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Health Care Usage During the COVID-19 Pandemic and the Adoption of Telemedicine: Retrospective Study of Chronic Disease Cohorts

Background: The COVID-19 pandemic accelerated telehealth adoption across disease cohorts of patients. For many patients, routine medical care was no longer an option, and others chose not to visit medical offices in order to minimize COVID-19 exposure. In this study, we take a comprehensive multidisease approach in studying the impact of the COVID-19 pandemic on health care usage and the adoption of telemedicine through the first 12 months of the COVID-19 pandemic. Objective: We studied the impact of the COVID-19 pandemic on in-person health care usage and telehealth adoption across chronic diseases to understand differences in telehealth adoption across disease cohorts and patient demographics (such as the Social Vulnerability Index [SVI]). Methods: We conducted a retrospective cohort study of 6 different disease cohorts (anxiety: n=67,578; depression: n=45,570; diabetes: n=81,885; kidney failure: n=29,284; heart failure: n=21,152; and cancer: n=35,460). We used summary statistics to characterize changes in usage and regression analysis to study how patient characteristics relate to in-person health care and telehealth adoption and usage during the first 12 months of the pandemic. Results: We observed a reduction in in-person health care usage across disease cohorts (ranging from 10% to 24%). For most diseases we study, telehealth appointments offset the reduction in in-person visits. Furthermore, for anxiety and depression, the increase in telehealth usage exceeds the reduction in in-person visits (by up to 5%). We observed that younger patients and men have higher telehealth usage after accounting for other covariates. Patients from higher SVI areas are less likely to use telehealth; however, if they do, they have a higher number of telehealth visits, after accounting for other covariates. Conclusions: The COVID-19 pandemic affected health care usage across diseases, and the role of telehealth in replacing in-person visits varies by disease cohort. Understanding these differences can inform current practices and provides opportunities to further guide modalities of in-person and telehealth visits. Critically, further study is needed to understand barriers to telehealth service usage for patients in higher SVI areas. A better understanding of the role of social determinants of health may lead to more support for patients and help individual health care providers improve access to care for patients with chronic conditions.

60 APPLIED LIFE SCIENCES

Negative Medium-Voltage Direct Current Discharges in Air under Simulated Sub-Atmospheric Pressures for All-Electric Aircraft

The increase in the global temperature due to greenhouse gas emissions is a major concern to the world. To achieve the goal of zero emissions by 2050 in the USA the practical realization of all-electric vehicles, particularly all-electric aircraft (AEA), is important. For the design of electrical power systems (EPSs) in all-electric aircraft, a bipolar medium-voltage direct current (MVDC) system of ±5 kV is being investigated. However, several challenges manifest when using such voltages in a low-pressure environment. One of the main challenges is the partial discharge (PD) behavior of the insulation. It is important to study the PD behavior of the insulation by simulating the aviation environment in the lab. This work aimed to study the partial discharge behavior of air under a negative DC voltage in a needle-to-plane electrode geometry by simulating the aviation pressures in the lab. The partial discharge inception voltage (PDIV) and the breakdown voltage (BDV) show an obvious pressure-dependent variation. Regression analysis was performed to better understand the relationship between the PDIV and pressures. Plots were drawn for the average discharge current at each voltage step until breakdown. This paper’s findings can provide valuable insight into the design of EPS for an AEA. To the best of our knowledge, such a study has not been carried out to date.

air discharge

Understanding and Modeling Pooled Rideshare Acceptance: Influential Factors, Preferred User Experiences, and Implications

This dissertation explores factors influencing pooled rideshare (PR) adoption to provide actionable insights for transportation network companies (TNCs) and policymakers. PR allows travelers to share rides with unknown passengers, offering benefits such as cost reduction and congestion relief. However, adoption remains limited due to safety concerns, privacy issues, and trust in rideshare platforms. A national U.S. survey with 5,385 respondents examined transportation preferences and barriers to PR adoption. Exploratory and confirmatory factor analyses identified five key factors influencing PR consideration—safety, service experience, privacy, traffic/environment, and time/cost. Second factor analyses examined ways to optimize PR experiences, revealing four factors—comfort/ease of use, convenience, vehicle technology/accessibility, and passenger safety. Privacy concerns, for instance, using regression analysis, were found to reduce the likelihood of PR adoption by 77%, and convenience had the potential to increase it by 156%. The Pooled Rideshare Acceptance Model (PRAM), based on the Technology Acceptance Model, assessed the impact of these factors using the Structural Equation Model (SEM). Privacy, safety, trust, and convenience had a large effect (Cohen's f2 > 0.35) on PR acceptance, while multigroup analyses (PRAMMA) explored 16 demographic variables such as gender, generation, and income, emphasizing the need for tailored strategies. Based on all the statistical analysis and workshops using descriptive statistics, 95 actionable recommendations were made from the riders' perspective. Findings highlight the importance of customized services, user experience improvements, and policy interventions to enhance PR adoption. This dissertation provides a roadmap for future research and policy development, ensuring evidence-based, practical strategies to improve PR services in the U.S. and beyond.

Gangadharaiah, Rakesh

Understanding Peelle’s Pertinent Puzzle bias in generalized least squares regression through eigenspectrum analysis

Certain correlation structures in the data covariance matrix (DCM) used for generalized least squares (GLS) regression can result in biased estimates, commonly known in the field of nuclear data evaluation as Peele’s Pertinent Puzzle (PPP). This article introduces a generative, forward modeling framework within which the PPP bias is characterized through an eigenspectrum analysis of the DCM. This analysis highlights the root cause of the bias, generalizes the problem beyond the nuclear data field, and provides insight to the problem regimes where it can occur. What follows is an understanding that the bias can show up for any experimental neutron time-of-flight data for which systematic uncertainties have been quantified. Lastly, a discussion of the adaptation of cross validation approaches that require pre-whitening to incorporate the known ‘fix’ to the PPP bias in the GLS estimator.

73 NUCLEAR PHYSICS AND RADIATION PHYSICS

Elongated particles in flow: commentary on small-angle scattering investigations

Here, this work thoroughly examines several analytical tools, each possessing a different level of mathematical intricacy, for the purpose of characterizing the orientation distribution function of elongated objects under flow. Our investigation places an emphasis on connecting the orientation distribution to the small-angle scattering spectra measured experimentally. The diverse range of mathematical approaches investigated herein provide insights into the flow behavior of elongated particles from different perspectives and serve as powerful tools for elucidating the complex interplay between flow dynamics and the orientation distribution function.

36 MATERIALS SCIENCE

Mountain Basin Controls on the Snow-to-Streamflow Signal: An AIC-Weighted Multiple Linear Regression Framework

A regression-based analysis quantifies how basin characteristics modulate the snow-to-streamflow signal. First, we use the ERA5-Land reanalysis gridded product (European Centre for Medium Range Weather Forecasts reanalysis 5 -Land component) for 4,655 hydrologic unit code - 10 (HUC10) mountain basins across the western United States (US) for water years 1987–2024. Linear regressions are performed for peak snow water equivalent (SWE) and annual streamflow for each mountain basin. Models use ordinary least squares in Python’s statsmodels package. After which, an Akaike Information Criterion (AIC)–weighted ensemble multiple linear regression (MLR) framework with 47 watershed traits is used to predict the linear regression coefficient of determination (r-squared) defining the ability of peak SWE to predict annual streamflow across all mountain basin. Predictor sets are constrained to avoid multicollinearity by excluding models with variance inflation factors (VIF) greater than 5. Mountain basin traits included in the MLR include seasonal climate, topography, vegetation type and structure, and bedrock geology. Accepted models are considered if their AIC is within 2.0 of the model with the minimum AIC, or best model. To compare predictor influence across acceptable models, we computed standardized regression coefficients. To evaluate structural redundancy among models, we constructed binary inclusion vectors for each acceptable model, denoting whether a predictor was present (1) or absent (0). Core predictor variables are defined as occurring in at least 67% of the acceptable models. For this regional analysis, only one model was found acceptable, with higher snow-to-streamflow translation (higher r-squared) occurring in colder mountain basins with higher relative winter precipitation, more snow accumulation and a lower fraction of annual precipitation that falls in the spring and summer. The second component of the data package uses previously published, high-resolution output from an integrated hydrological model of the East River watershed using the U.S. Geological Survey Groundwater and Surface water Flow model (GSFLOW, doi:10.15485/1998576). East River MLR expands upon the approach described above to explore the response of five streamflow metrics—annual streamflow, runoff efficiency, 7-day minimum flow, low-flow duration, and non-perennial stream fraction to snow system indicators including peak SWE, snow-covered area, snow disappearance date, and the fraction of basin area characterized by low-to-no snow, as well as seasonal precipitation and temperature, and annual hydrologic variables representing soil moisture, evapotranspiration (ET), the partitioning of incoming precipitation to evapotranspiration (ET/P), groundwater storage, and groundwater inflow to streams. MLR was done on all water years (P0: 1987-2024) and for each period as determined in the split analysis using pooled regression techniques (P1: 1987-2011 and P2: 2012-2024) to evaluate shifting predictor variable emphasis on streamflow generation. Results indicate that since 2012, peak SWE has lost statistical strength in its prediction of annual streamflow and runoff efficiency, and the indirect influence of spring temperature has emerged as critically important. Low-flow metrics remain largely influenced by soil moisture, vegetation water use and groundwater inflows with summer precipitation becoming a direct influence on minimum summer flow. Together, these data and Python-based analysis tools provide a framework for identifying the key watershed characteristics that control how streamflow responds to snow from year to year. The package also helps quantify uncertainty in statistical models and assess how snow–streamflow relationships vary across regions and over time. This dataset contains comma-separated values files (.csv), text files (.txt), python code files (.py), figure files (.png), and shapefiles (.cpg, .dbf, .prj, .sbn, .sbx, .shp, .xml). Further details on file contents and MLR execution can be found in the readme file and the FLMD files. Work was supported by the Watershed Function Science Focus Area at Lawrence Berkeley National Laboratory funded by the US Department of Energy, Office of Science, Biological and Environmental Research under Contract No. DE-AC02-05CH11231.

54 ENVIRONMENTAL SCIENCES

Automated Bayesian high-throughput estimation of plasma temperature and density from emission spectroscopy

Here, this paper introduces a novel approach for automated high-throughput estimation of plasma temperature and density using atomic emission spectroscopy, integrating Bayesian inference with sophisticated physical models. We provide an in-depth examination of Bayesian methods applied to the complexities of plasma diagnostics, supported by a robust framework of physical and measurement models. Our methodology is demonstrated using experimental observations in the field of magneto-inertial fusion, focusing on individual and sequential shot analyses of the Plasma Liner Experiment at LANL. The results demonstrate the effectiveness of our approach in enhancing the accuracy and reliability of plasma parameter estimation and in using the analysis to reveal the deep hidden structure in the data. This study not only offers a new perspective of plasma analysis but also paves the way for further research and applications in nuclear instrumentation and related domains.

Bayesian inference

Disentangling the Impacts of Microtopography and Shrub Distribution on Snow Depth in a Subarctic Watershed: Toward a Predictive Understanding of Snow Spatial Variability: Supporting Data and Code

This repository contains R code and associated datasets for reproducing the analysis described in the manuscript titled “Disentangling the Impacts of Microtopography and Shrub Distribution on Snow Depth in a Subarctic Watershed: Toward a Predictive Understanding of Snow Spatial Variability” (DOI: 10.1029/2024JG008604). The provided scripts facilitate a comprehensive analysis of snow depth variability influenced by microtopography and vegetation distribution in a subarctic watershed. Included datasets are high-resolution spatial maps of snow depth, terrain elevation, vegetation height, and distance from shrubs taller than 1 meter, all formatted as text files (.txt). These data are fully describe in doi:10.15485/2316038. Users can adapt the provided R scripts to accommodate different data formats or larger spatial domains, noting that some output files may require modification due to their size.The code includes implementations for boosted regression tree analysis adapted from methods outlined in Elith et al. (2008). Users interested in understanding or modeling landscape-scale snow distribution patterns, particularly in Arctic or subarctic ecosystems, will find this package useful. The Next-Generation Ecosystem Experiments: Arctic (NGEE Arctic), was a research effort to reduce uncertainty in Earth System Models by developing a predictive understanding of carbon-rich Arctic ecosystems and feedbacks to climate. NGEE Arctic was supported by the Department of Energy's Office of Biological and Environmental Research.The NGEE Arctic project had two field research sites: 1) located within the Arctic polygonal tundra coastal region on the Barrow Environmental Observatory (BEO) and the North Slope near Utqiagvik (Barrow), Alaska and 2) multiple areas on the discontinuous permafrost region of the Seward Peninsula north of Nome, Alaska.Through observations, experiments, and synthesis with existing datasets, NGEE Arctic provided an enhanced knowledge base for multi-scale modeling and contributed to improved process representation at global pan-Arctic scales within the Department of Energy's Earth system Model (the Energy Exascale Earth System Model, or E3SM), and specifically within the E3SM Land Model component (ELM).

54 ENVIRONMENTAL SCIENCES

Risk-Aware Framework Development for Disruption Prediction: Alcator C-Mod and DIII-D Survival Analysis

Abstract Survival regression models can achieve longer warning times at similar receiver operating characteristic performance than previously investigated models. Survival regression models are also shown to predict the time until a disruption will occur with lower error than other predictors. Time-to-event predictions from time-series data can be obtained with a survival analysis statistical framework, and there have been many tools developed for this task which we aim to apply to disruption prediction. Using the open-source Auton-Survival package we have implemented disruption predictors with the survival regression models Cox Proportional Hazards, Deep Cox Proportional Hazards, and Deep Survival Machines. To compare with previous work, we also include predictors using a Random Forest binary classifier, and a conditional Kaplan-Meier formalism. We benchmarked the performance of these five predictors using experimental data from the Alcator C-Mod and DIII-D tokamaks by simulating alarms on each individual shot. We find that developing machine-relevant metrics to evaluate models is an important area for future work. While this study finds cases where disruptive conditions are not predicted, there are instances where the desired outcome is produced. Giving the plasma control system the expected time-to-disruption will allow it to determine the optimal actuator response in real time to minimize risk of damage to the device.

70 PLASMA PHYSICS AND FUSION TECHNOLOGY

Exploring biofiber properties and their influence on biocomposite tensile properties

Biofibers serve as effective reinforcements for neat polylactic acid (PLA) in biocomposites, offering an attractive opportunity to decarbonize the manufacturing sector of the United States by displacing fossil-based reinforcement fibers such as carbon fibers. Also, biofiber production can stimulate economic growth in rural economies, fueling sustainable development. PLA resins are commonly compounded with biofibers to create biocomposites suitable for additive manufacturing. PLA-biofiber composites often exhibit better overall material properties than neat (pure) PLA, but the associations between biofiber properties and the material properties of their biocomposites remain largely unexplored. Hence, this research delves into a comprehensive exploration of diverse biofibers, scrutinizing their physical and chemical attributes, including size, shape, ash content and biochemical composition. The study meticulously analyzes the flow properties of each biofiber and elucidates the ultimate tensile strengths and Young's modulus of corresponding biocomposite samples. Noteworthy correlations between biofiber and biocomposite tensile properties are uncovered, shedding light on critical interrelationships. The study introduces an approach employing regression models to predict the ultimate tensile strength and Young's modulus of biocomposites. These models, validated with a cross-validation technique, exhibit remarkable predictive accuracy, particularly in estimating ultimate tensile strength. © 2024 Oak Ridge National Laboratory managed by UT-Battelle, LLC and The Author(s). Polymer International published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry.

36 MATERIALS SCIENCE

Predicting the viscoplastic response of a crystallizing fluoropolymer using transient network theory

We employ a molecular theory of dynamic polymer networks to describe the viscoplastic response of rubbery FK-800, a thermoplastic copolymer of chlorotrifluoroethylene and vinylidene fluoride, over a broad range of thermal histories. The kinetics of crystallization at different annealing temperatures was modeled using a modified Avrami equation, whose parameters were found to evolve through simple relationships over the full temperature range of the rubbery state. By fitting experimental compression data, we discovered predictable trends for the physical parameters in our mechanical model over its full range of crystallinities (up to ≈20%) and provided insights based on molecular-level physics to justify them. Using this, an end-to-end model was developed to predict the yielding and post-yield behavior of rubbery FK-800 for arbitrary thermal histories. The model successfully predicted the highly nonlinear evolution of characteristic mechanical signatures (stiffness, yield point, post-yield drop) throughout the crystallization process. A statistical analysis of variance test was employed to determine that the measured variations in the mechanical behavior of rubbery FK-800 are primarily dictated by its fractional crystallinity, regardless of its exact thermal history.

36 MATERIALS SCIENCE

Asymptotic inconsistency of the cumulative algorithm for laser-induced damage probability analysis

The “cumulative algorithm” is a data analysis method that has been proposed to provide an objective, nonparametric determination of laser-induced damage probability as a function of fluence from experimental data that contain both damaged sites and undamaged sites (i.e., 1-on-1 or S-on-1 testing protocols). In this work, the limitations of this approach are explored by considering the asymptotic limit of a large number of test sites. It is shown that the cumulative algorithm does not converge to the true probability distribution and significantly underestimates the damage probability near the damage onset. Here, based on the results of this work, the cumulative algorithm is not recommended for accurate estimation of damage probability.

Computational methods

Evolution of intermittent filaments in the scrape-off layer of NSTX

Filamentary structures naturally arise from background turbulence in the scrape-off layer (SOL) of plasmas, leading to significant particle and heat transport that can degrade overall plasma confinement. This enhanced transport can contribute to unacceptably high heat loads on plasma-facing components. As such, understanding the physics of SOL plasma filaments is critical for predicting and mitigating their effects in future fusion devices. On the National Spherical Torus Experiment (NSTX), plasma filaments—commonly referred to as “blobs”—were investigated using the gas-puff imaging (GPI) diagnostic in the edge and SOL regions. The analysis involved identifying, segmenting, and tracking the characteristic contours of the blobs in each frame of the GPI video sequences. Their evolution was characterized through shape descriptors, velocity, and angular velocity derived from their contour coordinates. The results indicate that as the blob area increases, their shapes become more concave and less circular, suggesting reduced structural stability in larger blobs. This result aligns with previous theoretical results where it was shown that larger blobs are more susceptible to instabilities [Krasheninnikov et al., J. Plasma Phys. 74, 679–717 (2008) and D'Ippolito et al., Phys. Plasmas 18, 060501 (2011)]. A positive correlation was observed between radial velocity and radial position, suggesting radially outward acceleration of the filaments, potentially driven by decreasing viscous drag toward the far SOL. Interestingly, blobs in background SOL turbulence exhibited minimal spinning in contrast to filaments originating from edge localized modes, which show substantial rotation during their paths [Lampert et al., Phys. Plasmas 29, 102502 (2022)]. Statistical analysis of the solidity and total curvature shape descriptors, along with their temporal evolution, revealed relatively broad, near-Gaussian distributions. This suggests that blob morphology is strongly influenced by stochastic turbulent processes in the surrounding plasma environment. Blob parameters were also compared with bulk plasma and radial profile measurements. Notable trends were found between blob rotation and poloidal velocity with collisionality and line-integrated density. These findings contribute to a deeper understanding of blob dynamics and provide valuable insights for refining SOL turbulence models.

Covariance and correlation

Parametric and Nonparametric Models of U.S. Cost Overruns for Nuclear Power Plants

This study presents new data-driven models to estimate the effect of capacity on the percentage of cost overruns in the United States for nuclear power plant construction projects before and after the Three Mile Island accident. Parametric and nonparametric models have been developed that describe the significant shifts in nuclear energy costs during the dynamic environment. Employing a contemporary descriptive methodology and a quantitative analysis, we furnish a comprehensive overview of the alterations in cost overrun distribution and show the changes observed in other pivotal metrics alongside cost overruns. Our emphasis lies in documenting the fluctuations in cost overruns alongside nuclear reactor capacity levels and the increase of the overnight capital costs to build nuclear reactors. Our results show that increasing the size of nuclear reactors is not a factor statistically significant to decrease the percentage of cost overruns, and the probit model results provide evidence that an increase in size increases the probability of having cost overruns larger than 100% (double the estimated cost). We also compare our findings to two other regions: Asia and Europe.

11 NUCLEAR FUEL CYCLE AND FUEL MATERIALS

Scattering-based structural inversion of soft materials via Kolmogorov–Arnold networks

Small-angle scattering techniques are indispensable tools for probing the structure of soft materials. However, traditional analytical models often face limitations in structural inversion for complex systems, primarily due to the absence of closed-form expressions of scattering functions. To address these challenges, we present a machine learning framework based on the Kolmogorov–Arnold Network (KAN) for directly extracting real-space structural information from scattering spectra in reciprocal space. This model-independent, data-driven approach provides a versatile solution for analyzing intricate configurations in soft matter. By applying the KAN to lyotropic lamellar phases and colloidal suspensions—two representative soft matter systems—we demonstrate its ability to accurately and efficiently resolve structural collectivity and complexity. Here, our findings highlight the transformative potential of machine learning in enhancing the quantitative analysis of soft materials, paving the way for robust structural inversion across diverse systems.

37 INORGANIC, ORGANIC, PHYSICAL, AND ANALYTICAL CH

Insights into distorted lamellar phases with small-angle scattering and machine learning

Lamellar phases are essential in various soft matter systems, with topological defects significantly influencing their mechanical properties. In this report, we present a machine-learning approach for quantitatively analyzing the structure and dynamics of distorted lamellar phases using scattering techniques. By leveraging the mathematical framework of Kolmogorov–Arnold networks, we demonstrate that the conformations of these distorted phases – expressed as superpositions of complex waves – can be reconstructed from small-angle scattering intensities. Through the contour analysis of wave field phase singularities, we obtain the statistics of the spatial distribution of topological defects. Furthermore, we establish that the temporal evolution of these defects can be derived from the time-dependent traveling wave field, informed by the dispersion relation of spectral components. This method opens new avenues for investigating the dynamics of distorted lamellar phases using various dynamic scattering techniques such as neutron spin echo and X-ray photon correlation spectroscopy. These findings enhance our microscopic understanding of how defects influence the physical properties of lamellar materials, with implications for both equilibrium and non-equilibrium states in general lamellar systems.

36 MATERIALS SCIENCE

Uniaxial compressive creep tests by spark plasma sintering of 70% theoretical density α -uranium and U-10Zr

Metallic fuels hold numerous advantages over conventional uranium dioxide fuels and are a key component of several liquid metal-cooled advanced reactor concepts including sodium fast reactors. These fuels undergo rapid swelling during early burnup; consequently, they spend most of their reactor lifetime in a porous state. The presence of this porosity alters many of the mechanical properties of the fuel including creep impacting fuel deformation during axial swelling. This work investigates the creep behavior of the porous fuel using a spark plasma sintering technique. Creep tests were performed for the first time on porous α-phase uranium and uranium with 10 wt. % zirconium (U-10Zr) samples. The samples of α-phase uranium and U-10Zr were fabricated from depleted uranium by spark plasma sintering and subjected to uniaxial compressive creep testing. Calculated stress exponents were found to be 2.6±1.6 and 5.7±1.4 for α-U and U-10Zr, respectively, and calculated activation energies were found to be 61.6±1.1kJ/mol for α-U. The creep data were also used to evaluate existing porosity inclusive in creep models.

11 NUCLEAR FUEL CYCLE AND FUEL MATERIALS