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Search indexed NASA NTRS and DOE OSTI research on propulsion, heat transfer, battery materials and energy systems. Follow report and document links to the original sources.

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All sourcesNASA NTRSDOE OSTI
DOE OSTI2021

Understanding Competing Risks

Highlights: • Clinicians and researchers need to be cognizant of competing risks (ie, the occurrence of an event that precludes future development of the outcome of interest). • Censoring is appropriate when a patient being censored at a particular time (eg, owing to loss to follow-up) is deemed to have approximately the same future risk of developing the outcome of interest as patients still being followed, and when the reason for censoring is not related to events of interest. • Censoring is not appropriate in many scenarios; for example, a dead patient can never develop a future cancer recurrence or late effect. • Kaplan-Meier (KM) analysis is commonly used for a time-to-event analysis when the primary outcome (eg, overall survival) has no meaningful competing risk and censoring is appropriate. Cox proportional hazards modeling can be used for multivariable analysis to examine the association between covariates and the primary outcome. • In the presence of competing events, incorrect use of the KM analysis will likely lead to an overestimation of the risk of the outcome of interest and biased estimates from both univariable and multivariable analyses. Therefore, KM usually should not be used to determine local recurrence risk because humanity is always at risk for dying, which is a competing risk. • A competing risk analysis is therefore most appropriate when there are competing events to the primary outcome of interest. The most commonly used multivariable model in these situations is the Fine-Gray model. • Many fundamental questions in radiation oncology—local and regional recurrence, treatment-related toxicity—are best addressed using competing risk methodologies.

62 RADIOLOGY AND NUCLEAR MEDICINE↗
DOE OSTI2023

Female “Paradox” in Atrial Fibrillation—Role of Left Truncation Due to Competing Risks

Female sex in patients with atrial fibrillation (AF) is a controversial and paradoxical risk factor for stroke—controversial because it increases the risk of stroke only among older women of some ethnicities and paradoxical because it appears to contradict male predominance in cardiovascular diseases. However, the underlying mechanism remains unclear. We conducted simulations to examine the hypothesis that this sex difference is generated non-causally through left truncation due to competing risks (CR) such as coronary artery diseases, which occur more frequently among men than among women and share common unobserved causes with stroke. We modeled the hazards of stroke and CR with correlated heterogeneous risk. We assumed that some people died of CR before AF diagnosis and calculated the hazard ratio of female sex in the left-truncated AF population. In this situation, female sex became a risk factor for stroke in the absence of causal roles. The hazard ratio was attenuated in young populations without left truncation and in populations with low CR and high stroke incidence, which is consistent with real-world observations. This study demonstrated that spurious risk factors can be identified through left truncation due to correlated CR. Female sex in patients with AF may be a paradoxical risk factor for stroke.

59 BASIC BIOLOGICAL SCIENCES↗
NASA NTRS2011

Sensitivity Analysis of Median Lifetime on Radiation Risks Estimates for Cancer and Circulatory Disease amongst Never-Smokers

Radiation risks are estimated in a competing risk formalism where age or time after exposure estimates of increased risks for cancer and circulatory diseases are folded with a probability to survive to a given age. The survival function, also called the life-table, changes with calendar year, gender, smoking status and other demographic variables. An outstanding problem in risk estimation is the method of risk transfer between exposed populations and a second population where risks are to be estimated. Approaches used to transfer risks are based on: 1) Multiplicative risk transfer models -proportional to background disease rates. 2) Additive risk transfer model -risks independent of background rates. In addition, a Mixture model is often considered where the multiplicative and additive transfer assumptions are given weighted contributions. We studied the influence of the survival probability on the risk of exposure induced cancer and circulatory disease morbidity and mortality in the Multiplicative transfer model and the Mixture model. Risks for never-smokers (NS) compared to the average U.S. population are estimated to be reduced between 30% and 60% dependent on model assumptions. Lung cancer is the major contributor to the reduction for NS, with additional contributions from circulatory diseases and cancers of the stomach, liver, bladder, oral cavity, esophagus, colon, a portion of the solid cancer remainder, and leukemia. Greater improvements in risk estimates for NS s are possible, and would be dependent on improved understanding of risk transfer models, and elucidating the role of space radiation on the various stages of disease formation (e.g. initiation, promotion, and progression).

Chappell, Lori J.↗
NASA NTRS2015

Assessing the Effect of Spaceflight on the Propensity for Astronauts to Develop Disc Herniation

A previous study reported that the instantaneous risk of developing a Herniated Nucleus Pulposus (HNP) was higher in astronauts who had flown at least one mission, as compared with those in the corps who had not yet flown. However, the study only analyzed time to HNP after the first mission (if any) and did not account for the possible effects of multiple missions. While many HNPs occurred well into astronauts' careers or in somecases years after retirement, the higher incidence of HNPs relatively soon after completion of space missions appears to indicate that spaceflight may lead to an increased risk of HNP. In addition, when an HNP occurs after spaceflight, is it related to previous spaceflight exposure? The purpose of this study was to investigate whether multiple missions, sex, age, vehicle landing dynamics, and flight duration affect the risk of developing an HNP usinga competing risks model. The outcome of the study will inform the Human System Risk Board assessment of back pain, inform the risk of injury due to dynamic loads, and update the previous dataset, which contained events up to December 31, 2006.

Feiveson, A.↗
DOE OSTI2022

Estimation of conditional cumulative incidence functions under generalized semiparametric regression models with missing covariates, with application to analysis of biomarker correlates in vaccine trials

Herein, this article presents generalized semiparametric regression models for conditional cumulative incidence functions with competing risks data when covariates are missing by sampling design or happenstance. A doubly robust augmented inverse probability weighted (AIPW) complete-case approach to estimation and inference is investigated. This approach modifies IPW complete-case estimating equations by exploiting the key features in the relationship between the missing covariates and the phase-one data to improve efficiency. An iterative numerical procedure is derived to solve the nonlinear estimating equations. The asymptotic properties of the proposed estimators are established. A simulation study examining the finite-sample performances of the proposed estimators shows that the AIPW estimators are more efficient than the IPW estimators. The developed method is applied to the RV144 HIV-1 vaccine efficacy trial to investigate vaccine-induced IgG binding antibodies to HIV-1 as correlates of acquisition of HIV-1 infection while taking account of whether the HIV-1 sequences are near or far from the HIV-1 sequences represented in the vaccine construct.

97 MATHEMATICS AND COMPUTING↗
NASA NTRS2014

Assessing the Effect of Spaceflight on the Propensity for Astronauts to Develop Disk Herniation

BACKGROUND: A previous study [1] reported that the instantaneous risk of developing a Herniated Nucleus Pulposus (HNP) was higher in astronauts who had flown at least one mission, as compared with those in the corps who had not yet flown. However, the study only analyzed time to HNP after the first mission (if any) and did not account for the possible effects of multiple missions. While many HNP's occurred well into astronauts' careers or in some cases years after retirement, the higher incidence of HNPs relatively soon after completion of space missions appears to indicate that spaceflight may lead to an increased risk of HNP. The purpose of this study was to support the Human System Risk Board assessment of back pain, evaluate the risk of injury due to dynamic loads, and update the previous dataset which contained events up to December 31, 2006. METHODS: Data was queried from the electronic medical record and provided by the Lifetime Surveillance of Astronaut Health. The data included all 330 United States astronauts from 1959 through February 2014. Cases were confirmed by Magnetic Resonance Imaging, Computerized Tomography, Myelography, operative findings, or through clinical confirmation with a neurologist or neurosurgeon. In this analysis, astronauts who had an HNP at selection into the corps or had an HNP diagnosis prior to their first flight were excluded. The statistical challenges in using the available data to separate effects of spaceflight from those associated with general astronaut training and lifestyle on propensity to develop HNPs are many. The primary outcome is reported date of first HNP (if any), which at best is only an approximation to the actual time of occurrence. To properly analyze this data with a survival analysis model, one must also know the "exposure" time - i.e. how long each astronaut has been at risk for developing an HNP. If an HNP is reported soon after a mission, is it mission caused or general? If the former, exposure time should be counted from the time of landing (assuming the risk of HNP occurring during a mission is zero). If the latter, exposure time should be counted from the time of selection; however we can't directly know which one to use. In our analysis we take both of these possibilities into account with a competing risks model, wherein two distinct stochastic processes are going on: TG = time to HNP (general) and TS = time to HNP (spaceflight). Under this type of model, whichever of these occurs first is what we observe; in other words we don't observe TG or TS, only min(TG, TS). Here, we parameterized the model in terms of separate Weibull hazard functions for each process and estimated all parameters using maximum likelihood. In addition, we allowed for a "cured fraction" - i.e. the possibility that some astronauts may never develop an HNP. RESULTS: Results will include a depiction of the competing hazard functions as well as a probability curve for the relative likelihood that an HNP reported at a given time after a mission is actually mission caused. Other factors, such as dwell time in microgravity and vehicle landing environment will be explored. An overall assessment as to whether spaceflight truly exacerbates HNP risk will be made.

Feiveson, A. H.↗
DOE OSTI2020

Lung cancer mortality among construction workers: implications for early detection

Objectives This study examined predictors of lung cancer mortality, beyond age and smoking, among construction workers employed at US Department of Energy (DOE) sites to better define eligibility for low-dose CT (LDCT) lung cancer screening. Methods Predictive models were based on 17 069 workers and 352 lung cancer deaths. Risk factors included age, gender, race/ethnicity, cigarette smoking, years of trade or DOE work, body mass index (BMI), chest X-ray results, spirometry results, respiratory symptoms, beryllium sensitisation and personal history of cancer. Competing risk Cox models were used to obtain HRs and to predict 5-year risks. Results Factors beyond age and smoking included in the final predictive model were chest X-ray changes, abnormal lung function, chronic obstructive pulmonary disease (COPD), respiratory symptoms, BMI, personal history of cancer and having worked 5 or more years at a DOE site or in construction. Risk-based LDCT eligibility demonstrated improved sensitivity, specificity and positive predictive value compared with current US Preventive Services Task Force guidelines. The risk of lung cancer death from 5 years of work in the construction industry or at a DOE site was comparable with the risk from a personal cancer history, a family history of cancer or a diagnosis of COPD. LDCT eligibility criteria used for DOE construction workers, which includes factors beyond age and smoking, identified 86% of participants who eventually would die from lung cancer compared with 51% based on age and smoking alone. Conclusions Results support inclusion of risk from occupational exposures and non-malignant respiratory clinical findings in LDCT clinical guidelines.

Public, Environmental & Occupational Health↗
DOE OSTI2023

Familial Associations of Prevalence and Cause-Specific Mortality for Thoracic Aortic Disease and Bicuspid Aortic Valve in a Large-Population Database

Thoracic aortic disease and bicuspid aortic valve (BAV) likely have a heritable component, but large population-based studies are lacking. This study characterizes familial associations of thoracic aortic disease and BAV, as well as cardiovascular and aortic-specific mortality, among relatives of these individuals in a large-population database. In this observational case-control study of the Utah Population Database, we identified probands with a diagnosis of BAV, thoracic aortic aneurysm, or thoracic aortic dissection. Age- and sex-matched controls (10:1 ratio) were identified for each proband. First-degree relatives, second-degree relatives, and first cousins of probands and controls were identified through linked genealogical information. Cox proportional hazard models were used to quantify the familial associations for each diagnosis. We used a competing-risk model to determine the risk of cardiovascular-specific and aortic-specific mortality for relatives of probands. The study population included 3,812,588 unique individuals. Familial hazard risk of a concordant diagnosis was elevated in the following populations compared with controls: first-degree relatives of patients with BAV (hazard ratio [HR], 6.88 [95% CI, 5.62–8.43]); first-degree relatives of patients with thoracic aortic aneurysm (HR, 5.09 [95% CI, 3.80–6.82]); and first-degree relatives of patients with thoracic aortic dissection (HR, 4.15 [95% CI, 3.25–5.31]). In addition, the risk of aortic dissection was higher in first-degree relatives of patients with BAV (HR, 3.63 [95% CI, 2.68–4.91]) and in first-degree relatives of patients with thoracic aneurysm (HR, 3.89 [95% CI, 2.93–5.18]) compared with controls. Dissection risk was highest in first-degree relatives of patients who carried a diagnosis of both BAV and aneurysm (HR, 6.13 [95% CI, 2.82–13.33]). First-degree relatives of patients with BAV, thoracic aneurysm, or aortic dissection had a higher risk of aortic-specific mortality (HR, 2.83 [95% CI, 2.44–3.29]) compared with controls. Our results indicate that BAV and thoracic aortic disease carry a significant familial association for concordant disease and aortic dissection. The pattern of familiality is consistent with a genetic cause of disease. Furthermore, we observed higher risk of aortic-specific mortality in relatives of individuals with these diagnoses. In conclusion, this study provides supportive evidence for screening in relatives of patients with BAV, thoracic aneurysm, or dissection.

60 APPLIED LIFE SCIENCES↗
NASA NTRS1992

Advanced statistical methods for improved data analysis of NASA astrophysics missions

The investigators under this grant studied ways to improve the statistical analysis of astronomical data. They looked at existing techniques, the development of new techniques, and the production and distribution of specialized software to the astronomical community. Abstracts of nine papers that were produced are included, as well as brief descriptions of four software packages. The articles that are abstracted discuss analytical and Monte Carlo comparisons of six different linear least squares fits, a (second) paper on linear regression in astronomy, two reviews of public domain software for the astronomer, subsample and half-sample methods for estimating sampling distributions, a nonparametric estimation of survival functions under dependent competing risks, censoring in astronomical data due to nondetections, an astronomy survival analysis computer package called ASURV, and improving the statistical methodology of astronomical data analysis.

Feigelson, Eric D.↗
NASA NTRS2007

Evaluating Shielding Effectiveness for Reducing Space Radiation Cancer Risks

We discuss calculations of probability distribution functions (PDF) representing uncertainties in projecting fatal cancer risk from galactic cosmic rays (GCR) and solar particle events (SPE). The PDF s are used in significance tests of the effectiveness of potential radiation shielding approaches. Uncertainties in risk coefficients determined from epidemiology data, dose and dose-rate reduction factors, quality factors, and physics models of radiation environments are considered in models of cancer risk PDF s. Competing mortality risks and functional correlations in radiation quality factor uncertainties are treated in the calculations. We show that the cancer risk uncertainty, defined as the ratio of the 95% confidence level (CL) to the point estimate is about 4-fold for lunar and Mars mission risk projections. For short-stay lunar missions (<180 d), SPE s present the most significant risk, however one that is mitigated effectively by shielding, especially for carbon composites structures with high hydrogen content. In contrast, for long duration lunar (>180 d) or Mars missions, GCR risks may exceed radiation risk limits, with 95% CL s exceeding 10% fatal risk for males and females on a Mars mission. For reducing GCR cancer risks, shielding materials are marginally effective because of the penetrating nature of GCR and secondary radiation produced in tissue by relativistic particles. At the present time, polyethylene or carbon composite shielding can not be shown to significantly reduce risk compared to aluminum shielding based on a significance test that accounts for radiobiology uncertainties in GCR risk projection.

Cucinotta, Francis A.↗
NASA NTRS2019

Satellite Conjunction "Probability," "Possibility," and "Plausibility": A Categorization of Competing Conjunction Assessment Risk Assessment Paradigms

A number of different conjunction assessment (CA) risk analysis methods and metrics have been proposed in the critical literature, and they vary widely in purport and form. However, they tend to be proposed individually and episodically, so that it is difficult for a CA practitioner to take stock of the possibilities, under- stand their fundamental differences, and make informed choices for their particular CA risk assessment enterprise. The present study seeks to collect the major proposals for risk assessment methods and parameters and organize them categorically, under the proposed divisions of “probability,” “plausibility,” and “possibility,” as well as formulate what appears for each to be its fundamental question and, where applicable, null hypothesis. This activity can, through a bottom-up approach, provide some of the building blocks for an overarching CA philosophy, as well as establish concepts and terminology potentially useful to the broader discussion of these topics.

Hejduk, M. D.↗
NASA NTRS2019

Satellite Conjunction “Probability,” “Plausibility,” and “Possibility”: A Categorization of Competing Satellite Conjunction Assessment Risk Analysis Paradigms

A number of different conjunction assessment (CA) risk analysis methods and metrics have been proposed in the critical literature, and they vary widely in purport and form. However, they tend to be proposed individually and episodically, so that it is difficult for a CA practitioner to take stock of the possibilities, under- stand their fundamental differences, and make informed choices for their particular CA risk assessment enterprise. The present study seeks to collect the major proposals for risk assessment methods and parameters and organize them categorically, under the proposed divisions of “probability,” “plausibility,” and “possibility,” as well as formulate what appears for each to be its fundamental question and, where applicable, null hypothesis. This activity can, through a bottom-up approach, provide some of the building blocks for an overarching CA philosophy, as well as establish concepts and terminology potentially useful to the broader discussion of these topics.

Hejduk, M. D.↗
NASA NTRS2011

Independent Review of U.S. and Russian Probabilistic Risk Assessments for the International Space Station Mini Research Module #2 Micrometeoroid and Orbital Debris Risk

The Mini-Research Module-2 (MRM-2), a Russian module on the International Space Station, does not meet its requirements for micrometeoroid and orbital debris probability of no penetration (PNP). To document this condition, the primary Russian Federal Space Agency ISS contractor, S.P. Korolev Rocket and Space Corporation-Energia (RSC-E), submitted an ISS non-compliance report (NCR) which was presented at the 5R Stage Operations Readiness Review (SORR) in October 2009. In the NCR, RSC-E argued for waiving the PNP requirement based on several factors, one of which was the risk of catastrophic failure was acceptably low at 1 in 11,100. However, NASA independently performed an assessment of the catastrophic risk resulting in a value of 1 in 1380 and believed that the risk at that level was unacceptable. The NASA Engineering and Safety Center was requested to evaluate the two competing catastrophic risk values and determine which was more accurate. This document contains the outcome of the assessment.

Squire, Michael D.↗
NASA NTRS2005

Managing Lunar and Mars Mission Radiation Risks: Cancer Risks, Uncertainties, and Shielding Effectiveness - Part 1

This document addresses calculations of probability distribution functions (PDFs) representing uncertainties in projecting fatal cancer risk from galactic cosmic rays (GCR) and solar particle events (SPEs). PDFs are used to test the effectiveness of potential radiation shielding approaches. Monte-Carlo techniques are used to propagate uncertainties in risk coefficients determined from epidemiology data, dose and dose-rate reduction factors, quality factors, and physics models of radiation environments. Competing mortality risks and functional correlations in radiation quality factor uncertainties are treated in the calculations. The cancer risk uncertainty is about four-fold for lunar and Mars mission risk projections. For short-stay lunar missins (<180 d), SPEs present the most significant risk, but one effectively mitigated by shielding. For long-duration (>180 d) lunar or Mars missions, GCR risks may exceed radiation risk limits. While shielding materials are marginally effective in reducing GCR cancer risks because of the penetrating nature of GCR and secondary radiation produced in tissue by relativisitc particles, polyethylene or carbon composite shielding cannot be shown to significantly reduce risk compared to aluminum shielding. Therefore, improving our knowledge of space radiobiology to narrow uncertainties that lead to wide PDFs is the best approach to ensure radiation protection goals are met for space exploration.

Cucinotta, Francis A.↗
NASA NTRSDate not supplied

Evidence-Based Process for Assessing Teamwork Competencies in Applicant Performance in High-Risk, Operational Occupations

In this work, we provide a detailed look at how behavioral competencies necessary for high-risk, operational jobs, including task- and person-oriented aspects of teamwork, leadership, and followership, should be defined and operationalized in context. These competencies are thought to positively predict performance in aerospace professions. Indeed, the assessments applied in high stakes selection contexts and the way associated behavioral competencies are evaluated must be carefully considered to ensure that optimal applicants are selected. We provide insight into the behavioral competency development and measurement process, elaborating upon particularly critical competencies (i.e., team orientation) and describing challenges to measurement.

Isabel Bilotta↗
NASA NTRSDate not supplied

CHP-PRA Proof-of-Concept [Simulation] Sensitivity Assessment

An effort is underway to establish a Crew Health and Performance system (CHP) tradespace tool using a Probabilistic Risk Assessment (PRA) modeling and simulation system. The goal of the CHP-PRA effort is to provide a means of quantifying the integrated influence of CHP functions and capabilities on risk outcome metrics associated with health, performance, and long-term health. These metrics can then be used to establish potential risk-based trades on CHP system designed functionality and capabilities. Previously, our team demonstrated a proof-of-concept PRA approach that estimated the integrated influence of exercise countermeasures on 8 human system risks (Figure 1a) with outcomes associated with health and medical risk metrics. We reported that the change in the integrated relative health risk was small (Figure 1b) and that the small change in overall risk resulted from compounding and competing contribution levels of the individual risks. This interesting observation illustrates the emergent complexity of even straightforward representations of the human health and performance risk space and the ability of PRA models to capture this balance of global risk concerns. A key question that is not addressed in the initial analysis is “even though the global risk is relatively nominal, do any of the local risks become unacceptable?” In essence, we seek to determine what relative change in the human system risks are contributing to the relatively muted sensitivity of the proof-of-concept model combined risk assessments. Evaluations at the component risk level should elucidate if any individual risk reaches a high level that is subsequentially balanced by reductions in other areas. To further understand the relative changes in the component risks in the proof-of-concept model, and to elucidate how future refinements can be targeted, a means of establishing the contributions of the robustness of the proof-of-concept approach will be demonstrated.

astronaut health↗
NASA NTRS2024

Risk of Bone Fracture due to Spaceflight-induced Changes to Bone

The Human Research Program (HRP) is taking a biomechanical approach to assessing subsequent fracture risk in active astronauts as a consequence of spaceflight exposure. Triennial testing of active and retired astronauts continues as Space Medicine monitors for a premature diagnosis of primary osteoporosis, which is associated with age-related bone loss and skeletal fragility. This updated 2023 Fracture Evidence Report has expanded the description of skeletal changes to capture the full effects of spaceflight on bone: • Recent analysis of fractures from health records of the full astronaut cohort, suggests an increased incidence rate of hip and spine fractures in astronauts following longer spaceflight duration flights compared to incident rates found in shorter duration flights. • Routine preflight-to-postflight surveillance by DXA (dual-energy x-ray absorptiometry) does not provide the full detection of loss and recovery in the long-duration (LD) astronaut nor the full recovery of hip trabecular bone. • The inclusion of hip quantitative computed tomography (QCT) in flight studies delineates effects of spaceflight, of countermeasures, and of post-flight recovery on cortical and trabecular bone parameters—some of which are verified predictors of hip fracture in the aged. • QCT detects and compares the distinct countermeasure effects of the pharmaceutical alendronate and of resistive exercise (on the Advanced Resistive Exercise Device, ARED) in specific cortical and trabecular bone sub-regions during spaceflight. • A published comparison of QCT-determined loss rates of hip trabecular bone in LD astronauts compared to terrestrial cohorts suggest that accelerated loss rates in trabecular volumetric BMD (vBMD) during spaceflight might be analogous to skeletal effects of accelerated loss rates in females due to menopause, potentially leading to disruptions in trabecular microarchitecture. • A dataset of finite element (FE) estimates of hip bone strength in aging terrestrial cohorts (spanning astronaut age-range) provides comparative context for changes in the FE of hip bone strength in LD astronauts, including comparison (force unit of newton) to percentiles (50th, 75th, and 100th) of sex-matched aged humans with hip fractures. • Risk of fracture, due to the mechanical overloading of bones, is being updated with IMPACT, the next-generation tool suite for probabilistic risk assessment (PRA) for exploration missions being created by the Exploration and Medical Capability Element (ExMC) at NASA. IMPACT is currently in development and will not be included in this 2024 update. The risk for fracture necessitates understanding the relationship between applied loads to bone and the biomechanical competence of bone. The Risk for Early Onset Osteoporosis focuses on the weakened condition of bone (including development of new technologies, measurements of novel skeletal attributes, translation of multiple measures to an index of bone fragility, and interpretations of data used to reflect a weakened bone), while the Risk for Fracture assesses factors that influence the probability an astronaut would encounter applied loads exceeding the biomechanical competence of bones, resulting in fracture. This Evidence Report combines the research gaps and tasks associated with both risks.

Fracture↗