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DOE OSTI2020

Evolving Trust in Robots: Specification Through Sequential and Comparative Meta-Analyses

Objective The objectives of this meta-analysis are to explore the presently available empirical findings on the antecedents of trust in robots and use this information to expand upon a previous meta-analytic review of the area. Background Human–robot interaction (HRI) represents an increasingly important dimension of our everyday existence. Currently, the most important element of these interactions is proposed to be whether the human trusts the robot or not. We have identified three overarching categories that exert effects on the expression of trust. These consist of factors associated with (a) the human, (b) the robot, and (c) the context in which any specific HRI event occurs. Method The current body of literature was examined and all qualifying articles pertaining to trust in robots were included in the meta-analysis. A previous meta-analysis on HRI trust was used as the basis for this extended, updated, and evolving analysis. Results Multiple additional factors, which have now been demonstrated to significantly influence trust, were identified. The present results, expressed as points of difference and points of commonality between the current and previous analyses, are identified, explained, and cast in the setting of the emerging wave of HRI. Conclusion The present meta-analysis expands upon previous work and validates the overarching categories of trust antecedent (human-related, robot-related, and contextual), as well as identifying the significant individual precursors to trust within each category. A new and updated model of these complex interactions is offered. Application The identified trust factors can be used in order to promote appropriate levels of trust in robots.

Behavioral Sciences↗

DOE OSTI2025

A mixture parameterized biologically based dosimetry model to predict body burdens of polycyclic aromatic hydrocarbons in developmental zebrafish toxicity assays

Polycyclic aromatic hydrocarbons (PAHs) are a group of environmental toxicants found ubiquitously as complex mixtures in human-impacted environments. Developmental zebrafish exposures have been used widely to study PAH toxicity, but most studies report nominal exposure concentrations. Nominal exposure concentrations can be unreliable dose metrics due to differences in toxicant bioavailability resulting from disparate exposure methodologies and chemical properties. Toxicokinetic modeling can predict toxicant tissue doses to facilitate comparison between exposures of different chemicals, methodologies, and biological models. We parameterize a biologically based dosimetry model for developmental zebrafish toxicity assays for 9 PAHs. The model was optimized with measurements from media, tissue, and plastic plate walls throughout a static developmental exposure to a mixture of 10 PAHs of high abundance within the Portland Harbor Superfund Site. Plate binding, volatilization, zebrafish permeability, and tissue—media partitioning coefficients vary widely between PAHs. Model predictions accounted for 83% and 54% of 48 hpf body burdens within a factor of 2 resulting from exposures to mixtures and individual PAHs, respectively. Accounting for solubility significantly improves model performance. Competition for active sites in metabolizing enzymes may change biotransformation kinetics between individual PAH and mixture exposures. Area under the curve estimations of concentrations in zebrafish resulted in altered hazard rankings from nominal exposure concentrations. Future work will be oriented to generalizing the model to other PAHs. This PAH dosimetry model improves the interpretability of developmental zebrafish toxicity assays by providing time-resolved body burdens from nominal exposure concentrations.

63 RADIATION, THERMAL, AND OTHER ENVIRON. POLLUTAN↗

DOE OSTI2020

Applying Two Active Acoustic Technologies to Document Presence of Large Marine Animal Targets at a Marine Renewable Energy Site

Coastal regions are highly used by humans. The growing marine renewable energy (MRE) industry will add to existing anthropogenic pressures in these regions. Regulatory bodies require animal risk assessment before new industrial activities can progress, and MRE is no exception. Preliminary data of marine mammal use of an MRE device deployment location could be informative to permitting. A combination of downlooking hydroacoustics using an echosounder and acoustic camera (imaging sonar) was used to provide a number of large targets (proxy for large fish and marine mammals) in an area of interest for MRE tidal turbine deployment in Western Passage, Maine, USA. Data were collected in May, June, August, and September of 2010 and 2011. Of the nine large targets confirmed to be animals, eight were porpoises and one was a shark. Few large targets were observed in May and June, with the majority (90%) being present in August and September of both years. The most large targets were observed when tidal current speed was less than 1 m·s−1. These data provide a preliminary assessment of large targets in a single location over sixteen 24-h surveys. The aforementioned methodology could be used for future pre- and post-installation assessments at MRE device deployment locations. Their use in concert with visual and passive acoustic monitoring can provide water depth usage by marine mammals, which is a metric that is difficult to assess with passive acoustic and visual techniques.

Staines, Garrett↗

DOE OSTI2022

D 3 -creatine dilution for skeletal muscle mass measurement: historical development and current status

The French chemist Michel Eugène Chevreul discovered creatine in meat two centuries ago. Extensive biochemical and physiological studies of this organic molecule followed with confirmation that creatine is found within the cytoplasm and mitochondria of human skeletal muscles. Two groups of investigators exploited these relationships five decades ago by first estimating the creatine pool size in vivo with 14 C and 15 N labelled isotopes. Skeletal muscle mass (kg) was then calculated by dividing the creatine pool size (g) by muscle creatine concentration (g/kg) measured on a single muscle biopsy or estimated from the literature. This approach for quantifying skeletal muscle mass is generating renewed interest with the recent introduction of a practical stable isotope (creatine-(methyl-d 3 )) dilution method for estimating the creatine pool size across the full human lifespan. The need for a muscle biopsy has been eliminated by assuming a constant value for whole-body skeletal muscle creatine concentration of 4.3 g/kg wet weight. The current single compartment model of estimating creatine pool size and skeletal muscle mass rests on four main assumptions: tracer absorption is complete; tracer is all retained; tracer is distributed solely in skeletal muscle; and skeletal muscle creatine concentration is known and constant. Three of these assumptions are false to varying degrees. Not all tracer is retained with urinary isotope losses ranging from 0% to 9%; an empirical equation requiring further validation is used to correct for spillage. Not all tracer is distributed in skeletal muscle with non-muscle creatine sources ranging from 2% to 10% with a definitive value lacking. Lastly, skeletal muscle creatine concentration is not constant and varies between muscles (e.g. 3.89–4.62 g/kg), with diets (e.g. vegetarian and omnivore), across age groups (e.g. middle-age, ~4.5 g/kg; old-age, 4.0 g/kg), activity levels (e.g. athletes, ~5 g/kg) and in disease states (e.g. muscular dystrophies, <3 g/kg). Some of the variability in skeletal muscle creatine concentrations can be attributed to heterogeneity in the proportions of wet skeletal muscle as myofibres, connective tissues, and fat. These observations raise serious concerns regarding the accuracy of the deuterated-creatine dilution method for estimating total body skeletal muscle mass as now defined by cadaver analyses of whole wet tissues and in vivo approaches such as magnetic resonance imaging. A new framework is needed in thinking about how this potentially valuable method for measuring the creatine pool size in vivo can be used in the future to study skeletal muscle biology in health and disease.

body composition↗

DOE OSTI2021

Computational studies reveal Fluorine based quinolines to be potent inhibitors for proteins involved in SARS-CoV-2 assembly

World is witnessing one of the worst pandemics of this century caused by SARS-CoV-2 virus which has affected millions of individuals. Despite rapid efforts to develop vaccines and drugs for COVID-19, the disease is still not under control. Chloroquine (CQ) and Hydroxychloroquine (HCQ) are two very promising inhibitors which have shown positive effect in combating the disease in preliminary experimental studies, but their use was reduced due to severe side-effects. Here, we performed a theoretical investigation of the same by studying the binding of the molecules with SARS-COV-2 Spike protein, the complex formed by Spike and ACE2 human receptor and a human serine protease TMPRSS2 which aids in cleavage of the Spike protein to initiate the viral activation in the body. Both the molecules had shown very good docking energies in the range of -6kcal/mol. Subsequently, we did a high throughput screening for other potential quinoline candidates which could be used as inhibitors. From the large pool of ligand candidates, we shortlisted the top three ligands (binding energy -8kcal/mol). We tested the stability of the docked complexes by running Molecular Dynamics (MD) simulations where we observed the stability of the quinoline analogues with the Spike-ACE2 and TMPRSS2 nevertheless the quinolines were not stable with the Spike protein alone. Thus, although the inhibitors bond very well with the protein molecules their intrinsic binding affinity depends on the protein dynamics. Moreover, the quinolines were stable when bound to electronegative pockets of Spike-ACE2 or TMPRSS2 but not with Viral Spike protein. We also observed that a Fluoride based compound: 3-[3-(Trifluoromethyl)phenyl]quinoline helps the inhibitor to bind with both Spike-ACE2 and TMPRSS2 with equal probability. The molecular details presented in this study would be very useful for developing quinoline based drugs for COVID-19 treatment.

37 INORGANIC, ORGANIC, PHYSICAL, AND ANALYTICAL CH↗

DOE OSTI2023

An Explainable Machine-Learning Model for Compensatory Reserve Measurement: Methods for Feature Selection and the Effects of Subject Variability

Tracking vital signs accurately is critical for triaging a patient and ensuring timely therapeutic intervention. The patient’s status is often clouded by compensatory mechanisms that can mask injury severity. The compensatory reserve measurement (CRM) is a triaging tool derived from an arterial waveform that has been shown to allow for earlier detection of hemorrhagic shock. However, the deep-learning artificial neural networks developed for its estimation do not explain how specific arterial waveform elements lead to predicting CRM due to the large number of parameters needed to tune these models. Alternatively, we investigate how classical machine-learning models driven by specific features extracted from the arterial waveform can be used to estimate CRM. More than 50 features were extracted from human arterial blood pressure data sets collected during simulated hypovolemic shock resulting from exposure to progressive levels of lower body negative pressure. A bagged decision tree design using the ten most significant features was selected as optimal for CRM estimation. This resulted in an average root mean squared error in all test data of 0.171, similar to the error for a deep-learning CRM algorithm at 0.159. By separating the dataset into sub-groups based on the severity of simulated hypovolemic shock withstood, large subject variability was observed, and the key features identified for these sub-groups differed. This methodology could allow for the identification of unique features and machine-learning models to differentiate individuals with good compensatory mechanisms against hypovolemia from those that might be poor compensators, leading to improved triage of trauma patients and ultimately enhancing military and emergency medicine.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2020

Figure Descriptive Text Extraction Using Ontological Representation

Abstract Experimental research publications provide figure form resources including graphs, charts, and any type of images to effectively support and convey methods and results. To describe figures, authors add captions, which are often incomplete, and more descriptions reside in body text. This work presents a method to extract figure descriptive text from the body of scientific articles. We adopted ontological semantics to aid concept recognition of figure-related information, which generates human- and machine-readable knowledge representations from sentences. Our results show that conceptual models bring an improvement in figure descriptive sentence classification over word-based approaches.

97 MATHEMATICS AND COMPUTING↗

DOE OSTI2023

Structure of metallochaperone in complex with the cobalamin-binding domain of its target mutase provides insight into cofactor delivery

G-protein metallochaperone MeaB in bacteria [methylmalonic aciduria type A (MMAA) in humans] is responsible for facilitating the delivery of adenosylcobalamin (AdoCbl) to methylmalonyl-CoA mutase (MCM), the only AdoCbl-dependent enzyme in humans. Genetic defects in the switch III region of MMAA lead to the genetic disorder methylmalonic aciduria in which the body is unable to process certain lipids. Here, we present a crystal structure of Methylobacterium extorquens MeaB bound to a nonhydrolyzable guanosine triphosphate (GTP) analog guanosine-5'-[(β,γ)-methyleno]triphosphate (GMPPCP) with the Cbl-binding domain of its target mutase enzyme (MeMCM cbl ). This structure provides an explanation for the stimulation of the GTP hydrolyase activity of MeaB afforded by target protein binding. We find that upon MCM cbl association, one protomer of the MeaB dimer rotates ~180°, such that the inactive state of MeaB is converted to an active state in which the nucleotide substrate is now surrounded by catalytic residues. Importantly, it is the switch III region that undergoes the largest change, rearranging to make direct contacts with the terminal phosphate of GMPPCP. These structural data additionally provide insights into the molecular basis by which this metallochaperone contributes to AdoCbl delivery without directly binding the cofactor. Our data suggest a model in which GTP-bound MeaB stabilizes a conformation of MCM that is open for AdoCbl insertion, and GTP hydrolysis, as signaled by switch III residues, allows MCM to close and trap its cofactor. Substitutions of switch III residues destabilize the active state of MeaB through loss of protein:nucleotide and protein:protein interactions at the dimer interface, thus uncoupling GTP hydrolysis from AdoCbl delivery.

59 BASIC BIOLOGICAL SCIENCES↗

DOE OSTI2023

The Western Lake Erie culture collection: A promising resource for evaluating the physiological and genetic diversity of Microcystis and its associated microbiome

Cyanobacterial harmful algal blooms (cyanoHABs) dominated by Microcystis spp. have significant public health and economic implications in freshwater bodies around the world. These blooms are capable of producing a variety of cyanotoxins, including microcystins, that affect fishing and tourism industries, human and environmental health, and access to drinking water. In this study, we isolated and sequenced the genomes of 21 primarily unialgal Microcystis cultures collected from western Lake Erie between 2017 and 2019. While some cultures isolated in different years have a high degree of genetic similarity (genomic Average Nucleotide Identity >99%), genomic data show that these cultures also represent much of the breadth of known Microcystis diversity in natural populations. Only five isolates contained all the genes required for microcystin biosynthesis while two isolates contained a previously described partial mcy operon. Microcystin production within cultures was also assessed using Enzyme-Linked Immunosorbent Assay (ELISA) and supported genomic results with high concentrations (up to 900 μg L⁻¹) in cultures with complete mcy operons and no or low toxin detected otherwise. These xenic cultures also contained a substantial diversity of bacteria associated with Microcystis, which has become increasingly recognized as an essential component of cyanoHAB community dynamics. These results highlight the genomic diversity among Microcystis strains and associated bacteria in Lake Erie, and their potential impacts on bloom development, toxin production, and toxin degradation. Furthermore, this culture collection significantly increases the availability of environmentally relevant Microcystis strains from temperate North America.

CyanoHABs↗

DOE OSTI2024

Emergency department visits in California associated with wildfire PM 2.5 : differing risk across individuals and communities

The threats to human health from wildfires and wildfire smoke (WFS) in the United States (US) are increasing due to continued climate change. A growing body of literature has documented important adverse health effects of WFS exposure, but there is insufficient evidence regarding how risk related to WFS exposure varies across individual or community level characteristics. To address this evidence gap, we utilized a large nationwide database of healthcare utilization claims for emergency department (ED) visits in California across multiple wildfire seasons (May through November, 2012–2019) and quantified the health impacts of fine particulate matter <2.5 μm (PM 2.5 ) air pollution attributable to WFS, overall and among subgroups of the population. We aggregated daily counts of ED visits to the level of the Zip Code Tabulation Area (ZCTA) and used a time-stratified case-crossover design and distributed lag non-linear models to estimate the association between WFS and relative risk of ED visits. We further assessed how the association with WFS varied across subgroups defined by age, race, social vulnerability, and residential air conditioning (AC) prevalence. Over a 7 day period, PM 2.5 from WFS was associated with elevated risk of ED visits for all causes (1.04% (0.32%, 1.71%)), non-accidental causes (2.93% (2.16%, 3.70%)), and respiratory disease (15.17% (12.86%, 17.52%)), but not with ED visits for cardiovascular diseases (1.06% (–1.88%, 4.08%)). Analysis across subgroups revealed potential differences in susceptibility by age, race, and AC prevalence, but not across subgroups defined by ZCTA-level Social Vulnerability Index scores. These results suggest that PM 2.5 from WFS is associated with higher rates of all cause, non-accidental, and respiratory ED visits with important heterogeneity across certain subgroups. Notably, lower availability of residential AC was associated with higher health risks related to wildfire activity.

54 ENVIRONMENTAL SCIENCES↗

DOE OSTI2025

Development of a military-specific mesh-type computational phantom library and its application to internal dosimetry and in-field radiological triage screening

Estimates of organ-absorbed and committed doses to individuals exposed to radioactive materials via acute inhalation often rely on internal dose coefficients and detector responses from reference human computational models. To achieve more accurate dose assessments to United States Armed Forces service members exposed in-field, computational models with varying morphometric parameters representative of this population are necessary. The International Commission on Radiological Protection (ICRP) Publication 145 provides detailed mesh reference computational phantoms (MRCPs) for adult males and females, with morphometric parameters matched to the 50th percentile. Previously, these phantoms were 2D and 3D scaled to match desired height, mass, and secondary anthropomorphic parameters in the creation of the University of Florida / Memorial Sloan Kettering (UF/MSK) computational phantom library. To achieve body fat percentage targets required for accession into the US Armed Forces, muscle and fat volumes were adjusted accordingly, thus, creating the UF/Department of Defence computational phantom library presented in this study. A comprehensive library of mesh-type computational human phantoms was created, including 57 adult males and 49 adult females with morphometric parameters aligned with United States Armed Forces service members. Phantoms were restricted to a body mass index between 19 and 27.5, with body fat percentages below 26% for males and 36% for females. Specific absorbed fractions were computed for selected source and target combinations, demonstrating how variations in height and body mass influence energy absorption in target regions relative to the ICRP MRCPs. Radiation detector responses were also computed, revealing that higher body masses resulted in decreased registered counts in the detection volume. These findings highlight the importance of incorporating morphometric variability in computational phantoms to achieve more accurate dose assessments and radiation detection responses for United States Armed Forces service members who inhale radioactive materials in-field.

computational phantoms↗

DOE OSTI2020

Large-scale inflatable structures for tunnel protection: a review of the Resilient Tunnel Plug project

The protection of underground civil infrastructure continues to be a high priority for transportation and transit security agencies. In particular, rail transit tunnels running under bodies of water are susceptible to disruptions due to flooding caused by extraordinary climatic events such as hurricanes or other events resulting from human activities. Several events have taken place in the past decades that have demonstrated the need to mitigate vulnerabilities or, at least, minimize the consequences of catastrophic events. Although it is impossible to prevent all situations that can lead to flooding, damage can be substantially decreased by reducing the area affected by the event. To minimize the effects of an event, a possible approach is to compartmentalize the tunnel system by creating temporary barriers that can contain the propagation of flooding until a more permanent solution can be implemented. One way to create a temporary barrier is by the deployment of a large-scale inflatable structure, also known as an inflatable plug. In such an application, the inflatable structure is prepared for placement, either permanently or temporally, and maintained ready for deployment, inflation, and pressurization when needed. The internal plug pressure imparts a normal force against the tunnel wall surface with the friction between the plug and tunnel surfaces opposing axial movement of the plug. The sealing effectiveness depends on the ability of the inflatable structure to self-deploy and fit, without human intervention, to the intricacies of the perimeter of the conduit being sealed. Primary design constraints include having the plug stowed away from the dynamic envelope of the trains and being able to withhold the pressure of the flooding water. This work presents a compilation of the main aspects of the activities completed for the development of large-scale inflatable structures as part of the Resilient Tunnel Plug (RTP) Project. The main test results and lessons learned are presented to demonstrate the viability of implementing large-scale inflatable plugs for the containment of flooding in rail tunnels systems. Over 400 coupon and specimen tests, 200 reduced scale tests, and 100 full-scale tests were conducted to demonstrate the efficacy of the design of different prototypes over a 10-year research and development project. The culmination of the work was 12 large-scale flooding demonstrations where the inflatable tunnel plug was shown able to be deployed remotely and withstand a simulated flooding event.

42 ENGINEERING↗

DOE OSTI2024

Activity-Based Protein Profiling to Probe Relationships between Cytochrome P450 Enzymes and Early-Age Metabolism of Two Polycyclic Aromatic Hydrocarbons (PAHs): Phenanthrene and Retene

A growing body of literature has linked early life exposures to polycyclic aromatic hydrocarbons (PAH) with adverse neurodevelopmental effects. Once in the body, metabolism serves as a powerful mediator of PAH toxicity by bioactivating and detoxifying PAH metabolites. Since enzyme expression and activity varies considerably throughout human development, we evaluated infant metabolism of PAHs as a potential contributing factor to PAH susceptibility. Here, we measured and compared rates of phenanthrene and retene (two primary PAH constituents of woodsmoke) metabolism in human hepatic microsomes from individuals ≤21 months of age to a pooled sample (n = 200) consisting primarily of adults. We used activity-based protein profiling (ABPP) to characterize cytochrome P450 enzymes (CYPs) in the same hepatic microsome samples. Once incubated in microsomes, phenanthrene demonstrated rapid depletion. Best fit models for phenanthrene metabolism demonstrated either 1 or 2 phases, depending on the sample, indicating that multiple enzymes could metabolize phenanthrene. We observed no statistically significant differences in phenanthrene metabolism as a function of age, although samples from the youngest individuals had the slowest phenanthrene metabolism rates. We observed slower rates of retene metabolism compared to phenanthrene also in multiple phases. Rates of retene metabolism increased in an age-dependent manner until adult (pooled) levels were achieved at ~12 mo. ABPP identified 28 unique CYPs among all samples, and we observed lower amounts of active CYPs in individuals ≤21 months of age compared to the pooled sample. Phenanthrene metabolism correlated to CYPs 1A1, 1A2, 2C8, 4A22, 3A4, and 3A43 and activities and retene metabolism correlated to CYPs 1A1, 1A2, and 2C8 activities measured by ABPP and vendor-supplied substrate marker activities. These results will aid efforts to determine human health risk and susceptibility to PAHs exposures during early life.

59 BASIC BIOLOGICAL SCIENCES↗

DOE OSTI2024

Do we owe our existence to gravitational waves?

Two heavy elements essential to human biology are thought to have been produced by the astrophysical r-process, which occurs in neutron-rich environments: iodine is a constituent of thyroid hormones that affect many physiological processes including growth and development, body temperature and heart rate, and bromine is essential for tissue development and architecture. Collisions of neutron stars (kilonovae) have been identified as sources of r-process elements including tellurium, which is adjacent to iodine in the periodic table, and lanthanides. Neutron-star collisions arise from energy loss due to gravitational-wave emission from binary systems, leading us to suggest that gravitational waves have played a key role in enabling human life by producing iodine and bromine. We propose probing this proposal by searching in lunar material for live 129 I deposited by a recent nearby kilonova explosion.

Human biochemistry↗

DOE OSTI2023

Applying Cyber-Informed Engineering to Power System Operations

This presentation covers the interaction of the discipline of system operations with the growing body of knowledge around Cyber-Informed Engineering (CIE). First is discussion of a number of fundamental concepts for system operators - organizational division of responsibilities, human and machine cooperation, goals, and priorities. The next section covers the reasons why CIE was developed, what it is, and the key design and operational, and organizational principles of CIE. Finally, some thoughts on how CIE can be applied to power system operations are offered, along with some examples of how an organization can approach applying CIE principles in their particular circumstances.

24 POWER TRANSMISSION AND DISTRIBUTION↗

DOE OSTI2022

Failure Mechanism Traceability and Application in Human System Interface of Nuclear Power Plants using RESHA

In recent years, there has been considerable effort to modernize existing and new nuclear power plants with digital instrumentation and control systems (DI&C). However, there has also been considerable concern both by industry and regulatory bodies for the risk and consequence analysis of these systems. Of particular concern are digital common cause failures (CCFs) specifically related to software defects. These “misbehaviors” by the software can occur in both the control and monitoring of a system. While many new methods have been proposed to identify potential software failure modes, such as Systems-theoretic Process Analysis (STPA), Hazard and Consequence Analysis for Digital Systems (HAZCADS), etc., these methods are focused primarily on the control action pathway of a system. In contrast, the information feedback pathway lacks unsafe control actions (UCAs), which are typically related to software basic events; thus, assessment of software basic events in such systems is unclear. In this work, we present the idea of intermediate processors and unsafe information flow (UIF) to help safety analysts trace failure mechanisms in the feedback pathway and how they can be integrated into a fault tree for improved assessment capability. The concepts presented are demonstrated in two comprehensive case studies, a smart sensor integrated platform for unmanned autonomous vehicles and another on a representative advanced human system interface (HSI) for safety critical plant monitoring. The qualitative software basic events are identified, and a fault tree analysis is conducted based on a modified Redundancy-guided Systems-theoretic Hazard Analysis (RESHA) methodology. The case studies demonstrate the use of UIF and intermediate processors in the fault tree to improve traceability of software failures in highly complex digital instrumentation feedback. The improved method can also clarify fault tree construction when multiple component dependencies are present in the system.

22 GENERAL STUDIES OF NUCLEAR REACTORS↗

DOE OSTI2022

Failure Mechanism Traceability and Application in Human System Interface of Nuclear Power Plants using RESHA

22 GENERAL STUDIES OF NUCLEAR REACTORS↗

DOE OSTI2022

How Management and Leadership Training Can Impact a Health System: Evaluation Findings From a Public Health Management Training Program in Cambodia

In 2017, the National Institute of Public Health in Cambodia collaborated with the U.S. Centers for Disease Control and Prevention to provide management and leadership training for 20 managers and senior staff from 10 health centers. We conducted a mixed methods evaluation of the program's outcomes and impact on the graduates and health centers. From June 2018 (baseline) to January 2019 (endpoint), we collected data from a competency assessment, observational visits, and interviews. From baseline to endpoint, all 20 participants reported increased competence in seven management areas. Comparing baseline and endpoint observational visits, we found improvements in leadership and governance, health workforce, water, sanitation, and hygiene, and health centers' use of medical products and technologies. When evaluating the improvements made by participants against the World Health Organization's key components of a well-functioning health system, the program positively contributed toward building four of the six components—leadership and governance, health information systems, human resources for health, and service delivery. While these findings are specific to the context of Cambodian health centers, we hope this evaluation adds to the growing body of research around the impact of skilled public health management on health systems.

60 APPLIED LIFE SCIENCES↗