The public health benefits of insulation retrofits in existing housing in the United States

BACKGROUND: Methodological limitations make it difficult to quantify the public health benefits of energy efficiency programs. To address this issue, we developed a risk-based model to estimate the health benefits associated with marginal energy usage reductions and applied the model to a hypothetical case study of insulation retrofits in single-family homes in the United States. METHODS: We modeled energy savings with a regression model that extrapolated findings from an energy simulation program. Reductions of fine particulate matter (PM(2.5)) emissions and particle precursors (SO(2 )and NOx) were quantified using fuel-specific emission factors and marginal electricity analyses. Estimates of population exposure per unit emissions, varying by location and source type, were extrapolated from past dispersion model runs. Concentration-response functions for morbidity and mortality from PM(2.5 )were derived from the epidemiological literature, and economic values were assigned to health outcomes based on willingness to pay studies. RESULTS: In total, the insulation retrofits would save 800 TBTU (8 × 10(14 )British Thermal Units) per year across 46 million homes, resulting in 3,100 fewer tons of PM(2.5), 100,000 fewer tons of NOx, and 190,000 fewer tons of SO(2 )per year. These emission reductions are associated with outcomes including 240 fewer deaths, 6,500 fewer asthma attacks, and 110,000 fewer restricted activity days per year. At a state level, the health benefits per unit energy savings vary by an order of magnitude, illustrating that multiple factors (including population patterns and energy sources) influence health benefit estimates. The health benefits correspond to $1.3 billion per year in externalities averted, compared with$5.9 billion per year in economic savings. CONCLUSION: In spite of significant uncertainties related to the interpretation of PM(2.5 )health effects and other dimensions of the model, our analysis demonstrates that a risk-based methodology is viable for national-level energy efficiency programs

[Photograph 2012.201.B1028.0635]

Photograph used for a newspaper owned by the Oklahoma Publishing Company

Integrating air pollution, climate change, and economics in a risk-based lifecycle analysis: A case study of residential insulation. Hum Ecol Risk Assess 12:552–571

ABSTRACT One of the ways in which risk assessment can inform life-cycle analysis (LCA) is by providing a mechanism to translate midpoint categories into common endpoints. Although this analytical step is complex and often highly uncertain, it can allow for prioritization among disparate midpoints and subsequent analytical refinements focused on the endpoints that dominate policy decisions. In this article, we present an approach to address three widely differing impact categories-particulate matter air pollution, greenhouse gas emissions, and personal income. We use the case of increased residential insulation as a measure to reduce energy consumption, which implies economic and public health tradeoffs across all three categories. We apply previously developed models that combined input-output LCA and risk assessment to address public health impacts from particulate matter, and extend the framework to address greenhouse gases and the public health consequences of changes in income. For a hypothetical loan program applied to both new and existing singlefamily homes, we find a payback period of approximately one year for the particulate matter and greenhouse gas-related midpoints and endpoints, with the structure of the loan implying that no economic payback is required. Our central estimates for avoided disability adjusted life years (DALYs) for a 50-year period are approximately 200,000 for particulate matter, 900,000 for greenhouse gases, and 300,000 for income changes, although values are highly dependent on discount rates and other model assumptions. We conclude that all three impact categories are potentially significant in this case, indicating that analytical refinements should be considered for all three impact categories to reduce model uncertainties. Our study demonstrates how LCA and risk assessment can work together in a framework that includes multiple impact categories, aiding in the evaluation of the net impacts of an energy policy change on society

y A P P L I C AT I O N S A N D I M P L E M E N TAT I O N Saving Energy versus Saving Materials Life-Cycle Inventory Analysis of Housing in a Cold-Climate Region of Japan

Summary To reduce energy consumption and carbon dioxide (CO 2 ) emissions in housing construction, the energy-intensive processes and life-cycle stages should be identified and integrated. The environmental impact of vertically integrated factory-built homes (VIHs) constructed with increased material inputs in Japan's nor thern island of Hokkaido was assessed using life-cycle inventory (LCI) analysis methods. Manufacturing process energy and CO 2 intensities of the homes were evaluated based on the material inputs. They were compared with those of a counterpar t home hypothetically built using the ver tically integrated construction methods, but in accordance with the specifications of a less material-intensive conventional home (CH) in Hokkaido today. Cumulative household energy consumption and CO 2 emissions were evaluated and compared with those of the production stages. The annual household energy consumption was compared among a VIH, a CH, and an P P L I C AT I O N S A N D I M P L E M E N TAT I O N 120 Jour nal of Industrial Ecology average home in Hokkaido. The energy intensity of the VIH was 3.9 GJ production energy per m 2 of floor area, 59% higher than that of the CH. Net CO 2 emissions during VIH manufacturing processes were 293 kg/m 2 , after discounting the carbon fixation during tree growth. The cumulative use-phase household energy consumption and CO 2 emissions of a VIH will exceed energy consumption and CO 2 emissions during the initial production stage in less than six years. Although VIHs housed 21% more residents on average, the energy consumption per m 2 was 17% lower than that of a CH. This may indicate that using more materials initially can lead to better energy efficiency.

Combination Assay of Methylated HOXA1 with Tumor Markers Shows High Sensitivity for Detection of Early-Stage Hepatocellular Carcinoma

Background: Patients with hepatitis virus-related hepatocellular carcinoma (viral HCC) are decreasing as hepatitis control improves, but those with non-viral-related HCC (non-viral HCC) are increasing in Japan. No established surveillance system exists for patients with non-viral HCC, so they are often diagnosed at an advanced stage. To address this, we performed this study. Methods: We collected serum samples from 516 participants (154 healthy subjects, 93 chronic liver disease [CLD] patients without HCC, and 269 HCC patients). Participants were divided into a control group comprising healthy subjects and patients with CLD and an HCC group. We evaluated serum methylated HOXA1 (m-HOXA1) copy numbers using modified combined restriction digital PCR (CORD) assay (1-step CORD assay). We assessed diagnostic performance of m-HOXA1 compared to HCC tumor markers alpha-fetoprotein (AFP) and des-gamma-carboxy prothrombin (DCP) and created a novel index to improve HCC prediction. Results: Serum m-HOXA1 level was significantly higher in each HCC stage group versus the control group. Its sensitivity was 69.1% and specificity was 78.5% for diagnosing HCC. The area under the curve (AUC) of m-HOXA1 was superior to that of AFP and equal to that of DCP. Multivariate logistic regression analysis revealed independent contributions of m-HOXA1, DCP, and AFP, in that order of strength, to diagnose HCC after adjustment for age and sex. We designated the predictive probability of HCC based on the regression model as the ASDAm-H1 (Age, Sex, DCP, AFP, and m-HOXA1) index. Its diagnostic accuracy was 0.96 by AUC with a sensitivity of 86.2% and specificity of 93.9%. Sensitivity was identical for viral and non-viral HCCs. When limited to early-stage HCC, sensitivity of the ASDAm-H1 index was 76.3%. Conclusions: We showed distinguished performance of the ASDAm-H1 index to detect viral and non-viral HCC even at an early stage. This index might have potential as a non-viral HCC surveillance system

Outcomes in Newly Diagnosed Atrial Fibrillation and History of Acute Coronary Syndromes: Insights from GARFIELD-AF

BACKGROUND: Many patients with atrial fibrillation have concomitant coronary artery disease with or without acute coronary syndromes and are in need of additional antithrombotic therapy. There are few data on the long-term clinical outcome of atrial fibrillation patients with a history of acute coronary syndrome. This is a 2-year study of atrial fibrillation patients with or without a history of acute coronary syndromes