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At least 235 records · Page 13

Experiences with Mobile Units for Liquid RAW Management in Slovak and Czech Nuclear Power Plants - 20089

In Nuclear Power Plants VVER 440, Russian type of reactor there was designed auxiliary building where according to basic design all operational liquid radioactive waste (RAW) should be stored in large capacity tanks during the whole operational period. That's why there are in the auxiliary building several types of large storage tanks with different internal volume from 110 m{sup 3}, 460 m{sup 3} to 550 m{sup 3}. Storage tanks are usually situated in rooms with limited access and minimal handling space. Operational waste was here transported by the system of pipes from the reactor building. There is possibility to handle with the waste and set the pipeline in to the chosen storage tanks. Nobody takes care about the quality of waste in the storage tanks and waste waits for the period of decommissioning when it should be treated. The storage capacity was designed for the whole lifetime of nuclear power plant. Currently the life time of Nuclear Power Plant's (NPP) is extended and there is necessity to retrieve and treat the RAW in advance. Another reason why the stakeholder, who operates the NPPs, decides to treat the operational RAW during the operational period of NPP, is that there are still new requirements from safety point of view which need to have free available space for example because of potential accident. So treating the operational RAW during the life time of NPP is present issue. Because in basic design nobody cares how the RAW will be retrieved and treated in the future, there is usually no technology for that in existing NPP. Some of the NPPs build an additional building with suitable technologies for treatment or hire the company which offer mobile technology for retrieving the waste from the storage tanks. Wood Nuclear Slovakia PLC provides all activities within liquid RAW management projects by its own staff including management, design, construction and deployment of equipment, engineering support, as well as all RAW retrieval and solidification activities. We offer RAW management as a service without any significant changes in existing NPP's buildings and technology. It is always a technical challenge to conduct successful retrieval, pumping and treatment of RAW. The complex RAW retrieval system can be designed as tailored solution for any RAW storage according to known boundary conditions and specific needs. These systems are based on years of experience with RAW manipulation, processing and treatment and the whole RAW management knowledge by Wood Nuclear Slovakia LTD. (authors)

12 MANAGEMENT OF RADIOACTIVE AND NON-RADIOACTIVE W↗

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↗

Uranium Mill Tailings Radiation Control Act Title II DOE Due Diligence and Lessons Learned from a Previous Site Transfer - 20352

Title II of the Uranium Mill Tailings Radiation Control Act (UMTRCA) established that a government agency will provide perpetual care for closed uranium and thorium ore-processing sites that were operating under an NRC source material license in 1978 or were licensed thereafter. Commercial owners (licensees) operating under an NRC or agreement state specific license when UMTRCA was passed are responsible for conducting reclamation of any byproduct material remaining from uranium-ore processing operations in accordance with an NRC or agreement state approved reclamation plan. Reclamation includes both surface and groundwater remedies. Upon completion of reclamation and approval by NRC, the site is required to be transferred to either the host state or the DOE for long-term surveillance and maintenance. Since UMTRCA's enactment, six Title II sites have been transferred to DOE; an additional 24 Title II sites are anticipated to be transferred before 2050. DoE's role mandated under UMTRCA Title II as the long-term care custodian is to perform 'monitoring, maintenance, and emergency measures necessary to protect the public health and safety.' UMTRCA requires that the licensee pay a long-term surveillance charge 'sufficient to cover the annual costs of site surveillance.' However, at some sites such as the Bluewater, New Mexico, Disposal Site, this mandate has required additional effort and expense by DOE, beyond the originally anticipated and intended scope within UMTRCA, but within the authority of DOE under UMTRCA. In 1997, the Bluewater site became the second UMTRCA Title II site to be transferred to DOE. The site was the location of a uranium mill operated from 1953 until 1982. The specific licensee began site reclamation in 1991, and by 1995 all tailings and contaminated materials were encapsulated in two tailings disposal cells and other disposal areas. In addition to surface contamination, milling activities impacted groundwater in the two upper aquifers. In 1989, the specific licensee attempted active groundwater remediation; however, no significant reduction in contaminant concentrations was observed. As a result, the specific licensee applied to NRC for alternate concentration limits (ACLs) in 1990, which were approved in 1996 as being protective, after additional corrective actions were performed. Since transfer of the Bluewater site to DOE, unforeseen challenges have occurred, requiring additional actions. The first challenge is the occurrence of surface depressions located on the northern section of the main tailings disposal cell. The depressions were first observed during DoE's initial inspection in 1998; however, evidence of these can be observed on satellite images taken prior to transfer. Since being first observed, the depressions have continued to grow both in depth and areal extent. Due to the design of the main tailings disposal cell, the depressions impede storm water from being effectively shed off the 101- hectare (250-acre) top slope of the main tailings disposal cell. Instead, storm water accumulates in the depressions, forming a large ephemeral pond that has stored up to 16.3 x 10{sup 6} liters (4.3 million gallons) of stormwater. The ponding poses a potential risk to the integrity of the main tailings disposal cell in the case of a large storm event, with the potential to cause the pond to overtop and erode the cover material and underlying waste. DOE has taken a number of short-term actions to monitor, measure, and reduce the ponding and is currently working with the US Army Corps of Engineers to design and construct a repair. Additional challenges are associated with groundwater at the Bluewater site. Nine wells were present on the 1335-hectare (3300-acre) site upon transfer. Groundwater compliance was called into question after the State of New Mexico reduced its uranium groundwater standard from 5.0 to 0.03 milligrams per liter in 2004, and when an ACL for uranium was exceeded in a site monitoring well in 2010. Acquiring historical groundwater data and subsequent evaluations as well as additional DOE groundwater monitoring led to installing 10 new monitoring wells and performing additional site hydrogeology recharacterization. DOE continues to evaluate groundwater conditions at the site and works with the NRC to determine regulatory requirements and a path forward. As a result of lessons learned at the Bluewater site and other Title II sites, improved processes have been implemented at a programmatic level to increase due diligence before site transfer and prevent similar issues from occurring at other UMTRCA Title II sites under long-term management. DoE's due diligence process is documented in the Process for Transition of UMTRCA Title II Disposal Sites to DOE for Long-Term Surveillance and Maintenance and is designed to ensure that DOE has no technical or compliance concerns with regulatory decisions that might compromise protectiveness following site transfer to DOE. Implementation of the due diligence process has increased DoE's role prior to site transfer and has been effective in identifying potential issues. Actions by NRC and specific licensees, in response to enhanced due diligence efforts by DOE, are expected to minimize, if not totally prevent, the need for unanticipated actions by DOE pertaining to the surface and groundwater remedies after site transfer. (authors)

12 MANAGEMENT OF RADIOACTIVE AND NON-RADIOACTIVE W↗

Oil and Natural Gas Development near and beneath Uranium Tailings Cells and Other Remediated Sites - 20358

DOE LM is responsible for maintaining remedies at more than 50 remediated sites that require active long-term surveillance and maintenance (LTS and M). Institutional controls (ICs) were established to limit human and environmental exposures to residual contamination by controlling land use, restricting access to potential hazards, and making the public aware of potential dangers from the residual contamination. ICs for each site were developed based on current and foreseeable conditions; however, these controls should evolve to mitigate potential human health and other environmental risks from unanticipated changes in activities or site conditions. Activities conducted beyond the DOE long-term care boundaries by non-DOE parties may impact the effectiveness of ICs or even the long-term stability of disposal cells and groundwater remedies. Several sites that LM manages or that will transfer to LM for LTS and M are in active oil and gas production basins. The sites are associated with uranium ore milling or nuclear test sites and have been remediated or are in the process of remediation and have no ongoing DOE mission. Particularly since 2005, hydraulic fracturing ('fracking') combined with directional drilling has dramatically increased oil and natural gas (oil/gas) production in the United States, now making it the number one hydrocarbon-producing country. Fracking has allowed production from shale and other rocks of low natural permeability that were historically not considered viable oil/gas resources. Also, because wellbores can now be drilled as many as 5 kilometers or more horizontally, hydrocarbons can be recovered from zones without having access to the surface above them. Drilling activity near Rulison, Colorado, the location of an underground nuclear detonation managed by LM, has raised public concerns that remnant radioactivity in the detonation zone could migrate to producing wells and enter the natural gas distribution system. At sites like the Falls City, Texas, Disposal site, transitioned to LM with a split estate, increased production in the region has resulted in wellbores beneath the long-term care boundary of the site. While the DOE license for Falls City was approved by the NRC in 1997 without the acquisition of the subsurface rights, NRC has raised concerns on whether this activity impacts the integrity of the cell and/or groundwater remedies. In Wyoming, LM is anticipating receiving the license for the Bear Creek site and manages the Spook site, both locations of uranium mill tailings disposal cells. These Wyoming sites are in an active region of major oil and gas development. This change in surrounding land use will require LM to work collaboratively with NRC to address these concerns. At several DOE sites radioactive waste, and often intermixed nonradioactive constituents, is permanently isolated in engineered disposal cells. At other sites, residual contamination can be present in groundwater, blast cavities, and infinite amounts within soil. Areas targeted for oil and gas development at the Texas and Wyoming sites range from depths of 2440 to 3350 meters (8000-11000 feet) below ground surface. When most site remedies were designed, oil and gas development was not considered to be an issue within the site boundary. With the more recent uses of directional drilling, fracking, and associated wastewater injections, the evaluative criteria for incoming sites and ICs for managing long-term protectiveness and regulatory compliance are changing. Although DOE surface ownership was previously thought to be a robust IC to prevent surface and subsurface development, particularly at disposal sites, that may no longer be the case. Whereas the subsurface development at Texas and Wyoming sites is currently occurring at thousands of meters beneath the surface, shallower and direct onsite development would be more of a concern for LM. The energy introduced when a well is hydraulically fractured causes microseismic events (magnitude -2 to 1.0) as the fractures propagate but does not directly cause seismic events (earthquakes) of sufficient magnitude to damage surface structures. Additionally, the extent of the hydraulic fractures is limited to the targeted depths, which are far below the surface. However, earthquakes of sufficient magnitude to damage surface structures have been attributed to the injection of wastewater into disposal wells. States that have experienced these effects have enacted regulations that limit the rate and pressures that wastewater can be injected into disposal wells. Items LM may consider are the need for monitoring the volume of water injected into nearby disposal wells and possibly installing seismic stations at sites most susceptible to damage. While the need to demonstrate that no impact from oil and gas extraction activities on a site groundwater remedy or disposal cells will vary from site to site, LM is assessing risk criteria for this activity. Though LM has not experienced an issue yet at a uranium tailings disposal site, it cannot assume that there will be none, and must address NRC concerns. LM is building on past experiences at other sites and beginning to form new processes with the hope that these concepts can be applied for other future sites. (authors)

04 OIL SHALES AND TAR SANDS↗

LINAC Longitudinal Simulation and Measurement of Output Energy

The Linac at Fermilab, one of the oldest accelerators on-site, plays a crucial role in delivering 400 MeV proton beams to other accelerating facilities. The beam traveling through Linac needs to be carefully monitored for better accelerator operation. One of the key factors of efficient Linac operation is its longitudinal stability. The stability can minimize Linac loss and maximize beam current. For this purpose, I examined the beam's longitudinal profile, which is crucial for proper beam transfer between its two sections. After careful monitoring of the beam through Linac, we need to ensure that it leaves with desired parameters. The beam coming out from the Linac is subsequently injected into the Booster, a synchrotron that relies on dipole magnets to bend the beam at injection. If the output energy of the beam deviates from the expected value, the beam will bend at an incorrect radius, leading to potential beam loss. Therefore, precise regulation of the output energy is critical for the efficient operation of the accelerator. To address this, I have conducted a thorough examination of the Linac longitudinal simulations and data from Beam Position Monitors (BPMs). My objective is to measure and stabilize the output energy and verify its correspondence with the predicted simulation results. All these analyses are important for efficient operation of the accelerator.

Safaryan, Milena↗

Control, Fault Management, and Grid Support Functionality of an MV AC-DC Solid State Transformer based EV Extreme Fast Charging Station

Electric vehicles (EVs) have become increasingly popular in recent times while revolutionizing the consumer and commercial transportation market. The development of charging infrastructure has become one of the priorities for increasing the adoption of EVs. Extreme fast charging (XFC) technology can reduce the so-called ’range anxiety’ of consumers as they significantly reduce the charging time. With the advent of wide band-gap (WBG) power devices and improvement in power electronic converters, medium voltage (MV) solid state transformer (SST) based XFC system has the potential to replace the traditional XFC stations because of the lower footprint, ease of installation, enhanced control feature, and better system efficiency. The control system design is one of the critical aspects of the SST development process. Careful consideration and detailed analysis are required to find out suitable control method for the SST based on its topology among different centralized and decentralized control architectures. Also, the control parameters selection and potential improvement to the transient response of the controller ought to be investigated. Another major concern of the SST is different types of internal fault which reduces the overall reliability of the XFC system. As a result, designing a robust protection system is essential. Among different fault modes, open circuit switch faults have received significant attention as an active research area because of their likelihood and severe effects on converters. Therefore, the power stages used in the XFC system require functional and accurate open circuit switch fault management methods. An equally significant aspect of this SST based XFC is its compatibility in a microgrid where there is no synchronous generator present. When the grid is not available, the XFC SSTs can provide grid forming capability and continue supplying the critical loads in islanded mode. The transition between grid connected and islanded mode, especially the grid resynchronization process has to be carefully performed for the safety of the microgrid components. The challenges posed by the aforementioned issues have inspired the work done in this dissertation. Here, a 13.2 kV, 1 MVA, AC/DC SST for the XFC system is examined and a comparative analysis is conducted to select the control architecture based on feasibility of implementation and performance. A detailed control parameter design process is demonstrated considering the sensor dynamics and delay. The selected decentralized control method is augmented by introducing a novel sensor-less load current feedforward method to provide better voltage regulation at the DC bus during a change of load. Next, in the fault management section, a hierarchical failure mode effect analysis (FMEA) is proposed to enable a systematic design of the internal fault protection of the XFC SST as there are limited examples in the literature regarding the analysis of the safety and design of the protection of a power electronic converter system. Novel open circuit switch fault management methods for the converters in the system are presented. Finally, XFC SST based MV microgrid operations in grid connected mode and islanded mode are explored. A secondary control method for grid resynchronization is presented and a design process of control parameters is shown to ensure the stability of the secondary voltage and frequency regulation.

30 DIRECT ENERGY CONVERSION↗

The Importance of Being Adaptable: An Exploration of the Power and Limitations of Domain Adaptation for Simulation-Based Inference with Galaxy Clusters

The application of deep machine learning methods in astronomy has exploded in the last decade, with new models showing remarkably improved performance on benchmark tasks. Not nearly enough attention is given to understanding the models' robustness, especially when the test data are systematically different from the training data, or "out of domain." Domain shift poses a significant challenge for simulation-based inference, where models are trained on simulated data but applied to real observational data. In this paper, we explore domain shift and test domain adaptation methods for a specific scientific case: simulation-based inference for estimating galaxy cluster masses from X-ray profiles. We build datasets to mimic simulation-based inference: a training set from the Magneticum simulation, a scatter-augmented training set to capture uncertainties in scaling relations, and a test set derived from the IllustrisTNG simulation. We demonstrate that the Test Set is out of domain in subtle ways that would be difficult to detect without careful analysis. We apply three deep learning methods: a standard neural network (NN), a neural network trained on the scatter-augmented input catalogs, and a Deep Reconstruction-Regression Network (DRRN), a semi-supervised deep model engineered to address domain shift. Although the NN improves results by 17% in the Training Data, it performs 40% worse on the out-of-domain Test Set. Surprisingly, the Scatter-Augmented Neural Network (SANN) performs similarly. While the DRRN is successful in mapping the training and Test Data onto the same latent space, it consistently underperforms compared to a straightforward Yx scaling relation. These results serve as a warning that simulation-based inference must be handled with extreme care, as subtle differences between training simulations and observational data can lead to unforeseen biases creeping into the results.

Ntampaka, Michelle [Baltimore, Space Telescope Sci↗

Identification of drug repurposing candidates for amyotrophic lateral sclerosis using electronic health records: a retrospective cohort study

Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease with a life expectancy of only 3–5 years and few approved treatments. To identify drug repurposing candidates for the treatment of ALS, we analysed the electronic health records (EHRs) of a large cohort of military veterans with ALS. We analysed the EHRs of individuals in the US Veterans Health Administration (VHA) database who were diagnosed with ALS between Jan 1, 2009 and Dec 31, 2019 to assess medication effects. Individuals without recorded prescriptions after the date of diagnosis were excluded. Two sets of criteria were applied to ascertain exposure. Exposure criteria A were met if the dispense date or the end date of the medication was within 12 months of ALS diagnosis and the end date was at least 6 months after the dispense date. Exposure criteria B were met if there were at least two dispenses within 6 months before diagnosis and 12 months after diagnosis. Propensity score-matched control groups were generated on the basis of confounders included in the EHR, with methodology of potential outcomes used to infer treatment effects. The primary outcome was death. A standard Cox proportional hazards analysis was done to assess association with survival. Survival was defined as the time from diagnosis date recorded in the EHR to death reported in the Department for Veterans Affairs Vital Status File. Follow-up survival time was censored on Dec 31, 2020, for those alive on this date. Downstream protein targets of drugs with clinically significant effects were analysed using the protein–protein interaction networks-based algorithm PathFX. The EHRs of 11 003 individuals with ALS in the VHA database were appropriate for analysis. 162 medications with treatment groups of 30 or more individuals were identified. Among these 162 medications, 27 were associated with statistically significant changes (≥0·1) in the hazard ratio (HR) for death. 18 of the medications were associated with a reduced HR for death (prolonged survival), and nine were associated with an increased HR for death (reduced survival). Drugs associated with reduced HR included HMG-CoA reductase inhibitors (simvastatin, pravastatin, lovastatin, and atorvastatin), PDE5 inhibitors (vardenafil and sildenafil), and α-adrenergic antagonists (tamsulosin and terazosin). The medications associated with an increased HR were drugs used either in the management of clinical features of ALS associated with poor outcomes or in end-of-life care. PathFx analysis identified a complex of proteins interacting with several of the identified drugs. To our knowledge, this analysis is the largest EHR-based study for identifying drug repurposing candidates for ALS. We identified several drugs that warrant further assessment as therapeutic options in ALS, as well as a protein network complex that might serve as a therapeutic target for ALS.

Reimer, Richard J. [Stanford Univ., CA (United Sta↗

CO 2 plume evolution in a depleted natural gas reservoir: Modeling of conformance uncertainty reduction over time

Uncertainty in the long-term fate of CO 2 injected for geologic carbon sequestration (GCS) is a significant barrier to the adoption of GCS as a greenhouse-gas emission-mitigation for industry and regulatory agencies alike. Here, we present a modeling study that demonstrates that the uncertainty in forecasts of GCS site performance decreases over time as monitoring data are used to update operational models. We consider a case study of GCS in a depleted natural gas reservoir, with CO 2 injection occurring over 20 years, with a 50-year post-injection site care period. We constructed a detailed model to generate the actual model output, which is considered synthetic observation data. A series of simpler operational models based on limited data and assumptions about how an operator would model such a site are then run and compared against actual model output at specific monitoring points after one year, two years, etc. The operational model is updated and improved using the synthetic observation data from the actual model at the same time intervals. Model parameter values and model features needed to be updated over time to improve matches to the actual model. These kinds of model adjustments would be a normal part of reservoir engineering and site management at GCS sites. Uncertainty in two key measures related to site performance decreases with time: extent of the CO 2 plume up-dip migration, and radial extent of the pressure pulse. This conclusion should help allay the concerns of industry and regulators about uncertainty in long-term fate of CO 2 at GCS sites.

54 ENVIRONMENTAL SCIENCES↗

Quantifying CO 2 Plume Stabilization at Carbon Storage Projects, North Dakota, USA

This study presents an approach for quantifying when injected carbon dioxide (CO 2 ) stabilizes pursuant to carbon capture and storage (CCS) project permitting and site closure requirements. The distribution of mobile-phase CO 2 (CO 2 plume) will evolve within the storage reservoir during and after injection through both physical and chemical trapping mechanisms. CCS policies generally agree that the CO 2 plume’s migratory behavior in post-injection should demonstrate nonendangerment to the environment but do not provide specific guidance on how to meet the definition of plume stabilization, generating some uncertainty for operators. Plume stability herein means the CO 2 plume 1) changes size minimally and predictably in the storage reservoir such that it will not cross key boundaries identified in the permit and 2) does not pose a threat to human health, underground sources of drinking water (USDWs), and the environment because of lateral migration to areas where leakage pathways may exist. Published literature on plume metrics was reviewed to determine which metric(s) may be most appropriate for determining CO 2 plume stability. A technical approach that defines plume stabilization by estimating the rate of change in the geographic footprint of the CO 2 plume with respect to time was developed and illustrated using a case study from North Dakota, USA, as a proposed solution for CCS operators to apply at the project permitting stage. Any prospective CCS operator may benefit from using the same approach to inform the selection of pore space lease and monitoring areas and develop post-injection site care plans.

03 NATURAL GAS↗

Entropy removal of medical diagnostics

Shannon entropy is a core concept in machine learning and information theory, particularly in decision tree modeling. To date, no studies have extensively and quantitatively applied Shannon entropy in a systematic way to quantify the entropy of clinical situations using diagnostic variables (true and false positives and negatives, respectively). Decision tree representations of medical decision-making tools can be generated using diagnostic variables found in literature and entropy removal can be calculated for these tools. This concept of clinical entropy removal has significant potential for further use to bring forth healthcare innovation, such as quantifying the impact of clinical guidelines and value of care and applications to Emergency Medicine scenarios where diagnostic accuracy in a limited time window is paramount. This analysis was done for 623 diagnostic tools and provided unique insights into their utility. For studies that provided detailed data on medical decision-making algorithms, bootstrapped datasets were generated from source data to perform comprehensive machine learning analysis on these algorithms and their constituent steps, which revealed a novel and thorough evaluation of medical diagnostic algorithms.

97 MATHEMATICS AND COMPUTING↗

Question-answering system extracts information on injection drug use from clinical notes

Background. Injection drug use (IDU) can increase mortality and morbidity. Therefore, identifying IDU early and initiating harm reduction interventions can benefit individuals at risk. However, extracting IDU behaviors from patients’ electronic health records (EHR) is difficult because there is no other structured data available, such as International Classification of Disease (ICD) codes, and IDU is most often documented in unstructured free-text clinical notes. Although natural language processing can efficiently extract this information from unstructured data, there are no validated tools. Methods. Here, to address this gap in clinical information, we design a question-answering (QA) framework to extract information on IDU from clinical notes for use in clinical operations. Our framework involves two main steps: (1) generating a gold-standard QA dataset and (2) developing and testing the QA model. We use 2323 clinical notes of 1145 patients curated from the US Department of Veterans Affairs (VA) Corporate Data Warehouse to construct the gold-standard dataset for developing and evaluating the QA model. We also demonstrate the QA model’s ability to extract IDU-related information from temporally out-of-distribution data. Results. Here, we show that for a strict match between gold-standard and predicted answers, the QA model achieves a 51.65% F1 score. For a relaxed match between the gold-standard and predicted answers, the QA model obtains a 78.03% F1 score, along with 85.38% Precision and 79.02% Recall scores. Moreover, the QA model demonstrates consistent performance when subjected to temporally out-of-distribution data. Conclusions. Our study introduces a QA framework designed to extract IDU information from clinical notes, aiming to enhance the accurate and efficient detection of people who inject drugs, extract relevant information, and ultimately facilitate informed patient care.

60 APPLIED LIFE SCIENCES↗

Decoding substance use disorder severity from clinical notes using a large language model

Substance use disorder (SUD) poses a major concern due to its detrimental effects on health and society. SUD identification and treatment depend on a variety of factors such as severity, co-determinants (e.g., withdrawal symptoms), and social determinants of health. Existing diagnostic coding systems used by insurance providers, like the International Classification of Diseases (ICD-10), lack granularity for certain diagnoses, but American clinicians will add this granularity (as that found within the Diagnostic and Statistical Manual of Mental Disorders classification or DSM-5) as supplemental unstructured text in clinical notes. Traditional natural language processing (NLP) methods face limitations in accurately parsing such diverse clinical language. Large language models (LLMs) offer promise in overcoming these challenges by adapting to diverse language patterns. This study investigates the application of LLMs for extracting severity-related information for various SUD diagnoses from clinical notes. We propose a workflow employing zero-shot learning of LLMs with carefully crafted prompts and post-processing techniques. Through experimentation with Flan-T5, an open-source LLM, we demonstrate its superior recall compared to the rule-based approach. Focusing on 11 categories of SUD diagnoses, we show the effectiveness of LLMs in extracting severity information, contributing to improved risk assessment and treatment planning for SUD patients.

60 APPLIED LIFE SCIENCES↗

A simulation framework for evaluating electronic order workflows in integrated health records

Electronic health record (EHR) systems are critical to modern healthcare delivery, yet the dynamic workflows that govern electronic order processing remain underexplored. Inefficiencies in these digital pathways can cause delays in care, repetitive workloads, and even patient harm. This study presents a discrete-event simulation framework used to reconstruct and evaluate EHR-based order workflows in a large integrated healthcare system. Using real-world data extracted from the Veterans Health Administration’s Corporate Data Warehouse, the authors mapped order events to standardized state transitions and modeled their progression across different facilities of varying complexity levels. After being calibrated with empirical distributions of transition times and validated against observed time-in-system metrics, the simulation demonstrates close alignment with historical performance. Scenario analyses reveal that resource capacity constraints significantly amplify the impact of electronic order surges, which are reflected in the disproportionate growth in backlogs and processing delays. Adjustments in transition probabilities further increased recirculation and extended workflow paths. Network-based analysis identified Reserved, InProgress, and Completed as structurally critical states that function as hubs within the process network but the transitions in-between also act as major bottlenecks. These results showcased the effectiveness of simulation-based approaches in monitoring EHR order processing performance and evaluating consequences of workflow changes on healthcare network resources planning. The proposed simulation framework provides a scalable data-driven tool to support operational decision-making and improve the efficiency of electronic order management in complex healthcare environments.

Engineering↗

Unstructured clinical notes within the 24 hours since admission predict short, mid & long-term mortality in adult ICU patients

Mortality prediction for intensive care unit (ICU) patients is crucial for improving outcomes and efficient utilization of resources. Accessibility of electronic health records (EHR) has enabled data-driven predictive modeling using machine learning. However, very few studies rely solely on unstructured clinical notes from the EHR for mortality prediction. In this work, we propose a framework to predict short, mid, and long-term mortality in adult ICU patients using unstructured clinical notes from the MIMIC III database, natural language processing (NLP), and machine learning (ML) models. Depending on the statistical description of the patients’ length of stay, we define the short-term as 48-hour and 4-day period, the mid-term as 7-day and 10-day period, and the long-term as 15-day and 30-day period after admission. We found that by only using clinical notes within the 24 hours of admission, our framework can achieve a high area under the receiver operating characteristics (AU-ROC) score for short, mid and long-term mortality prediction tasks. The test AU-ROC scores are 0.87, 0.83, 0.83, 0.82, 0.82, and 0.82 for 48-hour, 4-day, 7-day, 10-day, 15-day, and 30-day period mortality prediction, respectively. We also provide a comparative study among three types of feature extraction techniques from NLP: frequency-based technique, fixed embedding-based technique, and dynamic embedding-based technique. Lastly, we provide an interpretation of the NLP-based predictive models using feature-importance scores.

60 APPLIED LIFE SCIENCES↗

VA Community Determinants of Health Data Curation Documentation FY26-Q2

The U.S. Department of Veterans Affairs (VA) places the health and well-being of our nation’s veterans as its top priority. VA is dedicated to offering timely access to high-quality, evidence-based mental health care that meets the needs of veterans and supports their reintegration into society. One of our core missions is to prevent suicide among veterans through innovative approaches and resources. With funding from the VA Office of Mental Health and Suicide Prevention (OMHSP), the Community Determinants of Health (EDH) Data project has developed innovative datasets associated with specific health outcomes, a methodology for transforming spatiotemporal data from one spatial reference (e.g., a 1 km grid) to another (e.g., U.S. Census Tracts), and capabilities for modeling health outcomes. These datasets represent an enhancement of the Agency for Healthcare Research and Quality (AHRQ), addressing key gaps by introducing finer spatial resolution (Census Tract) and additional geographical covariates into existing data. The curation and standardization of these datasets is a complex task since they often originate from various sources and are measured at different spatial and temporal resolutions. For example, U.S. Census data products typically use census blocks, block groups, or counties, while data like weather data are available on 1 km grids. Some economic data may only be available at the ZIP code level. In this context, ‘standardized’ means that all datasets share the same spatial extent (e.g., U.S. Census Tract and/or County), and ‘curated’ implies a repeatable process with data provenance and the use of appropriate methodologies for covariate conversion. The Community Determinants of Health datasets draw from multiple sources, resulting in variables with varying degrees of availability, patterns of missing data, and methodological considerations across different sources, geographies, and years.

99 GENERAL AND MISCELLANEOUS↗

Impact of Tuned Lighting on Skilled Nursing Center Residents' Sleep

The Problem: Sleep disturbance is common among nursing center residents and places them at risk for poor health outcomes. Lighting that changes in color and intensity over the course of the day and night may improve sleep and other outcomes, like dementia behaviors, but has has not been rigorously evaluated under real-world conditions. The Resolution: This single-facility study establishes that facility-level tuned lighting is feasible to implement and evaluate in a nursing center. Researchers randomly-assigned three corridors to one of two lighting conditions, then the other. Residents experienced half as many sleep disturbances while exposed to tuned vs. static lighting. There was no effect on behaviors. Tips for Success: Tuned lighting is a low-risk intervention that could be employed in new construction or when retrofitting fixtures into existing buildings. Key Words: Nursing home, long-term care, lighting, sleep, behaviors

60 APPLIED LIFE SCIENCES↗

The Evolution of Randomized Clinical Trial Designs to Assess Therapeutics in Alzheimer Disease

Importance The success of recent randomized clinical trials (RCTs) for Alzheimer disease (AD), particularly those focusing on anti-amyloid therapies, has been discussed at length. However, the evolution of RCT design features for AD that preceded this success remain underexplored. Objective To describe temporal changes in the features of RCT design for interventions in AD. Evidence Review PubMed, Scopus, and Web of Science databases were searched in January 2025 for phase 2 and 3 AD RCTs published between January 1992 and December 2024. RCTs that investigated an intervention for AD, with a placebo or standard-of-care control group, were included. Four assessors independently reviewed full-text articles to capture study characteristics. Main Outcomes and Measures The number of participants and the duration of RCTs as well as the target population, outcomes, and funding were extracted from published reports. These features were analyzed with respect to time using linear regression and χ 2 analyses. Results The study included 203 RCTs with 79 589 participants testing interventions in AD. From 1992 to 2024, the mean sample size increased by 464% for phase 2 RCTs (from 42 to 237), and 50% for phase 3 RCTs (from 632 to 951), while the mean trial duration increased by 188% (from 16 to 46 weeks) for phase 2, and 256% (from 20 to 71 weeks) for phase 3 RCTs. This longer duration of RCTs may be partially attributed by a greater share of disease-modifying rather than symptomatic treatments. Similarly, more recent trials required AD biomarker evidence for enrollment (from 1 of 36 [2.7%] before 2006 to 40 of 76 [52.6%] since 2019). A substantial difference in the type of therapeutics researched was observed, with anti-amyloid and anti-tau RCTs being more likely to be funded by the pharmaceutical industry compared with neurotransmitter or other RCTs (anti-amyloid or anti-tau, 68 of 71 [95.8%]; neurotransmitter, 52 of 69 [77.6%]; other, 33 of 52 [63.5%]). RCT transparency improved, with more frequent data accessibility statements, registered reports, and better reporting on race and ethnicity. Conclusions and Relevance This methodology research of AD RCTs highlights substantial changes in key features of AD clinical trials from 1992 to 2024. AD RCTs have become larger and longer, such that they are powered to detect smaller clinical differences. The increased sample sizes and duration should enable the detection of smaller and more slowly occurring outcomes, which may lead to successful RCTs of therapies with slower and more subtle efficacy.

General & Internal Medicine↗