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Instrumentation Working Group Summary

The Instrumentation Working Group compiled a summary of measurement techniques applicable to gas turbine engine aerosol precursors and particulates. An assessment was made of the limits, accuracy, applicability, and technology readiness of the various techniques. Despite advances made in emissions characterization of aircraft engines, uncertainties still exist in the mechanisms by which aerosols and particulates are produced in the near-field engine exhaust. To adequately assess current understanding of the formation of sulfuric acid aerosols in the exhaust plumes of gas turbine engines, measurements are required to determine the degree and importance of sulfur oxidation in the turbine and at the engine exit. Ideally, concentrations of all sulfur species would be acquired, with emphasis on SO2 and SO3. Numerous options exist for extractive and non-extractive measurement of SO2 at the engine exit, most of which are well developed. SO2 measurements should be performed first to place an upper bound on the percentage of SO2 oxidation. If extractive and non-extractive techniques indicate that a large amount of the fuel sulfur is not detected as SO2, then efforts are needed to improve techniques for SO3 measurements. Additional work will be required to account for the fuel sulfur in the engine exhaust. Chemical Ionization Mass Spectrometry (CI-MS) measurements need to be pursued, although a careful assessment needs to be made of the sampling line impact on the extracted sample composition. Efforts should also be placed on implementing non-intrusive techniques and extending their capabilities by maximizing exhaust coverage for line-of-sight measurements, as well as development of 2-D techniques, where feasible. Recommendations were made to continue engine exit and combustor measurements of particulates. Particulate measurements should include particle size distribution, mass fraction, hydration properties, and volatile fraction. However, methods to ensure that unaltered samples are obtained need to be developed. Particulate speciation was also assigned a high priority for quantifying the fractions of carbon soot, PAH, refractory materials, metals, sulfates, and nitrates. High priority was also placed on performing a comparison of particle sizing instruments. Concern was expressed by the workshop attendees who routinely make particulate measurements about the variation in number density measured during in-flight tests by different instruments. In some cases, measurements performed by different groups of researchers during the same flight tests showed an order of magnitude variation. Second priority was assigned to measuring concentrations of odd hydrogen and oxidizing species. Since OH, HO2, H2O2, and O are extremely reactive, non-extractive measurements are recommended. A combination of absorption and fluorescence is anticipated to be effective for OH measurements in the combustor and at the engine exit. Extractive measurements of HO2 have been made in the stratosphere, where the ambient level of OH is relatively low. Use of techniques that convert HO2 to OH for combustor and engine exit measurements needs to be evaluated, since the ratio of HO2/OH may be 1% or less at both the combustor and engine exit. CI-MS might be a viable option for H2O2, subject to sampling line conversion issues. However, H2O2 is a low priority oxidizing species in the combustor and at the engine exit. Two candidates for atomic oxygen measurements are Resonance Enhanced Multi-Photon Ionization (REMPI) and Laser-Induced Fluorescence (LIF). Particulate measurement by simultaneous extractive and non-extractive techniques was given equal priority to the oxidizer measurements. Concern was expressed over the ability of typical ground test sampling lines to deliver an unaltered sample to a remotely located instrument. It was suggested that the sampling probe and line losses be checked out by attempting measurements using an optical or non-extractive technique immediately upstream of the sampling probe. This is a possible application for Laser Induced Incandescence (LII) as a check on the volume fraction of soot. Optical measurements of size distribution are not well developed for ultrafine particles less than about 20 nm in diameter, so a non-extractive technique for particulate size distribution cannot be recommended without further development. Carbon dioxide measurements need to be made to complement other extractive measurement techniques. CO2 measurements enable conversion of other species concentrations to emission indices. Carbon monoxide, which acts as a sink for oxidizing species, should be measured using non-extractive techniques. CO can be rapidly converted to CO2 in extractive probes, and a comparison between extractive and non-extractive measurements should be performed. Development of non-extractive techniques would help to assess the degree of CO conversion, and might be needed to improve the concentration measurement accuracy. Measurements of NO(x) will continue to be critical due to the role of NO and NO2 in atmospheric chemistry, and their influence on atmospheric ozone. Time-resolved measurements of temperature, velocity, and species concentrations were included on the list of desired measurement. Thermocouples are typically adequate for engine exit measurements. PIV and LDV are well established for obtaining velocity profiles. The techniques are listed in the accompanying table; are divided into extractive and non-extractive techniques. Efforts were made to include a measurement uncertainty for each technique. An assessment of the technology readiness was included.

Zaller, Michelle↗

Contemporary Toxicity Profile of Breast Brachytherapy Versus External Beam Radiation After Lumpectomy for Breast Cancer

Purpose: We compared toxicities after brachytherapy versus external beam radiation therapy (EBRT) in contemporary breast cancer patients. Methods and Materials: Using MarketScan healthcare claims, we identified 64,112 women treated from 2003 to 2012 with lumpectomy followed by radiation (brachytherapy vs EBRT). Brachytherapy was further classified by multichannel versus single-channel applicator approach. We identified the risks and predictors of 1-year infectious and noninfectious postoperative adverse events using logistic regression and temporal trends using Cochran-Armitage tests. We estimated the 5-year Kaplan-Meier cumulative incidence of radiation-associated adverse events. Results: A total of 4522 (7.1%) patients received brachytherapy (50.2% multichannel vs 48.7% single-channel applicator). The overall risk of infectious adverse events was higher after brachytherapy than after EBRT (odds ratio [OR] = 1.21; 95% confidence interval [CI] 1.09-1.34, P<.001). However, over time, the frequency of infectious adverse events after brachytherapy decreased, from 17.3% in 2003 to 11.6% in 2012, and was stable after EBRT at 9.7%. Beyond 2007, there were no longer excess infections with brachytherapy (P=.97). The overall risk of noninfectious adverse events was higher after brachytherapy than after EBRT (OR=2.27; 95% CI 2.09-2.47, P<.0001). Over time, the frequency of noninfectious adverse events detected increased: after multichannel brachytherapy, from 9.1% in 2004 to 18.9% in 2012 (Ptrend = .64); single-channel brachytherapy, from 12.8% to 29.8% (Ptrend<.001); and EBRT, from 6.1% to 10.3% (Ptrend<.0001). The risk was significantly higher with single-channel than with multichannel brachytherapy (hazard ratio = 1.32; 95% CI 1.03-1.69, P=.03). Of noninfectious adverse events, 70.9% were seroma. Seroma significantly increased breast pain risk (P<.0001). Patients with underlying diabetes, cardiovascular disease, and treatment with chemotherapy had increased infectious and noninfectious adverse events. The 5-year incidences of fat necrosis, breast pain, and rib fracture were slightly higher after brachytherapy than after EBRT (13.7% vs 8.1%, 19.4% vs 16.0%, and 1.6% vs 1.3%, respectively), but the risks were not significantly different for multichannel versus single-channel applicators. Conclusion: Toxicities after breast brachytherapy were distinct from those after EBRT. Temporal toxicity trends may reflect changing technology and evolving practitioner experience with brachytherapy.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

Incidence and predictors of loss to follow-up among adult patients receiving antiretroviral therapy in Central Ethiopia: a multi-center retrospective cohort study

Background: Globally, loss to follow-up (LTFU) remains a significant public health concern despite the rapid expansion of antiretroviral medication programs. It is a significant cause of treatment failure and threatens the enhancement of HIV treatment outcomes among patients on antiretroviral therapy (ART). However, there is a paucity of evidence on its incidence and predictors in Ethiopia. Thus, this study aimed to examine the incidence and predictors of LTFU among adult HIV patients receiving ART at hospitals in Central Ethiopia. Methods: A multi-centered facility-based retrospective cohort study was conducted among 432 randomly selected adult patients who received antiretroviral therapy. Data were entered into EpiData version 3.1 and exported to Stata version 14 for analysis. The Kaplan–Meier failure function was employed to determine the overall failure estimates, and the log-rank test was used to compare the probability of failure among the different categories of variables. The Cox proportional hazard model was used to identify independent predictors of LTFU. Results: Overall, 172 (39.8%) study participants were lost to follow-up over the 10-year follow-up period with an incidence rate of 8.12 (95% CI: 7.11, 9.09) per 1,000 person-months. Undisclosed HIV status (AHR: 1.96, 95% CI: 1.14, 3.36), not able to work (AHR: 1.84, 95% CI: 1.13, 2.22), opportunistic infections (AHR: 3.13, 95% CI: 2.17, 4.52), CD4 < 200 cell/mL (AHR: 1.95, 95% CI: 1.18, 3.21), not receiving isoniazid preventive therapy (IPT) (AHR: 2.57, 95% CI: 1.62, 4.06), not participating in clubs (AHR: 1.68, 95% CI: 1.10, 2.22), side effects of drugs (AHR: 1.44, 95% CI: 1.02, 2.04), and high viral load (AHR: 3.15, 95% CI: 1.81, 5.47) were identified as significant predictors of loss to follow-up. Conclusion: In this study, the incidence of LTFU was high. The focus should be on creating awareness and prevention programs that aim to reduce loss to follow-up by continuing counseling, especially on the negative effects of loss to follow-up and the benefits of ART care.

60 APPLIED LIFE SCIENCES↗

Do Piperonyl Butoxide Long-Lasting Insecticide Treated Nets Provide Additional Protection Against Malaria Infections Compared with Conventional Nets in an Operational Setting in Western Kenya?

Malaria control in sub-Saharan Africa has stagnated despite widespread adoption of control measures such as long-lasting insecticidal nets (LLINs). Progress has stalled, in part, because of pyrethroid insecticide resistance, driving the need for retooling to increase the effectiveness of bed nets. Consequently, LLINs have been treated with the chemical synergist piperonyl butoxide (PBO). Piperonyl butoxide LLINs have been shown to be efficacious in controlled settings; however, their effectiveness in real-world settings warrants investigation. In Bungoma County, Western Kenya, a cohort of 768 participants was followed from June 2017 to December 2023 via active and passive surveillance. Household visits were conducted monthly, during which LLIN use for nets distributed in 2017 and 2021 was recorded, and symptomatic malaria cases were identified using rapid diagnostic tests (RDTs). The comparative effectiveness of PBO versus conventional LLINs was assessed in terms of malaria infections. A multilevel logistic regression model was fit with monthly RDT results as the dependent variable. The study results indicate that PBO LLINs provide greater protection against malaria at the individual level than conventional LLINs (odds ratio: 0.70; 95% CI: 0.47–1.03), although the findings were not statistically significant. The added protection against malaria infections provided by PBO LLINs compared with conventional LLINs observed in the current study aligns with findings from most previous studies, although this finding was not statistically significant. In areas with documented pyrethroid resistance, the use of LLINs with an added synergist, such as PBO, can provide additional protection against malaria infections (compared with pyrethroid-only LLINs) and should be considered for scaled-up scenarios despite the additional cost.

60 APPLIED LIFE SCIENCES↗

Investigation of Current Methods to Identify Helicopter Gear Health

This paper provides an overview of current vibration methods used to identify the health of helicopter transmission gears. The gears are critical to the transmission system that provides propulsion, lift and maneuvering of the helicopter. This paper reviews techniques used to process vibration data to calculate conditions indicators (CI s), guidelines used by the government aviation authorities in developing and certifying the Health and Usage Monitoring System (HUMS), condition and health indicators used in commercial HUMS, and different methods used to set thresholds to detect damage. Initial assessment of a method to set thresholds for vibration based condition indicators applied to flight and test rig data by evaluating differences in distributions between comparable transmissions are also discussed. Gear condition indicator FM4 values are compared on an OH58 helicopter during 14 maneuvers and an OH58 transmission test stand during crack propagation tests. Preliminary results show the distributions between healthy helicopter and rig data are comparable and distributions between healthy and damaged gears show significant differences.

Dempsey, Paula J.↗

Investigation of Current Methods to Identify Helicopter Gear Health

This paper provides an overview of current vibration methods used to identify the health of helicopter transmission gears. The gears are critical to the transmission system that provides propulsion, lift and maneuvering of the helicopter. This paper reviews techniques used to process vibration data to calculate conditions indicators (CI's), guidelines used by the government aviation authorities in developing and certifying the Health and Usage Monitoring System (HUMS), condition and health indicators used in commercial HUMS, and different methods used to set thresholds to detect damage. Initial assessment of a method to set thresholds for vibration based condition indicators applied to flight and test rig data by evaluating differences in distributions between comparable transmissions are also discussed. Gear condition indicator FM4 values are compared on an OH58 helicopter during 14 maneuvers and an OH58 transmission test stand during crack propagation tests. Preliminary results show the distributions between healthy helicopter and rig data are comparable and distributions between healthy and damaged gears show significant differences.

Dempsey, Paula J.↗

False positives in PIRADS (V2) 3, 4, and 5 lesions: relationship with reader experience and zonal location

Purpose: To investigate the effect of reader experience and zonal location on the occurrence of false positives (FPs) in PIRADS (V2) 3, 4, and 5 lesions on multiparametric (MP)-MRI of the prostate. Materials and methods: This retrospective study included 139 patients who had consecutively undergone an MP-MRI of the prostate in combination with a transrectal ultrasound MRI fusion-guided biopsy between 2014 and 2017. MRI exams were prospectively read by a group of inexperienced radiologists (cohort 1; 54 patients) and an experienced radiologist (cohort 2; 85 patients). Multivariable logistic regression analysis was performed to determine the association of experience of the radiologist and zonal location with a FP reading. FP rates were compared between readings by inexperienced and experienced radiologists according to zonal location, using Chi-square (χ{sup 2}) tests. Results: A total of 168 lesions in 139 patients were detected. Median patient age was 68 years (Interquartile range (IQR) 62.5–73), and median PSA was 10.9 ng/mL (IQR 7.6–15.9) for the entire patient cohort. According to multivariable logistic regression, inexperience of the radiologist was significantly (P = 0.044, odds ratio 1.927, 95% confidence interval [CI] 1.017–3.651) and independently associated with a FP reading, while zonal location was not (P = 0.202, odds ratio 1.444, 95% CI 0.820–2.539). In the transition zone (TZ), the FP rate of the inexperienced radiologists 59% (17/29) was significantly higher (χ{sup 2}P = 0.033) than that of the experienced radiologist 33% (13/40). Conclusion: Inexperience of the radiologist is significantly and independently associated with a FP reading, while zonal location is not. Inexperienced radiologists have a significantly higher FP rate in the TZ.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

Comparison of navigator-gated and breath-held image acquisition techniques for multi-echo quantitative dixon imaging of the liver in children and young adults

Purpose: Acquired over a breath hold, multi-echo Dixon (mDixon) magnetic resonance imaging (MRI) of the liver can be used to quantify proton density fat fraction (PDFF) and iron-related signal decay. However, young, obese, and co-morbid patients may have limited breath holding capacity and could benefit from a motion-robust mDixon acquisition. The purpose of this study was to compare hepatic PDFF and R2* values between navigator-gated and breath-held mDixon MRI acquisition techniques in children and young adults with suspected liver disease. Materials and methods: This retrospective study was institutional review board-approved with a waiver of informed consent. Patients who underwent liver MRI with breath-held and navigator-gated mDixon sequences between January 2017 and July 2018 were included. One reviewer, blinded to sequence, measured PDFF and R2* on four images from each sequence. Another blinded reviewer graded respiratory motion (5-point Likert scale). Pearson correlation (r), Lin’s concordance coefficients (r{sub c}), and Bland–Altman analyses were used to assess agreement between techniques. Frequency of clinically limiting motion (score ≥ 3) was compared with Fisher’s exact test. Results: Forty-two patients were included (15 female, 27 male; mean age: 15.7 ± 4.6 years). Mean PDFF and R2* were 16.6 ± 13.1% and 29.3 ± 4.7 s{sup −1} (breath-held) versus 17.0 ± 13.2% and 29.6 ± 5.2 s{sup −1} (navigator-gated). PDFF agreed almost perfectly between sequences (r{sub c} = 0.997, 95% CI 0.994–0.998; mean bias: 0.3%; 95% limits of agreement: − 2.4 to +1.7%), while R2* values correlated very strongly but with poor agreement (r = 0.837, r{sub c} = 0.832, 95% CI 0.716–0.910). Navigator-gated images exhibited significantly higher frequency of clinically limiting respiratory motion (88% vs. 48%, p = 0.0001). Conclusion: Despite greater respiratory motion artifact, a free-breathing navigator-gated mDixon sequence produces PDFF values with almost perfect agreement to a breath-held sequence.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

Interaction between arsenic exposure from drinking water and genetic susceptibility in carotid intima–media thickness in Bangladesh

Epidemiologic studies that evaluated genetic susceptibility for the effects of arsenic exposure from drinking water on subclinical atherosclerosis are limited. We conducted a cross-sectional study of 1078 participants randomly selected from the Health Effects of Arsenic Longitudinal Study in Bangladesh to evaluate whether the association between arsenic exposure and carotid artery intima–media thickness (cIMT) differs by 207 single-nucleotide polymorphisms (SNPs) in 18 genes related to arsenic metabolism, oxidative stress, inflammation, and endothelial dysfunction. Although not statistically significant after correcting for multiple testing, nine SNPs in APOE, AS3MT, PNP, and TNF genes had a nominally statistically significant interaction with well-water arsenic in cIMT. For instance, the joint presence of a higher level of well-water arsenic (≥ 40.4 μg/L) and the GG genotype of AS3MT rs3740392 was associated with a difference of 40.9 μm (95% CI = 14.4, 67.5) in cIMT, much greater than the difference of cIMT associated with the genotype alone (β = − 5.1 μm, 95% CI = − 31.6, 21.3) or arsenic exposure alone (β = 7.2 μm, 95% CI = − 3.1, 17.5). The pattern and magnitude of the interactions were similar when urinary arsenic was used as the exposure variable. Additionally, the at-risk genotypes of the AS3MT SNPs were positively related to the proportion of monomethylarsonic acid (MMA) in urine, which is indicative of arsenic methylation capacity. The findings provide novel evidence that genetic variants related to arsenic metabolism may play an important role in arsenic-induced subclinical atherosclerosis. Future replication studies in diverse populations are needed to confirm the findings. - Highlights: • Nine SNPs had a nominally significant interaction with well-water arsenic in cIMT. • Three SNPs in AS3MT showed nominally significant interactions with urinary arsenic. • cIMT was much higher among subjects with higher arsenic exposure and AS3MT SNPs. • The at-risk genotypes of AS3MT SNPs were positively related to urinary MMA%.

60 APPLIED LIFE SCIENCES↗

Impact of Crystalline Silicotitanate Particle Size on Cesium Removal Efficiency

Washington River Protection Solutions is working on a Tank-Side Cesium Removal (TSCR) system to remove Cs from Hanford tank waste supernate. Removal of 137 Cs from tank waste supernate by TSCR results in a low-activity waste (LAW) form that can be fed directly to the Hanford Waste Treatment and Immobilization Plant (WTP) LAW vitrification facility, where the supernate can be vitrified into a glass form. Crystalline silicotitanate (CST) ion exchange media, manufactured by Honeywell UOP, LLC (product IONSIV TM R9140-B), was selected for use as the ion exchange media to remove Cs at TSCR. The particle size used in testing is expected to impact the kinetic performance of the ion exchange media. Therefore, two single-column systems were tested with CST Lot 2002009604. One column contained <25 mesh sieve cut fraction and the other column contained <35 mesh sieve cut fraction. Flowrate through both test systems was adjusted to match the CST contact time expected for the full-scale operation, i.e., matched bed volumes per hour (BV/h) at 1.83 BV/h. The feed was processed downflow through the columns until ~1000 BVs of feed were processed. The waste acceptance criteria (WAC) limit for the WTP LAW vitrification facility is <3.18E-5 Ci 137 Cs per mole Na. For a tank waste containing 156 µCi/mL 137 Cs and 5.6 M Na, up to 0.114% of the influent 137 Cs concentration may be delivered to the WTP (based on 137 Cs content in AP-107 tank waste); this required a Cs decontamination factor of 876. The WAC limit was used as one of the relevant process parameters, along with the 50% breakthrough point, Cs loading per gram of CST, and the mass transfer zone.

12 MANAGEMENT OF RADIOACTIVE AND NON-RADIOACTIVE W↗

Laisk measurements in the nonsteady state: Tests in plants exposed to warming and variable CO2 concentrations

Abstract Light respiration (RL) is an important component of plant carbon balance and a key parameter in photosynthesis models. RL is often measured using the Laisk method, a gas exchange technique that is traditionally employed under steady-state conditions. However, a nonsteady-state dynamic assimilation technique (DAT) may allow for more rapid Laisk measurements. In 2 studies, we examined the efficacy of DAT for estimating RL and the parameter Ci* (the intercellular CO2 concentration where Rubisco's oxygenation velocity is twice its carboxylation velocity), which is also derived from the Laisk technique. In the first study, we compared DAT and steady-state RL and Ci* estimates in paper birch (Betula papyrifera) growing under control and elevated temperature and CO2 concentrations. In the second, we compared DAT-estimated RL and Ci* in hybrid poplar (Populus nigra L. × P. maximowiczii A. Henry “NM6”) exposed to high or low CO2 concentration pre-treatments. The DAT and steady-state methods provided similar RL estimates in B. papyrifera, and we found little acclimation of RL to temperature or CO2; however, Ci* was higher when measured with DAT compared to steady-state methods. These Ci* differences were amplified by the high or low CO2 pre-treatments. We propose that changes in the export of glycine from photorespiration may explain these apparent differences in Ci*.

59 BASIC BIOLOGICAL SCIENCES↗

Low Cerebral Blood Volume Identifies Poor Outcome in Stent Retriever Thrombectomy

BackgroundMechanical thrombectomy (MT) is an efficient treatment of acute stroke caused by large-vessel occlusion. We evaluated the factors predicting poor clinical outcome (3-month modified Rankin Scale, mRS >2) although MT performed with modern stent retrievers.MethodsWe prospectively collected the clinical and imaging data of 105 consecutive anterior circulation stroke patients who underwent MT after multimodal CT imaging. Patients with occlusion of the internal carotid artery and/or middle cerebral artery up to the M2 segment were included. We recorded baseline clinical, procedural and imaging variables, technical outcome, 24-h imaging outcome and the clinical outcome. Differences between the groups were studied with appropriate statistical tests and binary logistic regression analysis.ResultsLow cerebral blood volume Alberta stroke program early CT score (CBV-ASPECTS) was associated with poor clinical outcome (median 7 vs. 9, p = 0.01). Lower collateral score (CS) significantly predicted poor outcome in regression modelling with CS = 0 increasing the odds of poor outcome 4.4-fold compared to CS = 3 (95% CI 1.27–15.5, p = 0.02). Lower CBV-ASPECTS significantly predicted poor clinical outcome among those with moderate or severe stroke (OR 0.82, 95% CI 0.68–1, p = 0.05) or poor collateral circulation (CS 0–1, OR 0.66, 95% CI 0.48–0.90, p = 0.009) but not among those with mild strokes or good collaterals.ConclusionsCBV-ASPECTS estimating infarct core is a significant predictor of poor clinical outcome among anterior circulation stroke patients treated with MT, especially in the setting of poor collateral circulation and/or moderate or severe stroke.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

Risk of Mortality in Family Members of Men Seeking Fertility Assessment

Objective: To assess mortality in family members of men seeking fertility assessment. Subfertility serves as a biomarker for overall somatic health, and poor semen quality is associated with increased risk of hospitalization and mortality from chronic conditions. However, it is unclear if these risks extend to family members of men with low sperm count. Design: Retrospective cohort study. Subjects: Family members, up to third-degree relatives, of men in the Subfertility, Health and Assisted Reproduction and the Environment cohort who underwent a semen analysis as part of a fertility assessment 1996–2017. Relatives of men with a recorded total sperm count who lived in Utah for ≥1 year 1904–2017 were included in the analysis (N = 22,280 families). Exposure: Individuals were classified by family membership. Families were classified as relatives of azoospermic (0M), oligozoospermic (<39M), or normozoospermic (≥39M) men. The average total sperm count of the proband (male relative) with fertility assessment was also included as a continuous exposure measure. Main Outcome Measures: The main outcomes were all-cause and cause-specific mortality risk by sex, age, and degree of relation: first-, second-, and third-degree. Cox proportional hazard models were used to test the association between fertility classification and mortality, controlling for sex, race/ethnicity, and birth year. Results: A total of 666,437 relatives of men with fertility assessment (N deaths = 183,974) were included in the analysis. Relative to normozoospermia families, all-cause mortality risk increased in oligozoospermia families (hazard ratio [HR] oligozoospermia , 1.03; 95% confidence interval [CI], 1.01–1.05). Close relatives, first- (HR oligozoospermia , 1.17; 95% CI, 1.07–1.28) and second-degree relatives (HR azoospermia , 1.11; 95% CI, 1.04–1.20; HR oligozoospermia , 1.05; 95% CI,1.01–1.09), of azoospermic and oligozoospermic men had the highest all-cause and cause-specific mortality risk, including death attributed to cardiovascular disease or congenital birth conditions. Conclusion: Our results suggest that familial all-cause and cause-specific mortality risk differ by fertility phenotype. Families of azoospermic and oligozoospermic men showed significantly increased risk, particularly for close relatives. This study provides further evidence that shared genetic and/or environmental factors could influence both fertility and somatic health.

Male fertility↗

Hybrid Correlation Energy (HyCE): An Approach Based on Separate Evaluations of Internal and External Components

In this work, a novel hybrid correlation energy (HyCE) approach is proposed that determines the total correlation energy via distinct computation of its internal and external components. This approach evolved from two related studies. First, rigorous assessment of the accuracies and size extensivities of a number of electron correlation methods, that include perturbation theory (PT2), coupled-cluster (CC), configuration interaction (CI), and coupled electron pair approximation (CEPA), shows that the CEPA(0) variant of the latter and triples-corrected CC methods consistently perform very similarly. These findings were obtained by comparison to near full CI results for four small molecules and by charting recovered correlation energies for six steadily growing chain systems. Second, by generating valence virtual orbitals (VVOs) and utilizing the CEPA(0) method, we were able to partition total correlation energies into internal (or nondynamic) and external (or dynamic) parts for the aforementioned six chain systems and a benchmark test bed of 36 molecules. When using triple-ζ basis sets it was found that per orbital internal correlation energies were appreciably larger than per orbital external energies and that the former showed far more chemical variation than the latter. Additionally, accumulations of external correlation energies were seen to proceed smoothly, and somewhat linearly, as the virtual space is gradually increased. Combination of these two studies led to development of the HyCE approach, whereby the internal and external correlation energies are determined separately by CEPA(0)/VVO and PT2/external calculations, respectively. When applied to the six chain systems and the 36-molecule benchmark test set it was found that HyCE energies followed closely those of triples-corrected CC and CEPA(0) while easily outperforming MP2 and CCSD. Lastly, the success of the HyCE approach is more notable when considering that its cost is only slightly more than MP2 and significantly cheaper than the CC approaches.

37 INORGANIC, ORGANIC, PHYSICAL, AND ANALYTICAL CH↗

WE-H-207A-03: The Universality of the Lognormal Behavior of [F-18]FLT PET SUV Measurements

Purpose: Log transforming [F-18]FDG PET standardized uptake values (SUVs) has been shown to lead to normal SUV distributions, which allows utilization of powerful parametric statistical models. This study identified the optimal transformation leading to normally distributed [F-18]FLT PET SUVs from solid tumors and offers an example of how normal distributions permits analysis of non-independent/correlated measurements. Methods: Forty patients with various metastatic diseases underwent up to six FLT PET/CT scans during treatment. Tumors were identified by nuclear medicine physician and manually segmented. Average uptake was extracted for each patient giving a global SUVmean (gSUVmean) for each scan. The Shapiro-Wilk test was used to test distribution normality. One parameter Box-Cox transformations were applied to each of the six gSUVmean distributions and the optimal transformation was found by selecting the parameter that maximized the Shapiro-Wilk test statistic. The relationship between gSUVmean and a serum biomarker (VEGF) collected at imaging timepoints was determined using a linear mixed effects model (LMEM), which accounted for correlated/non-independent measurements from the same individual. Results: Untransformed gSUVmean distributions were found to be significantly non-normal (p<0.05). The optimal transformation parameter had a value of 0.3 (95%CI: −0.4 to 1.6). Given the optimal parameter was close to zero (which corresponds to log transformation), the data were subsequently log transformed. All log transformed gSUVmean distributions were normally distributed (p>0.10 for all timepoints). Log transformed data were incorporated into the LMEM. VEGF serum levels significantly correlated with gSUVmean (p<0.001), revealing log-linear relationship between SUVs and underlying biology. Conclusion: Failure to account for correlated/non-independent measurements can lead to invalid conclusions and motivated transformation to normally distributed SUVs. The log transformation was found to be close to optimal and sufficient for obtaining normally distributed FLT PET SUVs. These transformations allow utilization of powerful LMEMs when analyzing quantitative imaging metrics.

60 APPLIED LIFE SCIENCES↗

Cesium Ion Exchange Testing Using a Three-Column System with Crystalline Silicotitanate and Hanford Tank Waste 241-AP-107

Washington River Protection Solutions (WRPS) is working to support early production of immobilized low-activity waste by feeding Hanford tank supernate from tank farms to the Hanford Waste Treatment and Immobilization Plant (WTP) Low-Activity Waste (LAW) facility. This goal incorporates the design of a Tank-Side Cesium Removal (TSCR) system, which in effect filters tank waste supernate and processes it through a cesium ion exchange medium to remove 137Cs. The 137Cs-depleted product is sent to the WTP for vitrification. Rovira et al. (2018) reported the successful Cs removal from Hanford tank 241-AP-107 waste (hereafter called AP-107) using crystalline silicotitanate (CST) ion exchange media manufactured by Honeywell UOP, LLC (product IONSIVTM R9140-B, Batch 2081000057) in a lead-lag column system. Since that testing, WRPS has changed the column design to a three-column system. WRPS requested a repeated study with AP-107 tank waste using a different batch of IONSIVTM R9140-B, Lot 2002009604, in a three-column format. A small-scale test platform was constructed to demonstrate solids filtration, Cs removal, and LAW vitrification and installed at Pacific Northwest National Laboratory. This report describes the small-scale ion exchange testing system component of the test platform and the processing of approximately 8.55 L of filtered AP-107 supernate using CST, Lot 8056262-999, that passed through a 25-mesh filter. This report also describes the Cs ion exchange batch contact testing to determine the Cs distribution coefficient and the maximum Cs loading capacity in the AP-107 tank waste matrix. Batch contact testing helps to evaluate CST performance on tank waste supernate and is often used prior to processing tank waste through ion exchange columns to assess some performance metrics (e.g., 50% Cs breakthrough). Batch contact tests were performed with the filtered AP-107 tank waste at four Cs concentrations at a phase ratio of 200 (liquid volume to exchanger mass). The distribution coefficient (K d ) at the equilibrium condition of 9.2 µg Cs/mL (AP-107 feed condition) was determined to be 806 mL AP 107/g CST. With a CST bed density of 1.01 g/mL (<25 mesh CST), this K d corresponded to a predicted 50% Cs breakthrough of 814 bed volumes (BVs). The Cs load capacity at the equilibrium feed condition was determined to be 8.3 mg Cs/g dry CST. The three-column format testing was prototypic to the intended TSCR operations, albeit on a small scale with 10-mL CST beds. Flowrate was adjusted to match the CST contact time expected for the full-scale operation, i.e., matched bed volumes per hour (BV/h) flow rate. The feed was processed downflow through the lead column, then through the middle column, and then through the polish column. Loading continued at an average of 1.88 BV/h (1.83 to 2.04 BV/h range) until the entire available AP-107 feed was processed. The Cs-decontaminated product will be provided for vitrification testing. The lead column only reached 45% Cs breakthrough after processing 855 BVs of feed. The 50% Cs breakthrough was extrapolated to occur at ~900 BVs. This extrapolated 50% Cs breakthrough value differed from the batch contact estimate (814 BVs) by 13%. The waste acceptance criteria (WAC) or contract limit for the WTP LAW vitrification facility is 3.18E-5 Ci 137 Cs per mole Na. For the AP-107 tank waste, only 0.127% of the influent 137 Cs concentration may be delivered to the WTP; this required a Cs decontamination factor of 787. The Cs effluent from the middle column reached the WAC after processing 590 BVs. Cs breakthrough from the polish column began at 590 BVs, reaching 6.3E-3 µCi/mL or 4.3E-3% Cs breakthrough after processing 844 BVs of feed.

12 MANAGEMENT OF RADIOACTIVE AND NON-RADIOACTIVE W↗

An evaluation of prognostic factors, oncologic outcomes, and management for primary and recurrent squamous cell carcinoma of the vulva

Objective: To evaluate prognostic factors, outcomes, and management patterns of patients treated for squamous cell carcinoma of the vulva. Methods: One hundred sixty-four women were retrospectively identified with primary squamous cell carcinoma of the vulva treated at our institution between 1/1996–12/2018. Descriptive statistics were performed on patient, tumor, and treatment characteristics. The χ 2 tests and t-tests were used to compare categorical variables and continuous variables, respectively. Recurrence free survival (RFS), overall survival (OS), and disease-specific survival (DSS) were analyzed with Kaplan-Meier estimates, the log-rank test, and Cox proportional hazards. Results: Median follow-up was 52.5 months. Five-year RFS was 67.9%, 60.0%, 42.1%, and 20.0% for stage I–IV, respectively. Five-year DSS was 86.2%, 81.6%, 65.0%, and 42.9% for stage I–IV, respectively. On multivariate analysis, positive margins predicted overall RFS (hazard ratio [HR]=3.55; 95% confidence interval [CI]=1.18–10.73; p=0.025), while presence of lichen sclerosus on pathology (HR=2.78; 95% CI=1.30–5.91; p=0.008) predicted local RFS. OS was predicted by nodal involvement (HR=2.51; 95% CI=1.02–6.13; p=0.043) and positive margins (HR=5.19; 95% CI=2.03–13.26; p=0.001). Adjuvant radiotherapy significantly improved RFS (p=0.016) and DSS (p=0.012) in node-positive patients. Median survival after treatment of local, groin, and pelvic/distant recurrence was 52, 8, and 5 months, respectively. Conclusion: For primary treatment, more conservative surgical approaches can be considered with escalation of treatment in patients with concurrent precursor lesions, positive margins, and/or nodal involvement. Further studies are warranted to improve risk stratification in order to optimize treatment paradigms for vulvar cancer patients.

60 APPLIED LIFE SCIENCES↗

Development and validation of a 30-day mortality index based on pre-existing medical administrative data from 13,323 COVID-19 patients: The Veterans Health Administration COVID-19 (VACO) Index

Background Available COVID-19 mortality indices are limited to acute inpatient data. Using nationwide medical administrative data available prior to SARS-CoV-2 infection from the US Veterans Health Administration (VA), we developed the VA COVID-19 (VACO) 30-day mortality index and validated the index in two independent, prospective samples. Methods and findings We reviewed SARS-CoV-2 testing results within the VA between February 8 and August 18, 2020. The sample was split into a development cohort (test positive between March 2 and April 15, 2020), an early validation cohort (test positive between April 16 and May 18, 2020), and a late validation cohort (test positive between May 19 and July 19, 2020). Our logistic regression model in the development cohort considered demographics (age, sex, race/ethnicity), and pre-existing medical conditions and the Charlson Comorbidity Index (CCI) derived from ICD-10 diagnosis codes. Weights were fixed to create the VACO Index that was then validated by comparing area under receiver operating characteristic curves (AUC) in the early and late validation cohorts and among important validation cohort subgroups defined by sex, race/ethnicity, and geographic region. We also evaluated calibration curves and the range of predictions generated within age categories. 13,323 individuals tested positive for SARS-CoV-2 (median age: 63 years; 91% male; 42% non-Hispanic Black). We observed 480/3,681 (13%) deaths in development, 253/2,151 (12%) deaths in the early validation cohort, and 403/7,491 (5%) deaths in the late validation cohort. Age, multimorbidity described with CCI, and a history of myocardial infarction or peripheral vascular disease were independently associated with mortality–no other individual comorbid diagnosis provided additional information. The VACO Index discriminated mortality in development (AUC = 0.79, 95% CI: 0.77–0.81), and in early (AUC = 0.81 95% CI: 0.78–0.83) and late (AUC = 0.84, 95% CI: 0.78–0.86) validation. The VACO Index allows personalized estimates of 30-day mortality after COVID-19 infection. For example, among those aged 60–64 years, overall mortality was estimated at 9% (95% CI: 6–11%). The Index further discriminated risk in this age stratum from 4% (95% CI: 3–7%) to 21% (95% CI: 12–31%), depending on sex and comorbid disease. Conclusion Prior to infection, demographics and comorbid conditions can discriminate COVID-19 mortality risk overall and within age strata. The VACO Index reproducibly identified individuals at substantial risk of COVID-19 mortality who might consider continuing social distancing, despite relaxed state and local guidelines.

60 APPLIED LIFE SCIENCES↗