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DOE OSTI2025

Risk of Mortality in Family Members of Men Seeking Fertility Assessment

Objective: To assess mortality in family members of men seeking fertility assessment. Subfertility serves as a biomarker for overall somatic health, and poor semen quality is associated with increased risk of hospitalization and mortality from chronic conditions. However, it is unclear if these risks extend to family members of men with low sperm count. Design: Retrospective cohort study. Subjects: Family members, up to third-degree relatives, of men in the Subfertility, Health and Assisted Reproduction and the Environment cohort who underwent a semen analysis as part of a fertility assessment 1996–2017. Relatives of men with a recorded total sperm count who lived in Utah for ≥1 year 1904–2017 were included in the analysis (N = 22,280 families). Exposure: Individuals were classified by family membership. Families were classified as relatives of azoospermic (0M), oligozoospermic (<39M), or normozoospermic (≥39M) men. The average total sperm count of the proband (male relative) with fertility assessment was also included as a continuous exposure measure. Main Outcome Measures: The main outcomes were all-cause and cause-specific mortality risk by sex, age, and degree of relation: first-, second-, and third-degree. Cox proportional hazard models were used to test the association between fertility classification and mortality, controlling for sex, race/ethnicity, and birth year. Results: A total of 666,437 relatives of men with fertility assessment (N deaths = 183,974) were included in the analysis. Relative to normozoospermia families, all-cause mortality risk increased in oligozoospermia families (hazard ratio [HR] oligozoospermia , 1.03; 95% confidence interval [CI], 1.01–1.05). Close relatives, first- (HR oligozoospermia , 1.17; 95% CI, 1.07–1.28) and second-degree relatives (HR azoospermia , 1.11; 95% CI, 1.04–1.20; HR oligozoospermia , 1.05; 95% CI,1.01–1.09), of azoospermic and oligozoospermic men had the highest all-cause and cause-specific mortality risk, including death attributed to cardiovascular disease or congenital birth conditions. Conclusion: Our results suggest that familial all-cause and cause-specific mortality risk differ by fertility phenotype. Families of azoospermic and oligozoospermic men showed significantly increased risk, particularly for close relatives. This study provides further evidence that shared genetic and/or environmental factors could influence both fertility and somatic health.

Male fertility↗

DOE OSTI2025

TCCSP Task 6 Risk Assessment Report

For this Risk Assessment Plan, TCCSP has conducted a site-based risk assessment that quantifies the risk of CO 2 and/or brine leakage as a result of CO 2 injection at TCCSP. The risk assessment covers project planning, construction, injection, post-injection periods and closure of TCCSP. Key technical and non-technical Project risks are identified as part of the Risk Workshop and include a thorough evaluation of related scenarios. Mitigation strategies for the identified risk scenarios are defined to develop a scientifically sound, and community acceptable CO 2 storage Project.

58 GEOSCIENCES↗

DOE OSTI2020

A Tool for the Risk-Informed Management of Critical Mission Resilience

We describe a methodology and tool for the risk-informed management and planning of mission resilience. By mapping concepts of resilience onto the elements of a streamlined risk model we are able to tap the substantial portfolio of established risk concepts to provide rapid insights in the evaluation and high-level screening of prospective resilience enhancement measures. This provides a risk-informed, levelized basis for the comparison of disparate resilience solutions and the means of establishing preferences. The methodology begins with identification of critical missions met by a site, and establishment of the supporting physical assets. Scenarios that would result in failure of these assets are systematically identified. Each scenario comprises three elements: realization of a hazard or threat resulting in loss of resources (the current focus being on power, natural gas, and water) to the asset, failure of measures in place to protect the asset against those losses, and realization of the consequent impacts. These scenarios are quantified in terms of their probabilities of occurrence and the magnitude of the resultant consequences (mission outage time), allowing risk-prioritization to focus resilience enhancement considerations. What-If? analyses are conducted through adjusting elements of the risk calculation to reflect the deployment of prospective resilience measures, by which means the efficacies of each of those measures can be compared using common risk metrics across diverse resilience strategies. This paper will also describe the insights from example applications.

resilience, risk, risk assesment, energy, water↗

DOE OSTI2023

Adaptive changes in sexual behavior in the high–risk population in response to human monkeypox transmission in Canada can help control the outbreak: Insights from a two–group, two–route epidemic model

Monkeypox, a zoonotic disease, is emerging as a potential sexually transmitted infection/disease, with underlying transmission mechanisms still unclear. We devised a risk-structured, compartmental model, incorporating sexual behavior dynamics. We compared different strategies targeting the high-risk population: a scenario of control policies geared toward the use of condoms and/or sexual abstinence (robust control strategy) with risk compensation behavior change, and a scenario of control strategies with behavior change in response to the doubling rate (adaptive control strategy). Monkeypox's basic reproduction number is 1.464, 0.0066, and 1.461 in the high-risk, low-risk, and total populations, respectively, with the high-risk group being the major driver of monkeypox spread. Policies imposing condom use or sexual abstinence need to achieve a 35% minimum compliance rate to stop further transmission, while a combination of both can curb the spread with 10% compliance to abstinence and 25% to condom use. With risk compensation, the only option is to impose sexual abstinence by at least 35%. Adaptive control is more effective than robust control where the daily sexual contact number is reduced proportionally and remains constant thereafter, shortening the time to epidemic peak, lowering its size, facilitating disease attenuation, and playing a key role in controlling the current outbreak.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2025

A quantitative risk assessment framework for fault reactivation in underground hydrogen storage: Coupled simulation and deep learning approach

Underground hydrogen storage (UHS) is emerging as a critical solution for large-scale energy storage. However, like all subsurface fluid injection activities, UHS poses the risk of injection-induced fault reactivation. Accurate risk assessment is essential to ensuring the safety and efficiency of UHS operations. This study presents the development of deep-learning surrogate models for fault reactivation prediction in UHS, trained on a comprehensive database of fully coupled fluid flow-geomechanics simulations. Our findings reveal that analytical models often yield unreliable estimates, with errors up to 54% in the allowable injection pressure, potentially leading to a 40% reduction in UHS operational capacity. The developed surrogate models were incorporated into a quantitative risk assessment (QRA) framework, enabling probabilistic evaluation of fault reactivation risk while accounting for uncertainties in the input variables. Site-specific features, such as horizontal stress gradients, fault’s dip and strike angles, and operational parameters like bottom-hole injection pressure and well-fault distance, were identified as the primary drivers of fault reactivation across various stress regimes. Whereas other hydraulic, geological, and poroelastic reservoir properties were found to have a secondary impact. Notably, we observed that the risk of fault reactivation for a critically oriented fault with a static friction coefficient greater than 0.55 remains below 10% in a normal faulting stress regime. However, the risk significantly increases as the stress regime transitions from normal to strike-slip and ultimately to reverse faulting conditions. These findings underscore the importance of rigorous site characterization and comprehensive QRA evaluations to optimize UHS performance and minimize geomechanical risks.

25 ENERGY STORAGE↗

DOE OSTI2023

Role of reinforcement learning for risk-based robust control of cyber-physical energy systems

Critical infrastructures such as cyber-physical energy systems (CPS-E) integrate information flow and physical operations that are vulnerable to natural and targeted failures. Safe, secure, and reliable operation and control of CPS-E is critical to ensure societal well-being and economic prosperity. Automated control is key for real-time operations and may be mathematically cast as a sequential decision-making problem under uncertainty. Emergence of data-driven techniques for decision making under uncertainty, such as reinforcement learning (RL), have led to promising advances for addressing sequential decision-making problems for risk-based robust CPS-E control. However, existing research challenges include understanding the applicability of RL methods across diverse CPS-E applications, addressing the effect of risk preferences across multiple RL methods, and development of open-source domain-aware simulation environments for RL experimentation within a CPS-E context. This article systematically analyzes the applicability of four types of RL methods (model-free, model-based, hybrid model-free and model-based, and hierarchical) for risk-based robust CPS-E control. Problem features and solution stability for the RL methods are also discussed. We demonstrate and compare the performance of multiple RL methods under different risk specifications (risk-averse, risk-neutral, and risk-seeking) through the development and application of an open-source simulation environment. Motivating numerical simulation examples include representative single-zone and multizone building control use cases. Finally, six key insights for future research and broader adoption of RL methods are identified, with specific emphasis on problem features, algorithmic explainability, and solution stability.

24 POWER TRANSMISSION AND DISTRIBUTION↗

DOE OSTI2020

Collagen Turnover in Relation to Risk Factors and Hemodynamics in Human Intracranial Aneurysms

Determinants for molecular and structural instability, that is, impending growth or rupture, of intracranial aneurysms (IAs) remain uncertain. To elucidate this, we endeavored to estimate the actual turnover rates of the main molecular constituent in human IA (collagen) on the basis of radiocarbon ( 14 C) birth dating in relation to IA hemodynamics. Collagen turnover rates in excised human IA samples were calculated using mathematical modeling of 14 C birth dating data of collagen in relation to risk factors and histological markers for collagen maturity/turnover in selected IA. Hemodynamics were simulated using image-based computational fluid dynamics. Correlation, logistic regression, and receiver operating characteristic analyses were performed. Collagen turnover rates were estimated in 46 IA (43 patients); computational fluid dynamics could be performed in 20 IA (20 patients). The mean collagen turnover rate (γ) constituted 126% (±1% error) per year. For patients with arterial hypertension, γ was greater than 2600% annually, whereas γ was distinctly lower with 32% (±1% error) per year for patients without risk factors, such as smoking and hypertension. There was a distinct association between histological presence of rather immature collagen in human IA and the presence of modifiable risk factors. Spatial-temporal averaged wall shear stress predicted rapid collagen turnover (odds ratio, 1.6 [95% CI, 1.0–2.7]). Receiver operating characteristic analysis demonstrated a good test accuracy (area under the curve, 0.798 [95% CI, 0.598–0.998]) for average wall shear stress with a threshold ≥4.9 Pa for rapid collagen turnover. Our data indicate that turnover rates and stability of collagen in human IA are strongly associated with the presence of modifiable risk factors and aneurysmal hemodynamics. Finally, these findings underline the importance of strict risk factor modification in patients with unruptured IA. Future should include more detailed risk factor data to establish a more causal understanding of hemodynamics and the rupture risk of individual IA.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2021

Evaluation of the Los Alamos Nuclear Material Packaging Risk Ranking Method

Repackaging nuclear material into robust containers to protect workers and the public has been ongoing at LANL and around the DOE complex for nearly two decades. The number of containers at LANL is around 5,000; limited resources for repackaging material has led to extended repackaging campaigns and the need to prioritize repackaging. Various methodologies have been used to prioritize the repackaging efforts and to demonstrate progress in risk reduction over time (e.g., Boerigter, 1997). The 2000-1 DNFSB recommendation recognized the limited DOE resources for repackaging, and acknowledged the need to “prioritize and schedule tasks to be undertaken with available funds according to consideration of risks.” Later, in DNFSB recommendation 2005-1, in addition to recommending that DOE develop a packaging standard, the Board recommended that “Characterization information should also be used to develop a surveillance program prioritized according to expected material and container risk (including, for example, material type, material form, and the age and type of container).” In response to requests and recommendations from the DOE and DNSFB to prioritize according to worker risk, a risk ranking method based on the potential consequence of dropping a container from 3 meters was developed in 2007 (Smith, 2007) and updated in 2014 (Hoffman, 2014). Various LANL implementation plans for repackaging were developed over the years using this methodology (Stone, 2014). Currently, this method is utilized in conjunction with an algorithm to mitigate programmatic risk to prioritize container repackaging and material processing (Prochnow, 2015). The purpose of this study is to document how the current risk ranking method works, how it is used and potential limitations.

11 NUCLEAR FUEL CYCLE AND FUEL MATERIALS↗

DOE OSTI2021

Treatment of uncertainties for security-related design aspects of advanced reactors when using a risk-informed licensing approach

Sabotage of nuclear plants and theft of special nuclear material are different from many other issues potentially affecting public health and safety, and some of those differences drive the content of the present report. A high-level indication of these differences is provided in the US Nuclear Regulatory Commission’s Safety Goal Policy. Promulgated in the mid-1980’s, when it had become reasonably clear that risk analysis had improved to the point where it was possible to understand the risks associated with plant operation, the Safety Goal Policy articulates qualitative safety goals and quantitative health objectives that are meant to guide regulatory and risk management activities, with the following key exceptions noted in the original policy statement: The possible effects of sabotage or diversion of nuclear material are also not presently included in the safety goals. At present there is no basis on which to provide a measure of risk on these matters. It is the Commission’s intention that everything that is needed will be done to keep these types of risks at their present very low level; and it is the Commission’s expectation that efforts on this point will continue to be successful. With these exceptions, it is the Commission’s intent that the risks from all the various initiating mechanisms be considered to the best of the capability of current evaluation techniques. The present report discusses extensions of classical risk management to address some of the special issues that arise in the context of security. Although the present emphasis is on physical security, some attention will be paid to cyber security. A particular focus of the report is on quantitative framework to manage and address uncertainties. This framework is demonstrated via a couple of hypothetical examples.

98 NUCLEAR DISARMAMENT, SAFEGUARDS, AND PHYSICAL P↗

DOE OSTI2024

Large-scale Hydrogen Storage Risk Assessment

This project investigated risks involved in deploying a large-scale hydrogen storage system at the Port of Seattle (hereafter, the Port) for its on-terminal and maritime applications in an urban industrial setting. Alongside, the project attempted to address some of the barriers to risk assessment such as need for an exact system design for a systematic investigation, direct access to surrounding communities to gauge their perceptions, and an integrated software required to undertake a full-fledged risk assessment. These barriers were overcome using illustrative reference station designs, engaging with community-facing agencies through Port support, and pooling national laboratory capabilities available for risk assessments. The project identified relevant public safety risk metrics, compared various hydrogen carriers, engaged with community-facing agencies, and explored potential gaps in existing safety codes and standards. The primary impacts of this project include the development of risk assessment guidance for ports and utilities, informing them of the trade-offs in the choice of hydrogen carriers, and the ability to increase public capacity for dialog and engagement. This paves the way toward decarbonization of the Port activities, bringing about awareness around jobs in the market for risk assessments, and the need to ramp up community engagement long before any hydrogen system deployment is undertaken.

08 HYDROGEN↗

DOE OSTI2025

Adapting Traditional Hazards Analysis Methods to Address Cyber Risks

Traditional hazards analysis (HA) methods, originally developed to address physical and operational risks, often fall short when it comes to identifying and mitigating cyber threats. These cyber threats pose unique and evolving risks to critical infrastructure and industrial control systems (ICS). This report explores the integration of Cyber-Informed Engineering (CIE) principles into existing HA methods to enhance their ability to address cyber-induced risks. CIE provides organizations with a practical, cost-effective approach to closing the gap between traditional HA methods and the need for cyber risk mitigation. By leveraging existing safety processes and controls, CIE allows users to examine and mitigate cyber vulnerabilities without overhauling existing HA methods. This report identifies areas where HA and CIE naturally align and where their approaches diverge. It emphasizes how CIE principles can be used to adapt HA methods, broadening their scope to include cyber risks and enabling the mitigation of cyber- induced impacts alongside traditional hazards and failure scenarios. This report examines how CIE can be applied across various HA methods—such as Hazard and Operability Studies (HAZOP), Probabilistic Risk Assessment (PRA), Failure Modes and Effects Analysis (FMEA), Systems-Theoretic Process Analysis (STPA), Hazard and Consequence Analysis for Digital Systems (HAZCADS), and Layers of Protection Analysis (LOPA). It provides strategies for integrating CIE to strengthen the identification, assessment, and mitigation of cyber-induced risks. The findings offer a structured entry point for organizations to embed CIE concepts into hazards and safety analyses, as well as broader engineering processes, ultimately supporting the design and operation of a more resilient infrastructure.

42 ENGINEERING↗

DOE OSTI2025

Adapting Traditional Hazards Analysis Methods to Address Cyber Risks

42 - ENGINEERING↗

DOE OSTI2023

Dynamic probabilistic risk assessment for electric grid cybersecurity

Electric grid cybersecurity risk has become a significant concern of industries and governments. This paper proposes a dynamic probabilistic risk assessment method for electric grid cybersecurity risk analysis. The proposed method helps reduce the reliance on expert judgment, capture a broad range of components and system dynamics, and model the interactions between various contributing entities (e.g., attacker, operator). In addition, the scenarios with multiple events, such as the occurrence of both cyberattacks and failures of physical components, the occurrence of both cyberattacks and operators’ (in)correct reactions, are considered and analyzed. Further, for each cyberattack scenario, Monte Carlo simulations are used to obtain possible sequences of the system's evolution under study and then derive risk estimates. As an application of the proposed method, the risk assessment method serves as the basis of risk-informed defense resource allocation to improve electric grid cybersecurity. The proposed method is verified using the IEEE 14-bus system by evaluating different security resource allocations for selected cyberattack scenarios.

24 POWER TRANSMISSION AND DISTRIBUTION↗

DOE OSTI2022

Toward More Actionable Flood‐Risk Information

Abstract The increasingly urgent need to develop knowledge and practices to manage flood risks drives innovative information design. However, experts often disagree about design practices. As a result, flood‐risk estimates can diverge, leading to different conclusions for decision‐making. Using examples of household‐scale fluvial (riverine) flood‐risk information in the United States, we assess design features and risk communication approaches that may lead to more actionable information for decision‐making. We argue that increased attention to uncertainty characterization and model diagnostics is a critical intermediate step for developing simpler approaches for designing flood‐risk information. Simpler frameworks are desirable because flood risks change over time, and simpler frameworks are less costly to update. Developing frameworks for large spatial domains require collaboration grounded in principles of open science. Finally, systematically evaluating how decision‐makers access and use information can provide new insights to guide risk communication and information design.

54 ENVIRONMENTAL SCIENCES↗

DOE OSTI2021

Near-term transition and longer-term physical climate risks of greenhouse gas emissions pathways

Policy, business, finance and civil society stakeholders are increasingly looking to compare future emissions pathways across both their associated physical climate risks stemming from increasing temperatures and their transition climate risks stemming from the shift to a low-carbon economy. Herein, we present an integrated framework to explore near-term (to 2030) transition risks and longer-term (to 2050) physical risks, globally and in specific regions, for a range of plausible greenhouse gas emissions and associated temperature pathways, spanning 1.5–4 °C levels of long-term warming. By 2050, physical risks deriving from major heatwaves, agricultural drought, heat stress and crop duration reductions depend greatly on the temperature pathway. By 2030, transition risks most sensitive to temperature pathways stem from economy-wide mitigation costs, carbon price increases, fossil fuel demand reductions and coal plant capacity reductions. Considering several pathways with a 2 °C target demonstrates that transition risks also depend on technological, policy and socio-economic factors.

54 ENVIRONMENTAL SCIENCES↗

DOE OSTI2026

Unlocking the benefits of transparent and reusable science for climate-risk management

People around the world seek climate-risk information to guide their decisions. For instance, projections about future flood risk inform where households choose to live, how lenders manage credit risks, and which communities receive federal funding. Yet data limitations and fundamental validation challenges raise important concerns about the reliability of such projections. The principles of transparency and reusability help address these concerns by enabling scrutiny of assumptions and methods, development of foundational data and tools, and consistent application of evaluation standards. While there is ongoing debate about how much transparency commercial climate-risk services should provide, many expect non-commercial actors to lead the way on operationalizing transparency and reusability to fulfill their knowledge-building role in the climate-risk ecosystem. However, despite prominent success stories, we find a substantial gap between principles and practice: only four percent of the most-cited peer-reviewed climate-risk studies in recent years fully share their data and code despite this being a widely accepted minimum standard for transparency. We highlight low-cost measures that non-commercial researchers can take now to improve transparency and reusability. We also emphasize that transformative progress requires substantial investment, cross-sector collaboration, and careful consideration of tradeoffs, data rights, and multiple perspectives on equity. We hope this perspective accelerates both immediate actions and longer-term conversations to improve the ability of science to effectively support timely, evidence-based, and sound climate-risk management.

Open Science↗

DOE OSTI2024

Organochlorine pesticides and risk of papillary thyroid cancer in U.S. military personnel: a nested case-control study

Background: The effects of organochlorine pesticide (OCP) exposure on the development of human papillary thyroid cancer (PTC) are not well understood. A nested case-control study was conducted with data from the U.S. Department of Defense Serum Repository (DoDSR) cohort between 2000 and 2013 to assess associations of individual OCPs serum concentrations with PTC risk. Methods: This study included 742 histologically confirmed PTC cases (341 females, 401 males) and 742 individually-matched controls with pre-diagnostic serum samples selected from the DoDSR. Associations between categories of lipid-corrected serum concentrations of seven OCPs and PTC risk were evaluated for classical PTC and follicular PTC using conditional logistic regression, adjusted for body mass index category and military branch to compute odds ratios (OR) and 95% confidence intervals (CIs). Effect modification by sex, birth cohort, and race was examined. Results: There was no evidence of associations between most of the OCPs and PTC, overall or stratified by histological subtype. Overall, there was no evidence of an association between hexachlorobenzene (HCB) and PTC, but stratified by histological subtype HCB was associated with significantly increased risk of classical PTC (third tertile above the limit of detection (LOD) vs. <LOD, OR = 1.61, 95% CI, 1.09, 2.38; p for trend = 0.05) and significantly decreased risk of follicular variant PTC (third tertile above the limit of detection (LOD) vs. <LOD, OR = 0.38, 95% CI, 0.16, 0.91; p for trend = 0.04). Further stratified by sex, risk of classical PTC was higher for females (third tertile above LOD vs. <LOD, OR = 2.23, 95% CI: 1.23, 4.06; p-trend = 0.02) than for males (OR = 1.22, 95%CI: 0.72–2.08; p-trend = 0.56), though the test for interaction by sex was not statistically significant (p-interaction = 0.30). Similarly, β-hexachlorocyclohexane (β-HCCH) was associated with a higher risk for classical PTC for women with concentrations ≥LOD versus <LOD (OR = 1.76, 95% CI: 1.07, 2.89), while the effects were null for men. There were no consistent trends when stratified by race or birth year. Conclusions: The U.S. Environmental Protection Agency has classified HCB and other OCPs we studied here as probable human carcinogens. Our findings of increased risks for classical PTC associated with increased concentrations of HCB and β-HCCH, which were stronger among females, should be replicated in future studies of other populations.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2025

Risk of longer-term endocrine and metabolic conditions in the Deepwater Horizon Oil Spill Coast Guard cohort study – five years of follow-up

Abstract Introduction Long-term endocrine and metabolic health risks associated with oil spill cleanup exposures are largely unknown, despite the endocrine-disrupting potential of crude oil and oil dispersant constituents. We aimed to investigate risks of longer-term endocrine and metabolic conditions among U.S. Coast Guard (USCG) responders to the Deepwater Horizon (DWH) oil spill. Methods Our study population included all active duty DWH Oil Spill Coast Guard Cohort members ( N = 45,224). Self-reported spill exposures were ascertained from post-deployment surveys. Incident endocrine and metabolic outcomes were defined using International Classification of Diseases (9th Revision) diagnostic codes from military health encounter records up to 5.5 years post-DWH. Using Cox proportional hazards regression, we estimated adjusted hazard ratios (aHR) and 95% confidence intervals (CIs) for various incident endocrine and metabolic diagnoses (2010–2015, and separately during 2010–2012 and 2013–2015). Results The mean baseline age was 30 years (~ 77% white, ~ 86% male). Compared to non-responders ( n = 39,260), spill responders ( n = 5,964) had elevated risks for simple and unspecified goiter (aHR = 2.09, 95% CI: 1.29–3.38) and disorders of lipid metabolism (aHR = 1.09, 95% CI: 1.00–1.18), including its subcategory other and unspecified hyperlipidemia (aHR = 1.10, 95% CI: 1.01–1.21). The dysmetabolic syndrome X risk was elevated only during 2010–2012 (aHR = 2.07, 95% CI: 1.22–3.51). Responders reporting ever ( n = 1,068) vs. never ( n = 2,424) crude oil inhalation exposure had elevated risks for disorders of lipid metabolism (aHR = 1.24, 95% CI: 1.00–1.53), including its subcategory pure hypercholesterolemia (aHR = 1.71, 95% CI: 1.08–2.72), the overweight, obesity and other hyperalimentation subcategory of unspecified obesity (aHR = 1.52, 95% CI: 1.09–2.13), and abnormal weight gain (aHR = 2.60, 95% CI: 1.04–6.55). Risk estimates for endocrine/metabolic conditions were generally stronger among responders reporting exposure to both crude oil and dispersants (vs. neither) than among responders reporting only oil exposure (vs. neither). Conclusion In this large cohort of active duty USCG responders to the DWH disaster, oil spill cleanup exposures were associated with elevated risks for longer-term endocrine and metabolic conditions.

Denic-Roberts, Hristina↗