Search NASA⌕ Search

SEARCH · Search NASA

Results for “Health care”

Search indexed NASA NTRS and DOE OSTI research on propulsion, heat transfer, battery materials and energy systems. Follow report and document links to the original sources.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 199 records · Page 11

Use of Event-Time Embeddings via RNN to Discern Novel Event Sequences in EHRs

In highly configurable health information technology (HIT) systems, such as VistA of the Veterans Health Administration, the variations in how the system is used among different healthcare facilities and how the data are recorded can be significant. Despite the successful standardization of care efforts, some of these variations can be indicative of HIT hazards and demand further investigation. In this work, we implemented a recurrent neural network (RNN) architecture to learn clinical provider order sequences and their temporal dynamics while predicting the orders' terminal state. We demonstrate model performance and provide a use case for the model discerning novel event sequences. This model is proposed to find novel event sequences in an operational environment.

Ozmen, Ozgur↗

Empowering Women in Biomedical Informatics: Pivoting for Success in the Post-Pandemic World

The COVID-19 pandemic and the isolation measures implemented to contain its spread have exacerbated pre-existing barriers to advancement for women in biomedical informatics. In 2020, the Women in AMIA (WIA) Networking, Mentoring, and Lifecycle Committee administered a survey to identify resources and needs to assist women in informatics. Part of this survey identified several factors impacted by the pandemic: 1) work-life boundaries disappeared and caring for family while working from home became increasingly challenging; 2) isolation, stress and safety of well-being was heightened during the pandemic impacting physical and mental health; 3) diverse working environment and modality brought unforeseen challenges in collaborations and unified communications. These challenges present an opportunity for promoting career development for women professionals in biomedical informatics. This WIA-sponsored panel brings together leaders in the field to highlight their personal experiences and strategies to support women professionals.

Dua, Prerna↗

Canonsburg, Pennsylvania, UMTRCA Title I Disposal Site 35 Years Postclosure (1985-2020) - 20288

The DOE Office of Legacy Management (LM) Canonsburg, Pennsylvania, Disposal Site is a former uranium ore-processing site located in the borough of Canonsburg and an important part of US history. For 46 years (1911-1957), the site processed ore, for vanadium, radium and then uranium. Soils and groundwater beneath the site were contaminated by the milling operations. The 15-hectare (37-acre) site is owned by the US government and managed by LM, which serves as the federal land manager and steward of cultural, historical, and natural resources at Cold War legacy sites that have been successfully cleaned up to remedial standards. In 1978 Congress directed DOE to remediate 22 inactive uranium-ore processing sites under the Uranium Mill Tailings Radiation Control Act (UMTRCA), in accordance with standards promulgated by the US Environmental Protection Agency in Title 40 CFR Part 192 (40 (CFR 192). Subpart B of 40 CFR 192 regulates the cleanup of contaminated groundwater at the processing sites. The radioactive materials were encapsulated in US Nuclear Regulatory Commission (NRC)-approved disposal cells, and the NRC general license for UMTRCA Title I sites is established in 10 CFR 40.27. Canonsburg was the first site to be remediated under UMTRCA. From 1983 to 1985, the Canonsburg site underwent cleanup under this US law that provides for the safe and environmentally sound disposal, long-term stabilization, and control of uranium mill tailings in a manner that minimizes or eliminates radiation health hazards to the public. The site is unique in that it is one of only two UMTRCA Title I sites in the eastern half of the United States, the other site being the Burrell, Pennsylvania, Title I Disposal Site, a vicinity property to the Canonsburg site. It has been 35 years since the disposal cell at the Canonsburg site was completed. This paper discusses the many efforts that have been taken to maintain the site and presents some of the lessons learned concerning the long-term care of the site. The discussion includes but is not limited to the following: (1) Preserving site history so the community can better appreciate and understand the site. (2) Community outreach efforts, and the importance of maintaining transparency of environmental monitoring results with the community. (3) Pursuing reuse opportunities that offer the potential for improving the community. (4) Remaining engaged with the local community. (5) Remaining proactive in the long-term care of the site. (authors)

12 MANAGEMENT OF RADIOACTIVE AND NON-RADIOACTIVE W↗

Arctic sea-ice loss drives a strong regional atmospheric response over the North Pacific and North Atlantic on decadal scales

Previous studies have suggested that Arctic sea-ice loss can have a profound influence on atmospheric circulation far away from the Arctic. However, there is little scientific consensus on the features of these remote responses, with the opposite impacts reported. Here we present a multi-model analysis of the decadal climate response to Arctic sea-ice loss using state-of-the-art energy conserving methodologies to isolate the impacts of sea-ice decline. We observe weakening of the Aleutian Low and development of a geopotential ridge in the North Pacific, associated with drier winter conditions over the southwest United States. Over the Atlantic, a negative NAO-like response drives wetter winter conditions across the western Mediterranean. These decadal-scale impacts substantially differ from reported centennial-scale responses to Arctic sea-ice loss simulated using non-energy conserving methodologies. Factors such as the timescale of the response and methodologies used to isolate the impacts of disappearing sea-ice cover should be carefully considered when consolidating scientific understanding on the future impacts of changing Arctic.

54 ENVIRONMENTAL SCIENCES↗

Geospatial analysis of preterm and small-for-gestational age births in Washington D.C.

Background: This study is based on the recognition that adverse pregnancy outcomes significantly affect maternal and infant health, leading to increased morbidity and mortality. These outcomes are shaped by a complex interplay of individual-level factors—like maternal age and education—and community-level influences, including socio-economic status and access to healthcare. Understanding these determinants is crucial for developing effective public health strategies, especially for marginalized populations, by identifying high-risk areas and informing targeted interventions that address both individual and structural barriers. Methods: We utilized geospatial analysis to explore the association between individual- and community-level factors and adverse pregnancy outcomes, specifically preterm birth (PTB) and small-for-gestational-age (SGA) birthweight in Washington, D.C. We used Empirical Bayes smoothing methods to calculate rates of adverse birth outcomes from 2010 to 2018 at the U.S. Census tract–level. Spatial scan statistics were used to investigate if adverse birth outcomes clustered in specific areas. ANOVA tests were conducted for individual- and community-level factors within identified clusters. Results: Spatial analysis identified significant high-risk clusters for PTB and SGA infants primarily in southeastern Washington, D.C., particularly in Wards 7 and 8. Individuals residing within these clusters experienced a 47% increased risk of PTB (RR = 1.467) and a 56% increased risk of SGA (RR = 1.560) compared to those outside clusters. Space–time analysis revealed temporal variation, with PTB clusters persisting from 2011 to 2014 and SGA clusters extending through 2017. Compared to low-risk clusters, high-risk clusters had younger birthing individuals (mean age ~26.5 vs. ~33 years), lower maternal college degree attainment (~20% vs. ~80%), higher rates of late or no prenatal care (~16% vs. 11%), and increased prevalence of smoking and hypertension (all P < 0.001). Community-level indicators showed lower median household incomes ($\$40,000$ vs. ~$\$105,000$), greater poverty (~16% vs. ~7% below $\$10,000$/year), higher public assistance use (~32% vs. ~5%), and reduced healthcare access (greater distances to emergency and specialty care) in high-risk areas (all P < 0.001). Neighborhood deprivation indices were significantly elevated, commutes were longer, and population density was lower in these clusters. These findings highlight that adverse birth outcomes cluster in neighborhoods with pronounced socioeconomic and health disparities. Conclusion: High-risk birth clusters highlight intertwined factors: individual, socio-economic, and geographic. Addressing these requires comprehensive interventions focusing on social and structural determinants of health.

Birth outcomes↗

Research Reactors Division Infrastructure Investment Plan for the High Flux Isotope Reactor

The High Flux Isotope Reactor (HFIR) is a unique national asset. Operational for nearly 60 years, continued investment into the aging infrastructure is necessary to ensure operation for another 6 decades. Additionally, growing missions require HFIR as well as important upgrades. Consequently, carefully integrated planning is required to ensure that infrastructure investments are timely executed to ensure long-term, reliable operation of HFIR. Concerns about challenges to the operational reliability of HFIR resulted in a recommendation from the 2023 Operations Review by the US Department of Energy (DOE) Office of Basic Energy Sciences that a HFIR management strategy be developed to address the infrastructure needs. This report defines the investment needs, which are evolving as new upgrade efforts are better defined. HFIR is part of the three-source strategy within the Neutron Sciences Directorate (NScD) and contributes to the five strategic science areas outlined in the NScD 10 Year Strategic Science Plan: quantum materials, soft matter, materials and engineering, chemistry, and biosciences. Fundamental to this strategy are three core values: operational excellence, responsible stewardship, and servant leadership. These values guide our mission of safe and reliable operation of the reactor and require a strong and just nuclear safety culture, a solemn respect for responsible care of the facility, good workforce development, robust procedures and processes, an effective communication strategy, world-class asset management, a determined customer focus, and a commitment to protecting the environment, the safety and health of the public and our people, and the quality of work performed within our facility. These principles are all essential to operate HFIR at a world-class level. The Research Reactors Division (RRD) will lead a new era of neutron science and isotope production at HFIR through responsible and purposeful leadership and unwavering support of the science community. The approach outlined in this plan highlights the direction leadership is taking to ensure that HFIR is ready to support the science challenges and national needs of the future and that the United States maintains world leadership in neutron sciences. The plan is in alignment with the DOE’s desire to continue operating HFIR and with the NScD strategic science goals for the future. HFIR is an aging facility with numerous infrastructure challenges and needs. It has an aging workforce in relation to the general population of Oak Ridge National Laboratory (ORNL), with many expected retirements over the next 5–10 years. With an increase in work scope caused by changing national priorities and science goals, several critical hires have been identified. To manage HFIR’s infrastructure needs, a prioritized list of equipment upgrades has been identified along with an analysis of future staffing requirements. A desire to operate HFIR at eight cycles per year will necessarily require some significant changes to procedures and processes currently in place as well as targeted staffing additions. Many of the equipment upgrades identified in this plan will significantly increase the reliability of the plant, thus contributing to the effort to reach the goal of safely operating eight cycles per year. A plan to attain eight-cycle operation is being prepared in parallel with the activities identified in this plan, although the actions identified to satisfy both plans will overlap. This plan identifies new infrastructure needs—for both plant equipment and staffing—thus necessitating formulation of future budget requests to fund the increased work scope and improvement activities. Some activities are currently being scheduled with the expectation that funding will be received. Any delays to funding or reductions of funding from the identified cost estimations will directly and negatively affect the plan’s implementation.

21 SPECIFIC NUCLEAR REACTORS AND ASSOCIATED PLANTS↗

Machine Learning in Infectious Disease for Risk Factor Identification and Hypothesis Generation: Proof of Concept Using Invasive Candidiasis

Machine learning (ML) models can handle large data sets without assuming underlying relationships and can be useful for evaluating disease characteristics, yet they are more commonly used for predicting individual disease risk than for identifying factors at the population level. We offer a proof of concept applying random forest (RF) algorithms to Candida-positive hospital encounters in an electronic health record database of patients in the United States. Candida-positive encounters were extracted from the Cerner HealthFacts database; invasive infections were laboratory-positive sterile site Candida infections. Features included demographics, admission source, care setting, physician specialty, diagnostic and procedure codes, and medications received before the first positive Candida culture. We used RF to assess risk factors for 3 outcomes: any invasive candidiasis (IC) vs non-IC, within-species IC vs non-IC (eg, invasive C. glabrata vs noninvasive C. glabrata), and between-species IC (eg, invasive C. glabrata vs all other IC). Fourteen of 169 (8%) variables were consistently identified as important features in the ML models. When evaluating within-species IC, for example, invasive C. glabrata vs non-invasive C. glabrata, we identified known features like central venous catheters, intensive care unit stay, and gastrointestinal operations. In contrast, important variables for invasive C. glabrata vs all other IC included renal disease and medications like diabetes therapeutics, cholesterol medications, and antiarrhythmics. Known and novel risk factors for IC were identified using ML, demonstrating the hypothesis-generating utility of this approach for infectious disease conditions about which less is known, specifically at the species level or for rarer diseases.

60 APPLIED LIFE SCIENCES↗

A Case Study of Tunable White LED Lighting with Networked Lighting Controls (Emory University Cognitive Empowerment Program)

Emory University and Georgia Institute of Technology (Georgia Tech) partnered to create the Charlie and Harriet Schaffer Cognitive Empowerment Program (CEP) facility in northeast Atlanta. Together with the funders they are building a program to help individuals experiencing mild cognitive impairment (MCI) to maintain their physical and cognitive health, and independence as long as possible. In addition to applying effective strategies and therapies, the two research groups are investigating the responses of the MCI members to treatments that involve acoustical conditions, exercise and movement, and lighting changes that may support retention or relearning of skills. Care partners and family members receive support and instruction to improve home and work life, promoting joy, purpose, and wellness in the family groups. The lighting system uses tunable-white LEDs, employing luminaires with both warm and cool-color emitters that can be dimmed separately to produce any white correlated color temperature (CCT) between 2700 K and 6500 K. All luminaires were dimmable to achieve subdued or lively surroundings for different treatments, time-of-day, and mood. A central networked digital control system was employed to allow tuning of multiple spaces together (for example, bright, cool morning light could be programmed for extra stimulation, or lighting in all spaces at the end of the day could be reduced in both light output and CCT to promote relaxation and not interfere with the melatonin cycle of occupants). Almost all spaces were equipped with individual room control of dimming and color temperature with touch screens to allow users to tune the lighting as desired, but each room’s controls could also be specially programmed through the server in case the research staff were investigating lighting settings on learning, for example. The server incorporates a timeclock, and it is able to send signals to switch off all lighting after occupancy hours, or enable occupancy sensors to control the lighting. The bulk of the construction work was completed in January 2020. It was clear from an initial walk-through that although the lighting system produced the expected high light level with low-glare qualities of light, that there were issues and inconsistencies to be resolved. These were noted in an initial punchlist visit and expected to be resolved when the tech representatives from the agency visited with the electrical contractor in the following few weeks. What followed was 2.5 years of identifying unexpected lighting performance in terms of light output, color, scheduling, and occupancy. This report documents the issues encountered in the effort to get the lighting and controls systems to operate as intended. It concludes with guidance for design professionals and manufacturers to help avoid problematic complexity in future projects.

42 ENGINEERING↗

Leveraging BERT and Network-Based Attention Analysis for Identifying Treatment Milestones in EHRs

This study introduces a sophisticated data-driven framework for analyzing Electronic Health Records (EHRs) using transformer-based models to identify and disentangle overlapping treatment contexts. The framework leverages a preprocessing pipeline that transforms structured procedural codes into semantically enriched descriptive text, enabling the use of attention mechanisms to cluster medical events into treatment milestones—cohesive and distinct components of care processes. The methodology is rigorously validated using synthetic datasets derived from the MIMIC-III database, designed to simulate the heterogeneity and overlapping procedural contexts characteristic of real-world EHR scenarios. Quantitative evaluation highlights the framework’s robustness in disentangling concurrent care pathways, with attention metrics and unsupervised clustering approaches demonstrating the ability to preserve intra-context relationships while distinguishing inter-context dependencies. By addressing challenges inherent in data heterogeneity, this approach provides a foundation for uncovering complex treatment patterns, advancing clinical decision-making, and optimizing resource allocation in diverse healthcare environments.

Kim, Minsu [ORNL] (ORCID:0000000224185535)↗

DFT calculations and theory do not support enantiospecificity in NMR J-coupling constants

Distinguishing the enantiomers of small organic molecules is an industrially relevant problem with important implications for the health of the population. In a recent publication, Bouchard and co-workers have suggested that large differences in indirect spin-spin (J) coupling constants between enantiomers are possible. A close inspection of their work revealed significant flaws in their density functional theory (DFT) calculations and that the reported effects disappear with appropriate care. We thus conclude that enantiospecificity in spin-spin coupling constants has not be demonstrated either experimentally or theoretically.

Perras, Frédéric A. [Ames Laboratory (AMES), Ames,↗

Integrated Fuel Cycle Materials and Chemistry Program (FY21 Plutonium Science Task Report)

Task 2 of the IFCMCP was designed to utilize vibrational spectroscopy, microscopy, X-ray diffraction, and calorimetry to explore the spectroscopic, structural, and chemical properties of plutonium compounds relevant to the nuclear fuel cycle. An important precursor to this work is production of fresh, high-quality plutonium samples. Given the health hazards and material accountability associated with plutonium, sample production is not trivial and production experiments require extensive planning and coordination by research and support staff. Further, because alpha-emissions from plutonium produce time- and dose dependent radiolysis resulting in structural defects, particularly in the presence of water, freshly prepared plutonium samples must be carefully packaged and analyzed with urgency following their production. In FY21, SRNL and UND engaged in numerous research studies involving production and subsequent characterization of plutonium dioxide, plutonium fluoride, plutonium oxalate, and plutonium nitrate. Specific efforts involving each of these compounds are described in detail in the body of this report.

11 NUCLEAR FUEL CYCLE AND FUEL MATERIALS↗

COVID-19 Outcomes by Cancer Status, Site, Treatment, and Vaccination

Background: Studies have shown an increased risk of severe SARS-CoV-2–related (COVID-19) disease outcome and mortality for patients with cancer, but it is not well understood whether associations vary by cancer site, cancer treatment, and vaccination status. Methods: Using electronic health record data from an academic medical center, we identified a retrospective cohort of 260,757 individuals tested for or diagnosed with COVID-19 from March 10, 2020, to August 1, 2022. Of these, 52,019 tested positive for COVID-19 of whom 13,752 had a cancer diagnosis. We conducted Firth-corrected logistic regression to assess the association between cancer status, site, treatment, vaccination, and four COVID-19 outcomes: hospitalization, intensive care unit admission, mortality, and a composite “severe COVID” outcome. Results: Cancer diagnosis was significantly associated with higher rates of severe COVID, hospitalization, and mortality. These associations were driven by patients whose most recent initial cancer diagnosis was within the past 3 years. Chemotherapy receipt, colorectal cancer, hematologic malignancies, kidney cancer, and lung cancer were significantly associated with higher rates of worse COVID-19 outcomes. Vaccinations were significantly associated with lower rates of worse COVID-19 outcomes regardless of cancer status. Conclusions: Patients with colorectal cancer, hematologic malignancies, kidney cancer, or lung cancer or who receive chemotherapy for treatment should be cautious because of their increased risk of worse COVID-19 outcomes, even after vaccination. Impact: Additional COVID-19 precautions are warranted for people with certain cancer types and treatments. Further, significant benefit from vaccination is noted for both cancer and cancer-free patients.

60 APPLIED LIFE SCIENCES↗

Association between long-term exposure to ambient air pollution and COVID-19 severity: a prospective cohort study

The tremendous global health burden related to COVID-19 means that identifying determinants of COVID-19 severity is important for prevention and intervention. We aimed to explore long-term exposure to ambient air pollution as a potential contributor to COVID-19 severity, given its known impact on the respiratory system. Methods: We used a cohort of all people with confirmed SARS-CoV-2 infection, aged 20 years and older and not residing in a long-term care facility in Ontario, Canada, during 2020. We evaluated the association between long-term exposure to fine particulate matter (PM 2.5 ), nitrogen dioxide (NO 2 ) and ground-level ozone (O 3 ), and risk of COVID-19-related hospital admission, intensive care unit (ICU) admission and death. We ascertained individuals’ longterm exposures to each air pollutant based on their residence from 2015 to 2019. We used logistic regression and adjusted for confounders and selection bias using various individual and contextual covariates obtained through data linkage. Results: Among the 151105 people with confirmed SARS-CoV-2 infection in Ontario in 2020, we observed 8630 hospital admissions, 1912 ICU admissions and 2137 deaths related to COVID-19. For each interquartile range increase in exposure to PM 2.5 (1.70 µg/m 3 ), we estimated odds ratios of 1.06 (95% confidence interval [CI] 1.01–1.12), 1.09 (95% CI 0.98–1.21) and 1.00 (95% CI 0.90–1.11) for hospital admission, ICU admission and death, respectively. Estimates were smaller for NO 2 . We also estimated odds ratios of 1.15 (95% CI 1.06–1.23), 1.30 (95% CI 1.12–1.50) and 1.18 (95% CI 1.02–1.36) per interquartile range increase of 5.14 ppb in O 3 for hospital admission, ICU admission and death, respectively.

60 APPLIED LIFE SCIENCES↗

Oral microbiome and mycobiome dynamics in cancer therapy-induced oral mucositis

Cancer therapy-induced oral mucositis is a frequent major oncological problem, secondary to cytotoxicity of chemo-radiation treatment. Oral mucositis commonly occurs 7–10 days after initiation of therapy; it is a dose-limiting side effect causing significant pain, eating difficulty, need for parenteral nutrition and a rise of infections. The pathobiology derives from complex interactions between the epithelial component, inflammation, and the oral microbiome. Our longitudinal study analysed the dynamics of the oral microbiome (bacteria and fungi) in nineteen patients undergoing chemo-radiation therapy for oral and oropharyngeal squamous cell carcinoma as compared to healthy volunteers. The microbiome was characterized in multiple oral sample types using rRNA and ITS sequence amplicons and followed the treatment regimens. Microbial taxonomic diversity and relative abundance may be correlated with disease state, type of treatment and responses. Identification of microbial-host interactions could lead to further therapeutic interventions of mucositis to re-establish normal flora and promote patients’ health. Data presented here could enhance, complement and diversify other studies that link microbiomes to oral disease, prophylactics, treatments, and outcome.

60 APPLIED LIFE SCIENCES↗

Travel Time to Radiation Oncology Facilities in the United States and the Influence of Certificate of Need Policies

Radiation therapy often requires weeks of daily treatment making travel distance a known barrier to care. However, the full extent and variability of travel burden, defined by travel time, across the nation is poorly understood. Additionally, some states restrict radiation oncology (RO) services through Certificate of Need (CON) policies, but it is unknown how this affects travel times to care. Therefore, we aim to evaluate travel times to US RO facilities and assess the association with CON policies.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

Stakeholder-Engaged Structured Decision Making for the Los Alamos Legacy Cleanup Mission - 20501

The Los Alamos National Laboratory (LANL) environmental legacy cleanup program requires decisions to be made for environmental remediation, decommissioning and disposal or management of radioactive waste. This legacy cleanup program was established to address groundwater contamination, material disposal areas (MDAs) that have been used to dispose of radioactive and other waste material, and 'aggregate areas' that might produce radioactive or other chemical waste as a result of remediation activities. The LANL site is regulated for environmental concerns under the Resource Conservation and Recovery Act (RCRA). However, some parts of LANL, such as material disposal area G (MDA G), have disposed of radioactive waste under DOE Order 435.1, and are subject to other regulations. For example, decommissioning the remote-handled TRU material stored in 33 shafts at MDA G falls under EPA's 40 CFR 191. Collectively, the regulations are all aimed in the same direction of finding the best solution, either through constructs such as 'as low as reasonably achievable' (ALARA), considering balancing factors as opposed to only cost and human health risk, and, under EPA regulations such as RCRA and NEPA, evaluating impact from all chemicals and both human health and ecological endpoints. Despite the basic goals and objectives of the regulations or their guidance, the main challenge is in their implementation. Arguably perhaps, but really in principle, all of these (and similar) regulations are asking for a decision analysis to be performed. Implementation challenges encountered have included lack of understanding of decision analysis in the industry, lack of effective stakeholder engagement in the decision analysis process, and lack of appreciation of the need to separate value judgments from science, the latter leading to developing conservative, or protective, science-based models. Conservative models lead to poor solutions, lack of effective stakeholder engagement leads to long drawn out protracted approaches to finding a solution (which also might never be found with this approach), and lack of understanding of decision analysis and Bayesian statistics causes poor models to be built, which creates unfortunate situations of 'garbage in, garbage out' becoming the basis for decision making. Stakeholder-engaged structured decision making (SDM) is an approach to solving problems that relies on the theory of decision science to involve stakeholders in the decision-making process. This approach incorporates stakeholder values using a scientifically rigorous methodology that separates value judgments from science in a way that helps avoid the pitfalls of biased, protective, or conservative modeling. This approach has its foundation in Keeney's 1992 treatise on value-focused thinking [1]. Keeney advocated a paradigm shift in decision making based on the idea that the standard way of thinking about decisions is backwards. The standard approach of focusing first on identifying alternatives rather than on articulating values results in a reactive approach with the emphasis on mechanics and fixed choices instead of the core values that have meaning to stakeholders. This paradigm shift effectively engages all stakeholders in the decision-making process while using a values focused thinking approach that can lead to the identification of decision opportunities and the creation of better alternatives. The intent is to be proactive and generate solutions that are related directly to values and objectives as identified by stakeholders. There are, perhaps, two overarching reasons why SDM can be used to benefit LANL's environmental legacy cleanup. Some of LANL's remaining waste management and environmental management problems are challenging and complex (for example, the Cr and RDX plumes, and MDAs) and while the traditional approach has, arguably, worked well for relatively simple risk-based problems, it cannot, or should not, be applied to more complex problems if the most effective and efficient solutions are desired. The second reason is cost. This has perhaps become more critical since publication of the Government Accountability Office (GAO) reports that DoE's environmental liability is considered a high-risk concern for the nation [2]. The focus of SDM is on structuring solutions to decision risk problems by first addressing stakeholder and decision maker values and subsequently developing decision objectives and ways to measure those objectives, preference weighting across objectives, identifying decision alternatives that best achieve those values, and characterizing uncertainty in predictions of the measures. Because a complete decision model is created using SDM, it can be evaluated to find the main elements of the model that drive, or predict, the best solution. This approach creates complete decision models that are transparent, traceable, reproducible and technically defensible. The science behind SDM, or decision analysis, is well founded, yet it is not unusual to see ad hoc approaches to decision making implemented under various environmental regulations that are pertinent to the LANL site, including NEPA, RCRA and DOE Order 435.1. Such ad hoc approaches are often not transparent or traceable, and lack reproducibility and technical defensibility. The LANL legacy cleanup program has embarked on using SDM to address the complex problems that remain. Stakeholder meetings have been held, and a prototype version of the stakeholder value system has been developed. Further meetings are expected in the future to address specific project needs. This is a long-term endeavor considering the complex environmental problems faced by DOE EM in Los Alamos (EM-LA), and careful planning, consideration of stakeholder value systems, and engagement with stakeholders throughout the SDM process is expected to lead to a successful endpoint. (authors)

12 MANAGEMENT OF RADIOACTIVE AND NON-RADIOACTIVE W↗

Sequential Inference of Hospitalization Electronic Health Records Using Probabilistic Models

In the dynamic hospital setting, decision support can be a valuable tool for improving patient outcomes. Data-driven inference of future outcomes is challenging in this dynamic setting, where long sequences such as laboratory tests and medications are updated frequently. This is due in part to heterogeneity of data types and mixed-sequence types contained in variable length sequences. In this work we design a probabilistic unsupervised model for multiple arbitrary-length sequences contained in hospitalization Electronic Health Record (EHR) data. The model uses a latent variable structure and captures complex relationships between medications, diagnoses, laboratory tests, neurological assessments, and medications. It can be trained on original data, without requiring any lossy transformations or time binning. Inference algorithms are derived that use partial data to infer properties of the complete sequences, including their length and presence of specific values. We train this model on data from subjects receiving medical care in the Kaiser Permanente Northern California integrated healthcare delivery system. The results are evaluated against held-out data for predicting the length of sequences and presence of Intensive Care Unit (ICU) in hospitalization bed sequences. Our method outperforms a baseline approach, showing that in these experiments the trained model captures information in the sequences that is informative of their future values.

97 MATHEMATICS AND COMPUTING↗

COVID ‐19 outcomes in patients with cancer: Findings from the University of California health system database

Abstract Background The interaction between cancer diagnoses and COVID‐19 infection and outcomes is unclear. We leveraged a state‐wide, multi‐institutional database to assess cancer‐related risk factors for poor COVID‐19 outcomes. Methods We conducted a retrospective cohort study using the University of California Health COVID Research Dataset, which includes electronic health data of patients tested for severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) at 17 California medical centers. We identified adults tested for SARS‐CoV‐2 from 2/1/2020–12/31/2020 and selected a cohort of patients with cancer. We obtained demographic, clinical, cancer type, and antineoplastic therapy data. The primary outcome was hospitalization within 30d after the first positive SARS‐CoV‐2 test. Secondary outcomes were SARS‐CoV‐2 positivity and severe COVID‐19 (intensive care, mechanical ventilation, or death within 30d after the first positive test). We used multivariable logistic regression to identify cancer‐related factors associated with outcomes. Results We identified 409,462 patients undergoing SARS‐CoV‐2 testing. Of 49,918 patients with cancer, 1781 (3.6%) tested positive. Patients with cancer were less likely to test positive (RR 0.70, 95% CI: 0.67–0.74, p < 0.001). Among the 1781 SARS‐CoV‐2‐positive patients with cancer, BCR/ABL‐negative myeloproliferative neoplasms (RR 2.15, 95% CI: 1.25–3.41, p = 0.007), venetoclax (RR 2.96, 95% CI: 1.14–5.66, p = 0.028), and methotrexate (RR 2.72, 95% CI: 1.10–5.19, p = 0.032) were associated with greater hospitalization risk. Cancer and therapy types were not associated with severe COVID‐19. Conclusions In this large, diverse cohort, cancer was associated with a decreased risk of SARS‐CoV‐2 positivity. Patients with BCR/ABL‐negative myeloproliferative neoplasm or receiving methotrexate or venetoclax may be at increased risk of hospitalization following SARS‐CoV‐2 infection. Mechanistic and comparative studies are needed to validate findings.

60 APPLIED LIFE SCIENCES↗