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

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All sourcesNASA NTRSDOE OSTI
DOE OSTI2021

Addressing Parental Vaccine Hesitancy and Other Barriers to Childhood/Adolescent Vaccination Uptake During the Coronavirus (COVID-19) Pandemic

Routine childhood immunizations are proven to be one of the most effective public health interventions at controlling numerous deadly diseases. Therefore, the CDC recommends routine immunizations for children and adolescent populations against vaccine-preventable diseases e.g., tetanus, pertussis, diphtheria, etc. This current review sought to examine barriers to pediatric vaccine uptake behaviors during the COVID-19 pandemic. We also explored the implications for parental vaccine hesitancy/delay during an ongoing health crisis and proposed recommendations for increasing vaccine confidence and compliance. Our review determined that the receipt for vaccinations steadily improved in the last decade for both the United States and Tennessee. However, this incremental progress has been forestalled by the COVID-19 pandemic and other barriers i.e. parental vaccine hesitancy, social determinants of health (SDoH) inequalities, etc. which further exacerbate vaccination disparities. Moreover, non-compliance to routine vaccinations could cause an outbreak of diseases, thereby, worsening the ongoing health crisis and already strained health care system. Healthcare providers are uniquely positioned to offer effective recommendations with presumptive languaging to increase vaccination rates, as well as, address parental vaccine hesitancy. Best practices that incorporate healthcare providers’ quality improvement coaching, vaccination reminder recall systems, adherence to standardized safety protocols (physical distancing, hand hygiene practices, etc.), as well as, offer telehealth and outdoor/drive-through/curbside vaccination services, etc. are warranted. Additionally, a concerted effort should be made to utilize public health surveillance systems to collect, analyze, and interpret data, thereby, ensuring the dissemination of timely, accurate health information for effective health policy decision-making e.g., vaccine distribution, etc.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2021

Ride-hailing and taxi versus walking: Long term forecasts and implications from large-scale behavioral data

Introduction: Although ride-hailing and taxi trips can potentially reduce single-occupant vehicle trips and auto ownership, they can also replace pedestrian trips. Because physical activity is associated with improved health outcomes, the extent to which ride-hailing and taxi travel captures walking's mode share is of interest to policymakers. Methods: Based on large-scale behavioral data from the 2017 U.S. National Household Travel Survey, this paper reports on the development of a full Bayesian logistic regression model for determining the mode split between (1) ride-hailing and taxi and (2) walk while accounting for unobserved heterogeneity. The results from the stand-alone model inform two longer-term travel forecasting scenarios: a) higher risk of walk trips converting to ride-hailing and taxi, specifically in the future with high prevalence of automated vehicles, b) higher probability of such trips remaining as walking. Results: The results revealed that some of the important characteristics that increase the likelihood of a traveler using the ride-hailing and taxi mode versus walking include having a longer trip, using a smartphone to access the internet, having an interest in technologies, having a medical condition, and living in a metropolitan area with rail access. Further, the results from the first scenario suggest that an overall increase of up to 2.9% in the ride-hailing and taxi mode share may be expected. The second scenario shows that between 68% and 76% of ride-hailing and taxi trips could be diverted to walking if supportive pedestrian infrastructure were provided in the case study locations. The planning process can be adapted to consider not only congestion, crash, and emissions impacts of such shifts but also the effects of a loss of physical activity. Conclusions: The study findings show how the ride-hailing and taxi mode competes with walking. Further, the findings enable planners to update their regional travel forecasting models; policy makers can thus encourage active travel by prioritizing pedestrian infrastructure investments that may divert ride-hailing and taxi trips to walking. However, equity should be a key consideration to ensure that addressing the competition between these two modal choices does not hinder the provision of pedestrian facilities in communities that depend on walking.

99 GENERAL AND MISCELLANEOUS↗
DOE OSTI2025

Effects of PFOS on the behavior, growth, emergence, and predation susceptibility of larval mosquitoes ( Culex quinquefasciatus )

Per-/polyfluoroalkyl substances (PFAS) have been commonly used over several decades for a variety of products and are very persistent in the environment. However, not much is known about their direct effects on aquatic invertebrates and their ecosystems. We examined the survival, behavior, development, and predation susceptibility of mosquito larvae Culex quinquefasciatus exposed to concentrations of perfluorooctanesulfonic acid (PFOS) ranging from 0.02 to 453.7 µg/L. PFOS exposure resulted in reduced larval survival, with a 48 hour LC50 (concentration with 50 % mortality) of 255.99 µg/L. PFOS exposure also resulted in reduced developmental success and slower maturation to adulthood (and thus slower emergence from the water) compared to control larvae. PFOS also resulted in delays in reaction to prodding stimuli, which were meant to simulate a predator attack, and longer reactions to prodding. Larvae exposed to PFOS also spent more time at the bottom of the water column, rather than at the surface where respiration takes place. Effects of larval mosquito PFOS exposure on predation by unexposed damselfly naiads (genus Ischnura) were not detected. Overall, this research suggests that PFOS impacts mosquito larvae survival, behavior, development, and adult emergence, which could have important implications for food webs or public health given the role of mosquitos as disease vectors.

Food web dynamics↗
DOE OSTI2023

Data Analysis of X-ray Panels Used in X-ray CT Scientific Instruments

This report is a follow-up study on M. Skeate’s study on System Drift Detection for Health Monitoring (Skeate, 2023). The following report highlights analyses of the panel’s behavior with extended use. This includes effects of burn-in on the panel from over-use and bad pixels (defined in Methodology.) Using data-forward statistical analyses across a sequence of scans, and given that the other conditions present in the data can be replicated, this study show that overtime use of panels does not affect bad pixel count. Also, I present conclusive evidence of a direct relationship between the regions of the panel that are exposed to radiation and burn-in damage to that region overtime. Additionally, this study also highlights the effect of the duty cycle on the dark current change in the panel.

42 ENGINEERING↗
DOE OSTI2022

What can we learn from decarbonization of the energy sector?

This is a chapter that will be part of an Open Source e-book published by the International Water Association Publishing House. The co-editors are Professors Z. Jason Ren and Krishna Pagilla. Decarbonizing water and wastewater treatment is an enormous challenge, but it is substantially smaller, in total carbon emissions, than decarbonizing the energy sector. When planning, executing, and assessing strategies for decarbonizing the water sector, water experts should partner with the energy sector and heed that sector’s lessons-learned in its ongoing process of decarbonization. In the energy sector, decarbonization pathways can be as simple as a supply-side technology that converts fuel to electricity more efficiently, reducing net carbon emissions for every kilowatt-hour generated. The pathways can be much more complex, however, as is the case with the demand-side reordering of behavior as seen with online shopping or working from home during a public health crisis. Both of those pathways reduce demand for private-vehicle fuel and shift some work, and associated carbon emissions, to other parts of the economy. This chapter explores decarbonization pathways that have been followed by the energy sector and assesses their applicability to the water sector.

29 ENERGY PLANNING, POLICY, AND ECONOMY↗
DOE OSTI2024

The Kinematics of Proal Chewing in Rats

Chewing kinematics are well-documented in several mammal species with fused mandibular symphyses, but relatively understudied in mammals with an unfused symphysis, despite the fact that more than half of extant Mammalia have an unfused mandibular symphysis. The Wistar brown rat (Rattus norvegicus) is widely used in human health research, including studies of mastication or neurological studies where mastication is the output behavior. These animals are known to have unfused mandibular symphyses and proal jaw (rostrocaudal) motion during occlusion, but the lack of high resolution, 3-dimensional analysis of rat chewing leaves the functional significance of symphyseal mobility unknown. We used biplanar fluoroscopy and the X-ray reconstruction of moving morphology workflow to quantify chewing kinematics in 3 brown rats, quantifying overall jaw kinematics, including motions about the temporomandibular joint and unfused mandibular symphysis. During occlusion, the teeth and the mandibular condyle translate almost exclusively anteriorly (proal) during occlusion, with little motion in any other degrees of freedom. At the symphysis, we observed minimal flexion throughout the chew cycle. Overall, there are fundamental differences in jaw kinematics between rats and other mammals and therefore rats are not an appropriate proxy for ancestral mammal jaw mechanics. Additionally, differences between humans and rat chewing kinematics must be considered when using rats as a clinical model for pathological feeding research.

59 BASIC BIOLOGICAL SCIENCES↗
DOE OSTI2024

Technical Language Processing of Nuclear Power Plants Equipment Reliability Data

Operating nuclear power plants (NPPs) generate and collect large amounts of equipment reliability (ER) element data that contain information about the status of components, assets, and systems. Some of this information is in textual form where the occurrence of abnormal events or maintenance activities are described. Analyses of NPP textual data via natural language processing (NLP) methods have expanded in the last decade, and only recently the true potential of such analyses has emerged. So far, applications of NLP methods have been mostly limited to classification and prediction in order to identify the nature of the given textual element (e.g., safety or non-safety relevant). In this paper, we target a more complex problem: the automatic generation of knowledge based on a textual element in order to assist system engineers in assessing an asset’s historical health performance. The goal is to assist system engineers in the identification of anomalous behaviors, cause–effect relations between events, and their potential consequences, and to support decision-making such as the planning and scheduling of maintenance activities. “Knowledge extraction” is a very broad concept whose definition may vary depending on the application context. In our particular context, it refers to the process of examining an ER textual element to identify the systems or assets it mentions and the type of event it describes (e.g., component failure or maintenance activity). In addition, we wish to identify details such as measured quantities and temporal or cause–effect relations between events. This paper describes how ER textual data elements are first preprocessed to handle typos, acronyms, and abbreviations, then machine learning (ML) and rule-based algorithms are employed to identify physical entities (e.g., systems, assets, and components) and specific phenomena (e.g., failure or degradation). A few applications relevant from an NPP ER point of view are presented as well.

97 MATHEMATICS AND COMPUTING↗
DOE OSTI2025

Capturing Historic Reliability Performance Through Graph Databases: A Model Based System Engineering Approach

With the goal of improving the performance and reliability of high dependable technological systems such as nuclear power plants, advanced monitoring and health management systems are employed to inform system engineers on observed degradation processes and anomalous behaviors of assets and components. This information is captured in the form of large amount of data which can be heterogenous in nature (e.g., numeric, textual). Such large data availability poses challenges when system engineers are required to parse and analyze them in order to track historic reliability performance of assets and components. This paper tackles directly this challenge by providing means to organize data in the form of a graph: a knowledge graph. The presented approach distinguish itself from current knowledge graph-based methods by the fact that model-based system engineering (MBSE) models are used to “put data into context”. In particular, MBSE models are used as skeleton of a knowledge graph; numeric and textual data elements, once processed, are associated to MBSE model elements. Thus, a knowledge graph captures both system architecture (though MBSE models) and health/performance data. Such feature opens the door to new data analytics methods designed to identify causal relations between observed phenomena.

97 - MATHEMATICS AND COMPUTING↗
DOE OSTI2020

NASA’s first ground-based Galactic Cosmic Ray Simulator: Enabling a new era in space radiobiology research

With exciting new NASA plans for a sustainable return to the moon, astronauts will once again leave Earth’s protective magnetosphere only to endure higher levels of radiation from galactic cosmic radiation (GCR) and the possibility of a large solar particle event (SPE). Gateway, lunar landers, and surface habitats will be designed to protect crew against SPEs with vehicle optimization, storm shelter concepts, and/or active dosimetry; however, the ever penetrating GCR will continue to pose the most significant health risks especially as lunar missions increase in duration and as NASA sets its aspirations on Mars. The primary risks of concern include carcinogenesis, central nervous system (CNS) effects resulting in potential in-mission cognitive or behavioral impairment and/or late neurological disorders, degenerative tissue effects including circulatory and heart disease, as well as potential immune system decrements impacting multiple aspects of crew health. Characterization and mitigation of these risks requires a significant reduction in the large biological uncertainties of chronic (low-dose rate) heavy-ion exposures and the validation of countermeasures in a relevant space environment. Historically, most research on understanding space radiation-induced health risks has been performed using acute exposures of monoenergetic single-ion beams. However, the space radiation environment consists of a wide variety of ion species over a broad energy range. Using the fast beam switching and controls systems technology recently developed at the NASA Space Radiation Laboratory (NSRL) at Brookhaven National Laboratory, a new era in radiobiological research is possible. NASA has developed the “GCR Simulator” to generate a spectrum of ion beams that approximates the primary and secondary GCR field experienced at human organ locations within a deep-space vehicle. The majority of the dose is delivered from protons (approximately 65%–75%) and helium ions (approximately 10%–20%) with heavier ions (Z ≥ 3) contributing the remainder. The GCR simulator exposes state-of-the art cellular and animal model systems to 33 sequential beams including 4 proton energies plus degrader, 4 helium energies plus degrader, and the 5 heavy ions of C, O, Si, Ti, and Fe. A polyethylene degrader system is used with the 100 MeV/n H and He beams to provide a nearly continuous distribution of low-energy particles. A 500 mGy exposure, delivering doses from each of the 33 beams, requires approximately 75 minutes. To more closely simulate the low-dose rates found in space, sequential field exposures can be divided into daily fractions over 2 to 6 weeks, with individual beam fractions as low as 0.1 to 0.2 mGy. In the large beam configuration (60 × 60 cm 2 ), 54 special housing cages can accommodate 2 to 3 mice each for an approximately 75 min duration or 15 individually housed rats. On June 15, 2018, the NSRL made a significant achievement by completing the first operational run using the new GCR simulator. This paper discusses NASA’s innovative technology solution for a ground-based GCR simulator at the NSRL to accelerate our understanding and mitigation of health risks faced by astronauts. Ultimately, the GCR simulator will require validation across multiple radiogenic risks, endpoints, doses, and dose rates.

59 BASIC BIOLOGICAL SCIENCES↗
DOE OSTI2022

Behavioral and neuroinflammatory changes caused by glyphosate: Base herbicide in mice offspring

Abstract Background Glyphosate is a pesticide considered of low toxicity, but scientific evidences show it can be harmful to health. This study aimed to evaluate the toxicity in mice offspring exposed to glyphosate‐based herbicide (GBH) during the intrauterine period. Methods Female matrices received glyphosate 0.3 mg/kg daily per oral throughout the gestational period, which was variable between 18 and 22 days. From the 25th until the 28th days post‐birth, mice offspring were subjected to behavioral tests, and the prefrontal cortex was processed for immunohistochemical analysis. Results Two significant behavioral changes were observed: anxiety in the GLIF0.3 group, increase in the behavior burying marbles in the marble‐burying test and hyperactivity, expressed by the significant increase of the crossing number in the open field test. The increased microglia, TNF‐alpha, and astrocyte expression were also observed in the prefrontal cortex of offspring treated with GLIF0.3. Conclusion Exposure to GBH during mice intrauterine development induces hyperactive and anxious behavior, evidencing neuroinflammation.

de Castro Vieira Carneiro, Carla Larissa↗
DOE OSTI2024

Investigating Soil Organic Matter Complexation using Spectral Induced Polarization

Spectral induced polarization (SIP) laboratory experiments were conducted to determine the sensitivity of this method to the formation of soil organic matter (SOM) complexes, with a long-term goal of field-scale monitoring. There are few SIP experiments that have explored this topic, yet understanding the dynamic behavior and interactions of SOM at the field scale could provide insight into soil fertility and health which influences crop yields, microorganisms that degrade organic pollutants, and carbon stabilization. We present the results of three experiments where the iron oxide, ferrihydrite (Fhy), was used to coat different media, and then the OM compound pentaglycine (PG) was pulse injected to form SOM complexes. SIP data was collected during these injections to capture any surface complexation changes. These experiments were performed in 1) a fluidic cell containing a micromodel, 2) a column containing Fhy coated ceramic beads and 3) a column containing Fhy coated Accusand®. Our results show a higher frequency response (defined here as > 1 Hz) in all three experiments, with the largest amplitude response after the first PG injection (Figure S.1). The repeatability of this response is encouraging and supporting data collected on the Accusand® experiment provides preliminary insight into the mechanisms controlling the SIP signatures. Sampling of fluid conductivity $σ_w$ and pH may indicate deprotonation of SOM occurring or rapid adsorption and release of protons from the Fhy sites. However additional experiments are needed to identify and confirm the primary and secondary reactions impacting the SIP response. We are looking towards other opportunities to continue this work, particularly to repeat experiments while collecting supporting datasets.

58 GEOSCIENCES↗
DOE OSTI2023

Screening and Brief Interventions for Alcohol Use During Pregnancy: Practices Among US Primary Care Clinicians, DocStyles 2019

Alcohol use during pregnancy can cause birth defects and developmental disabilities. From 2018 through 2020, 13.5% of pregnant women reported current drinking. The US Preventive Services Task Force recommends evidence-based tools (eg, AUDIT-C and SASQ) for implementing screening and brief interventions to reduce excessive alcohol use among adults, including pregnant people, for whom any alcohol use is considered excessive. We used DocStyles 2019 data to conduct a cross-sectional analysis to examine current screening and brief intervention practices that primary care clinicians conduct among pregnant patients; clinicians’ confidence levels in conducting screening, brief interventions, and referral to treatment; and the documentation of brief interventions in the medical record. A total of 1,500 US adult medicine clinicians completed the entire survey. Among the respondents who conduct screening (N = 1,373) and brief interventions (N = 1,357) in their practice, nearly all reported implementing screening (94.6%) and brief interventions (94.9%) with their pregnant patients for alcohol use, but fewer than half felt confident about conducting their screening practices (46.5%). Two-thirds (64%) reported using a tool that met the criteria recommended by the US Preventive Services Task Force (USPSTF). Over half documented brief interventions in electronic health record notes (51.7%) or designated space (50.7%). Pregnancy presents a unique opportunity for clinicians to incorporate screening into routine obstetric care and encourage behavior change among patients. Most providers reported always screening their pregnant patients for alcohol use, but fewer used evidence-based USPSTF-recommended screening tools. Increased clinician confidence in screening and brief intervention, the use of standardized screening tools tailored to pregnant people, and maximal use of electronic health record technology may enhance the benefits of their application to alcohol use, which ultimately can reduce adverse outcomes associated with alcohol use during pregnancy.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2025

Exploring Electrode-Level State-of-Charge and State-of-Health Dynamics in Lithium-Ion Battery Cells: Modeling and Experimental Identification

A computationally efficient model serves as a critical prerequisite for battery performance analysis and advanced battery management algorithm design. Although battery models that capture cell-level behavior have been widely explored in existing literature, electrode-level battery models have received much lesser attention till to date. However, such electrode-level models can significantly increase battery performance and life by enabling electrode-level health-conscious control. Such electrode-level control can effectively expand usable energy and power limits of the battery cells by utilizing the knowledge of individual electrodes' charge and health. In this context, this paper presents a comprehensive battery model developed with a reference electrode insertion that captures (i) electrode-level charge/discharge dynamics, (ii) stoichiometric and temporal dependencies of electrode-level resistances, (iii) solid electrolyte interface (SEI) layer growth as key degradation phenomenon, and (iv) capacity fade and resistance rise in each electrode due to nominal battery aging. The proposed model is identified, and a preliminary validation is performed utilizing terminal voltage and negative electrode potential data collected from a pouch cell under one continuous cycling and accelerated aging conditions where the cell experienced 14% capacity loss.

aging↗
DOE OSTI2021

Advanced Downhole Acoustic Sensing for Wellbore Integrity (Final Report)

Borehole cement is used across the range of energy technologies to stabilize casing, to serve as a barrier to behind-casing fluid movement. Cement debonding and other flaws, both at cement interfaces and within the cement itself, can create leakage pathways that can threaten safety to personnel, and wellbore performance, with economic and regulatory consequences. A primary method to assess cement health and wellbore integrity is via acoustic methods. This project was designed with three aims: demonstrate a significant improvement in the interpretation of cement acoustic behavior, both during curing, and in interpreting effects of flaws and evolving interfaces; develop sensor technologies to improve signal-noise ratios and cement acoustic responses; and lastly, provide a borehole demonstration of at least one of these technologies. We have accomplished the first two objectives, and the third, delayed by pandemic health concerns, is proceeding as of this writing via a technology partner with the University of Texas Advanced Energy Consortium.

15 GEOTHERMAL ENERGY↗
DOE OSTI2025

Rooftop solar and energy storage programs can remediate energy-limiting behaviors of energy insecure households in the United States

Energy insecurity, or the inability to afford energy needs, affects most low-income households in the United States and leads to risky choices and additional insecurities including food and health. Although there are government programs designed to provide relief from energy insecurity, eligibility is usually determined by household income, and those with incomes close to the threshold face uncertainty or may be left out. In many cases, these households turn to energy-limiting behaviors as a strategy to lower their electric utility bills. Here we explore the relationship between energy insecurity and energy-limiting behaviors and investigate alternative solutions such as energy storage and rooftop solar. This analysis demonstrates that solar and energy storage can offset two-thirds of the bill savings that households could attain through severe energy-limiting behavior. These systems could complement existing energy assistance programs to provide long-term bill relief, enabling occupants to live in their homes with comfort and dignity.

Kerby, Jessica R. [Pacific Northwest National Labo↗
DOE OSTI2022

National Renewable Energy Laboratory Wildland Fire Management Plan (August 2022-August 2025): February-August 2022

The National Renewable Energy Laboratory (NREL) is located in a moderate wildfire risk region. The region has a history of damaging wildland fire activity and is also susceptible to changing environmental conditions (drought, elevated temperatures) that may lead to an increase in wildfire frequency and consequence over time. An integrated, site-wide wildland fire management plan is required by the Department of Energy and is to be consistent with the Federal Wildland Fire Management Policy. The NREL Wildland Fire Management Plan (WFMP) provides an integrated approach to reducing risk to wildland fire at NREL. The goals of the WFMP are to protect human health and safety, protect NREL facilities and research, enhance community protection, diminish risk and consequences of wildland fires, and maintain the health of the ecosystem. The WFMP accomplishes these goals through the use of tools such as fire behavior modeling, fire growth modeling, a structure ignition risk assessment, and through the application of robust fire prevention, emergency management, and environmental programs. The NREL WFMP was developed in a collaborative manner with input from regional stakeholders including cities, counties, local fire departments, and other governmental agencies. The WFMP provides for recommendations to reduce overall wildland fire risk to life safety and property at NREL.

54 ENVIRONMENTAL SCIENCES↗
DOE OSTI2020

Mercury Speciation via Diffusive Gradients Thin-Films Technology

Objectives: Develop and test various diffusive gradient in thin films (DGT) samplers for mercury - SRNL is developing reactive DGTS (rDGTs). Test chemistry to differentiate methylmercury from total and/or inorganic mercury in environmental samples. Fabricate and test rDGT samplers for deployment. Deploy the rDGTs in variable settings. Mercury is a persistent-bioaccumulative-toxic environmental pollutant. Mercury exists in different species such as elemental, inorganic, and methyl. Mercury speciation determine mercury behavior and toxicity. For example, methylmercury strongly accumulates in biota such as fish resulting in potential human health impacts. DGTs are innovative samplers to measure water concentration by diffusion and capture. Types of Hg DGTs used: Total Hg, Inorganic Hg, and Methyl Hg. Deployment Sites: Upper Three Runs, Lower Three Runs, Steele Creek, East Fork Poplar Creek (SRNL Sites), Horizons Creek, NOA Creek, Bruners Creek (ORNL Sites). DGT concentration estimates closely matched alternative measurements for soluble mercury at each Oak Ridge site - DGTs did not respond to particulate mercury. DGTs provide a representative measure for biota uptake since they are left out longer which allows for an average exposure concentration. DMA-80 provided an efficient and quick analysis. Variability in site location made a difference in Hg species. DGT preparations and sampling wasn't as quick and simple as microcolumn technology. Copper reagent degraded agarose gel - more work and cleaner data are needed to assess speciation in rDGTs. Future Work: Use cross-linked polyacrylamide for the collection layer for a stronger plastic. Make a copper diffusion layer without agarose. Test copper separation in lab using realistic stream conditions such as high organic carbon.

37 INORGANIC, ORGANIC, PHYSICAL, AND ANALYTICAL CH↗
DOE OSTI2023

Joint Analysis of the Epidemic Evolution and Human Mobility During the First Wave of COVID-19 in Spain: Retrospective Study

Background The initial wave of the COVID-19 pandemic placed a tremendous strain on health care systems worldwide. To mitigate the spread of the virus, many countries implemented stringent nonpharmaceutical interventions (NPIs), which significantly altered human behavior both before and after their enactment. Despite these efforts, a precise assessment of the impact and efficacy of these NPIs, as well as the extent of human behavioral changes, remained elusive. Objective In this study, we conducted a retrospective analysis of the initial wave of COVID-19 in Spain to better comprehend the influence of NPIs and their interaction with human behavior. Such investigations are vital for devising future mitigation strategies to combat COVID-19 and enhance epidemic preparedness more broadly. Methods We used a combination of national and regional retrospective analyses of pandemic incidence alongside large-scale mobility data to assess the impact and timing of government-implemented NPIs in combating COVID-19. Additionally, we compared these findings with a model-based inference of hospitalizations and fatalities. This model-based approach enabled us to construct counterfactual scenarios that gauged the consequences of delayed initiation of epidemic response measures. Results Our analysis demonstrated that the pre–national lockdown epidemic response, encompassing regional measures and heightened individual awareness, significantly contributed to reducing the disease burden in Spain. The mobility data indicated that people adjusted their behavior in response to the regional epidemiological situation before the nationwide lockdown was implemented. Counterfactual scenarios suggested that without this early epidemic response, there would have been an estimated 45,400 (95% CI 37,400-58,000) fatalities and 182,600 (95% CI 150,400-233,800) hospitalizations compared to the reported figures of 27,800 fatalities and 107,600 hospitalizations, respectively. Conclusions Our findings underscore the significance of self-implemented prevention measures by the population and regional NPIs before the national lockdown in Spain. The study also emphasizes the necessity for prompt and precise data quantification prior to enacting enforced measures. This highlights the critical interplay between NPIs, epidemic progression, and human behavior. This interdependence presents a challenge in predicting the impact of NPIs before they are implemented.

Public, Environmental & Occupational Health↗