It is clear that genetic sequence variation does not account for a substantial portion of disease burden. It is likely that the broad environment contributes to HLB disease via epigenomic alterations and interaction with genetic variants. There is an urgent need to understand the environmental contribution to disease as most exposures are modifiable and are targets for prevention interventions.

Self-report data indicate that insufficient sleep is more common in minority populations. This seems to be related to socioeconomic status. There is a need to move this beyond self-report and obtain objective measures in the relevant populations. Moreover, the basis of this difference needs to be established. What aspect of the environment leads to these differences, e.g., noise, stress related to sense of vulnerability, ...more »

We have done the best we can to mimic the human internal environment in vitro for the discovery, testing, and validation of therapeutics, but there is a critical need to do better. The use of more complex cell-based in vitro models is the result of the recognition of how little predictive power there is in current experimental conditions, even with animal models. With an in vitro environment that goes beyond temperature ...more »

What alterations in respiratory epithelia in response to environmental / external insults are irreversible and lead to disease onset or progression?

It is beginning to be known that malignant cells interact with neighboring cells and the course of their malignancy is directed by those cells. It is also known that transplanted stem cells interact with nearby cells and acquire direction of maturation and cell type from those cells. In my experience in unpublished work, the nature of the materials that leukocytes and monocytes have encountered during their apheresis ...more »

What are the biological, environmental, social and economic determinants of health in rural areas related to COPD and other lung disease.

What biomarkers of acute environmental exposure are predictive of disease onset or progression?

In spite of many years of research, we still cannot predict the short term risk of a heart attack or sudden CHD death. Most CHD deaths occur outside of the hospital. In spite of improvement of out-of-hospital emergency care, most “sudden death events” are still not successfully resuscitated.