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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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DOE OSTI2021

Improving Detection of Disease Re-emergence Using a Web-Based Tool (RED Alert): Design and Case Analysis Study

Background: Currently, the identification of infectious disease re-emergence is performed without describing specific quantitative criteria that can be used to identify re-emergence events consistently. This practice may lead to ineffective mitigation. In addition, identification of factors contributing to local disease re-emergence and assessment of global disease re-emergence require access to data about disease incidence and a large number of factors at the local level for the entire world. This paper presents Re-emerging Disease Alert (RED Alert), a web-based tool designed to help public health officials detect and understand infectious disease re-emergence. Objective: Our objective is to bring together a variety of disease-related data and analytics needed to help public health analysts answer the following 3 primary questions for detecting and understanding disease re-emergence: Is there a potential disease re-emergence at the local (country) level? What are the potential contributing factors for this re-emergence? Is there a potential for global re-emergence? Methods: We collected and cleaned disease-related data (eg, case counts, vaccination rates, and indicators related to disease transmission) from several data sources including the World Health Organization (WHO), Pan American Health Organization (PAHO), World Bank, and Gideon. We combined these data with machine learning and visual analytics into a tool called RED Alert to detect re-emergence for the following 4 diseases: measles, cholera, dengue, and yellow fever. We evaluated the performance of the machine learning models for re-emergence detection and reviewed the output of the tool through a number of case studies. Results: Our supervised learning models were able to identify 82%-90% of the local re-emergence events, although with 18%-31% (except 46% for dengue) false positives. This is consistent with our goal of identifying all possible re-emergences while allowing some false positives. The review of the web-based tool through case studies showed that local re-emergence detection was possible and that the tool provided actionable information about potential factors contributing to the local disease re-emergence and trends in global disease re-emergence. Conclusions: To the best of our knowledge, this is the first tool that focuses specifically on disease re-emergence and addresses the important challenges mentioned above.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2020

Adaptive Recovery Model: Designing Systems for Testing Tracing and Vaccination to Support COVID-19 Recovery Planning.

This report documents a new approach to designing disease control policies that allocate scarce testing, contact tracing, and vaccination resources to better control community transmission of COVID19 or similar diseases. The Adaptive Recovery Model (ARM) combines a deterministic compartmental disease model with a stochastic network disease propagation model to enable us to simulate COVID-19 community spread through the lens of two complementary modeling motifs. ARM contact networks are derived from cell-phone location data that have been anonymized and interpreted as individual arrivals to specic public locations. Modeling disease spread over these networks allows us to identify locations within communities conducive to rapid disease spread. ARM applies this model- and data-derived abstractions of community transmission to evaluate the effectiveness of disease control measures including targeted social distancing, contact tracing, testing and vaccination. The architecture of ARM provides a unique capacity to help decision makers understand how best to deploy scarce testing, tracing and vaccination resources to minimize disease-spread potential in a community. This document details the novel mathematical formulations underlying ARM, presents a dynamical stability analysis of the deterministic model components, a sensitivity analysis of control parameters and network structure, and summarizes a process for deriving contact networks from cell-phone location data. An example use case steps through applying ARM to evaluate three targeted social distancing policies using Bernalillo County, New Mexico as an exemplar test locale. This step-by-step analysis demonstrates how ARM can be used to measure the relative performance of competing public health policies. Initial scenario tests of ARM shows that ARMs design focus on resource utilization rather than simple incidence prediction can provide decision makers with additional quantitative guidance for managing ongoing public health emergencies and planning future responses.

29 ENERGY PLANNING, POLICY, AND ECONOMY↗
DOE OSTI2020

Applying Non-Energy Impacts from Other Jurisdictions in Cost-Benefit Analyses of Energy Efficiency Programs: Resources for States for Utility Customer-Funded Programs

Avoided energy and capacity costs are the primary yardstick utilities use to determine which energy efficiency programs are cost-effective for their customers. But sometimes "non-energy impacts" — not commonly recognized as directly associated with energy generation, transmission and distribution — represent substantial benefits, such as improving comfort, air quality and public health. Considering whether and how to include non-energy impacts is an important part of cost-benefit analyses for these programs. This report offers practical considerations for deciding which non-energy impacts to include and how to apply values or methods from other jurisdictions. Researchers reviewed studies quantifying non-energy impacts used in 30 states and applied a five-point system to indicate transferability of a value or method from each study for 16 categories of non-energy impacts: Water resource costs and benefits; Other fuels costs and benefits; Avoided environmental compliance costs; Environmental impacts; Productivity; Health and safety; Asset value; Energy and/or capacity price suppression effects; Avoided costs of compliance with Renewable Portfolio Standard requirements; Avoided credit and collection costs; Avoided ancillary services; Comfort; Economic development and job impacts; Public health impacts; Energy security impacts; Increased reliability. The U.S. Department of Energy’s Building Technologies Office supported this work.

32 ENERGY CONSERVATION, CONSUMPTION, AND UTILIZATI↗
DOE OSTI2021

Mining and Validating Social Media Data for COVID-19–Related Human Behaviors Between January and July 2020: Infodemiology Study

Background: Health authorities can minimize the impact of an emergent infectious disease outbreak through effective and timely risk communication, which can build trust and adherence to subsequent behavioral messaging. Monitoring the psychological impacts of an outbreak, as well as public adherence to such messaging, is also important for minimizing long-term effects of an outbreak. Objective: We used social media data from Twitter to identify human behaviors relevant to COVID-19 transmission, as well as the perceived impacts of COVID-19 on individuals, as a first step toward real-time monitoring of public perceptions to inform public health communications. Methods: We developed a coding schema for 6 categories and 11 subcategories, which included both a wide number of behaviors as well codes focused on the impacts of the pandemic (eg, economic and mental health impacts). We used this to develop training data and develop supervised learning classifiers for classes with sufficient labels. Classifiers that performed adequately were applied to our remaining corpus, and temporal and geospatial trends were assessed. We compared the classified patterns to ground truth mobility data and actual COVID-19 confirmed cases to assess the signal achieved here. Results: We applied our labeling schema to approximately 7200 tweets. The worst-performing classifiers had F1 scores of only 0.18 to 0.28 when trying to identify tweets about monitoring symptoms and testing. Classifiers about social distancing, however, were much stronger, with F1 scores of 0.64 to 0.66. We applied the social distancing classifiers to over 228 million tweets. We showed temporal patterns consistent with real-world events, and we showed correlations of up to –0.5 between social distancing signals on Twitter and ground truth mobility throughout the United States. Conclusions: Behaviors discussed on Twitter are exceptionally varied. Twitter can provide useful information for parameterizing models that incorporate human behavior, as well as for informing public health communication strategies by describing awareness of and compliance with suggested behaviors.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2021

National variability in Americans’ COVID-19 protective behaviors: Implications for vaccine roll-out

Protective behaviors such as mask wearing and physical distancing are critical to slow the spread of COVID-19, even in the context of vaccine scale-up. Understanding the variation in self-reported COVID-19 protective behaviors is critical to developing public health messaging. The purpose of the study is to provide nationally representative estimates of five self-reported COVID-19 protective behaviors and correlates of such behaviors. In this cross-sectional survey study of US adults, surveys were administered via internet and telephone. Adults were surveyed from April 30-May 4, 2020, a time of peaking COVID-19 incidence within the US. Participants were recruited from the probability-based AmeriSpeak® national panel. Brief surveys were completed by 994 adults, with 73.0% of respondents reported mask wearing, 82.7% reported physical distancing, 75.1% reported crowd avoidance, 89.8% reported increased hand-washing, and 7.7% reported having prior COVID-19 testing. Multivariate analysis (p critical value .05) indicates that women were more likely to report protective behaviors than men, as were those over age 60. Respondents who self-identified as having low incomes, histories of criminal justice involvement, and Republican Party affiliation, were less likely to report four protective behaviors, though Republicans and individuals with criminal justice histories were more likely to report having received COVID-19 testing. The majority of Americans engaged in COVID-19 protective behaviors, with low-income Americans, those with histories of criminal justice involvement, and self-identified Republicans less likely to engage in these preventive behaviors. Culturally competent public health messaging and interventions might focus on these latter groups to prevent future infections. These findings will remain highly relevant even with vaccines widely available, given the complementarities between vaccines and protective behaviors, as well as the many challenges in delivering vaccines.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2020

Working Safely at LANL during the COVID-19 Pandemic (Rev. 2)

The COVID-19 pandemic is an emerging, rapidly evolving public health emergency. The content of this course reflects the most up-to-date guidance and information from the Centers for Disease Control and Prevention (CDC), World Health Organization (WHO) and scientific literature available at the time the course was developed. Check the LANL COVID-19 Hub for the latest information and guidance. Updates to the course will be made as necessary to reflect evolving guidance form public health authorities and new data form the scientific literature.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2022

Foodborne illness outbreaks linked to unpasteurised milk and relationship to changes in state laws – United States, 1998–2018

Consumption of unpasteurised milk in the United States has presented a public health challenge for decades because of the increased risk of pathogen transmission causing illness outbreaks. We analysed Foodborne Disease Outbreak Surveillance System data to characterise unpasteurised milk outbreaks. Using Poisson and negative binomial regression, we compared the number of outbreaks and outbreak-associated illnesses between jurisdictions grouped by legal status of unpasteurised milk sale based on a May 2019 survey of state laws. During 2013–2018, 75 outbreaks with 675 illnesses occurred that were linked to unpasteurised milk; of these, 325 illnesses (48%) were among people aged 0–19 years. Of 74 single-state outbreaks, 58 (78%) occurred in states where the sale of unpasteurised milk was expressly allowed. Compared with jurisdictions where retail sales were prohibited (n = 24), those where sales were expressly allowed (n = 27) were estimated to have 3.2 (95% CI 1.4–7.6) times greater number of outbreaks; of these, jurisdictions where sale was allowed in retail stores (n = 14) had 3.6 (95% CI 1.3–9.6) times greater number of outbreaks compared with those where sale was allowed on-farm only (n = 13). This study supports findings of previously published reports indicating that state laws resulting in increased availability of unpasteurised milk are associated with more outbreak-associated illnesses and outbreaks.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2022

Looking Beyond Bill Savings to Equity in Renewable Energy Microgrid Deployment

Microgrids powered by renewable energy can provide backup power to critical infrastructure during grid outages. These systems can also play an important role in advancing energy justice by providing economic, environmental, health, and resilience benefits for underserved communities. The value of microgrids is often measured by the economic savings and resilience provided, but there are other energy justice factors that should be considered. This paper describes a methodology for quantifying broader costs and benefits including utility bill savings, value of resilience, social cost of carbon, public health costs, and jobs associated with the construction and operation of microgrids. We evaluate these factors at three case study sites and find that including energy justice values in the cost-benefit analysis of microgrids can change investment decisions. When climate, health, resilience, and job creation are considered, cost-optimal microgrids include more renewable generation, leading to a 52-82% reduction in emissions and diesel fuel use. The net present values of the microgrids grow from negative $626,000-843,000 in the diesel only case to $10-16 million in the hybrid microgrid case and $12-19 million in the renewable microgrid case, indicating potential for greater microgrid deployment if energy justice values are incorporated in decision making. However, we also see large increases in capital expenses, which could limit deployment unless accompanied by innovative financing measures. These findings may be useful to communities as they seek to strengthen resilience to natural disasters while also improving public health, meeting climate goals, and providing economic opportunity for residents.

29 ENERGY PLANNING, POLICY, AND ECONOMY↗
DOE OSTI2026

Dataset of U.S. School Bus Depots

A large body of public health literature describes how undesirable or dangerous facilities, such as truck depots and industrial plants, located in or near communities can lead to health harms. Research also describes the high levels of traffic-related air and noise pollution that is linked to health harms and may be disproportionately distributed near many schools. Therefore, a primary use case for this dataset is to analyze the location of school bus depots and to create an evidence base that would better enable the work of community members, advocates, and other stakeholders toward improving air quality and public health. Other possible uses for this school bus depot dataset include electricity grid planning and reliability, given recent momentum toward school bus electrification. This dataset was created using an object-based approach with remote sensing data. The primary source of aerial imagery was the National Agriculture Imagery Program (NAIP) dataset. NAIP imagery was analyzed to locate individual school buses based on their color and size, and then classified clusters of school buses as potential depots, which were then verified visually. The resulting dataset contains 11,309 depots across the 48 contiguous U.S. states and Washington, D.C. Fifty-one percent (5,730 depots) are at schools, defined as being 350 meters or less from the nearest school. The accuracy of the dataset was assessed by comparing it with independent reference datasets containing 506 depots from the records of two school transportation companies. We found good agreement, with an omission error rate of 15.2% (77 depots). This dataset represents one of the only remote sensing projects to conduct object detection using data at the sub-meter to 1-meter resolution for a continental-scale application.

32 ENERGY CONSERVATION, CONSUMPTION, AND UTILIZATI↗
DOE OSTI2022

Healthy Buildings Guide for Small Businesses: A Quick Reference to Improve Indoor Air Quality (Restaurants Excluded)

Indoor air pollutant concentrations can be higher than those outdoors, putting occupants at risk. These pollutants come from a variety of sources: materials used to build and furnish indoor spaces, retail products and services, and occupants themselves. Ventilation, temperature, and humidity also affect indoor air quality. It is important to consider the documented benefits of healthy indoor environments at any time – not just during a public health crisis – and it is key to consider the indoor air quality where we do business as well as at home. Small businesses vary in size, services, products, ownership style, and building mechanical systems, yet all benefit from healthy indoor spaces for employees and customers. This guide provides steps, in conjunction with public health guidance, that small businesses can take to improve and maintain indoor air quality. Small businesses often have unique ownership structures – the building owner and business owner can be different parties – so this guide addresses both building and business owner action items. There are many ways to pursue healthy indoor air, including eliminating, minimizing, and/or controlling the contaminants we bring in, and removing or diluting any existing contaminants through ventilation, filtration, air cleaning, and/or disinfection. Best results are achieved through a comprehensive approach combining various strategies, including those discussed in this guide.

air filtration↗
DOE OSTI2022

Guia de Edificios Saludables para Pequenas Empresas: Una Referencia Rapida para Mejorar la Calidad del Aire Interior (Restaurantes Excluidos)

Indoor air pollutant concentrations can be higher than those outdoors, putting occupants at risk. These pollutants come from a variety of sources: materials used to build and furnish indoor spaces, retail products and services, and occupants themselves. Ventilation, temperature, and humidity also affect indoor air quality. It is important to consider the documented benefits of healthy indoor environments at any time - not just during a public health crisis - and it is key to consider the indoor air quality where we do business as well as at home. Small businesses vary in size, services, products, ownership style, and building mechanical systems, yet all benefit from healthy indoor spaces for employees and customers. This guide provides steps, in conjunction with public health guidance, that small businesses can take to improve and maintain indoor air quality. Small businesses often have unique ownership structures - the building owner and business owner can be different parties - so this guide addresses both building and business owner action items. There are many ways to pursue healthy indoor air, including eliminating, minimizing, and/or controlling the contaminants we bring in, and removing or diluting any existing contaminants through ventilation, filtration, air cleaning, and/or disinfection. Best results are achieved through a comprehensive approach combining various strategies, including those discussed in this guide.

air filtration↗
DOE OSTI2022

Tracking ebolavirus genomic drift with a resequencing microarray

Filoviruses are emerging pathogens that cause acute fever with high fatality rate and present a global public health threat. During the 2013–2016 Ebola virus outbreak, genome sequencing allowed the study of virus evolution, mutations affecting pathogenicity and infectivity, and tracing the viral spread. In 2018, early sequence identification of the Ebolavirus as EBOV in the Democratic Republic of the Congo supported the use of an Ebola virus vaccine. However, field-deployable sequencing methods are needed to enable a rapid public health response. Resequencing microarrays (RMA) are a targeted method to obtain genomic sequence on clinical specimens rapidly, and sensitively, overcoming the need for extensive bioinformatic analysis. This study presents the design and initial evaluation of an ebolavirus resequencing microarray (Ebolavirus-RMA) system for sequencing the major genomic regions of four Ebolaviruses that cause disease in humans. The design of the Ebolavirus-RMA system is described and evaluated by sequencing repository samples of three Ebolaviruses and two EBOV variants. The ability of the system to identify genetic drift in a replicating virus was achieved by sequencing the ebolavirus glycoprotein gene in a recombinant virus cultured under pressure from a neutralizing antibody. Comparison of the Ebolavirus-RMA results to the Genbank database sequence file with the accession number given for the source RNA and Ebolavirus-RMA results compared to Next Generation Sequence results of the same RNA samples showed up to 99% agreement.

59 BASIC BIOLOGICAL SCIENCES↗
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 OSTI2023

Grid Interconnection and Renewables Deployment Related Air Quality and Human Health Benefits in Southeast Asia

The Association of Southeast Asian Nations (ASEAN) has increasingly focused on multilateral electricity trade, improved grid resiliency and modernization. These opportunities in the power sector have been studied through the ASEAN Interconnection Masterplan Studies, the most recent of which is the ASEAN Interconnection Masterplan Study III (AIMS III). AIMS III assessed four different scenarios of power system in the ASEAN countries that include a base scenario and three additional scenarios (called optimum RE, ASEAN RE, and High RE) considering different levels of deployment of renewable energy (RE) and cross-border generation and trade of electricity for three years (2025, 2030, 2040). In this work, we quantify the potential air quality and public health co-benefits of AIMS III scenarios. For a rapidly expanding, energy hungry region like SE Asia generation is power generation is expected to increase significantly. The AIMS III scenarios' capacity expansion modeling suggest that: 1) Generation nearly doubles from 2025 to 2040 in all four AIMS III scenarios; 2) Most of the increased generation is met by coal in all four AIMS III scenarios; 3) While renewables generation increases in all four AIMS III scenarios, the fraction of total generation (its share) generally decreases because of the much greater increase in non-renewable sources, mostly coal. Only in the High RE Target scenario do renewables represent a higher share in 2040 than in 2025, though even here it is at the expense of natural gas rather than coal; 4) As a result, emissions of gaseous and aerosol pollutants increase significantly in all scenarios. Because emissions increase in 2040 compared to 2025 for all four AIMS III scenarios, so do PM2.5 concentrations. Even for the High RE Target scenario (the scenario with highest share of renewable energy), compared to the Base scenario in 2025, in 2040 PM2.5 concentrations are higher. Compared to the Base scenario in the same years, the Optimum RE and ASEAN RE Target scenarios do not differ very much from the Base in terms of PM2.5 concentration. The High RE Target scenario, on the other hand, yields noticeably lower PM2.5 concentration. For example, in 2040 the population-weighted decrease in annual average PM2.5 concentration in the High RE Target scenario relative to the Base scenario is 0.5 ug m-3. Compared to the Base scenario in 2040, each of the alternative AIMS III scenarios is estimated to result in net reductions in power-sector air quality-related excess mortality in the ASEAN region. Yet there are a few countries for which the Optimum RE and ASEAN RE Target result in increases in PM2.5-related excess mortality (Thailand and Vietnam for the ASEAN RE Target scenario and Thailand for the Optimum RE scenario). However, for the High RE Target scenario, all countries benefit and find reductions in excess mortality resulting from the power sector scenarios modeled in AIMS III with regionwide mortality decreasing by 16,000 compared to the Base scenario in 2040. In summary, our analysis finds that changing power generation emissions is a crucial lever for improving public health in ASEAN member countries and provides a pathway for policymakers to make decision backed by a realistic power sector expansion and air quality analyses.

air quality↗
DOE OSTI2024

Geographical Insights into Suicide Mortality Through Spatial Machine Learning

Suicide mortality is a leading cause of death in the United States, with an upward trend that emphasizes its significance as a public health issue. Previous research has employed global models like ordinary least squares (OLS) regression and local models such as geographically weighted regression (GWR). While local models are useful for analyzing spatial variations in suicide mortality, they share limitations with traditional global models, particularly about their inability to handle multi-collinearity and non-linear relationships. Machine learning approaches, like random forests (RF), can address some of these limitations but often fail to account for spatial variability. This gap highlights the need for spatial ML models specifically designed to tackle suicide mortality. This research seeks to fill this void by using a geographically weighted random forest model (GWRF) to examine the associations between county-level suicide mortality in the U.S. from 2010 to 2020 and various social and environmental determinants of health. A key aspect of our methodology is disciplined feature selection, which reduces the pool of explanatory variables by about 90%. This refinement enhances the explanatory power of both global (R2 improved from 0.59 to 0.67) and local (R2 improved from 0.64 to 0.67) RF models while reducing their run times. An analysis of the importance scores for these selected features reveals that the drivers of suicide mortality vary by context. Thus, to effectively address regional disparities and inform targeted public health interventions, a holistic approach that incorporates multiple county-level characteristics is essential.

Lebakula, Viswadeep [ORNL] (ORCID:0000000152935914↗
DOE OSTI2025

Data Assimilation for Robust UQ Within Agent-Based Simulation on HPC Systems

Agent-based simulation provides a powerful tool for in silico system modeling. However, these simulations do not provide built-in methods for uncertainty quantification (UQ). Within these types of models a typical approach to UQ is to run multiple realizations of the model then compute aggregate statistics. This approach is limited due to the compute time required for a solution. When faced with an emerging biothreat, public health decisions need to be made quickly and solutions for integrating near real-time data with analytic tools are needed. We propose an integrated Bayesian UQ framework for agent-based models based on sequential Monte Carlo sampling. Given streaming or static data about the evolution of an emerging pathogen this Bayesian framework provides a distribution over the parameters governing the spread of a disease through a population. These estimates of the spread of a disease may be provided to public health agencies seeking to abate the spread. By coupling agent-based simulations with Bayesian modeling in a data assimilation, our proposed framework provides a powerful tool for modeling dynamical systems in silico. We propose a method which reduces model error and provides a range of realistic possible outcomes. Moreover, our method addresses two primary limitations of ABMs: the lack of UQ and an inability to assimilate data. Our proposed framework combines the flexibility of an agent-based model with UQ provided by the Bayesian paradigm in a workflow which scales well to HPC systems. We provide algorithmic details and results on a simulated outbreak with both static and streaming data.

Spannaus, Adam [ORNL] (ORCID:0000000225213657)↗
DOE OSTI2023

Performance of methods for SARS-CoV-2 variant detection and abundance estimation within mixed population samples

The accurate identification of SARS-CoV-2 (SC2) variants and estimation of their abundance in mixed population samples (e.g., air or wastewater) is imperative for successful surveillance of community level trends. Assessing the performance of SC2 variant composition estimators (VCEs) should improve our confidence in public health decision making. Here, we introduce a linear regression based VCE and compare its performance to four other VCEs: two re-purposed DNA sequence read classifiers (Kallisto and Kraken2), a maximum-likelihood based method (Lineage deComposition for Sars-Cov-2 pooled samples (LCS)), and a regression based method (Freyja). We simulated DNA sequence datasets of known variant composition from both Illumina and Oxford Nanopore Technologies (ONT) platforms and assessed the performance of each VCE. We also evaluated VCEs performance using publicly available empirical wastewater samples collected for SC2 surveillance efforts. Bioinformatic analyses were performed with a custom NextFlow workflow (C-WAP, CFSAN Wastewater Analysis Pipeline). Relative root mean squared error (RRMSE) was used as a measure of performance with respect to the known abundance and concordance correlation coefficient (CCC) was used to measure agreement between pairs of estimators. Based on our results from simulated data, Kallisto was the most accurate estimator as it had the lowest RRMSE, followed by Freyja. Kallisto and Freyja had the most similar predictions, reflected by the highest CCC metrics. We also found that accuracy was platform and amplicon panel dependent. For example, the accuracy of Freyja was significantly higher with Illumina data compared to ONT data; performance of Kallisto was best with ARTICv4. However, when analyzing empirical data there was poor agreement among methods and variations in the number of variants detected (e.g., Freyja ARTICv4 had a mean of 2.2 variants while Kallisto ARTICv4 had a mean of 10.1 variants). This work provides an understanding of the differences in performance of a number of VCEs and how accurate they are in capturing the relative abundance of SC2 variants within a mixed sample (e.g., wastewater). Such information should help officials gauge the confidence they can have in such data for informing public health decisions.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2022

Provider Perspectives: Identification and Follow-up of Infants who Are Deaf or Hard of Hearing

Objective Without timely screening, diagnosis, and intervention, hearing loss can cause significant delays in a child's speech, language, social, and emotional development. In 2019, Texas had nearly twice the average rate of loss to follow-up (LFU) or loss to documentation (LTD; i.e., missing documentation of services received) among infants who did not pass their newborn hearing screening compared to the United States overall (51.1 vs. 27.5%). We aimed to identify factors contributing to LFU/LTD among infants who do not pass their newborn hearing screening in Texas. Study Design Data were collected through semistructured qualitative interviews with 56 providers along the hearing care continuum, including hospital newborn hearing screening program staff, audiologists, primary care physicians, and early intervention (EI) program staff located in three rural and urban public health regions in Texas. Following recording and transcription of the interviews, we used qualitative data analysis software to analyze themes using a conventional content analysis approach. Results Frequently cited barriers included problems with family access to care, difficulty contacting patients, problems with communication between providers and referrals, lack of knowledge among providers and parents, and problems using the online reporting system. Providers in rural areas more often mentioned problems with family access to care and contacting families compared to providers in urban areas. Conclusion These findings provide insight into strategies that public health professionals and health care providers can use to work together to help further increase the number of children identified early who may benefit from EI services. Key Points

Obstetrics & Gynecology↗