SEARCH · Search NASA

Results for “Health care”

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.

SourceResearch connectionFrom yearThrough year

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 163 records · Page 9

All sources NASA NTRS DOE OSTI

DOE OSTI2023

Medication abortion via digital health in the United States: a systematic scoping review

Digital health, including telemedicine, has increased access to abortion care. The convenience, flexibility of appointment times, and ensured privacy to abortion users may make abortion services via telemedicine preferable. This scoping review systematically mapped studies conducted on abortion services via telemedicine, including their effectiveness and acceptability for abortion users and providers. All published papers included abortion services via telemedicine in the United States were considered. Articles were searched in PubMed, CINAHL, and Google Scholar databases in September 2022. The findings were synthesized narratively, and the PRISMA-ScR guidelines were used to report this study. Out of 757 retrieved articles, 33 articles were selected based on the inclusion criteria. These studies were published between 2011 and 2022, with 24 published in the last 3 years. The study found that telemedicine increased access to abortion care in the United States, especially for people in remote areas or those worried about stigma from in-person visits. The effectiveness of abortion services via telemedicine was comparable to in-clinic visits, with 6% or fewer abortions requiring surgical intervention. Both care providers and abortion seekers expressed positive perceptions of telemedicine-based abortion services. However, abortion users reported mixed emotions, with some preferring in-person visits. The most common reasons for choosing telemedicine included the distance to the abortion clinic, convenience, privacy, cost, flexibility of appointment times, and state laws imposing waiting periods or restrictive policies. Telemedicine offered a preferable option for abortion seekers and providers. The feasibility of accessing abortion services via telemedicine in low-resource settings needs further investigation.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2023

Knowledge of lactation amenorrhea method among postpartum women in Ethiopia: a facility-based cross-sectional study

While the importance of knowledge about contraceptives in improving their utilization and thereby reducing the risk of unintended pregnancies is well documented, there are limited studies documented about the Lactational Amenorrhea Method (LAM). Thus, understanding the knowledge of postpartum mothers about LAM is essential for designing tailored interventions. This study assessed the level of knowledge about LAM and its associated factors among postpartum mothers in Ethiopia. A facility-based cross-sectional study was conducted among 3148 randomly selected postpartum participants. The study utilized multistage sampling approach in hospitals located across five regions and one city administration in Ethiopia. Data were collected using face-to-face interviews at discharge. A participant was categorized as having knowledge of LAM if she correctly answered the three LAM criteria: amenorrhea, the first 6 months, and exclusive breast feeding. A binary logistic regression model was used to identify factors associated with knowledge of LAM. Variables with p < 0.25 in the binary logistic regression were included in the multiple logistic regression. Then, associations were described using the adjusted odds ratio (AOR) along with the 95% confidence interval (CI), and statistical significance was declared at p < 0.05. Only four in 10 participants (40.6%; 95% CI 38.9–42.3) had knowledge of LAM. Participants who attended college or above educational level (AOR = 2.1, 95% CI 1.5–2.8), those with parity of two (AOR = 2.3; 95% CI 1.6–3.6) or more than two (AOR = 2.4; 95% CI 1.5–4.0), those who expressed a desire for further fertility (AOR = 1.3; 95% CI 1.1–1.5), individuals who received counselling on LAM (AOR = 3.0; 95% CI 2.6–3.7), and those who gave birth in hospital (AOR = 2.6; 95% CI 1.4–2.6) had higher odds of knowledge about LAM, compared to their counter parts. In contrary, participants resided far away from health facilities had 30% lower odd of knowledge about LAM compared to those resided near the health facilities (AOR = 0.70; 95% CI 0.6–0.8). The proportion of participants who had knowledge of LAM was low. Strengthening counseling about LAM during antenatal care and delivery with due attention to women with limited access to health facilities should be considered for increasing their level of knowledge on LAM.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2022

Detecting anomalous sequences in electronic health records using higher-order tensor networks

Detecting anomalous sequences is an integral part of building and protecting modern large-scale health information technology (HIT) systems. These HIT systems generate a large volume of records of patients’ state and significant events, which provide a valuable resource to help improve clinical decisions, patient care processes, and other issues. However, detecting anomalous sequences in electronic health records (EHR) remains a challenge in healthcare applications for several reasons, including imbalances in the data, complexity of relationships between events in the sequence, and the curse of dimensionality. Conventional anomaly detection methods use the finite sequence of events to discriminate sequences. They fail to incorporate salient event details under variable higher-order dependencies (e.g., duration between events) that can provide better discrimination of sequences in their models. To address this problem, we propose event sequence and subsequence anomaly detection algorithms that (1) use network-based representations of interactions in the data, (2) account for variable higher-order dependencies in the data, and (3) incorporate events duration for adequate discrimination of the data. The proposed approach identifies anomalies by monitoring the change in the graph after the test sequence is removed from the network. The change is quantified using graph distance metrics so that dramatic changes in the network can be attributed to the removed sequence. Furthermore, the proposed subsequence algorithm recommends plausible paths and salient information for the detected anomalous subsequences. Our results show that the proposed event sequence anomaly detection algorithm outperforms the baseline methods for both synthetic data and real-world EHR data.

96 KNOWLEDGE MANAGEMENT AND PRESERVATION↗

DOE OSTI2020

RSVP - Flu Like Illness and Respiratory Syndromes COVID-19 Syndromic Reporting Tool Prototype

Individuals infected with SARS-CoV-2, the virus that causes COVID-19, may be infectious between 1-3 days prior to symptom onset. People may delay seeking medical care after symptom development due to multiple determinants of health seeking behavior like availability of testing, accessibility of providers, and ability to pay. Therefore, understanding symptoms in the general public is important to better predict and inform resource management plans and engage in reopening. As the influenza season looms, the ability to differentiate between clinical presentation of COVID-19 and seasonal influenza will also be important to health providers and public health response efforts. This project has developed an algorithm that when used with captured syndromic trends can help provide both differentiation to various influenza-like illnesses (ILI) as well as provide public health decision makers a better understanding regarding spatial and temporal trends. This effort has also developed a web-based tool to allow for the capturing of generalized syndromic trends and provide both spatial and temporal outputs on these trends. This page left blank

59 BASIC BIOLOGICAL SCIENCES↗

DOE OSTI2024

Light: An Extrinsic Factor Influencing Animal-based Research

Abstract Light is an environmental factor that is extrinsic to animals themselves and that exerts a profound influence on the regulation of circadian, neurohormonal, metabolic, and neurobehavioral systems of all animals, including research animals. These widespread biologic effects of light are mediated by distinct photoreceptors—rods and cones that comprise the conventional visual system and melanopsin-containing intrinsically photosensitive retinal ganglion cells (ipRGCs) of the nonvisual system that interact with the rods and cones. The rods and cones of the visual system, along with the ipRGCs of the nonvisual system, are species distinct in terms of opsins and opsin concentrations and interact with one another to provide vision and regulate circadian rhythms of neurohormonal and neurobehavioral responses to light. Here, we review a brief history of lighting technologies, the nature of light and circadian rhythms, our present understanding of mammalian photoreception, and current industry practices and standards. We also consider the implications of light for vivarium measurement, production, and technological application and provide simple recommendations on artificial lighting for use by regulatory authorities, lighting manufacturers, designers, engineers, researchers, and research animal care staff that ensure best practices for optimizing animal health and well-being and, ultimately, improving scientific outcomes.

Veterinary Sciences↗

DOE OSTI2025

Low responsiveness of machine learning models to critical or deteriorating health conditions

Machine learning (ML) based mortality prediction models can be immensely useful in intensive care units. Such a model should generate warnings to alert physicians when a patient’s condition rapidly deteriorates, or their vitals are in highly abnormal ranges. Before clinical deployment, it is important to comprehensively assess a model’s ability to recognize critical patient conditions. We develop multiple medical ML testing approaches, including a gradient ascent method and neural activation map. We systematically assess these machine learning models’ ability to respond to serious medical conditions using additional test cases, some of which are time series. Guided by medical doctors, our evaluation involves multiple machine learning models, resampling techniques, and four datasets for two clinical prediction tasks. We identify serious deficiencies in the models’ responsiveness, with the models being unable to recognize severely impaired medical conditions or rapidly deteriorating health. For in-hospital mortality prediction, the models tested using our synthesized cases fail to recognize 66% of the injuries. In some instances, the models fail to generate adequate mortality risk scores for all test cases. Our study identifies similar kinds of deficiencies in the responsiveness of 5-year breast and lung cancer prediction models. Using generated test cases, we find that statistical machine-learning models trained solely from patient data are grossly insufficient and have many dangerous blind spots. Most of the ML models tested fail to respond adequately to critically ill patients. How to incorporate medical knowledge into clinical machine learning models is an important future research direction.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2022

The State of Virtual Healthcare

In recent years, telehealth or telemedicine has become an integral component of health systems. During the COVID-19 pandemic, telehealth became the primary route of treatment for patients and doctors. The goals of telehealth are to make healthcare more accessible to patients who have limited mobility, time, or transportation options and those who live in rural or isolated communities. Telehealth aims to improve coordination and care between healthcare teams and their patients. While addressing accessibility, telehealth sets health systems on a path to meet their decarbonization and energy reduction goals. The document provides insights and best practices for telehealth, including carbon reduction, space utilization, equitable access, and technology.

Better Buildings, telehealth, carbon footprint↗

DOE OSTI2021

Comparative Assessment of Data-driven Process Models in Health Information Technology

Process mining for conformance analysis consists of comparing a reference process model against a data-driven process model generated via log files from information technology systems. However, in the absence of a complete reference process model, we found no suggested approaches in the literature to address the need for evaluating process conformance among different healthcare facilities to assess standardization of care. Our goal is to find similarities and dissimilarities in data-driven process models among US Veterans Health Administration (VHA) facilities that can be indicative of patient safety issues. Our hypothesis was that the analysis would not produce statistically significant differences in outcome. We present a unique implementation of conformance analysis in process mining that consists of combining process mining, process mapping and statistical metrics. We illustrate our approach by applying it to the analysis of two clinical radiology order process models generated from healthcare data provided by two similar facilities in the VHA. The comparative assessment showed that about 70% of the orders completed successfully and 30% were not completed due to policy and duplications. Our analysis found a good statistical correlation between both facilities, as the Spearman’s correlation coefficient between facilities for the frequency of cases per total hours was 0.87879, for the frequency of cases by state transition was 0.79702 and for the throughput time per state transition was 0.63582. Additional statistical analyses using the Mann-Whitney U test and the root mean square error both produced values that were not significant. The foregoing approach validated our hypothesis by demonstrating a good statistical correlation of data describing the flow of clinical radiology orders absent a credible reference model. Finding good agreement between both facilities was important in confirming that the clinical orders flow in a similar manner, suggesting standardization of care.

97 MATHEMATICS AND COMPUTING↗

DOE OSTI2022

Towards mapping biodiversity from above: Can fusing lidar and hyperspectral remote sensing predict taxonomic, functional, and phylogenetic tree diversity in temperate forests?

Abstract Aim Rapid global change is impacting the diversity of tree species and essential ecosystem functions and services of forests. It is therefore critical to understand and predict how the diversity of tree species is spatially distributed within and among forest biomes. Satellite remote sensing platforms have been used for decades to map forest structure and function but are limited in their capacity to monitor change by their relatively coarse spatial resolution and the complexity of scales at which different dimensions of biodiversity are observed in the field. Recently, airborne remote sensing platforms making use of passive high spectral resolution (i.e., hyperspectral) and active lidar data have been operationalized, providing an opportunity to disentangle how biodiversity patterns vary across space and time from field observations to larger scales. Most studies to date have focused on single sites and/or one sensor type; here we ask how multiple sensor types from the National Ecological Observatory Network’s Airborne Observation Platform (NEON AOP) perform across multiple sites in a single biome at the NEON field plot scale (i.e., 40 m × 40 m). Location Eastern USA. Time period 2017–2018. Taxa studied Trees. Methods With a fusion of hyperspectral and lidar data from the NEON AOP, we assess the ability of high resolution remotely sensed metrics to measure biodiversity variation across eastern US temperate forests. We examine how taxonomic, functional, and phylogenetic measures of alpha diversity vary spatially and assess to what degree remotely sensed metrics correlate with in situ biodiversity metrics. Results Models using estimates of forest function, canopy structure, and topographic diversity performed better than models containing each category alone. Our results show that canopy structural diversity, and not just spectral reflectance, is critical to predicting biodiversity. Main conclusions We found that an approach that jointly leverages spectral properties related to leaf and canopy functional traits and forest health, lidar derived estimates of forest structure, fine‐resolution topographic diversity, and careful consideration of biogeographical differences within and among biomes is needed to accurately map biodiversity variation from above.

54 ENVIRONMENTAL SCIENCES↗

DOE OSTI2022

Comprehensive compartmental model and calibration algorithm for the study of clinical implications of the population-level spread of COVID-19: a study protocol

The complex dynamics of the coronavirus disease 2019 (COVID-19) pandemic has made obtaining reliable long-term forecasts of the disease progression difficult. Simple mechanistic models with deterministic parameters are useful for short-term predictions but have ultimately been unsuccessful in extrapolating the trajectory of the pandemic because of unmodelled dynamics and the unrealistic level of certainty that is assumed in the predictions. We propose a 22-compartment epidemiological model that includes compartments not previously considered concurrently, to account for the effects of vaccination, asymptomatic individuals, inadequate access to hospital care, post-acute COVID-19 and recovery with long-term health complications. Additionally, new connections between compartments introduce new dynamics to the system and provide a framework to study the sensitivity of model outputs to several concurrent effects, including temporary immunity, vaccination rate and vaccine effectiveness. Subject to data availability for a given region, we discuss a means by which population demographics (age, comorbidity, socioeconomic status, sex and geographical location) and clinically relevant information (different variants, different vaccines) can be incorporated within the 22-compartment framework. Considering a probabilistic interpretation of the parameters allows the model's predictions to reflect the current state of uncertainty about the model parameters and model states. We propose the use of a sparse Bayesian learning algorithm for parameter calibration and model selection. This methodology considers a combination of prescribed parameter prior distributions for parameters that are known to be essential to the modelled dynamics and automatic relevance determination priors for parameters whose relevance is questionable. This is useful as it helps prevent overfitting the available epidemiological data when calibrating the parameters of the proposed model. Population-level administrative health data will serve as partial observations of the model states.

59 BASIC BIOLOGICAL SCIENCES↗

DOE OSTI2024

The lifetime risk and impact of vitiligo across sociodemographic groups: a UK population-based cohort study

Abstract Background Vitiligo is an autoimmune skin disorder characterized by depigmented patches of skin, which can have significant psychological impacts. Objectives To estimate the lifetime incidence of vitiligo, overall, by ethnicity and across other sociodemographic subgroups, and to investigate the impacts of vitiligo on mental health, work and healthcare utilization. Methods Incident cases of vitiligo were identified in the Optimum Patient Care Database of primary care records in the UK between 1 January 2004 and 31 December 2020. The lifetime incidence of vitiligo was estimated at age 80 years using modified time-to-event models with age as the timescale, overall and stratified by ethnicity, sex and deprivation. Depression, anxiety, sleep disturbance, healthcare utilization and work-related outcomes were assessed in the 2 years after vitiligo diagnosis and compared with matched controls without vitiligo. The study protocol for this retrospective observational study was registered with ClinicalTrials.gov (NCT06097494). Results In total, 9460 adults and children were newly diagnosed with vitiligo during the study period. The overall cumulative lifetime incidence was 0.92% at 80 years of age [95% confidence interval (CI) 0.90–0.94]. Cumulative incidence was similar in female (0.94%, 95% CI 0.92–0.97) and male patients (0.89%, 95% CI 0.86–0.92). There were substantial differences in lifetime incidence across ethnic groups, listed by Office for National Statistics criteria [Asian 3.58% (95% CI 3.38–3.78); Black 2.18% (95% CI 1.85–2.50); Mixed/multiple 2.03% (95% CI 1.58–2.47); Other 1.05% (95% CI 0.94–1.17); and White 0.73% (95% CI 0.71–0.76)]. Compared with matched controls, people with vitiligo had an increased risk of depression [adjusted odds ratio (aOR) 1.08, 95% CI 1.01–1.15]; anxiety (aOR 1.19, 95% CI 1.09–1.30); depression or anxiety (aOR 1.10, 95% CI 1.03–1.17); and sleep disturbance [adjusted hazard ratio (aHR) 1.15, 95% CI 1.02–1.31]. People with vitiligo also had a greater number of primary care encounters (adjusted incidence rate ratio 1.29, 95% CI 1.26–1.32) and a greater risk of time off work (aHR 1.15, 95% CI 1.06–1.24). There was little evidence of disparities in vitiligo-related impacts across ethnic subgroups. Conclusions Clinicians should be aware of the markedly increased incidence of vitiligo in people belonging to Asian, Black, Mixed/multiple and Other groups. The negative impact of vitiligo on mental health, work and healthcare utilization highlights the importance of monitoring people with vitiligo to identify those who need additional support.

Eleftheriadou, Viktoria↗

DOE OSTI2025

Hazard Detection Detector Cards

This report presents a comprehensive summary of five advanced anomaly detection tools developed and deployed by Oak Ridge National Laboratory in support of the VA’s Health Information Technology modernization. These detectors—Order Path Tracker, Trend Watcher, Pain Pointer, Performance Monitor, and Patient Record Flag Detector—leverage statistical and machine learning methods to monitor workflow disruptions, detect anomalies in care sequences and volumes, identify bottlenecks, and track system-level performance metrics across VistA and Millennium systems. All detectors have been integrated into the Health Data Analytics Platform (HDAP), with most having completed deployment and testing using live data from targeted stations in cardiology and oncology domains. This work enhances VA’s capacity for proactive system surveillance, promotes patient safety, and informs data-driven operational improvements across the EHR ecosystem.

97 MATHEMATICS AND COMPUTING↗

DOE OSTI2026

Storage Field Development Plan: One Earth Energy

This Storage Field Development plan presents the Storage Complex characterization results, construction, monitoring, and operational plans, and costs associated with the proposed One Earth Sequestration Carbon Capture and Storage (OES-CCS) site in McLean County, Illinois, near Gibson City. The proposed storage complex, known as the Mt. Simon Storage Complex, comprises the Cambrian Mt. Simon Sandstone reservoir and the primary seal, the Cambrian Eau Claire Formation. The lowermost Underground Source of Drinking Water (USDW) identified for the site is the Ordovician St. Peter Sandstone. Geologic characterization of the Mt. Simon Storage Complex at the OES-CCS site was performed by the Illinois Storage Corridor CarbonSAFE Phase III project, which also prepared and submitted three UIC Class VI applications to construct three injection wells; the permit applications were submitted and are in the federal EPA review process. A characterization well, OEE #1, was drilled to collect site-specific data. These data were analyzed and used to develop the UIC Class VI applications. The OEE #1 well will be converted to an in-zone monitoring (IZM) well for the injection phase. The proposed buildout for the OES-CCS site includes (1) three injection wells (OES #1, OES #2, and OES #3), (2) two IZM wells, (3) two above confining zone (ACZ) monitoring wells, one of which will be used to monitor the lowermost USDW, (4) capture and compression facilities, and (5) transportation facilities, i.e., pipelines. A pre-operational testing program was proposed in the Class VI permit application and will be employed at the site pending approval. Additional pre-injection (baseline), syn-injection, and post-injection monitoring and site care procedures will be followed by OES to ensure that injection activities are protective of human health and the environment. Injection is scheduled to begin in 2025, distributed across the three injection wells in accordance with the permit operating conditions. One Earth Sequestration intends to inject up to 90 million tonnes of CO 2 over a period of approximately 20 years. Injection will begin at approximately 0.5 million tonnes of CO 2 annually and ramp up to a maximum of 4.5 million tonnes annually. Daily injection rates are expected to range from 1,400 to 1,500 tonnes per day initially and reach a maximum of approximately 4,225 tonnes per day, depending on site geology and injectivity at each injection well location, and CO 2 availability. The costs associated with the OES-CCS project include pre-operational costs (e. g. additional seismic data acquisition and well drilling), capture and transportation facility and equipment costs, predicted field operating expenditures (OpEx), and decommissioning and post-injection site care (PISC) costs. The risks associated with project activities, such as site construction, injection operations, and verification of secure storage were evaluated, and mitigation strategies proposed to alleviate those risks.

09 BIOMASS FUELS↗

DOE OSTI2020

Nicotine Monitoring with a Wearable Sweat Band

The tobacco epidemic is a public health threat that has taken a heavy toll of lives around the globe each year. Smoking affects both the smokers and those who are exposed to secondhand smoke, and careful tracking of exposure can be key to mitigating the potential hazards. For smokers, the variation of chemical compositions between commercial cigarettes has led to ambiguity in estimating the health risks, both for active smokers and others involuntarily exposed to tobacco smoke and byproducts. In this regard, sweat possesses an attractive opportunity to monitor smoke exposure due to sweat's abundance in biomolecules and its great accessibility. In this paper, we present a wearable sweat band to monitor nicotine, a prominent ingredient in cigarettes, as a viable way to quantitatively assess a wearer's exposure to smoking. Both smokers and normal subjects are tested to demonstrate the use of this device for smoke-related health monitoring. Our results exhibit confirmable and elevated nicotine levels in sweat for subjects inhaling cigarette smoke. This continuous and personalized sweat sensing device is leverage to monitor smoke pollution for a potentially broad population.

37 INORGANIC, ORGANIC, PHYSICAL, AND ANALYTICAL CH↗

DOE OSTI2021

Gene expression for biodosimetry and effect prediction purposes: promises, pitfalls and future directions – key session ConRad 2021

In a nuclear or radiological event, an early diagnostic or prognostic tool is needed to distinguish unexposed from low- and highly exposed individuals with the latter requiring early and intensive medical care. Radiation-induced gene expression (GE) changes observed within hours and days after irradiation have shown potential to serve as biomarkers for either dose reconstruction (retrospective dosimetry) or the prediction of consecutively occurring acute or chronic health effects. The advantage of GE markers lies in their capability for early (1–3 days after irradiation), high-throughput, and point-of-care (POC) diagnosis required for the prediction of the acute radiation syndrome (ARS).

61 RADIATION PROTECTION AND DOSIMETRY↗

DOE OSTI2022

Models for Incorporating Equity in Transportation Electrification Considerations for Public Utility Regulators, An addendum to the NARUC report, Electric Vehicles: Key Trends, Issues, and Considerations for State Regulators

Momentum for the electric vehicle (EV) transition is well underway, and the utility sector plays an important role in supporting its success. For frontline communities, the transition offers a promising solution to improve environmental and public health outcomes, economic development, affordability, and transit equity. However, the transition will need to involve care and intention to ensure that the needs of underserved communities are prioritized throughout the planning, decision-making, and implementation processes. States have taken the lead in some cases, as profiled in Box 6. Whether driven by state commissions or utilities themselves, utilities have a range of options available to ensure equity is central in their transportation electrification plans and programs by drawing from a variety of existing and emerging experiences, as summarized in Table 1.

29 ENERGY PLANNING, POLICY, AND ECONOMY↗

DOE OSTI2022

Models for Incorporating Equity in Transportation Electrification Considerations for Public Utility Regulators, An addendum to the NARUC report, Electric Vehicles: Key Trends, Issues, and Considerations for State Regulators (2019)

29 ENERGY PLANNING, POLICY, AND ECONOMY↗

DOE OSTI2020

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

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

12 MANAGEMENT OF RADIOACTIVE AND NON-RADIOACTIVE W↗