Frontiers in Outreach and Education: The Florida Red Tide Experience

Beach-level 24-hour forecasts of Florida red tide-induced respiratory irritation

An accurate forecast of the red tide respiratory irritation level would improve the lives of many people living in areas affected by algal blooms. Using a decades-long database of daily beach conditions, two conceptually different models to forecast the respiratory irritation risk level one day ahead of time are trained. One model is wind-based, using the current days' respiratory level and the predicted wind direction of the following day. The other model is a probabilistic self-exciting Hawkes process model. Both models are trained on beaches in Florida during 2011--2017 and applied to the red tide bloom during 2018-2019. For beaches where there is enough historical data to develop a model, the model which performs best depends on the beach. The wind-based model is the most accurate at half the beaches, correctly predicting the respiratory risk level on average about 84% of the time. The Hawkes model is the most accurate (81% accuracy) at nearly all of the remaining beaches.

Florida’s Harmful Algal Bloom (HAB) Problem: Escalating Risks to Human, Environmental and Economic Health With Climate Change

Harmful Algal Blooms (HABs) pose unique risks to the citizens, stakeholders, visitors, environment and economy of the state of Florida. Florida has been historically subjected to reoccurring blooms of the toxic marine dinoflagellate Karenia brevis (C. C. Davis) G. Hansen & Moestrup since at least first contact with explorers in the 1500’s. However, ongoing immigration of more than 100,000 people year–1 into the state, elevated population densities in coastal areas with attendant rapid, often unregulated development, coastal eutrophication, and climate change impacts (e.g., increasing hurricane severity, increases in water temperature, ocean acidification and sea level rise) has likely increased the occurrence of other HABs, both freshwater and marine, within the state as well as the number of people impacted by these blooms. Currently, over 75 freshwater, estuarine, coastal and marine HAB species are routinely monitored by state agencies. While only blooms of K. brevis, the dinoflagellate Pyrodinium bahamense (Böhm) Steidinger, Tester, and Taylor and the diatom Pseudo-nitzschia spp. have resulted in closure of commercial shellfish beds, other HAB species, including freshwater and marine cyanobacteria, pose either imminent or unknown risks to human, environmental and economic health. HAB related human health risks can be classified into those related to consumption of contaminated shellfish and finfish, consumption of or contact with bloom or toxin contaminated water or exposure to aerosolized HAB toxins. While acute human illnesses resulting from consumption of brevetoxin-, saxitoxin-, and domoic acid-contaminated commercial shellfish have been minimized by effective monitoring and regulation, illnesses due to unregulated toxin exposures, e.g., ciguatoxins and cyanotoxins, are not well documented or understood. Aerosolized HAB toxins potentially impact the largest number of people within Florida. While short-term (days to weeks) impacts of aerosolized brevetoxin exposure are well documented (e.g., decreased respiratory function for at-risk subgroups such as asthmatics), little is known of longer term (>1 month) impacts of exposure or the risks posed by aerosolized cyanotoxin [e.g., microcystin, β-N-methylamino-L-alanine (BMAA)] exposure. Environmental risks of K. brevis blooms are the best studied of Florida HABs and include acute exposure impacts such as significant dies-offs of fish, marine mammals, seabirds and turtles, as well as negative impacts on larval and juvenile stages of many biota. When K. brevis blooms are present, brevetoxins can be found throughout the water column and are widespread in both pelagic and benthic biota. The presence of brevetoxins in living tissue of both fish and marine mammals suggests that food web transfer of these toxins is occurring, resulting in toxin transport beyond the spatial and temporal range of the bloom such that impacts of these toxins may occur in areas not regularly subjected to blooms. Climate change impacts, including temperature effects on cell metabolism, shifting ocean circulation patterns and changes in HAB species range and bloom duration, may exacerbate these dynamics. Secondary HAB related environmental impacts are also possible due to hypoxia and anoxia resulting from elevated bloom biomass and/or the decomposition of HAB related mortalities. Economic risks related to HABs in Florida are diverse and impact multiple stakeholder groups. Direct costs related to human health impacts (e.g., increased hospital visits) as well as recreational and commercial fisheries can be significant, especially with wide-spread sustained HABs. Recreational and tourism-based industries which sustain a significant portion of Florida’s economy are especially vulnerable to both direct (e.g., declines in coastal hotel occupancy rates and restaurant and recreational users) and indirect (e.g., negative publicity impacts, associated job losses) impacts from HABs. While risks related to K. brevis blooms are established, Florida also remains susceptible to future HABs due to large scale freshwater management practices, degrading water quality, potential transport of HABs between freshwater and marine systems and the state’s vulnerability to climate change impacts.

Status of state cyanoHAB outreach and monitoring efforts, United States

A widespread effort is underway to improve awareness of cyanobacteria harmful algal blooms (cyanoHABs) across the United States using a variety of monitoring programs and public health outreach measures to protect people, pets, and livestock. To determine the status of cyanoHAB outreach and monitoring efforts, 2 questionnaires were distributed to health/environmental departments in 50 states and the District of Columbia (DC). One questionnaire focused on cyanoHAB exposure to humans from drinking water and the second targeted exposure through recreational activities. All states plus DC responded to the recreational survey; 46 states plus DC responded to the drinking water survey. All states except Alaska answered that microcystins were the cyanotoxins of greatest concern for recreational exposure; microcystins were also of greatest concern for drinking water with the exception of Utah (anatoxin-a in reservoirs was greatest concern) and Rhode Island (microcystins and anatoxin-a in reservoirs/ponds were greatest concern). Regional comparisons disclosed a lack of cyanoHAB programs in southern states relative to northern states that may be related to the higher percentage of water surface area in northern states. Interestingly, recreational outreach is more extensive than drinking water outreach (only 16 states reported having some type of drinking water outreach program, compared with 35 states with recreational outreach), and preferred outreach methods are websites and press releases. Additionally, respondents reported very limited funding for outreach and monitoring programs. Our results establish baseline information to help determine what future direction cyanoHAB outreach and monitoring programs can take at local, regional, and national levels.

HABscope: A tool for use by citizen scientists to facilitate early warning of respiratory irritation caused by toxic blooms of Karenia brevis

Blooms of the toxic microalga Karenia brevis occur seasonally in Florida, Texas and other portions of the Gulf of Mexico. Brevetoxins produced during Karenia blooms can cause neurotoxic shellfish poisoning in humans, massive fish kills, and the death of marine mammals and birds. Brevetoxin-containing aerosols are an additional problem, having a severe impact on beachgoers, triggering coughing, eye and throat irritation in healthy individuals, and more serious respiratory distress in those with asthma or other breathing disorders. The blooms and associated aerosol impacts are patchy in nature, often affecting one beach but having no impact on an adjacent beach. To provide timely information to visitors about which beaches are low-risk, we developed HABscope; a low cost (~$400) microscope system that can be used in the field by citizen scientists with cell phones to enumerate K. brevis cell concentrations in the water along each beach. The HABscope system operates by capturing short videos of collected water samples and uploading them to a central server for rapid enumeration of K. brevis cells using calibrated recognition software. The HABscope has a detection threshold of about 100,000 cells, which is the point when respiratory risk becomes evident. Higher concentrations are reliably estimated up to 10 million cells L-1. When deployed by volunteer citizen scientists, the HABscope consistently distinguished low, medium, and high concentrations of cells in the water. The volunteers were able to collect data on most days during a severe bloom. This indicates that the HABscope can provide an effective capability to significantly increase the sampling coverage during Karenia brevis blooms.

Neurological illnesses associated with Florida red tide (Karenia brevis) blooms

Human respiratory and gastrointestinal illnesses can result from exposures to brevetoxins originating from coastal Florida red tide blooms, comprising the marine alga Karenia brevis (K. brevis). Only limited research on the extent of human health risks and illness costs due to K. brevis blooms has been undertaken to date. Because brevetoxins are known neurotoxins that are able to cross the blood-brain barrier, it is possible that exposure to brevetoxins may be associated with neurological illnesses. This study explored whether K. brevis blooms may be associated with increases in the numbers of emergency department visits for neurological illness. An exposure-response framework was applied to test the effects of K. brevis blooms on human health, using secondary data from diverse sources. After controlling for resident population, seasonal and annual effects, significant increases in emergency department visits were found specifically for headache (ICD-9 784.0) as a primary diagnosis during proximate coastal K. brevis blooms. In particular, an increased risk for older residents (≥55 years) was identified in the coastal communities of six southwest Florida counties during K. brevis bloom events. The incidence of headache associated with K. brevis blooms showed a small but increasing association with K. brevis cell densities. Rough estimates of the costs of this illness were developed for hypothetical bloom occurrences.

Education and notification approaches for harmful algal blooms (HABs), Washington State, USA

While numerous strategies have been used to educate and notify the public about potential hazards from exposure to Harmful Algal Blooms (HABs), at present there are no national guidelines or suggested outreach approaches. To raise public awareness and determine effective HAB outreach methods, two Washington State agencies and three counties in the Puget Sound region implemented several education and notification strategies. These approaches were rated for effectiveness by state and county public health and water quality professionals. At the state level, the most effective action was a three-tiered advisory posting protocol for notifying external users that was introduced to local health jurisdictions at workshops around the state. Supplemental permanent signage is recommended for lakes with blooms to overcome the time lag between HAB onset and testing/posting. The state also implements effective notification of toxicity test results through a web-based HAB database and listserv. Lake residents were best notified through electronic alerts including email and social media while mailers to lake residents were useful during initial HAB events and to gain subscribers to electronic alerts. Press releases were most valuable when used sparingly for severe blooms or for blooms in large lakes. Initial analyses of lake recreational use indicates these strategies encourage behavior change in lake users. Based on these findings, a general framework for HAB outreach and a specific notification strategy is proposed to assist other regions or agencies that are developing HAB education and notification programs.

Human responses to Florida red tides: policy awareness and adherence to local fertilizer ordinances

To mitigate the damages of natural hazards, policy responses can be beneficial only if they are effective. Using a self-administered survey approach, this paper focuses on the adherence to local fertilizer ordinances (i.e., county or municipal rules regulating the application of fertilizer to private lawns or facilities such as golf courses) implemented in jurisdictions along the Southwest Florida coast in response to hazardous blooms of Florida red tides (Karenia brevis). These ordinances play a role in the context of evolving programs of water pollution control at federal, state, water basin, and local levels. With respect to policy effectiveness, while the strength of physical linkages is of critical importance, the extent to which humans affected are aware of and adhere to the relevant rules, is equally critical. We sought to understand the public's depth of understanding about the rationales for local fertilizer ordinances. Respondents in Sarasota, Florida, were asked about their fertilizer practices in an area that has experienced several major blooms of Florida red tides over the past two decades. A highly educated, older population of 305 residents and "snowbirds" reported relatively little knowledge about a local fertilizer ordinance, its purpose, or whether it would change the frequency, size, or duration of red tides. This finding held true even among subpopulations that were expected to have more interest in or to be more knowledgeable about harmful algal blooms. In the face of uncertain science and environmental outcomes, and with individual motivations at odds with evolving public policies, the effectiveness of local community efforts to decrease the impacts of red tides may be compromised. Targeted social-science research on human perceptions about the risks of Florida red tides and education about the rationales for potential policy responses are warranted.

Florida Red Tide Knowledge and Risk Perception: Is there a need for tailored messaging?

Harmful algal blooms of the toxic dinoflagellate, Karenia brevis, occur throughout the Gulf of Mexico. Recent research efforts sponsored by the National Institute of Environmental Health Sciences (NIEHS) and others found that Florida red tide causes both acute and possibly chronic health effects from the toxic aerosols. Florida red tide also demonstrated significant social and economic impacts to both coastal residents and visitors. In conjunction with the research, persistent outreach efforts were conducted over the 11 year period. The goal of this project was to assess potential needs for tailored messaging needed among different red tide information user groups. Survey participants included 303 local residents, both with asthma and without, and 'snowbirds (seasonal residents that reside in the Sarasota area for more than 3 months but less than 6 months/year), also both with asthma and without. The questionnaire assessed Florida red tide knowledge and risk perception regarding Florida red tide using items drawn from two previously published surveys to allow comparison. Our results reveal that overall knowledge of Florida red tide has not changed. We found that knowledge was consistent across our selected groups and also did not vary by age, gender and education level. However, knowledge regarding consumption of seafood during Florida red tide has declined. Risk perception increased significantly for people who have asthma. Individuals responsible for public health communication regarding Florida red tide and human health concerns need to continue to pursue more effective outreach messages and delivery methods.

How Twitter Is Studied in the Medical Professions: A Classification of Twitter Papers Indexed in PubMed

Background

Since their inception, Twitter and related microblogging systems have provided a rich source of information for researchers and have attracted interest in their affordances and use. Since 2009 PubMed has included 123 journal articles on medicine and Twitter, but no overview exists as to how the field uses Twitter in research.

Objective

This paper aims to identify published work relating to Twitter within the fields indexed by PubMed, and then to classify it. This classification will provide a framework in which future researchers will be able to position their work, and to provide an understanding of the current reach of research using Twitter in medical disciplines.

Methods

Papers on Twitter and related topics were identified and reviewed. The papers were then qualitatively classified based on the paper’s title and abstract to determine their focus. The work that was Twitter focused was studied in detail to determine what data, if any, it was based on, and from this a categorization of the data set size used in the studies was developed. Using open coded content analysis additional important categories were also identified, relating to the primary methodology, domain, and aspect.

Results

As of 2012, PubMed comprises more than 21 million citations from biomedical literature, and from these a corpus of 134 potentially Twitter related papers were identified, eleven of which were subsequently found not to be relevant. There were no papers prior to 2009 relating to microblogging, a term first used in 2006. Of the remaining 123 papers which mentioned Twitter, thirty were focused on Twitter (the others referring to it tangentially). The early Twitter focused papers introduced the topic and highlighted the potential, not carrying out any form of data analysis. The majority of published papers used analytic techniques to sort through thousands, if not millions, of individual tweets, often depending on automated tools to do so. Our analysis demonstrates that researchers are starting to use knowledge discovery methods and data mining techniques to understand vast quantities of tweets: the study of Twitter is becoming quantitative research.

Conclusions

This work is to the best of our knowledge the first overview study of medical related research based on Twitter and related microblogging. We have used 5 dimensions to categorize published medical related research on Twitter. This classification provides a framework within which researchers studying development and use of Twitter within medical related research, and those undertaking comparative studies of research, relating to Twitter in the area of medicine and beyond, can position and ground their work.

The Art of Red Tide Science

Over the years, numerous outreach strategies by the science community, such as FAQ cards and website information, have been used to explain blooms of the toxic dinoflagellate, Karenia brevis that occur annually off the west coast of Florida to the impacted communities. Many state and federal agencies have turned to funded research groups for assistance in the development and testing of environmental outreach products. In the case of Florida red tide, the Fish and Wildlife Research Institute/Mote Marine Laboratory (MML) Cooperative Red Tide Agreement allowed MML to initiate a project aimed at developing innovative outreach products about Florida red tide. This project, which we coined "The Art of Red Tide Science," consisted of a team effort between scientists from MML and students from Ringling College of Art and Design. This successful outreach project focused on Florida red tide can be used as a model to develop similar outreach projects for equally complex ecological issues.

Florida Red Tide Toxins (Brevetoxins) and Longitudinal Respiratory Effects in Asthmatics

Having demonstrated significant and persistent adverse changes in pulmonary function for asthmatics after 1 hour exposure to brevetoxins in Florida red tide (Karenia brevis bloom) aerosols, we assessed the possible longer term health effects in asthmatics from intermittent environmental exposure to brevetoxins over 7 years. 125 asthmatic subjects were assessed for their pulmonary function and reported symptoms before and after 1 hour of environmental exposure to Florida red tide aerosols for upto 11 studies over seven years. As a group, the asthmatics came to the studies with normal standardized percent predicted pulmonary function values. The 38 asthmatics who participated in only one exposure study were more reactive compared to the 36 asthmatics who participated in ≥4 exposure studies. The 36 asthmatics participating in ≥4 exposure studies demonstrated no significant change in their standardized percent predicted pre-exposure pulmonary function over the 7 years of the study. These results indicate that stable asthmatics living in areas with intermittent Florida red tides do not exhibit chronic respiratory effects from intermittent environmental exposure to aerosolized brevetoxins over a 7 year period.