Engineering Papers⌕ Search

SEARCH · Engineering Papers

Results for “HOSPITALS”

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.

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

At least 181 records · Page 10
All sourcesNASA NTRSDOE OSTI
DOE OSTI2016

Orange County Photovoltaic Project & Educational COmponent

The purpose of this report is to discuss the projects implemented, utilizing Department of Energy grant funds, to support the use and understanding of renewable energy in Orange County, Florida and the Greater Orlando Area. Orange County is located in the State of Florida and is most popularly referred to as Orlando. The greater Orlando area’s current population is 1,225,267 and in 2015 was the first destination to surpass 60 million visitors. Orange County utilized grant funds to add to the growing demand for access to charging stations by installing one level 2 dual NovaCharge CT4021 electric vehicle charging station at the Orange County/University of Florida Cooperative Extension Center. The charging station is considered a “smart” charger connected to a central network operated by a third party. Data collected includes the number of charging sessions, session start and end times, the electricity usage, greenhouse gases saved and other pertinent data used for reporting purposes. Orange County continues to support the use of electric vehicles in Metro Orlando and this project continues to bring awareness to our public regarding using alternative vehicles. Additionally, we offer all visitors to the Orange County/University of Florida Cooperative Extension Center free charges for their electric vehicles 24 hours a day. Since the operation of the charging station there have been 52 unique driver users, a total of 532.2258 kg of greenhouse gas savings and 159.03 gallons of gasoline savings. The installation of the additional electric vehicle charging station is part of a county-wide goal of promoting implementation of renewable energy technologies as well as supporting the use of electric vehicles including the Drive Electric Orlando & Florida programs. http://driveelectricorlando.com/ & ; http://www.driveelectricflorida.org/ . Grant funds were also used for Outreach and Educational efforts. Educational efforts about renewable energy were accomplished through the continued support as well as a proposed expansion and potential relocation of the Climate Change Education Center. The growth of the Climate Change Education Center focused on 2 educational subsectors. The first educational sector focused on an apprenticeship with university students. The second sector Orange County partnered with a hospitality college that held seminars to educate students in sustainability best practices that would influence the industry as a whole as students take jobs around the U.S. and other parts of the world. Orange County completed five of the originally proposed six educational seminars. The first seminar focused on community based social marketing techniques for driving sustainable behavior changes. The second seminar held was a green team workshop. The third seminar focused on urban sustainability planning. The fourth and fifth seminars held were Florida Energy Code workshops for building inspectors. A sixth transit oriented development seminar in partnership with Rollins College was explored, but was not conducted because the proposed on campus venue was not accessible for an extended period of time due to renovations. Additionally, an ENERGY STAR training program was conducted with students from the University of Central Florida; three of the five buildings assessed received ENERGY STAR ratings; one student completed the training and received their certification as an ENERGY STAR Specialist. Background: Location: Orange County is located in the central region of the State of Florida and is most popularly known for including the City of Orlando. The greater Orlando area’s current population is 1,225,267 and is home to large corporations such as Walt Disney World, Universal Studios Orlando, Ritz Carlton, Darden Restaurants, and the nation’s second largest convention center. Opportunities Identified: Encouraging Sustainability in Major Sectors: The Central Florida economy is largely dependent on the hospitality industry and in 2015 it was the first destination to surpass 60 million visitors. With over 60 million visitors each year, 120,000 hotel rooms, 4,000 restaurants, and 75 theme parks and attractions, the local hospitality industry provided a wealth of opportunity to reduce greenhouse gas emissions through building energy efficiency and renewable energy. Accordingly, Central Florida is an ideal training ground for teaching best practices for sustainability focused on the hospitality industry. Meeting the Growing Demand for Electric Vehicle Infrastructure: According to the 2014 U.S Clean Tech Leadership Index Report, nationwide electric vehicle ownership in the top 50 largest metro areas increased sharply in 2013; the Orlando Metro Area was ranked #5 in the nation in in terms of electric vehicle charging stations per one million people. Additionally, the Orange County 2014-2015 Annual Sustainable Orange County Report indicated there are 300 electric vehicle charging stations in Central Florida (roughly 300 charging stations within ~70 mile radius available to our residents of Orange County). By increasing and improving access to charging stations, Orange County supports the growing demand for renewable energy technologies. Project Achievements/Accomplishments: Installed an Electric Charging Station: Orange County utilized grant funds to install one level 2 dual NovaCharge CT4021 electric vehicle charging station at the Orange County/University of Florida Cooperative Extension Center. The charging station is considered a “smart” charger connected to a central network operated by a third party that monitors the number of charging sessions, session start and end times, the electricity usage, greenhouse gases saved and other pertinent data. During the six months of operation of the charging station there have been 52 unique driver users of the charging station; a total of 532.2258 kg of greenhouse gas savings and 159.03 gallons of gasoline savings. Operation and Potential Relocation of the Orange County Climate Change Education Center: The Climate Change Education Center, originally located within the Orange County Convention Center, served as a central place to inform and educate commercial and residential sectors of environmental, health, and economic benefits of renewable energy, energy efficiency, and greenhouse gas emission reductions. Grant funds were used to pay for the rent required to maintain a lease at the Convention Center, conduct five educational workshops, and for planned upgrades to the Center displays highlighting a number of energy efficiency and renewable energy projects implemented at the Orange County Convention Center and Downtown Orange County. An initial design concept for an upgraded Climate Change Education Center and educational displays was proposed. However, after the Convention Center determined the space occupied by the Climate Change Education Center; a feasibility study for relocation to the proposed area was conducted in October 2013. In December 2013, it was determined that the desired location of the for the Climate Change Education Center at the Orange County Extension Education Center provided too many construction challenges for relocation with too many building retrofits and access problems, including lack of access for loading and unloading exhibits as well as roof drainage relocations and sewer service connection issues. Another suitable location for relocating the Climate Change Education Center could not be located so the project was terminated. The Climate Change Education Center is no longer in existence in Orange County and has been eliminated. Grant funds were used to pay for marketing services for a state wide marketing program including solar & other renewable energy technologies for rebranding and developing marketing materials including web site design and updating. A website was maintained and updated the www.PowerUpGreenEnergy.com website (no longer in service). Sustainability Training for the Hospitality Industry and Major Sectors: To introduce energy efficiency and renewable energy concepts to the hospitality industry, Orange County partnered with a hospitality college that held seminars to educate students in sustainability best practices that would influence the industry as a whole as students take jobs around the U.S. and other parts of the world. Orange County completed five of the originally proposed six education seminars. Seminar topics included: driving sustainable behavior change through community based social marketing; green team programs; urban sustainability planning; and Florida Energy Code workshops for building inspectors. In partnership with Rollins College, a sixth seminar focused on transit-oriented development was explored, but was not conducted due to extended renovations at the proposed on-campus venue. Green Job Training Development: To promote green industry development and on-the-job training in occupations that encourage energy efficiency and resource reduction, Orange County piloted an ENERGY STAR training and apprenticeship program with students from the University of Central Florida; three students applied for the program; one student completed the training and received their certification as an ENERGY STAR specialist; three of the five buildings assessed received ENERGY STAR Ratings.

14 SOLAR ENERGY↗
DOE OSTI2017

Control and Cost-benefit Analysis of Fast Spreading Diseases: The case of Ebola

Mitigating the spread of infectious disease is of great importance for policy makers. Taking the recent outbreak of Ebola as an example, it was difficult for policy makers to identify the best course of action based on the cost-effectiveness of what was available. In effort to address the needs of policy makers to mitigate the spread of infectious disease before an outbreak becomes uncontrollable, we have devised a cost-benefit disease control model to simulate the effect of various control methods on disease incidence and the cost associated with each of the scenarios. Here, we present a case study of Ebola used to quantify the cost effectiveness of vaccination and isolation methods to minimize the spread of the disease. We evaluate the impact of changing strategy levels on the incidence of the disease and address the benefits of choosing one strategy over the other with regards to cost of vaccine and isolation. Disease. We use a general SEIRJ model for disease transmission. Here, S-Susceptible, E- Exposed (latent), IA– Infected (asymptomatic),IM– Infected (mild symptoms), IS– Infected (severe symptoms),JM– Isolated (mild symptoms at home), JS– Isolated (severe symptoms in hospital), and R- Recovered individuals. In this model, we consider the dynamics of the system and the effect of the relative transmissibility of isolated individuals (L) compared to other infected individuals. Cost. Ebola vaccination and treatment are very expensive and not widely available. Some preliminary data shows that it will take$73 million (M) to produce 27 M vaccines plus the cost for vaccine delivery and health care professionals (not included here). On the other hand, the treatment for Ebola in the U.S. would cost $25,000dollars a day per person to ensure proper isolation and adequate care(treatment, health care professionals, facilities and special equipment).Although not included in this research, the proper isolation of Ebola patients would also lead to a loss in hospital revenue of $148,000per day due to reduced patient capacity3. Here, we use $27,000 per individual hospitalized per day and $2.70 per person vaccinated. Model. To evaluate the cost-effectiveness of control methods on disease transmission, we assessed the affect of different levels of vaccination coverage on the resulting number of infected individuals. Then, we calculated the overall estimated cost of vaccination and resulting hospitalization for each scenario to identify the lowest cost-benefit ratio. Using a base population of 10 M individuals, we ran scenarios for different levels of vaccination (μ= 0.01, 0.05, 0.1) while varying the relative transmissibility of isolated individuals (L = 0.5, 0.6, 0.65).For each combination, we calculated the incidence, vaccination and hospitalization cost per individual per day (Fig 1). We note that an increase in the relative transmissibility of isolated individuals leads to a higher number of infected people and, therefore, a reduced number of candidates for vaccination and an overall increase in cost. Since the cost of vaccination is 1 ten-thousandth of the cost of hospitalization, our results clearly show the cost-benefit of vaccinating over hospital treatment. In every scenario studied, we observed a measurable reduction in disease incidence when vaccinating a higher fraction of the population compared to isolating individuals post infection. Given these preliminary results, we plan to extend the framework of our model to a dynamic control system where we consider the cost of vaccination and isolation embedded in the system of differential equations. This approach will allow us see the best available control implementation while minimizing the cost of treatment and vaccination.

EBOLA↗
NASA NTRS1978

Medical Telemetry

Telemetry is the process whereby physiological or other data is acquired by instruments, translated into radio signals and j sent to a receiving station where the signals are decoded and recorded. Extensively used in I space operations, it is finding new Earth applications, among them transmission of medical data between emergency vehicles and hospitals. For example, transmission of an electrocardiogram from an ambulance to a hospital enables a physician to read the telemetered EKG and advise ambulance attendants on emergency procedures. Central Medical Emergency Dispatch (CMED) operates as a regional emergency medical communications center for Cleveland, Ohio and Cuyahoga County. The CMED system includes radio and telephone communications from hospital-to-hospital and from ambulance-to-hospital, but for improved emergency life support CMED sought to add a county-wide telemetry capability. The problem was that there were only eight radio frequencies available for telemetry and there were more than 30 potential users in Cleveland alone. NASA's Lewis Research Center volunteered its expert assistance. The Center's engineers studied the systems of other telemetry using cities, surveyed area hospitals to assure compatibility of telemetry equipment, and advised what types of equipment would be needed in emergency vehicles and at the various hospitals. The Lewis plan suggested that CMED be designated the central coordinating agency for the Cuyahoga County system, monitoring all telemetry frequencies and, when requested, assigning one not in use or one to be used at a sufficient distance that it would create no interference problem.

Source record↗
DOE OSTI2021

How New Mexico Leveraged a COVID-19 Case Forecasting Model to Preemptively Address the Healthcare Needs of the State: Quantitative Analysis

Prior to the COVID-19 pandemic, US hospitals relied on static projections of future trends for long-term planning and were only beginning to consider forecasting methods for short-term planning of staffing and other resources. With the overwhelming burden imposed by COVID-19 on the health care system, an emergent need exists to accurately forecast hospitalization needs within an actionable timeframe. Our goal was to leverage an existing COVID-19 case and death forecasting tool to generate the expected number of concurrent hospitalizations, occupied intensive care unit (ICU) beds, and in-use ventilators 1 day to 4 weeks in the future for New Mexico and each of its five health regions. We developed a probabilistic model that took as input the number of new COVID-19 cases for New Mexico from Los Alamos National Laboratory’s COVID-19 Forecasts Using Fast Evaluations and Estimation tool, and we used the model to estimate the number of new daily hospital admissions 4 weeks into the future based on current statewide hospitalization rates. The model estimated the number of new admissions that would require an ICU bed or use of a ventilator and then projected the individual lengths of hospital stays based on the resource need. By tracking the lengths of stay through time, we captured the projected simultaneous need for inpatient beds, ICU beds, and ventilators. We used a postprocessing method to adjust the forecasts based on the differences between prior forecasts and the subsequent observed data. Thus, we ensured that our forecasts could reflect a dynamically changing situation on the ground. Forecasts made between September 1 and December 9, 2020, showed variable accuracy across time, health care resource needs, and forecast horizon. Forecasts made in October, when new COVID-19 cases were steadily increasing, had an average accuracy error of 20.0%, while the error in forecasts made in September, a month with low COVID-19 activity, was 39.7%. Across health care use categories, state-level forecasts were more accurate than those at the regional level. Although the accuracy declined as the forecast was projected further into the future, the stated uncertainty of the prediction improved. Forecasts were within 5% of their stated uncertainty at the 50% and 90% prediction intervals at the 3- to 4-week forecast horizon for state-level inpatient and ICU needs. However, uncertainty intervals were too narrow for forecasts of state-level ventilator need and all regional health care resource needs. Real-time forecasting of the burden imposed by a spreading infectious disease is a crucial component of decision support during a public health emergency. Our proposed methodology demonstrated utility in providing near-term forecasts, particularly at the state level. This tool can aid other stakeholders as they face COVID-19 population impacts now and in the future.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2017

Continuous Activity Monitoring During Concurrent Chemoradiotherapy

Purpose: To perform a prospective trial testing the feasibility and utility of acquiring activity data as a measure of health status during concurrent chemoradiotherapy. Methods and Materials: Ambulatory patients who were planned for treatment with concurrent chemoradiotherapy with curative intent for cancers of the head and neck, lung, or gastrointestinal tract were provided with activity monitors before treatment initiation. Patients were asked to wear the devices continuously throughout the radiation therapy course. Step count data were downloaded weekly during radiation therapy and 2 and 4 weeks after radiation therapy completion. The primary objective was to demonstrate feasibility, defined as collection of step counts for 80% of the days during study subjects' radiation therapy courses. Secondary objectives included establishing step count as a dynamic predictor of unplanned hospitalization risk. Results: Thirty-eight enrolled patients were treated with concurrent chemoradiotherapy. Primary diagnoses included head and neck cancer (n=11), lung cancer (n=13), and a variety of gastrointestinal cancers (n=14). Step data were collected for 1524 of 1613 days (94%) during patients' radiation therapy courses. Fourteen patients were hospitalized during radiation therapy or within 4 weeks of radiation therapy completion. Cox regression modeling demonstrated a significant association between recent step counts (3-day average) and hospitalization risk, with a 38% reduction in the risk of hospitalization for every 1000 steps taken each day (hazard ratio 0.62, 95% confidence interval 0.46-0.83, P=.002). Inferior quality of life scores and impaired performance status were not associated with increased hospitalization risk. Conclusion: Continuous activity monitoring during concurrent chemoradiotherapy is feasible and well-tolerated. Step counts may serve as powerful, objective, and dynamic indicators of hospitalization risk.

62 RADIOLOGY AND NUCLEAR MEDICINE↗
DOE OSTI2024

Assessing the reliability of medical resource demand models in the context of COVID-19

Abstract Background Numerous medical resource demand models have been created as tools for governments or hospitals, aiming to predict the need for crucial resources like ventilators, hospital beds, personal protective equipment (PPE), and diagnostic kits during crises such as the COVID-19 pandemic. However, the reliability of these demand models remains uncertain. Methods Demand models typically consist of two main components: hospital use epidemiological models that predict hospitalizations or daily admissions, and a demand calculator that translates the outputs of the epidemiological model into predictions for resource usage. We conducted separate analyses to evaluate each of these components. In the first analysis, we validated various hospital use epidemiological models using a recent validation framework designed for epidemiological models. This allowed us to quantify the accuracy of the models in predicting critical aspects such as the date and magnitude of local COVID-19 peaks, among other factors. In the second analysis, we evaluated a range of demand calculators for ventilators, medical gowns, and COVID-19 test kits. To achieve this, we decoupled these demand calculators from the underlying epidemiological models and provided ground truth data for their inputs. This approach enabled a direct comparison of the demand calculators, comparing them against each other and actual usage data when available. The code is available athttps://doi.org/10.5281/zenodo.13712387. Results Performance varied greatly across the epidemiological models, with greater variability in COVID-19 hospital use predictions than for COVID-19 deaths as analyzed previously. Some models did not have any peaks. Among those that did, the models under-estimated date of peak approximately as often as they over-estimated, but were more likely to under-estimate magnitude of peak, with typical relative errors around 50%. Regarding demand calculator predictions, there was significant variability, including five-fold differences in predictions for gown models. Validation against actual or surrogate usage data illustrated the potential value of demand models while demonstrating their limitations. Conclusions The emerging field of demand modeling holds promise in averting medical resource shortages during future public health emergencies. However, achieving this potential necessitates focused efforts on standardization, transparency, and rigorous model validation before placing reliance on demand models in critical public health decision-making.

Medical Informatics↗
DOE OSTI2020

Dynamical model for social distancing in the U.S. during the COVID-19 epidemic

Social distancing has led to a “flattening of the curve” in many states across the U.S. This is part of a novel, massive, global social experiment which has served to mitigate the COVID-19 pandemic in the absence of a vaccine or effective anti-viral drugs. Hence it is important to be able to forecast hospitalizations reasonably accurately. We propose on phenomenological grounds a random walk/generalized diffusion equation which incorporates the effect of social distancing to describe the temporal evolution of the probability of having a given number of hospitalizations. The probability density function is log-normal in the number of hospitalizations, which is useful in describing pandemics where the number of hospitalizations is very high. We used this insight and data to make forecasts for states using Monte Carlo methods. Back testing validates our approach, which yields good results about a week into the future. States are beginning to reopen at the time of submission of this paper and our forecasts indicate possible precursors of increased hospitalizations. However, the trends we forecast for hospitalizations as well as infections thus far show moderate growth. Additionally we studied the reproducibility in New York (Italian strain) and California (Wuhan strain). We find that even if there is a difference in the transmission of the two strains, social distancing has been able to control the progression of COVID 19.

97 MATHEMATICS AND COMPUTING↗
NASA NTRS1978

Infant Transport Monitoring

The photo sequence illustrates the movement of an ill infant to a special care hospital by means of a new Pediatric Monitoring and Transport System, in which NASA technology and technical assistance are being applied to an urgent medical problem. Development of the system is a collaborative effort involving several organizations, principally, NASA Ames Research Center and Children's Hospital Medical Center, Oakland, California. Key to the system's efficacy is a custom-designed ambulance-to-hospital and hospital-to-hospital communications network, including two-way voice capability and space-derived biotelemetry; it allows a specialist at the destination hospital to monitor continuously the vital signs of the patient during transit.

Source record↗
DOE OSTI2015

Why (just) information is not enough: The contributions of information services in the management of healthcare information

Information is at the centre of every hospital activity including clinical decisions and healthcare service delivery systems. Although information is an important hospital asset, several issues related to its management and organization needs to be addressed within the hospitals. The management of healthcare information is a strategic goal related to the reduction of healthcare service provision costs, and to the improvement of quality and safety of healthcare services. By discussing the rather obvious necessity for information organization and management in the healthcare domain, this work aims at the role of healthcare information services, i.e. hospital libraries and patient medical records. Finally, a typology of information services’ contributions to hospital environment is presented.

99 GENERAL AND MISCELLANEOUS↗
DOE OSTI2016

SU-F-I-40: Impact of Scan Length On Patient Dose in Abdomen/pelvis CT Diagnosis

Purpose: To analysis the impact of scan length on patient doses in abdomen/pelvis CT diagnosis of each hospital. Methods: Scan length of 7 hospitals from abdomen/pelvis CT diagnosis was surveyed in Korea. Surveyed scan lengths were additional distance above diaphragm and distance below pubic symphysis except for standard scan range between diaphragm and pubic symphysis. Patient dose was estimated for adult male and female according to scan length of each hospital. CT-Expo was used to estimate the patient dose under identical equipment settings (120 kVp, 100 mAs, 10 mm collimation width, etc.) except scan length. Effective dose was calculated by using tissue weighting factor of ICRP 103 recommendation. Increase rate of effective dose was calculated comparing with effective dose of standard scan range Results: Scan lengths of abdomen/pelvis CT diagnosis of each hospital were different. Also effective dose was increased with increasing the scan length. Generally increasing the distance above diaphragm caused increase of effective dose of male and female, but increasing the distance below pubic symphysis caused increase of effective dose of male. Conclusion: We estimated the patient dose according to scan length of each hospital in abdomen/pelvis CT diagnosis. Effective dose was increased by increasing the scan length because dose of organs with high tissue weighting factor such as lung, breast, testis were increased. Scan length is important factor on patient dose in CT diagnosis. If radiologic technologist interested in patient dose, decreasing the unnecessary scan length will decrease the risk of patients from radiation. This research was supported by a grant of the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health & Welfare, Republic of Korea (grant number: HI13C0004).

60 APPLIED LIFE SCIENCES↗
DOE OSTI2019

Comparison of Endovascular and Open Carotid Artery Treatment in Germany: A Retrospective Analysis from 2010 to 2015

Introduction: We analyzed trends in carotid artery stenting (CAS) and carotid endarterectomy (CEA) in hospitalized cases in Germany in the years 2010–2015. Methods: Data from national statistics (DRG statistics) published by the Federal Statistical Office in Germany describing the number of hospitalized patients treated with CEA and CAS were used. In addition, numbers of patients hospitalized with the principal diagnosis stroke associated with precerebral lesions (ICD code I63), transitory cerebral ischemic attacks (G45) and precerebral carotid artery stenosis (I65) treated by CEA and CAS were analyzed for the year 2015. Results: Total number of CEA decreased by 4.0% from 24.067 (2010) to 23.104 (2015) and CAS increased by 5.1% from 5.703 to 5.992. In 2015, 79.4% of all procedures coded concerning the internal carotid artery were CEA and 21.6% CAS. From 27.798 cases hospitalized with the principal diagnosis stroke associated with precerebral lesions, CEA was performed in 3.921 (14.1%) and in 2.132 (7.7%) CAS was documented, with CAS making up one-third of all treatments within the stroke group. In 28.273 cases hospitalized with a TIA, CEA was specified in 853 (3.0%) and CAS in 255 (0.9%) cases. In 27.553 cases with an occlusion and stenosis of precerebral arteries, not resulting in cerebral infarction, 17.036 (61.8%) had a CEA and 3.156 (11.5%) a CAS procedure. Conclusion: CEA is still the primary treatment of extracranial artery stenosis. The impact of CAS becomes mainly apparent in cases presenting with acute strokes.

62 RADIOLOGY AND NUCLEAR MEDICINE↗
DOE OSTI2012

Creating 3D Web-Based Game Environment Using BIM Models for Virtual On-Site Visiting of Building HVAC Systems

A web-based 3D game project was presented in this paper to demonstrate the process of using building information modeling (BIM) to create an interactive 3D on-line `Green' training environment. The system architecture, the implementation process and major components of this virtual training environment were discussed. Existing studies on BIM-based collaborations mainly focused on local-file-sharing approach using proprietary applications. Limited research focused on using BIM as an online gaming platform to create a web browser-based interactive 3D virtual environment for collaboration, learning and/or training. The gap was partially caused by the lack of understanding how to implement a BIM-based game in web browser environment. In this paper, the authors provided an implementation example using a hospital BIM model to create an interactive web-based 3D BIM game environment to allow users to visualize and interact with the BIM components using regular web browsers. The intention of this project is to create a proprietaryindependent training environment to conduct energy re-commissioning trainings for hospital facility management staff. This virtual BIM environment can potentially be customized for engineering student learning and project collaborations as well. The conclusion was that current BIM and game technology are mature enough to allow us to create serious web-based interactive learning/training virtual environment. The successful integration of BIM and web browsers paved the way for many learning and training applications, which need built-environment as context.

32 ENERGY CONSERVATION, CONSUMPTION, AND UTILIZATI↗
DOE OSTI2014

Monte Carlo study for designing a dedicated “D”-shaped collimator used in the external beam radiotherapy of retinoblastoma patients

Purpose: Retinoblastoma is the most common intraocular malignancy in the early childhood. Patients treated with external beam radiotherapy respond very well to the treatment. However, owing to the genotype of children suffering hereditary retinoblastoma, the risk of secondary radio-induced malignancies is high. The University Hospital of Essen has successfully treated these patients on a daily basis during nearly 30 years using a dedicated “D”-shaped collimator. The use of this collimator that delivers a highly conformed small radiation field, gives very good results in the control of the primary tumor as well as in preserving visual function, while it avoids the devastating side effects of deformation of midface bones. The purpose of the present paper is to propose a modified version of the “D”-shaped collimator that reduces even further the irradiation field with the scope to reduce as well the risk of radio-induced secondary malignancies. Concurrently, the new dedicated “D”-shaped collimator must be easier to build and at the same time produces dose distributions that only differ on the field size with respect to the dose distributions obtained by the current collimator in use. The scope of the former requirement is to facilitate the employment of the authors' irradiation technique both at the authors' and at other hospitals. The fulfillment of the latter allows the authors to continue using the clinical experience gained in more than 30 years. Methods: The Monte Carlo codePENELOPE was used to study the effect that the different structural elements of the dedicated “D”-shaped collimator have on the absorbed dose distribution. To perform this study, the radiation transport through a Varian Clinac 2100 C/D operating at 6 MV was simulated in order to tally phase-space files which were then used as radiation sources to simulate the considered collimators and the subsequent dose distributions. With the knowledge gained in that study, a new, simpler, “D”-shaped collimator is proposed. Results: The proposed collimator delivers a dose distribution which is 2.4 cm wide along the inferior-superior direction of the eyeball. This width is 0.3 cm narrower than that of the dose distribution obtained with the collimator currently in clinical use. The other relevant characteristics of the dose distribution obtained with the new collimator, namely, depth doses at clinically relevant positions, penumbrae width, and shape of the lateral profiles, are statistically compatible with the results obtained for the collimator currently in use. Conclusions: The smaller field size delivered by the proposed collimator still fully covers the planning target volume with at least 95% of the maximum dose at a depth of 2 cm and provides a safety margin of 0.2 cm, so ensuring an adequate treatment while reducing the irradiated volume.

62 RADIOLOGY AND NUCLEAR MEDICINE↗
DOE OSTI2015

SU-E-P-19: A National Collaborative Academic Medical Physics Network: Structure, Activity and Outcomes

Purpose: A national Australian inter-university medical physics (MP) group was formed in 2011/12, supported by Department of Health Better Access to Radiation Oncology BARO) seed funding. Core membership includes the six universities providing postgraduate MP courses. Objectives include increasing capacity, development and efficiency of national academic MP structures/systems and hence supporting education, clinical training and research, for the MP workforce support. Although the BARO scheme focuses on Radiation Oncology, the group has wider MP interests. Methods: Two further BARO seed grants were achieved: 1) for networked academic activities, including shared-resource teaching, eg using virtual reality systems; MP outreach to schools and undergraduates; developing web-based student and registrar education/resources, etc.; and 2) for conjoint ‘translational research’ posts between universities and partner hospitals, to clinically progress advanced RT technologies and to support students and registrars. Each university received 0.5 FTE post from each grant over 2 years (total: $1.75M) and leveraged local additional partner funds. Results: Total funding: $4–5M. Overall there have been 35 (mainly overseas) postholders bringing specific expertise, beginning in early 2013. Periods in Australia have been from 0.25–2 years (median=1). As well as the education activities, research projects include lung/spine SBRT, 4D RT, FFF beams, technology assessment, complex treatment planning, imaging for radiation oncology, DIR, adaptive breast, datamining, radiomics,etc. Observed positive impacts include: increased interest in MP courses, training support, translational research infrastructure and/or clinical practice in the hospitals involved, plus increased collaboration and effectiveness between the universities. Posts are continuing beyond grant end using leveraged funds, providing the basis for sustainability of some posts. Conclusion: The BARO-funded projects have cost-effectively produced a range of positive impacts on training, research and practice in hospitals and between universities. The evaluation of the specific post roles and activities, and their outcomes, has produced focused recommendations on continuation and sustainability. Funding was from the Australian federal Department of Health; leveraged funding was from partner universities and hospitals.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

The Impact of Tunneled Catheters for Ascites and Peritoneal Carcinomatosis on Patient Rehospitalizations

PurposeThe aim of the study is to assess patient outcomes, complications, impact on rehospitalizations, and healthcare costs in patients with malignant ascites treated with tunneled catheters.Materials and MethodsA total of 84 patients with malignant ascites (mean age, 60 years) were treated with tunneled catheters. Patients with peritoneal carcinomatosis and malignant ascites treated with tunneled drain catheter placement over a 3-year period were studied. Overall survival from the time of ascites and catheter placement were stratified by primary cancer and analyzed using the Kaplan–Meier method. Complications were graded by the Common Terminology Criteria for Adverse Events v3.0 (CTCAE). The differences between pre- and post-catheter admissions, hospitalizations, and Emergency Department (ED) visits, as well as related inpatient expenses were compared using paired t tests.ResultsThere were no significant differences in gender, age, or race between different primary cancer subgroups. One patient (1 %) developed bleeding (CTCAE-2). Four patients (5 %) developed local cellulitis (CTCAE-2). Three patients (4 %) had prolonged hospital stay (between 7 and 10 days) to manage ascites-related complications such as abdominal distention, discomfort, or pain. Comparison between pre- and post-catheter hospitalizations showed significantly lower admissions (−1.4/month, p < 0.001), hospital stays (−4.2/month, p = 0.003), and ED visits (−0.9/month, p = 0.002). The pre- and post-catheter treatment health care cost was estimated using MS-DRG IPPS payment system and it demonstrated significant cost savings from decreased inpatient admissions in post-treatment period (−$9535/month, p < 0.001).ConclusionsTunneled catheter treatment of malignant ascites is safe, feasible, well tolerated, and cost effective. Tunneled catheter treatment may play an important role in improving patients’ quality of life and outcomes while controlling health care expenditures.

62 RADIOLOGY AND NUCLEAR MEDICINE↗
DOE OSTI2018

A Cost-Benefit Analysis of Automated Physiological Data Acquisition Systems Using Data-Driven Modeling

Precision medicine and the continuous analysis of “Big data” promises to improve patient outcomes dramatically in the near future. Very recently, healthcare facilities have started to explore automatic collection of patient-specific physiological data with the aim of reducing nursing workload and decreasing manual data entry errors. In addition to those purposes, continuous physiological data can be used for the early detection and prevention of common, and possibly fatal, diseases. For instance, poor patient outcomes from sepsis, a leading cause of mortality in healthcare facilities and a major driver of hospital costs in the USA, can be mitigated when detected early using screening tools that monitor the changing dynamics of physiological data. However, the potential cost of collecting continuous physiological data remains a barrier to the widespread adoption of automated high-frequency data collection systems. In this paper, we perform cost-benefit analysis (CBA) of machine learning applied to various types of acquisition systems (with different collection intervals) to determine if the benefits of such systems will outweigh their implementation costs. Although such systems can be used in the detection of various complications, in order to showcase the immediate benefits, we focus on the early detection of sepsis, one of the major challenges of hospital systems. We present a general approach to conduct such analysis for a wide range of hospitals and highlight its applicability using a case study for a small hospital with 150 beds and 3000 annual patients where the acquisition system would collect data at 1-min intervals. Finally, we discuss how the analysis may help guide incentives/policies with regard to adopting automated data acquisition systems.

99 GENERAL AND MISCELLANEOUS↗
DOE OSTI2016

Estimating the Need for Palliative Radiation Therapy: A Benchmarking Approach

Purpose: Palliative radiation therapy (PRT) benefits many patients with incurable cancer, but the overall need for PRT is unknown. Our primary objective was to estimate the appropriate rate of use of PRT in Ontario. Methods and Materials: The Ontario Cancer Registry identified patients who died of cancer in Ontario between 2006 and 2010. Comprehensive RT records were linked to the registry. Multivariate analysis identified social and health system-related factors affecting the use of PRT, enabling us to define a benchmark population of patients with unimpeded access to PRT. The proportion of cases treated at any time (PRT{sub lifetime}), the proportion of cases treated in the last 2 years of life (PRT{sub 2y}), and number of courses of PRT per thousand cancer deaths were measured in the benchmark population. These benchmarks were standardized to the characteristics of the overall population, and province-wide PRT rates were then compared to benchmarks. Results: Cases diagnosed at hospitals with no RT on-site and residents of poorer communities and those who lived farther from an RT center, were significantly less likely than others to receive PRT. However, availability of RT at the diagnosing hospital was the dominant factor. Neither socioeconomic status nor distance from home to nearest RT center had a significant effect on the use of PRT in patients diagnosed at a hospital with RT facilities. The benchmark population therefore consisted of patients diagnosed at a hospital with RT facilities. The standardized benchmark for PRT{sub lifetime} was 33.9%, and the corresponding province-wide rate was 28.5%. The standardized benchmark for PRT{sub 2y} was 32.4%, and the corresponding province-wide rate was 27.0%. The standardized benchmark for the number of courses of PRT per thousand cancer deaths was 652, and the corresponding province-wide rate was 542. Conclusions: Approximately one-third of patients who die of cancer in Ontario need PRT, but many of them are never treated.

62 RADIOLOGY AND NUCLEAR MEDICINE↗
DOE OSTI2024

Molecular and Epidemiological Investigation of Fluconazole-resistant Candida parapsilosis —Georgia, United States, 2021

Abstract Background Reports of fluconazole-resistant Candida parapsilosis bloodstream infections are increasing. We describe a cluster of fluconazole-resistant C parapsilosis bloodstream infections identified in 2021 on routine surveillance by the Georgia Emerging Infections Program in conjunction with the Centers for Disease Control and Prevention. Methods Whole-genome sequencing was used to analyze C parapsilosis bloodstream infections isolates. Epidemiological data were obtained from medical records. A social network analysis was conducted using Georgia Hospital Discharge Data. Results Twenty fluconazole-resistant isolates were identified in 2021, representing the largest proportion (34%) of fluconazole-resistant C parapsilosis bloodstream infections identified in Georgia since surveillance began in 2008. All resistant isolates were closely genetically related and contained the Y132F mutation in the ERG11 gene. Patients with fluconazole-resistant isolates were more likely to have resided at long-term acute care hospitals compared with patients with susceptible isolates (P = .01). There was a trend toward increased mechanical ventilation and prior azole use in patients with fluconazole-resistant isolates. Social network analysis revealed that patients with fluconazole-resistant isolates interfaced with a distinct set of healthcare facilities centered around 2 long-term acute care hospitals compared with patients with susceptible isolates. Conclusions Whole-genome sequencing results showing that fluconazole-resistant C parapsilosis isolates from Georgia surveillance demonstrated low genetic diversity compared with susceptible isolates and their association with a facility network centered around 2 long-term acute care hospitals suggests clonal spread of fluconazole-resistant C parapsilosis. Further studies are needed to better understand the sudden emergence and transmission of fluconazole-resistant C parapsilosis.

Misas, Elizabeth (ORCID:0000000162437716)↗