many companies will see the value of having at least some workers work from home, reducing the need for commuting and also reducing the office space needed to conduct business." 

See the full article with the beautiful interactive infographics and the list of sources including other scientists and business leaders who contributed Here. 

ABSTRACT
Aims
In current clinical practice, prenatal alcohol exposure is usually assessed by interviewing the pregnant woman. An alternative method for detecting alcohol use is to measure the biomarker carbohydrate-deficient transferrin (CDT). However, few studies measure CDT during pregnancy. This study examines the utility of CDT biomarker in the screening of alcohol exposure during early pregnancy.
Methods
A cohort of 91, first-trimester pregnant women assigned to a public reference maternity hospital, was screened using the Green Page (GP) questionnaire, an environmental exposure tool. CDT levels and other biomarkers of alcohol use were measured and compared with questionnaire data.
Results
About 70% of the mothers in the study consumed alcohol during early pregnancy and 22% met high-risk criteria for prenatal exposure to alcohol. CDT measurement showed a statistically significant area under the receiver operating characteristic curve with a value of 0.70. For a value of 0.95% of CDT, a specificity of 93% was observed. The most significant predictors of CDT were the number of binge drinking episodes, women’s body mass index and European white race.

Conclusion
Pregnant women with a CDT value >0.95% would be good candidates for the performance of the GP questionnaire during early pregnancy in order to detect potential high-risk pregnancy due to alcohol exposure.

Mothers who use beauty products containing chemicals known as parabens during pregnancy may be more likely to have overweight daughters, a small study suggests.
Babies tended to be heavier at birth, and more likely to become overweight by age 8, when mothers used makeup, lotions and other common beauty products containing parabens while pregnant, the study found. One of these chemicals, butylparaben, was associated with excess weight only in girls.

Even so, it makes sense for pregnant women to check product labels and steer clear of beauty items containing parabens, said Luz Claudio, an environmental health researcher at the Icahn School of Medicine in New York City who wasn’t involved in the study.

“The significance of this finding cannot be underestimated because girls and women typically used more personal care products and cosmetics containing parabens than do boys and men,” Claudio said. “Thus, this effect of early exposure to parabens in females could potentially continue to increase as they grow and use even more of these products, potentially affecting the next generation of girls.”

Read the full article at: Reuters, WebMD, Medscape 
Read the original research paper from Nature

Previous research shows that environmental and social factors contribute to the development of attention-deficit/hyperactivity disorder (ADHD).  Many questions arise from these observations, including: Are there particular air pollutants that may contribute to ADHD?  How does exposure to air pollutants interact with socioeconomic factors?  Can you see this effect in very young children before a definitive diagnosis of ADHD can be determined?

We set out to determine the relationship between early-life exposure to common ambient air pollutants (benzene, toluene, ethylbenzene, and xylene, also known as BTEX), household material hardship (a measure of socio-economic status), and ADHD-suggestive behaviours in kindergarten-age children.  We chose to assess BTEX partly because these are air toxins that are known to potentially cause effects on the brain.
To do this, we used estimated pollutant exposure from the 2002 National Air Toxics Assessment at each child's residential ZIP code at enrollment.  These data were linked to the Early Childhood Longitudinal Study Birth Cohort (which had been following 4650 children). Material hardship was assigned as a composite score of access to food, health care, and housing. Kindergarten teachers rated children's behaviours and activity in the classroom using a five-point Likert scale. Children with summary scores in the bottom decile were classified as displaying ADHD-suggestive behaviours. 
We showed that both, early life exposure to toxic chemicals in the ambient air and material hardship were independently associated with ADHD-suggestive behaviours at school entry.  
These associations were stronger in children who lived in urban areas. There was no evidence of interaction between early life BTEX exposure and material hardship, although the effects of BTEX exposure were slightly greater in magnitude among those with higher material hardship scores.
We concluded that children exposed to air toxics, material hardship, or both early in life are more likely to display signs of ADHD-suggestive behaviours as assessed by their kindergarten teachers. The associations between exposures to air pollution and to socio-economic hardship were observed in all children but were particularly strong in those living in urban areas.  This work adds to the evidence of the detrimental effects of exposure of air pollution on the developing brain.

I am Roberto F. Refeca, born in Habana, Cuba, on September 30, 1973, to Olga and Roberto J. Refeca.  I am a college graduate with an MBA from the University of Miami, Miami, Florida and a Bachelor’s of Science (Biology, Chemistry) from Maryville University, St. Louis, Missouri.  I am a husband to Amy M. Refeca, and father to Sophia C. Refeca and Sammy Refeca.  Lastly, Currently I’m working in the field of Regulatory Affairs. I’m the Director, Regulatory Affairs at Clinical Genomics, Inc., a company focused on the early detection of Colorectal Cancer (CRC). 
I should explain this now, as it can get very confusing for those that are not familiar with the term Regulatory Affairs.  For a company to place a medical device on the market and make it available for sale to the public, they must meet the requirements set forth by the US FDA.  The US-FDA regulates products according to the risk/potential risks that they may pose to the user, the risks are largely based on the intended use of the product and the functional attributes and characteristics of the product.  The core responsibility for the regulatory professional is to guide companies through this process.  Once the product is on the market/distributed, the RA professional also helps companies by interacting with the Regulatory Bodies to maintain the registrations current.  Often times the roles for RA professionals within organizations can vary by also including responsibilities for post market surveillance, labeling, and more.  I hope that provides some color to my role/profession. 
What defines you? 
My experiences and my environment define me.  I’m an immigrant to the United States, arrived in 1980.  A childhood in a lower middle-class environment in St. Louis, Missouri, with friends that took every opportunity to play sports and go fishing.  I had many nights of searching our area for lighted spaces where we could play stick ball and basketball, or head to a fishing spot (creeks, lakes, rivers).  It was not uncommon for my friends and I to sneak into gymnasiums after hours and on weekends to play basketball during the St. Louis Winters.  The fever for sports and fishing started early for me, participating in baseball in middle, high school, and college.  The love for the study of Biology came later and was fostered in high school by a couple great mentors Mr. Don McLain and a Mr. Charles Shepperd.  Once high school was completed, fast forward through a couple years of undergraduate study (Barry University, Miami, Florida, and then Florissant Valley Community College, St. Louis, Missouri) and then I found myself at Maryville University majoring in Biology with a Minor in Chemistry.  To gain additional experience in science, I started volunteering at the Center for the Study of Nervous System Injury (CSNI), Washington University School of Medicine, St. Louis, Missouri, with John W. McDonald MD, Ph.D., during my junior year at Maryville.  John’s research interests were focused on mechanisms of oligodendrocyte death, specifically spinal cord injury.  While working with Dr. McDonald, it was not uncommon to find ourselves in the lab at 1-3am in the morning on the weekends and during the summer. 
In sports, there is god-given talent, and then there is that grind that happens when you work and you know that putting in that extra effort will often yield a positive outcome.  I saw this in John, a relentless pursuit with passion for the work that he was doing.  It became familiar for me to see this type of behavior that I was so used to being a part of in sports….I was applying it to my love for biology/science, and I saw others with the common approach. 
Dr. McDonald invited me the Fall of 1997 to a conference in New Orleans, Louisiana, right around the Halloween time of year.  It was here where I had my chanced encounter with a Luz Claudio, Ph.D., if I recall correctly it was during the lunch period when everyone was taking breaks from the conference when we met.   As part of our brief conversation Dr. Claudio welcomed me to apply to her summer internship program. I was awarded the opportunity to participate in the program that summer in 1998, in Dr. Luz’s lab at the Environmental Health Sciences Center, Mt. Sinai School of Medicine, New York, New York.  My work included trying to establish a cell culture model of the blood brain barrier using astrocytes and HUVEC (Human umbilical vein endothelial cells). 
After that summer I ended up in Miami, Florida.  After working as a baseball instructor at Red Berry’s baseball academy, I then started my professional working career (after being a college graduate) working at the Diabetes Research Institute (DRI), University of Miami School of Medicine.  The work was amazing, I was a part of the Human Islet Transplant team. In short, the program leaders were Camillo Ricordi, MD, Norma Kenyon, Ph.D., and Rodolfo Alejandro, MD.  Our focus was finding a cure for Type I diabetes via the transplantation of islets, the insulin producing cells within the pancreas.  My job was to isolate islets for transplant and for research from cadaver pancreas, it was not uncommon for the harvesting procedure to take 4-12 hours in the lab.  As part of the DRI program I was also able to experience technology related to the processing and harvesting whole bone marrow for transplant from cadaver bone marrow, and living donor iliac crest aspirates.  The science that was happening at the DRI was second to none, and I enjoyed every part of it. 
After working in science/the lab for a number of years at the DRI, I had thoughts of graduate school/focus on science.  It was always my dream to drive research to a clinical benefit in people.  I also started to yearn for a different challenge within science that would include more interaction in non-lab settings, getting closer to the interphase between research and clinical practice.  That lead me to my decision to pursue an MBA at the University of Miami, Miami, Florida.  After I finished the MBA program, I then took a job with Cordis Neurovascular in Miami, Florida which was a division of Johnson & Johnson.  It made more sense than what I knew at the time. 
 
How did you decide on this career path? 
This is a great question, I have not met a person yet in my career that by design ended up in the field of Regulatory Affairs (I’m sure that they are out there), most persons including myself end up in Regulatory Affairs in a “sideways” type of manner in that there are not many college programs that offer RA degrees.  I have had colleagues with undergraduate training in: science, engineering, communications, and graduate degrees such as MBA, MSc., Ph.D., JD.
What you like, don't like?
 What I love about my current role and the field of Regulatory Affairs.  It is very broad: I’m at the forefront of a technology/science in bringing new things to market and it also requires me to communicate effectively with a broad group of persons/groups within my organization.  Regulatory Affairs also requires me to communicate effectively with persons outside of my organization which can be customers to the business and regulators globally.  It is common for me to have routine conversations with: sales, marketing, operations/manufacturing, research & development, legal, and finance/accounting.   
In my various roles I have interacted with a very diverse group of professionals in all of the global markets, the professional relationships that I still keep today are priceless.  And because my roles have been global in nature, I’ve had the chance to interact with regulators from around the world including: Canada, EU-Notified Bodies, Mexico, Costa Rica, Australia, and of course our US-FDA.  In today’s world, business is global and regulatory is a key partner to any company’s global success whether it be the introduction of new products or maintaining products in existing markets.   
 
What do you wish you had known before you embarked in your career? 
In hind sight, I sometimes wonder what it would have been like to have started earlier in the field of Regulatory Affairs….but that is only a brief thought, I enjoyed my time in research too much: Washington University School of Medicine (Study of Nervous System Injury); Mount Sinai School of Medicine, New York (Environmental Health Sciences Center); and the University of Miami, School of Medicine (Diabetes Research Institute), Miami, Florida.  The places, people, and experiences, I’m thankful for each.

What would you advise others thinking of similar career paths?
With regards to the field of Regulatory Affairs, my belief is that it is helpful to bring a skill set to the profession (science, technology, engineering, math) and that one of the most important attributes is to have good interpersonal skills including the ability to communicate effectively (verbally and in writing). 
 
What have been some of your biggest obstacles and how have you overcome them?
Myself.  We often get in our own way by over analyzing things or lacking self confidence.  The way to overcome is to take chances, and if things don’t workout you re-direct.  I believe this is a key to life and to success.  Don’t be afraid to make a mistake, acknowledge it, own it and move on.  If you miss “acknowledging” it, I believe this can be a detriment to leadership and slow your development. 
Don’t pass up opportunities, take chances! 
 
How has your background, gender, race, or any other aspects of yourself been an asset?
The fire inside of me comes from my background, gender, race.  Being an immigrant to the United States, which I believe is truly a place of opportunity whereby you can own your trajectory…what was instilled in me since being a very young boy is that I was different and that I had to work, work, work to have access to the things I wanted.  In sports, in school, in my work, I was raised to not be outworked.  I have learned in sports and in my profession that hard work does not always immediately yield what you expect, but if you keep at it…the model stands up and the results are there. 
This approach is common in sports and has a common thread in life with work and relationships.   
Growing up in St. Louis, Missouri my parents and family, we routinely spoke Spanish in stores, around town which was not as common in the early 1980’s compared to today.  We would get funny looks at times. This language skill that I did not think much of in my childhood also had a significant impact on my professional development when I entered the field of Regulatory Affairs.  English is the global language for business, however, when I interacted with my colleagues in Latin America being able to read and speak, and write Spanish was a huge asset.  The best part was that I routinely take the opportunity to work on my Spanish while my international colleagues use the opportunity to work on their English. 
 
Overall, I’ve had the kinds of experiences that any ethnic minority has in the United States.  I can say with certainty that the eyes and ears of your colleagues and bosses are blinded to your differences when you bring value and success to the work.
 
I am very thankful for the persons that I have shared my career with, very thankful and humbled by my experiences.