light and health: it is more than tunable white light! by mariana figueiro

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Designers Light Forum

Light and Health: It is more than tunable white light!

MarianaG.Figueiro,PhDLightingResearchCenter

RensselaerPolytechnicInstituteMarch28,2017

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LightandHealth:Itismorethantunablewhitelight!MarianaG.Figueiro,PhDMarch28,2017

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Credit(s)earnedoncompletionofthiscoursewillbereportedtoAIACESforAIAmembers.CertificatesofCompletionforbothAIAmembersandnon-AIAmembersareavailableuponrequest.

ThiscourseisregisteredwithAIACESforcontinuingprofessionaleducation.Assuch,itdoesnotincludecontentthatmaybedeemedorconstruedtobeanapprovalorendorsementbytheAIAofany

materialofconstructionoranymethodormannerofhandling,using,distributing,ordealinginanymaterialorproduct.___________________________________________Questionsrelatedtospecificmaterials,methods,andserviceswillbeaddressedattheconclusionofthispresentation.

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ThispresentationisprotectedbyUSandInternationalCopyrightlaws.Reproduction,distribution,displayanduseofthepresentationwithoutwrittenpermissionofthe

speakerisprohibited.

©Thenameofyourcompany2012

CopyrightMaterials

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Electriclightingsystemsengineeredtodeliver"healthy"lightingarefloodingthemarket,andsoareclaimsassociatedwithsuchproductsandtheirapplications.

Thistalkwillcoverwhatweknow,whatwedon'tknowandweneedtoknowtodeliverhealthylightingtovariouspopulations,fromprematureinfantstoAlzheimer’sdiseasepatients.

CourseDescription

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LearningObjectives

1. Understandbasicsofcircadiansystem

2.Undestandlightingcharacteristicsaffectingthecircadiansystem

3.Understandhowtocalculatecircadianstimulus

4.Understandwhatpopulationslighthasbeenshowntoaffectsleep,moodandbehavior

Attheendofthethiscourse,participantswillbeableto:

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LightingaffectsthreesystemsVisual+non-visual+message

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Distribution

Appearance Visual System Visual Performance

Performance, Well-being,

Satisfaction, and Comfort

Alerting Effects Non-Visual Systems Phase Shift

Amount Spectrum DurationDistribution Timing

Culture, Experience, Expectations

TimingSpectrum DurationAmount

LightingaffectsthreesystemsVisual

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Appearance Visual System Visual Performance

Performance, Well-being,

Satisfaction, and Comfort

Alerting Effects Non-Visual Systems Phase Shift

Amount Spectrum DurationDistribution Timing

Culture, Experience, Expectations

TimingSpectrum DurationAmount Distribution

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RelativevisualperformanceSize+Contrast+Illuminance+Age

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Luminancecontrast

Retinalilluminance

Visualsize

RVP

IESN

AHa

ndbo

okAppearance/BrightnessPerception

Warm 2700 K Cool 6500 K

Low 100 IxHigh 350 Ix r = 0.7

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Controloverglare,reflectionsandshadows

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Glare

Shadows

Reflection

PhotoResearchers

Encarta

DougM

artin

/PhotoResearchers,Inc

LightingaffectsthreesystemsMessage

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Appearance Visual System Visual Performance

Performance, Well-being,

Satisfaction, and Comfort

Alerting Effects Non-Visual Systems Phase Shift

Amount Spectrum DurationDistribution Timing

Culture, Experience, Expectations

TimingSpectrum DurationAmount Distribution

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Whatisthemessage?

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vs.

Perceptualsystem• Preferenceforview• Biophilia hypothesis

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LightingaffectsthreesystemsNon-Visual

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Appearance Visual System Visual Performance

Performance, Well-being,

Satisfaction, and Comfort

Alerting Effects Non-Visual Systems Phase Shift

Amount Spectrum DurationDistribution Timing

Culture, Experience, Expectations

TimingSpectrum DurationAmount Distribution

Circadiansystem• Plantsandanimalsexhibit

patternsofbehavioralandphysiologicalchangesoveranapproximately24-hourcyclethatrepeatoversuccessivedays—thesearecircadianrhythms

• circa=about;dies=day

• Circadianrhythmsareinfluencedbyexogenousandendogenousrhythms

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Lightistheprimarysynchronizerofcircadianrhythmstolocal

positiononEarth

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Light is the primary synchronizer of circadian rhythms to local position on Earth

The natural, 24-hour, light-dark cycle

light

retina

suprachiasmatic nucleus

hypothalamusthalamus

lateral geniculatenucleus

pineal gland

signals to body

optic nerve

24.2

AdaptedfromNationalLibraryofMedicineimage,2007(publicdomain)

…also the major disruptor

Circadiandisruptionandhealth• Circadian disruption has been associated with:

– Poorsleep,poorperformanceandhighstressEismann,E.A.,Lush,E.,&Sephton,S.E.(2010).Circadianeffectsincancer-relevantpsychoneuroendocrine andimmunepathways.Psychoneuroendocrinology,35(7),963-976.Gumenyuk,V.,Howard,R.,Roth,T.,Korzyukov,O.,Drake,C.L.(2014)Sleeploss,circadianmismatch,andabnormalitiesinreorientingofattentioninnightworkerswithshiftworkdisorder.Sleep.March1;37(3):545–556.

– IncreasedanxietyanddepressionDu-Quiton,J.,Wood,P.A.,Burch,J.B.,Grutsch,J.F.,Gupta,D.,Tyer,K.,...Reynolds,J.L.(2010).Actigraphic assessmentofdailysleep–activitypatternabnormalitiesreflectsself-assesseddepressionandanxietyinoutpatientswithadvancednon-smallcelllungcancer.Psycho-Oncology,19(2),180-189.

– IncreasedsmokingKageyama,T.,Kobayashi,T.,Nishikido,N.,Oga,J.,&Kawashima,M.(2005).AssociationsofsleepproblemsandrecentlifeeventswithsmokingbehaviorsamongfemalestaffnursesinJapanesehospitals.IndustrialHealth,43(1),133-141.

– CardiovasculardiseaseYoung,M.E.,&Bray,M.S.(2007).Potentialroleforperipheralcircadianclockdyssynchrony inthepathogenesisofcardiovasculardysfunction.SleepMedicine,8(6),656-667.Maemura,K.,Takeda,N.,&Nagai,R.(2007).CircadianrhythmsintheCNSandperipheralclockdisorders:roleofthebiologicalclockincardiovasculardiseases.JournalofPharmacologicalSciences,103(2),134-138.

– Type2diabetesKreier,F.,Kalsbeek,A.,Sauerwein,H.P.,Fliers,E.,Romijn,J.A.,&Buijs,R.M.(2007).“Diabetesoftheelderly”andtype2diabetesinyoungerpatients:Possibleroleofthebiologicalclock.ExperimentalGerontology,42(1),22-27.

– HigherincidenceofbreastcancerSchernhammer,E.S.,Laden,F.,Speizer,F.E.,Willett,W.C.,Hunter,D.J.,Kawachi,I.,&Colditz,G.A.(2001).RotatingnightshiftsandriskofbreastcancerinwomenparticipatingintheNurses'HealthStudy.JournaloftheNationalCancerInstitute,93(20),1563-1568.Hansen,J.(2006).Riskofbreastcancerafternight-andshiftwork:currentevidenceandongoingstudiesinDenmark.CancerCauses&Control,17(4),531-537.

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LightingaffectsthreesystemsVisual+non-visual+message

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Distribution

Appearance Visual System Visual Performance

Performance, Well-being,

Satisfaction, and Comfort

Alerting Effects Non-Visual Systems Phase Shift

Amount Spectrum DurationDistribution Timing

Culture, Experience, Expectations

TimingSpectrum DurationAmount

Lighting characteristicsSpectral and absolute sensitivities

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Absolute sensitivity

Rea, M. S., Figueiro, M. G., Bullough, J. D., & Bierman, A. (2005). A model of phototransduction by the human circadian system. Brain Research Reviews, 50(2), 213-228.

Rea, M. S., Figueiro, M. G., Bierman, A., & Hamner, R. (2012). Modelling the spectral sensitivity of the human circadian system. Lighting Research and Technology, 44(4), 386-396.

Spectral sensitivityoutdoors

nightindoorshome

indoorsoffice

outdoors daytime

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LightingcharacteristicsTiming

• Lightcanchangethetimingofsleepandeitherpromoteentrainmentorcausedisruption– Morninglight(afterminimumcore

bodytemperature)willadvancethetimingofsleep

– Eveninglight(beforeminimumcorebodytemperature)willdelaythetimingofsleep

– But,everyphotoncounts!

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Rajaratnam S,ArendtJ.Healthina24-hSociety.TheLancet.2001;358(9286):999-1005.

Figueiro,MG.Delayedsleepphasedisorder:clinicalperspectivewithafocusonlighttherapy. NatureandScienceofSleep2016;8:91-106.

Ourworkinghypothesis• Tailoredlightinginterventiondesignedtopromote

circadianentrainmentcanimprovesleep,mood,andbehaviorinvariouspopulations– SufferersfromSeasonalDepression– Officeworkers– Submariners– Teenagerswithdelayedsleeponset– Olderadultswithearlysleeponset– Alzheimer’sdiseaseandrelateddementiapatients– Cancerpatientsexperiencingfatigueandsleepdisturbances

• Tailoredinterventiondesignedtopromotealertnessindayshiftandnightshiftworkers

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• Circadianstimulus:Metricforquantifyingeffectivenessoflightsourcesforactivatingthecircadiansystem

• CSisequivalenttopercentmelatoninsuppressionafter1-hexposuretothelightsource– Anindicationofhoweffectivethe

lightsourceisforthecircadiansystem– Caveat:doesnottakeintoaccount

durationofexposure,photichistoryandisbasedonacutemelatoninsuppression(notphaseshiftingoftheclock)

• Threshold=0.1CS;halfmax=0.3CS;saturation=0.7CS

Specificationofthelightstimulus

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CalculatingCS• Importantconsiderations:

– VerticalIlluminance(lightattheplaneofthecornea)– Lightlevel– Spectrum– Timinganddurationofexposure– Photichistory

• ExposuretoCSof0.3orgreaterattheeye,foratleast1hourintheearlypartoftheday,iseffectiveforstimulatingthecircadiansystem

• CScalculatorwasdevelopedtoaiddesignersandspecifiersinselectinglightsourcesthathasthepotentialforaffectingthecircadiansystem

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http://www.lrc.rpi.edu/resources/CircadianStimulusCalculator_30Apr2016.xlsx

ImportantConsiderations:Lightatthecornea

• Whendesigningforcircadianhealth,lightattheplaneofthecorneabecomestheprimarytarget

• Theratioofhorizontalilluminancetoverticalilluminancebecomesimportantwhenlookingattheopticofafixture

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ImportantConsiderations:LightlevelandSpectrum

• LowerlightlevelswillachieverelativelylowerCSvaluesunlesscompensatedforbyanSPDwithmorepoweratshorterwavelengths

• Maintainingasinglecorrelatedcolortemperature(CCT)throughoutthedayandachievingchangesinCSvaluesispossiblebysimplyincreasingordecreasinglightlevel

• It’simportanttorequesttheSPDfromthemanufacturerforanyfixturesbeingconsidered.SPDscanvaryforasingleCCT

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ImportantConsiderations:LightlevelandSpectrum

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ImportantConsiderations:Timingandduration

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Exampleofarecommendedscheduleforaseniorcarefacility.

w Carefullyconsiderwhowillbeoccupyingthespace.› Schoolsandnursinghomeswillhaveoccupantsthatrequirecircadianstimulationatdifferenttimes.

w While0.3isagoodminimumCSforstimulatingthecircadiansystem,timingofexposurematters!

Tailoredlightinginterventiondesignedtopromotecircadianentrainment

• Promoteentrainmentinvariouspopulationsby– Deliveringhighcircadianstimulus(CS>0.3)duringtheday,especiallyinthemorning,andlowCS(CS<0.1)intheevening,topromoteentrainmentinAlzheimer’sdiseasepatients,olderadultswithearlysleeponset,adolescents,prematureinfants,cancerpatientsundergoingtreatment)

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Circadianentrainmentinadolescents

• USGBCresearchgrant– Lightimpactsstudents’performanceandwell-beingbypromotingtheircircadianentrainmenttothesolarday

– Performed3fieldstudies• Demonstratedthatlackofmorningcircadianlightdelaysdimlightmelatoninonset,whichcandelaysleeponset

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Sponsor: USGBCFigueiroMGandReaMS.Lackofshort-wavelengthlightduringtheschooldaydelaysdimlightmelatoninonset(DLMO)inmiddleschoolstudents.NeuroEndocrinology Letters.2010;31:4.FigueiroMG,Brons J,Plitnick B,Donlan B,LeslieR,andReaMS.2011.Measuringcircadianlightanditsimpactonadolescents.LightingResearchandTechnology(LR&T)43(2):201-215.FigueiroMGandReaMS.2010.Eveningdaylightmaycauseadolescentstosleeplessinspringthaninwinter.ChronobiologyInternational27(6):1242-58.

CircadianentrainmentinadolescentsImpactofcomputerscreensonmelatoninlevels

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0%

10%

20%

30%

40%

50%

1hour 2hour

Melatoninsuppression

PredictedsuppressionfromDaysimeterdata:10%Actualsuppression:25%

FigueiroandOverington,2015

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Circadianentrainmentinprematureinfants• Prematureinfants

– Increasedweightgainandreduceddaysinventilatorinprematureinfantswhoreceivedcycledlightcomparedtothosewhoreceivedeitherconstantlightorconstantdarkness

– Improvedsleepandcircadianrhythmsafterdischargeinprematureinfantswhoreceivedcycledlightcomparedtothosewhoreceivedeitherconstantlightorconstantdarkness

• LRCisworkingwithneonatologisttodevelopalightblanketthatcanbeplacedontopofincubator– Delivercycledlight– Goodcolorrendering– Examinationlight– Cameraforparentstomonitorinfants

fromafar33

Circadianentrainmentinpersonswithdementia

• Studytestedtheeffectivenessofatailoredlighttreatmentonsleepquality,agitationanddepressionin14patientswithAlzheimer’sdiseaseandrelateddementiaslivinginnursinghomes

• Highcircadianstimulation(CS>0.3)duringdaytime• 300-400luxatthecorneafromwakingto6pm• Bluish-whitelight,CCT>9000K

• Resultsshowedincreaseinsleepefficiency,totalsleeptime,reductioninagitationanddepression

34Sponsor:NationalInstituteonAging(R01AG034157)

Figueiroetal.2014

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Circadianentrainmentinpersonswithdementia• Exposed6subjectstolighttable

(CS>0.4)for4weeks• Resultsshowedasignificant

increaseinsleepefficiencyandduration

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Sponsor:NationalInstituteonAging(R01AG034157)Figueiro M, Plitnick B and Rea M. Research Note: A self-luminous light table for persons with Alzheimer’s disease. Light Res Technol. 2015: 1477153515603881.

Circadianentrainmenttoreducefatigueincancerpatients

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Patients:Breastandgynecologicalcancersurvivorswithclinicallysignificantfatigue

Protocol:30-minexposuretomorninglightatbaseline(aftercompletionofchemo),4weeksafterinterventionand3weeksaftercompletionofthelightintervention

Lightintervention:30mininfrontofalightboxwithin30minofwaking.Comparison:dimredlight

Results:Significantimprovementinfatiguesymptomsinthelightcondition

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Circadianentrainmenttoreducefatigueinbonemarrowtransplantpatients• IncollaborationwithDr.WilliamRedd (OncologicalSciences),weareinvestigatingtheimpactofaCSof0.3duringthemorninghourson:– Circadianmarkers(melatonin)– Fatigue– Depression– Sleep

37 Sponsor:NationalCancerInstitute,PI:Dr.Redd

Otherapplicationstolookoutfor• Usinglighttoreduce

– SleepdisturbancesinVeteranswithPTSD– Postpartumdepressionsymptoms– DeliriuminICUpatients– SleepandfatigueinParkinson’sdiseasepatients

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Tailoredinterventiondesignedtopromotealertnessindayshiftandnightshiftworkers

Promoteacutealertness(e.g.=cupofcoffee)

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Sponsor:OfficeofNavalResearch(N00014-11-1-0572)NIOSH/CDC

Lightingfornightshiftworkers

• Studiesshowedthatredlight,whichdoesnotsuppressnocturnalmelatonincan:– Improvesubjectiveandobjectivemeasuresofalertness– Improvecertaintypesofperformance,similartowhitelight

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Sponsor: Office of Naval Research

Figueiro MG, Sahin L, Wood B and Plitnick B. Light at night and measures of alertness and performance: Implications for shift workers. Biological Research for Nursing. 2014; In Press.

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Lightingfordayshiftworkers

• Studiesshowedthatredlightduringpost-lunchdip:– Improvessubjectiveandobjectivemeasuresofalertness– Improvescertaintypesofperformance

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Sponsor:OfficeofNavalResearch(N00014-11-1-0572)

Sahin L, Wood BM, Plinick BA, Figueiro MG. Daytime light exposure: Effects on biomarkers, measures of alertness, and performance. Behavioral Brain Research, 2014, 274:176-185.

Tipsfordesigningforcircadianhealth

• Thinkaboutlayers oflight!– SomedesignersorspecifiersmayhavestrictenergyrestrictionsthatpreventCStargetsfrombeingmet.

• Considerusingsaturatedblue(e.g.,peakwavelength=470nm)LEDsasawaytoboostCSincreativeways.

– Studieshaveshownthatredlightcanhaveanacutealertingeffectwithoutsuppressingmelatonin.

• Considerusingredlightasawaytoboostalertnessforoccupants.

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LightingPatternsforHealthyBuildings

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w TheLRChasdevelopedawebsitedetailinglightingdesignpatternsfor:› 24-hlightingschemeforseniors’facilities

http://lightingpatternsforhealthybuildings.org/

Summary• LightpromotesentrainmenttothelocaltimeonEarth

– Short-wavelength(blue)lightismaximallyeffective;– Whitelightathigherlightlevelsthanneededforvisionis

needed;– Redlightisnoteffective

• Morninglightis“good”buteveninglightshouldbeavoided– Needtokeeptrackoftotallightexposures

• Lighthasanacutealertingeffectonpeople– Brainactivities– Biomarkersotherthanmelatoninlevels– Anycoloroflightiseffective– Mechanismsarenotwelldefined;needtodevelopaspectral

sensitivity

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Thankyou.

www.lrc.rpi.eduhttp://lightingpatternsforhealthybuildings.org/

http://www.lrc.rpi.edu/resources/CircadianStimulusCalculator_30Apr2016.xlsx

ThisconcludesTheAmericanInstituteofArchitectsContinuingEducationSystemsCourse

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Acknowledgmentsv Organizersoftheevent

Ø GaryMannv LightingResearchCenter’sfaculty,staffandstudents

Ø MarkS.Rea,PhDØ BarbaraPlitnick,RNØ SharonLesageØ Kassandra Gonzalez,MSØ RyanBrommØ AndrewBierman,MSØ GeoffJonesØ DennisGuyonØ DavidPedlerØ Rohan NagarØ CharlieRoohanØ RyanKutler

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LightandHealthProjectSponsorsv NationalInstituteonAgingv NationalInstituteonDrugAbusev NationalInstituteofNursingResearchv NationalCancerInstitutev NationalCenterforComplementaryandAlternativeMedicinev EuniceShriverNationalInstituteofChildHealthandDevelopmentv NationalInstituteofOccupationalandSafetyHealth(CDC/NIOSH)v GeneralServicesAdministration(USGSA)v USDepartmentofStatev OfficeofNavalResearchv USNavyv USGreenBuildingCouncilv TheSwedishEnergyAgencyv Boeingv Googlev AcuityBrands

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LightandHealthAllianceSponsorsAcuityBrands,Cree,CurrentPoweredbyGE,Ketra,PhilipsLighting,OSRAM,USAILighting

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The Light and Health Alliance is a collaboration among Members (manufacturers, government organizations and NGOs, codes and standards bodies) and practitioners, including architects, specifi ers, medical facility managers and physicians, to enable the broad adoption of lighting for human health by producing factual information based on basic and applied research and by visualizing future applications.

Goals • Conduct evaluations, demonstrations, and research

projects to develop practical devices and applications.• Institutes to educate key audiences on light and health

with a particular emphasis on developing quantitative lighting specifi cations.

• Presentations at conferences to promote the topic of light and health, and the Light and Health Alliance.

MissionTo bridge the science of light and health to practical applications, and to provide objective information based on basic and applied research.

Member Benefi ts• Meetings to inform Members of our latest research

activities, and discussions that would advance attention to light and health in the public sector.

• Forums to provide an intellectual and physical meeting place — a neutral ground for Members and practitioners to share important insights.

• Infl uence to shape the research agenda.• Early presentations of research results.• Generation of pilot data — an essential requirement

for funding from the National Institutes of Health.• Confi dential research sponsored under separate

contract and IP agreement.

Cost: $30k per year; $20k per year for LRC Partners. A 3-year commitment provides an additional $5,000 discount per year. The LRC will establish and publically announce the alliance after three sponsors join.

21 Union Street, Troy, NY 12180518-687-7100

www.lrc.rpi.eduContact: Mariana G. Figueiro, PhD

fi guem@rpi.edu

www.lrc.rpi.edu/programs/lightHealth/index.asp

Light and Health Alliance

MissionTobridgethescienceoflightandhealthtopracticalapplications,andtoprovideobjectiveinformationbasedonbasicandappliedresearchGoals:• Conductevaluations,demonstrations,and

researchprojectstodeveloppracticaldevicesandapplications

• Institutestoeducatekeyaudiencesonlightandhealthwithaparticularemphasisondevelopingquantitativelightingspecifications

• Presentationsatconferencestopromotethetopicoflightandhealth,andtheLightandHealthAlliance

Projectcollaborators• Mt.SinaiIcahnSchoolofMedicine• BrownUniversity• YaleUniversity• CaseWesternReserveUniversity• UniversityofNorthCarolina,ChapelHill• HarvardUniversitySchoolofPublicHealth• SkidmoreCollege• DukeUniversity• NationalInstituteonDrugAbuseIntramuralResearch• NetherlandsInstituteforNeuroscience• CornellUniversity• NavalSubmarineMedicalResearchLaboratory

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