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At least 19 records
All sourcesNASA NTRSDOE OSTI
DOE OSTI2021

Expected individual benefit of prophylactic platelet transfusions in hemato‐oncology patients based on bleeding risks

Abstract Background Prophylactic platelet transfusions prevent bleeding in hemato‐oncology patients, but it is unclear how any benefit varies between patients. Our aim was to assess if patients with different baseline risks for bleeding benefit differently from a prophylactic platelet transfusion strategy. Study design and methods Using the data from the randomized controlled TOPPS trial (Trial of Platelet Prophylaxis), we developed a prediction model for World Health Organization grades 2, 3, and 4 bleeding risk (defined as at least one bleeding episode in a 30 days period) and grouped patients in four risk‐quartiles based on this predicted baseline risk. Predictors in the model were baseline platelet count, age, diagnosis, disease modifying treatment, disease status, previous stem cell transplantation, and the randomization arm. Results The model had a c‐statistic of 0.58 (95% confidence interval [CI] 0.54–0.64). There was little variation in predicted risks (quartiles 46%, 47%, and 51%), but prophylactic platelet transfusions gave a risk reduction in all risk quartiles. The absolute risk difference (ARD) was 3.4% (CI −12.2 to 18.9) in the lowest risk quartile (quartile 1), 7.4% (95% CI −8.4 to 23.3) in quartile 2, 6.8% (95% CI −9.1 to 22.9) in quartile 3, and 12.8% (CI −3.1 to 28.7) in the highest risk quartile (quartile 4). Conclusion In our study, generally accepted bleeding risk predictors had limited predictive power (expressed by the low c‐statistic), and, given the wide confidence intervals of predicted ARD, could not aid in identifying subgroups of patients who might benefit more (or less) from prophylactic platelet transfusion.

Cornelissen, Loes L.↗
DOE OSTI2024

Engineering and evaluation of FXa bypassing agents that restore hemostasis following Apixaban associated bleeding

Direct oral anticoagulants (DOACs) targeting activated factor Xa (FXa) are used to prevent or treat thromboembolic disorders. DOACs reversibly bind to FXa and inhibit its enzymatic activity. However, DOAC treatment carries the risk of anticoagulant-associated bleeding. Currently, only one specific agent, andexanet alfa, is approved to reverse the anticoagulant effects of FXa-targeting DOACs (FXaDOACs) and control life-threatening bleeding. However, because of its mechanism of action, andexanet alfa requires a cumbersome dosing schedule, and its use is associated with the risk of thrombosis. Here, we present the computational design, engineering, and evaluation of FXa-variants that exhibit anticoagulation reversal activity in the presence of FXaDOACs. Our designs demonstrate low DOAC binding affinity, retain FXa-enzymatic activity and reduce the DOAC-associated bleeding by restoring hemostasis in mice treated with apixaban. Importantly, the FXaDOACs reversal agents we designed, unlike andexanet alfa, do not inhibit TFPI, and consequently, may have a safer thrombogenic profile.

59 BASIC BIOLOGICAL SCIENCES↗
DOE OSTI2022

Susceptibility weighted MRI pinpoints spontaneous intracerebral hemorrhage in stroke-prone spontaneously hypertensive rats

Purpose: To find magnetic resonance imaging (MRI) precursors of spontaneous intracerebral hemorrhage in stroke-prone spontaneously hypertensive rats (SHRSP). Method: SHRSP rats were used with both a low/high salt (n = 18 or 11) Japanese diet and salty drinking water to generate spontaneous intracerebral hemorrhage (ICH). Various MRI sequences, and in particular, susceptibility weighted imaging (SWI), were used and combined with a gadolinium (Gd) contrast agent or oxygen gas to identify the rupture of the blood brain barrier (BBB) and the temporal ICH. Results: Most rats developed hypertensive ICH stroke in the high salt group during the 10–13 week period compared to only one third of rats in the low salt group during the 14–18 week period. The location of stroke for both the low/high-salt groups was highest in the striatum (58%/43%), followed by the cortex (21%/30%). The edematous enhancement on T2 weighted (T2W) imaging or Gd based T1 weighted (Gd-T1W) imaging due to the ruptured BBB preceded the striatal hemorrhages seen on SWI. The most recent bleeds were observed on temporal SWI or on oxygen-enhanced SWI. The mode of the volume of bleeds was 0.4 mm 3 . A positive correlation between susceptibility x volume and R2* x volume of the bleeds was observed. Conclusions: SHRSP rats with the high salt diet effectively generated a hypertensive hemorrhagic stroke which could be monitored by various MRI sequences. The venous dilation on SWI may precede any abnormality on T2W or Gd-T1W imaging. The edematous enhancement on T2W or Gd-T1W indicated a BBB breakdown that may precede striatal ICH by several days. This suggests the need for immediate treatment to improve outcome if this finding is observed. Here, the use of oxygen with SWI was able to help differentiate old bleeds from very recent bleeds.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2022

Closed-loop brayton cycle system with turbine blade cooling

A closed-loop Brayton cycle system utilizes supercritical carbon dioxide as the working fluid for the system to achieve higher efficiencies than can be achieved with traditional open-loop gas turbine engines. A bleed channel is used to direct a flow of cooling fluid to cool the turbine blades during operation of the system, preventing damage to the turbine blades during operation of the system. The bleed channel includes a bleed inlet fluidly coupled between a first recuperator and a second recuperator and a bleed outlet fluidly coupled to the turbine blades. The bleed channel is configured to direct the flow of cooling fluid to the turbine blades at a desired temperature and pressure.

Taylor, Stephen H.↗
DOE OSTI2020

Enhanced carbon-transfer and -utilization efficiencies achieved using membrane carbonation with gas sources having a range of CO 2 concentrations

The economic viability of microalgal biofuels relies on increasing productivity in a cost-effective manner. As microalgal biomass contains > 50% carbon, a high rate of CO 2 delivery is required for high productivity, and inefficient CO 2 delivery amplifies operating costs. Membrane carbonation using non-porous hollow fiber membranes can ideally deliver CO 2 without bubble formation and high carbon transfer efficiency. Because CO 2 streams from industrial resources are not 100% CO 2 , the buildup of inert gasses can significantly lower the CO 2 delivery rate when the distal end of the membrane is closed. To overcome the buildup of inert gases, we managed the distal end of the membranes with three different approaches: fully open end, restricted bleed valve, and restricted bleed valve with pH-actuated venting. For all approaches, CO 2 was delivered to membranes ondemand based on a pH set point. Evaluating a wide range of CO 2 concentrations (10% to 100%), we found that all approaches eliminated the buildup of inert gases, could maintain target pH values and gave the same biomass productivities and carbon distributions. However, carbon transfer efficiency depended on the operation of the distal end. Fully open-end operation gave a poor carbon transfer efficiency because of excessive loss of CO 2 from the distal end. However, restricting the exit flow rate to ≤4 cm 3 /min mitigated the problems of excessive CO 2 loss, but without incurring a large loss of CO 2 -delivery flux. For the continuous cultivation, combining a restricted bleed valve with pH-actuated venting improved the carbon-transfer efficiency and -utilization efficiencies up to 85% and 67%, respectively, with a sufficient CO 2 delivery flux.

42 ENGINEERING↗
DOE OSTI2022

Efficacy and safety of warfarin in patients with non-valvular atrial fibrillation and CKD G3–G5D

ABSTRACT Background Observational data comparing warfarin with no treatment for patients with non-valvular atrial fibrillation (NVAF) and severely reduced glomerular filtration rate (GFR) are conflicting and randomized controlled trials (RCTs) are lacking. Most studies do not provide information on warfarin treatment quality, making them difficult to compare. Methods This national cohort study investigates the risk of ischaemic stroke and major bleeding during warfarin treatment compared with no oral anticoagulants in patients with NVAF, GFR category 3–5 (G3–G5) or on dialysis (G5D), with kidney transplant recipients excluded, between 2009 and 2018. Data extracted from high-quality Swedish national healthcare registries, including the Swedish Renal Registry, AuriculA—the Swedish national quality registry for atrial fibrillation and anticoagulation—and the Stroke Registry. Results At enrolment of 12 106 patients, 21.4% were G3, 43.5% were G4, 11.6% were G5 and 23.6% were G5D. The mean time in the therapeutic range was 70%. Warfarin compared with no treatment showed a lower risk for ischaemic stroke for G3 {hazard ratio [HR] 0.37 [95% confidence interval (CI) 0.18–0.76]}, G4 [0.53 (0.38–0.74)] and G5D [0.49 (0.30–0.79)] and an increased risk of major bleeding in G4 [HR 1.22 (1.02–1.46)], G5 [1.52 (1.15–2.01)] and G5D [1.23 (1.00–1.51)]. All-cause mortality was more than halved on warfarin compared with no treatment in all GFR categories. Conclusions Warfarin treatment is associated with a lower risk of ischaemic stroke for patients with NVAF and G3, G4 and G5D at the cost of a higher risk of major bleeding for G4–G5D. Existing observational data are conflicting, stressing the need for RCTs on warfarin compared with no treatment in G4–G5D. Awaiting RCTs, it seems reasonable to treat selected patients on dialysis and NVAF with warfarin.

Welander, Frida (ORCID:0000000311117215)↗
DOE OSTI2020

Structure-guided design of pure orthosteric inhibitors of αIIbβ3 that prevent thrombosis but preserve hemostasis

A prevailing dogma is that inhibition of vascular thrombosis by antagonizing platelet integrin αIIbβ3 cannot be achieved without compromising hemostasis, thus causing serious bleeding and increased morbidity and mortality. It is speculated that these adverse outcomes result from drug-induced activating conformational changes in αIIbβ3 but direct proof is lacking. Here, we report the structure-guided design of peptide Hr10 and a modified form of the partial agonist drug tirofiban that act as “pure” antagonists of αIIbβ3, i.e., they no longer induce the conformational changes in αIIbβ3. Both agents inhibit human platelet aggregation but preserve clot retraction. Hr10 and modified tirofiban are as effective as partial agonist drugs in inhibiting vascular thrombosis in humanized mice, but neither causes serious bleeding, establishing a causal link between partial agonism and impaired hemostasis. Pure orthosteric inhibitors of αIIbβ3 may thus provide safer alternatives for human therapy, and valuable tools to probe structure–activity relationships in integrins.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2020

Annual Scientific Focus Area Report for the Energy Exascale Earth System Model Project: Phase II

The project's long-term goal is to assert and maintain an international scientific leadership position in the development of Earth system models that address the grand challenge of actionable predictions of Earth system variability and change, with an emphasis on the most critical scientific questions facing the nation and DOE. The grand challenge will be addressed by overcoming three major limitations: Pushing the high-resolution frontier of Earth system modeling through a combination of strategic model development and computational advances targeting exascale computers and beyond. Bridging the gap in scales and processes by developing a new class of models that couple the natural, managed, and man-made systems across scales to address energy sector vulnerability to variability and change. The project will achieve its goal through four intersecting project elements: A series of prediction and simulation experiments addressing scientific questions and mission needs; A well-documented and tested, continuously advancing, evolving, and improving system of model codes that comprise the E3SM Earth system model; The ability to use effectively leading (and “bleeding”) edge computational facilities soon after their deployment at DOE national laboratories; and An infrastructure to support code development, hypothesis testing, simulation execution, and analysis of results. To achieve the Grand Challenge of actionable Earth system predictions to address the most critical scientific questions facing our nation and DOE, the E3SM project defined its strategy in a fifteen-year roadmap with four intersecting project elements: A series of prediction and simulation experiments addressing scientific questions and mission needs; A well-documented and tested, continuously advancing, evolving, and improving system of model codes that comprise the E3SM Earth system model ; The ability to use effectively leading (and “bleeding”) edge computational facilities soon after their deployment at DOE national laboratories; and An infrastructure to support code development, hypothesis testing, simulation execution, and analysis of results. Figure 1 depicts the E3SM Project Roadmap, showing the relationships among the first three major project elements: the simulations, the modeling system to perform those simulations, and the machines on which they will be executed. Unlike the other three elements that have distinct but overlapping phases, the fourth element, the infrastructure, will evolve continuously based on the requirements imposed by project needs.

54 ENVIRONMENTAL SCIENCES↗
DOE OSTI2021

Tamper-Indicating Enclosures with Visually Obvious Tamper Response (Final Project Report)

Sandia National Laboratories is developing a new method for detecting penetration of tamper - indicating enclosures (TIEs). This method incorporates the use of "bleeding" materials (analogous to visually obvious, colorful bruised skin that doesn't heal) into the design of TIEs. As designed, it will allow inspectors to use simple visual observation to detect attempts to penetrate the external surfaces of a TIE, without providing adversaries the ability to repair damage. A material of this type can enhance tamper indication of current TIEs used to support treaty verification regimes. Current TIE inspections are time - consuming and rely on subjective visual assessment by an inspector, equipment such as eddy current or camera devices, or involve approaches that may be limited due to application environment. The complexities and requirements that volumetric sealing methods (or TIEs) must address are: (1) enclosures that are non - standard in size/shape; (2) enclosures that may be inspectorate - or facility - owned; (3) finding tamper attempts that are difficult and time consuming for an inspector to locate; (4) enclosures that are reliable and durable enough to survive the conditions that exist in the operating environment (including facility handling); and (5) methods that prevent adversaries from repairing penetrations. Early project R&D [1] focused on encapsulated transition metals. Due to the challenges associated with the transition metal - based approach, a mitigation approach was investigated resulting in two separate research paths — one that involves fabricating custom TIE molds that meet the specific (size and shape) needs of safeguards equipment a nd one that can be deployed as a sprayed on or painted coating to an existing TIE or surface. The "custom mold" approach is based on creating thin layers of materials that , when penetrated, expose an inner material to O 2 which causes an irreversible color change. The "in-situ coating" approach is based on applying a sensor solution containing color changing microcapsules that bleed when the microcapsule is ruptured. The anticipated benefits of this work are passive, flexible, scalable, robust , cost-effective TIEs with visually obvious responses to tamper attempts. This provides more efficient and effective monitoring , as inspectors will require little or no additional equipment and will be able to detect tamper without extensive time - consuming visual examination. Applications include custom TIEs (cabinets , equipment enclosures or seal bodies ), or spray-coating/painting onto facility-owned items, walls or structures, or circuit boards. The paper describes research and testing completed to-date on the method and integration of select system components.

36 MATERIALS SCIENCE↗
DOE OSTI2025

Effects of SRPPF ARS Effluent Variations on Magnesium Oxysulfate Solidification

A magnesium oxysulfate (MOS) grout formulation has been identified to solidify the liquid effluent from the Savannah River Plutonium Processing Facility (SRPPF) Aqueous Recovery System (ARS). The formulation uses reactive, light burnt MgO (28 wt%), anhydrous MgSO 4 (10 wt%), and dead burnt MgO (62 wt%), resulting in a grout with good mixability, acceptable density, acceptable setting times, and a leachate pH around 9.4, within the assumed Waste Isolation Pilot Plant (WIPP) brine pH range. A series of tests were then designed to observe how this formula reacted to variations in the liquid effluent. Liquid effluent temperature, the caustic pH level, concentration of NaNO 3 , and the presence of neutralization products, trace metals, and/or sodium sulfate (all potential residuals found in the effluent from upstream processing), were evaluated to see how each impacts the grout mixing time, peak temperature, setting time, presence of bleed water, leachate pH, and density. The standard mix has an average mixing time of 18 minutes, peak temperature of 100.5 °C, and set time of 60 minutes. Increasing the temperature of the liquid effluent increased the reaction rate of the mix and reduced mixing and setting times. Between 30 and 40°C the change was relatively small, raising no more than 6 °C compared to the standard mix maximum temperature. Increasing the pH of the liquid effluent had no significant impact on the mix. The addition of neutralization products and trace metals had an overall impact of decreasing the reactivity of the mix. The addition of more ions in the liquid effluent, such as an increase in the concentration of NaNO 3 and the addition of Na 2 SO 4 , generally decreased the reactivity of the mix. None of the variations to the liquid effluent hindered solidification as indicated by the lack of bleed water found on all the samples. The leachate pH values for all mixes tested did not significantly vary from the expected pH of 9.4 and none of the density values fell below 1.8 g/cm 3 . Overall, changes to the liquid effluent were found to have a minimal impact on the formulation suggesting the grout's ability to properly form despite increased temperatures and the presence of residuals typically found in the liquid effluent from the ARS.

12 MANAGEMENT OF RADIOACTIVE AND NON-RADIOACTIVE W↗
DOE OSTI2022

Development and Characterization of a Self-Tightening Tourniquet System

Uncontrolled hemorrhage remains a leading cause of death in both emergency and military medicine. Tourniquets are essential to stopping hemorrhage in these scenarios, but they suffer from subjective, inconsistent application. Here, we demonstrate how tourniquet application can be automated using sensors and computer algorithms. The auto-tourniquet self-tightens until blood pressure oscillations are no longer registered by the pressure sensor connected to the pneumatic pressure cuff. The auto-tourniquet’s performance in stopping the bleed was comparable to manual tourniquet application, but the time required to fully occlude the bleed was longer. Application of the tourniquet was significantly smoother, and less variable, for the automatic tourniquet compared to manual tourniquet application. This proof-of-concept study highlights how automated tourniquets can be integrated with sensors to provide a much more consistent application and use compared to manual application, even in controlled, low stress testing conditions. Future work will investigate different sensors and tourniquets to improve the application time and repeatability.

Vega, Saul J.↗
DOE OSTI2024

Bacterial vampirism mediated through taxis to serum

Bacteria of the family Enterobacteriaceae are associated with gastrointestinal (GI) bleeding and bacteremia and are a leading cause of death, from sepsis, for individuals with inflammatory bowel diseases. The bacterial behaviors and mechanisms underlying why these bacteria are prone to bloodstream entry remain poorly understood. Herein, we report that clinical isolates of non-typhoidal Salmonella enterica serovars, Escherichia coli , and Citrobacter koseri are rapidly attracted toward sources of human serum. To simulate GI bleeding, we utilized an injection-based microfluidics device and found that femtoliter volumes of human serum are sufficient to induce bacterial attraction to the serum source. This response is orchestrated through chemotaxis and the chemoattractant L-serine, an amino acid abundant in serum that is recognized through direct binding by the chemoreceptor Tsr. We report the first crystal structures of Salmonella Typhimurium Tsr in complex with L-serine and identify a conserved amino acid recognition motif for L-serine shared among Tsr orthologues. We find Tsr to be widely conserved among Enterobacteriaceae and numerous World Health Organization priority pathogens associated with bloodstream infections. Lastly, we find that Enterobacteriaceae use human serum as a source of nutrients for growth and that chemotaxis and the chemoreceptor Tsr provide a competitive advantage for migration into enterohemorrhagic lesions. We define this bacterial behavior of taxis toward serum, colonization of hemorrhagic lesions, and the consumption of serum nutrients as ‘bacterial vampirism’, which may relate to the proclivity of Enterobacteriaceae for bloodstream infections.

59 BASIC BIOLOGICAL SCIENCES↗
DOE OSTI2020

Using Resin to Reduce Silica in Borated Fluid - 20072

The Electric Power Research Institute (EPRI) strongly recommends the concentration of silica in the reactor coolant be limited, potential ingress be carefully controlled, and frequently monitored to assess potential silica deposits on fuel cladding surfaces. Boraflex is a product with silicone rubber encasing a neutron absorber for criticality control, and it was installed in the majority of nuclear power plant spent fuel pools. Over time and in the presence of radiation, the silicone rubber lining degrades into silica (SiO{sub 2}) and hydrogen gas. Silica is somewhat soluble in water and spent fuel pool water communicates with other plant systems during refueling outages, leading to a buildup of silica in the reactor coolant and connected systems. Due to the prevalence of Boraflex racks in spent fuel pools, the presence of silica is a chronic nuclear industry concern. To address this concern, many nuclear plants have installed reverse osmosis skid systems to remove the silica from their spent fuel pools and, by extension, from reactor coolant. These skids are expensive to install and maintain. Arcadis personnel demonstrated that an iron-impregnated resin could be used to remove silica from borated systems without impacting the water quality. The resin was readily available, inexpensive, and easy to install in existing plant equipment. During a nuclear power plant's refueling outage the iron-impregnated resin proved to be effective in reducing the need for feed and bleed operations, with concurrent cost savings and reduction in required outage water management activities. Thus, the following savings were realized: - Eliminated the need to purchase, install, and maintain a reverse osmosis system avoiding more than $10 million in up-front capital cost and ongoing operating and maintenance costs. - Removed 9.57 kilograms (21 pounds) of silica dioxide from the primary system fluid. - Reduced the volume of feed and bleed from 70,000 gallons (2.65 E+05 liters) to 35,000 gallons (1.32 E+05 liters). - Saved $380,000 in water production and disposal costs. (author)

12 MANAGEMENT OF RADIOACTIVE AND NON-RADIOACTIVE W↗
DOE OSTI2022

Porous Polymers as Universal Reversal Agents for Heparin Anticoagulants through an Inclusion–Sequestration Mechanism

Heparins are widely used anticoagulants for surgical procedures and extracorporeal therapies. However, all of them have bleeding risks. Protamine sulfate, the only clinically approved antidote for unfractionated heparin (UFH), has adverse effects. Moreover, protamine can only partially neutralize low-molecular-weight heparins (LMWHs) and is not effective for fondaparinux. In this report an inclusion–sequestration strategy for efficient neutralization of heparin anticoagulants by cationic porous supramolecular organic frameworks (SOFs) and porous organic polymers (POPs) is reported. Isothermal titration calorimetric and fluorescence experiments show strong binding affinities of these porous polymers toward heparins, whereas dynamic light scattering and zeta potential analysis confirm that the heparin sequences are adsorbed into the interior of the porous hosts. Activated partial thromboplastin time, anti-FXa, and thromboelastography assays indicate that their neutralization efficacies are higher than or as high as that of protamine for UFH and generally superior to protamine for LMWHs and fondaparinux, which is further confirmed by tail-transection model in mice and ex vivo aPTT or anti-FXa analysis in rats. Acute toxicity evaluations reveal that one of the SOFs displays outstanding biocompatibility. This work suggests that porous polymers can supply safe and rapid reversal of clinically used heparins, as protamine surrogates, providing an improved approach for their neutralization.

36 MATERIALS SCIENCE↗
DOE OSTI2021

Separation of zirconium and hafnium from early actinides and rare earth elements with eichrom’s pb resin in HCl

The separation of zirconium and hafnium isotopes from the early actinides and rare earth elements (REE) with Eichrom’s Pb resin has been studied. Batch studies were performed to characterize the behavior of actinium, thorium, zirconium, hafnium, lutetium, and yttrium on Pb resin from HCl solutions (0.001 M to 11 M). The early actinides and REE had no affinity for the resin at any concentration of HCl, but zirconium and hafnium showed a moderate uptake at high concentrations of HCl with a maximum extraction at 11 M HCl. Several column separations were tested, including with only tracer isotopes and with mass. Rapid, simple separations of zirconium from actinium, thorium, protactinium, and the REE with high yields and low elution volumes are presented with applications for tracer isotope production and fission product separations. Furthermore, the resin is less suitable for hafnium separations as hafnium tends to bleed off the resin even at high concentrations of HCl.

38 RADIATION CHEMISTRY, RADIOCHEMISTRY, AND NUCLEA↗