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All sourcesNASA NTRSDOE OSTI
DOE OSTI2024

Promoting Sustainable Transportation Modes: A Systematic Review of Behavior-Change Strategies

In previous studies, many travel-behavior-change strategies often relied on single behavior determinants or psychological theories, overlooking the incorporation of sociopsychological theories for guidance in their design. Integrating these theories could offer consistent guidance for program developers and enhance intervention effectiveness. This paper systematically reviews interventions targeting travel-behavior change, with a focus on self-determination theory and its principles of satisfying individuals’ competence, autonomy, and relatedness needs for enacting change. Additionally, experiment design methods, including randomized controlled trials and quasi-experimental designs, are reviewed and discussed. Key findings highlight the effectiveness of personalized interventions and integrating feedback with goal-setting strategies. Given the limited direct references to sociopsychological theories in existing studies, we explore relevant sociopsychological theories applicable to travel-behavior-change programs to provide examples of how strategies could be designed based on them. This review contributes valuable insights into the development of strategies for changing travel behavior, offering a theoretical framework for researchers and practitioners to guide intervention design, experimentation, and evaluation. In conclusion, leveraging these theories not only facilitates reproducibility but also provides a standardized approach for transportation demand management program developers.

32 ENERGY CONSERVATION, CONSUMPTION, AND UTILIZATI↗
DOE OSTI2024

Agent-Based Model of Combined Community- and Jail-Based Take-Home Naloxone Distribution

Importance Opioid-related overdose accounts for almost 80 000 deaths annually across the US. People who use drugs leaving jails are at particularly high risk for opioid-related overdose and may benefit from take-home naloxone (THN) distribution. Objective To estimate the population impact of THN distribution at jail release to reverse opioid-related overdose among people with opioid use disorders. Design, Setting, and Participants This study developed the agent-based Justice-Community Circulation Model (JCCM) to model a synthetic population of individuals with and without a history of opioid use. Epidemiological data from 2014 to 2020 for Cook County, Illinois, were used to identify parameters pertinent to the synthetic population. Twenty-seven experimental scenarios were examined to capture diverse strategies of THN distribution and use. Sensitivity analysis was performed to identify critical mediating and moderating variables associated with population impact and a proxy metric for cost-effectiveness (ie, the direct costs of THN kits distributed per death averted). Data were analyzed between February 2022 and March 2024. Intervention Modeled interventions included 3 THN distribution channels: community facilities and practitioners; jail, at release; and social network or peers of persons released from jail. Main Outcomes and Measures The primary outcome was the percentage of opioid-related overdose deaths averted with THN in the modeled population relative to a baseline scenario with no intervention. Results Take-home naloxone distribution at jail release had the highest median (IQR) percentage of averted deaths at 11.70% (6.57%-15.75%). The probability of bystander presence at an opioid overdose showed the greatest proportional contribution (27.15%) to the variance in deaths averted in persons released from jail. The estimated costs of distributed THN kits were less than $\$$15 000 per averted death in all 27 scenarios. Conclusions and Relevance This study found that THN distribution at jail release is an economical and feasible approach to substantially reducing opioid-related overdose mortality. Training and preparation of proficient and willing bystanders are central factors in reaching the full potential of this intervention.

Tatara, Eric [Argonne National Laboratory (ANL), A↗
DOE OSTI2023

Justice 40 Tool (J40 Tool) v1.0

The Justice 40 tool provides a quantitative framework to support decision-making around equitable energy interventions at the community level. The tool calculates the optimal portfolio of policy interventions that explicitly mitigates energy insecurity of an eligible population, by reducing its disproportionate energy burden. The place-based analysis assumes a spatial census tract-level resolution and distinguishes different sociodemographic groups within each tract. Instead of focusing on a specific technology, the underlying J40 model captures the combined effect of a set of policy interventions, currently including weatherization, rooftop solar, community solar and community wind. For each tract, the model chooses the optimal (least cost) combination of interventions to address the disproportionate burden, considering the specific population demographics and techno-economic potentials of technologies. Mathematically, this problem is formalized as an optimization model and formulated as a linear program.

Heleno, Miguel↗
DOE OSTI2023

Limited Role of Absolute Humidity in Intraurban Heat Variability

Abstract Monitoring and understanding the variability of heat within cities is important for urban planning and public health, and the number of studies measuring intraurban temperature variability is growing. Recognizing that the physiological effects of heat depend on humidity as well as temperature, measurement campaigns have included measurements of relative humidity alongside temperature. However, the role the spatial structure in humidity, independent from temperature, plays in intraurban heat variability is unknown. Here we use summer temperature and humidity from networks of stationary sensors in multiple cities in the United States to show spatial variations in the absolute humidity within these cities are weak. This variability in absolute humidity plays an insignificant role in the spatial variability of the heat index and humidity index (humidex), and the spatial variability of the heat metrics is dominated by temperature variability. Thus, results from previous studies that considered only intraurban variability in temperature will carry over to intraurban heat variability. Also, this suggests increases in humidity from green infrastructure interventions designed to reduce temperature will be minimal. In addition, a network of sensors that only measures temperature is sufficient to quantify the spatial variability of heat across these cities when combined with humidity measured at a single location, allowing for lower-cost heat monitoring networks. Significance Statement Monitoring the variability of heat within cities is important for urban planning and public health. While the physiological effects of heat depend on temperature and humidity, it is shown that there are only weak spatial variations in the absolute humidity within nine U.S. cities, and the spatial variability of heat metrics is dominated by temperature variability. This suggests increases in humidity will be minimal resulting from green infrastructure interventions designed to reduce temperature. It also means a network of sensors that only measure temperature is sufficient to quantify the spatial variability of heat across these cities when combined with humidity measured at a single location.

Meteorology & Atmospheric Sciences↗
DOE OSTI2022

Approaches for effective negative pressure isolation space control to minimize airborne transmission of contaminants in residential homes

Controlling airborne transmission of contaminants including respired viruses such as SARS-CoV-2 is necessary to protect occupants living in the same house with a contagious person. The effectiveness of interventions requiring minor efforts that create a negative pressure isolation zone (IZ) for a contagious person has yet to be systematically tested for residential homes. In this study, ASHRAE Standard 170, which offers guidance for negative pressure isolation space control in healthcare facilities, was used in developing practical and attainable recommendations for residential single-family homes. The relative effectiveness of several control strategies was evaluated through experimentally conducting 17 different test cases in a manufactured single-family house laboratory. These cases were designed based on various heating, ventilation and air-conditioning (HVAC) operating scenarios, intervention measures including closing the IZ door and/or sealing over supply and return air grilles in the IZ, and utilization of bathroom exhaust or portable window fans for pressure control. Four out of 17 test cases were identified as having the potential for strong containment with adequate depressurization in the IZ. The most effective IZ depressurization was achieved through continuously operating the exhaust fan in the bathroom attached to the IZ, by installing a portable window fan that extracted air out of the IZ, and a portable room air conditioner with the AC unit exhaust duct installed in one of the IZ windows.

Construction & Building Technology↗
DOE OSTI2020

Using mixed methods to construct and analyze a participatory agent-based model of a complex Zimbabwean agro-pastoral system

Complex social-ecological systems can be difficult to study and manage. Simulation models can facilitate exploration of system behavior under novel conditions, and participatory modeling can involve stakeholders in developing appropriate management processes. Participatory modeling already typically involves qualitative structural validation of models with stakeholders, but with increased data and more sophisticated models, quantitative behavioral validation may be possible as well. In this study, we created a novel agent-basedmodel applied to a specific context: Zimbabwean non-governmental organization the Muonde Trust has been collecting data on their agro-pastoral system for the last 35 years and had concerns about land-use planning and the effectiveness of management interventions in the face of climate change. We collaboratively created an agent-based model of their system using their data archive, qualitatively calibrating it to the observed behavior of the real system without tuning any parameters to match specific quantitative outputs. We then behaviorally validated the model using quantitative community-based data and conducted a sensitivity analysis to determine the relative impact of underlying parameter assumptions, Indigenous management interventions, and different rainfall variation scenarios. We found that our process resulted in a model which was successfully structurally validated and sufficiently realistic to be useful for Muonde researchers as a discussion tool. The model was inconsistently behaviorally validated, however, with some model variables matching field data better than others. We observed increased model system instability due to increasing variability in underlying drivers (rainfall), and also due to management interventions that broke feedbacks between the components of the system. Interventions that smoothed year-to-year variation rather than exaggerating it tended to improve sustainability. The Muonde trust has used the model to successfully advocate to local leaders for changes in land-use planning policy that will increase the sustainability of their system.

54 ENVIRONMENTAL SCIENCES↗
DOE OSTI2022

Feasibility and preliminary efficacy for morning bright light therapy to improve sleep and plasma biomarkers in US Veterans with TBI. A prospective, open-label, single-arm trial

Mild traumatic brain injury (TBI) is associated with persistent sleep-wake dysfunction, including insomnia and circadian rhythm disruption, which can exacerbate functional outcomes including mood, pain, and quality of life. Present therapies to treat sleep-wake disturbances in those with TBI (e.g., cognitive behavioral therapy for insomnia) are limited by marginal efficacy, poor patient acceptability, and/or high patient/provider burden. Thus, this study aimed to assess the feasibility and preliminary efficacy of morning bright light therapy, to improve sleep in Veterans with TBI (NCT03578003). Thirty-three Veterans with history of TBI were prospectively enrolled in a single-arm, open-label intervention using a lightbox (~10,000 lux at the eye) for 60-minutes every morning for 4-weeks. Pre- and post-intervention outcomes included questionnaires related to sleep, mood, TBI, post-traumatic stress disorder (PTSD), and pain; wrist actigraphy as a proxy for objective sleep; and blood-based biomarkers related to TBI/sleep. The protocol was rated favorably by ~75% of participants, with adherence to the lightbox and actigraphy being ~87% and 97%, respectively. Post-intervention improvements were observed in self-reported symptoms related to insomnia, mood, and pain; actigraphy-derived measures of sleep; and blood-based biomarkers related to peripheral inflammatory balance. The severity of comorbid PTSD was a significant positive predictor of response to treatment. Morning bright light therapy is a feasible and acceptable intervention that shows preliminary efficacy to treat disrupted sleep in Veterans with TBI. A full-scale randomized, placebo-controlled study with longitudinal follow-up is warranted to assess the efficacy of morning bright light therapy to improve sleep, biomarkers, and other TBI related symptoms.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2021

Transcranial Direct Current Stimulation (tDCS) Improves Empathy and Recognition of Facial Emotions Conveying Threat in Adults with Autism Spectrum Disorder (ASD): A Randomized Controlled Pilot Study

Introduction: Empathy is critical for human interactions to become shared and meaningful, and it is facilitated by the expression and processing of facial emotions. Deficits in empathy and facial emotion recognition are associated with individuals with autism spectrum disorder (ASD), with specific concerns over inaccurate recognition of facial emotion expressions conveying a threat. Yet, the number of evidenced interventions for facial emotion recognition and processing (FERP), emotion, and empathy remains limited, particularly for adults with ASD. Transcranial direct current stimulation (tDCS), a noninvasive brain stimulation, may be a promising treatment modality to safely accelerate and/or enhance treatment interventions to increase their efficacy. Methods: This study investigates the effectiveness of FERP, emotion, and empathy treatment interventions paired with tDCS for adults with ASD. Differences in scores on the Empathy Quotient (EQ) and on a FERP test were predicted for verum tDCS when compared to sham. Verum/sham tDCS was randomly assigned in a within-subjects, double-blinded design in adults with ASD without intellectual disability. Results: Verum tDCS significantly improved EQ scores and FERP scores for emotions that conveyed threat. Conclusions: These results suggest the potential for increasing the efficacy of treatment interventions by pairing them with tDCS for individuals with ASD.

59 BASIC BIOLOGICAL SCIENCES↗
DOE OSTI2022

MetaText: Compositional Generalization in Deep Language Models

Compositional generalization, the ability to infer and reason using novel combinations of previously encountered entities and structures, is a trait of great utility across a variety of deep learning tasks; it implies a certain ability to reason using consistent and therefore interpretable rules, to understand the constituent parts of its input at multiple levels of granularity, to be robust to spurious differences between semantically equivalent inputs, and more. We seek to understand the degree to which existing natural language models achieve or fall short of compositional generalization across a variety of tasks, whether there are distinct types of compositional generalization in practice, and to identify avenues of intervention through which we can improve models’ compositional generalization ability. After exploring these questions using an array of models, tasks, and potential interventions we see that large, pretrained language models have encountered sufficient training data to account for a variety of fine-grained compositional behavior but still struggle to reason at the level of phrases or larger language structures. Non-intrusive, data-based interventions in the form of augmenting individual sequences with compressed versions of themselves or deriving new examples from induced grammars prove insufficient to encourage greater levels of compositional reasoning, indicating that future work might benefit most from focusing on changes to a model’s inductive bias at the architectural or loss level, or by integrating compositionality-boosting data interventions into the large-scale pretraining process itself.

97 MATHEMATICS AND COMPUTING↗
NASA NTRS1999

Kennedy Space Center Coronary Heart Disease Risk Screening Program

The number one cause of death in the U.S. is coronary heart disease (CHD). It is probably a major cause of death and disability in the lives of employees at Kennedy Space Center (KSC) as well. The KSC Biomedical Office used a multifactorial mathematical formula from the Framingham Heart Study to calculate CHD risk probabilities for individuals in a segment of the KSC population that required medical evaluation for job certification. Those assessed to be high-risk probabilities will be targeted for intervention. Every year, several thousand KSC employees require medical evaluations for job related certifications. Most medical information for these evaluations is gathered on-site at one of the KSC or Cape Canaveral Air Station (CCAS) medical clinics. The formula used in the Framingham Heart Study allows calculation of a person's probability of acquiring CHD within 10 years. The formula contains the following variables: Age, Diabetes, Smoking, Left Ventricular Hypertrophy, Blood Pressure (Systolic or Diastolic), Cholesterol, and HDL cholesterol. The formula is also gender specific. It was used to calculate the 10-year probabilities of CHD in KSC employees who required medical evaluations for job certifications during a one-year time frame. This KSC population was profiled and CHD risk reduction interventions could be targeted to those at high risk. Population risk could also be periodically reevaluated to determine the effectiveness of intervention. A 10-year CHD risk probability can be calculated for an individual quite easily while gathering routine medical information. An employee population's CHD risk probability can be profiled graphically revealing high risk segments of the population which can be targeted for risk reduction intervention. The small audience of NASA/contractor physicians, nurses and exercise/fitness professionals at the breakout session received the lecture very well. Approximately one third indicated by a show of hands that they would be interested in implementing a similar program at their NASA Center. Questions were asked pertaining to standardization for age, the validity of using the idealized male values also for the female population, and indications of the screening test's sensitivity and specificity.

Tipton, David A.↗
NASA NTRS1995

A two-year program of aerobics and weight training enhances bone mineral density of young women

Previous research suggests that physical activity may have a beneficial effect on bone mineral density (BMD) in women. This relationship was explored in a 2-year, randomized, intervention trial investigating the efficacy of exercise and calcium supplementation on increasing peak bone mass in young women. One hundred and twenty-seven subjects (ages of 20-35 years) were randomly assigned either to an exercise program that contained both aerobics and weight training components or to a stretching program. Calcium supplementation (up to 1500 mg/day including dietary intake) or placebo was given in a double-blinded design to all subjects. Spinal trabecular BMD was determined using quantitative computed tomography (QCT). Spinal integral, femoral neck, and trochanteric BMD were measured by dual X-ray absorptiometry (DXA) and calcaneal BMD by single photon absorptiometry (SPA). Fitness variables included maximal aerobic capacity (VO2max), and isokinetic muscle performance of the trunk and thigh. Measurements were made at baseline, 1 year, and 2 years. Sixty-three subjects (32 exercise, 31 stretching) completed the study, and all the measured bone parameters indicated a positive influence of the exercise intervention. There were significant positive differences in BMD between the exercise and stretching groups for spinal trabecular (2.5%), femoral neck (2.4%), femoral trochanteric (2.3%), and calcaneal (6.4%) measurements. The exercise group demonstrated a significant gain in BMD for spinal integral (1.3 +/- 2.8%, p < 0.02), femoral trochanteric (2.6 +/- 6.1%, p < 0.05), and calcaneal (5.6 +/- 5.1, p < 0.01) measurements. In contrast to exercise, the calcium intervention had no positive effect on any of the bone parameters. In regard to fitness parameters, the exercise group completed the study with significant gains in VO2max and isokinetic (peak torque) values for the knee flexion and extension and trunk extension. This study indicates that over a 2-year period, a combined regimen of aerobics and weight training has beneficial effects on BMD and fitness parameters in young women. However, the addition of daily calcium supplementation does not add significant benefit to the intervention.

Randomized Controlled Trial↗
NASA NTRS2014

Integrated Arrival and Departure Schedule Optimization Under Uncertainty

In terminal airspace, integrating arrivals and departures with shared waypoints provides the potential of improving operational efficiency by allowing direct routes when possible. Incorporating stochastic evaluation as a post-analysis process of deterministic optimization, and imposing a safety buffer in deterministic optimization, are two ways to learn and alleviate the impact of uncertainty and to avoid unexpected outcomes. This work presents a third and direct way to take uncertainty into consideration during the optimization. The impact of uncertainty was incorporated into cost evaluations when searching for the optimal solutions. The controller intervention count was computed using a heuristic model and served as another stochastic cost besides total delay. Costs under uncertainty were evaluated using Monte Carlo simulations. The Pareto fronts that contain a set of solutions were identified and the trade-off between delays and controller intervention count was shown. Solutions that shared similar delays but had different intervention counts were investigated. The results showed that optimization under uncertainty could identify compromise solutions on Pareto fonts, which is better than deterministic optimization with extra safety buffers. It helps decision-makers reduce controller intervention while achieving low delays.

stochastic optimization↗
DOE OSTI2025

The Evolution of Randomized Clinical Trial Designs to Assess Therapeutics in Alzheimer Disease

Importance The success of recent randomized clinical trials (RCTs) for Alzheimer disease (AD), particularly those focusing on anti-amyloid therapies, has been discussed at length. However, the evolution of RCT design features for AD that preceded this success remain underexplored. Objective To describe temporal changes in the features of RCT design for interventions in AD. Evidence Review PubMed, Scopus, and Web of Science databases were searched in January 2025 for phase 2 and 3 AD RCTs published between January 1992 and December 2024. RCTs that investigated an intervention for AD, with a placebo or standard-of-care control group, were included. Four assessors independently reviewed full-text articles to capture study characteristics. Main Outcomes and Measures The number of participants and the duration of RCTs as well as the target population, outcomes, and funding were extracted from published reports. These features were analyzed with respect to time using linear regression and χ 2 analyses. Results The study included 203 RCTs with 79 589 participants testing interventions in AD. From 1992 to 2024, the mean sample size increased by 464% for phase 2 RCTs (from 42 to 237), and 50% for phase 3 RCTs (from 632 to 951), while the mean trial duration increased by 188% (from 16 to 46 weeks) for phase 2, and 256% (from 20 to 71 weeks) for phase 3 RCTs. This longer duration of RCTs may be partially attributed by a greater share of disease-modifying rather than symptomatic treatments. Similarly, more recent trials required AD biomarker evidence for enrollment (from 1 of 36 [2.7%] before 2006 to 40 of 76 [52.6%] since 2019). A substantial difference in the type of therapeutics researched was observed, with anti-amyloid and anti-tau RCTs being more likely to be funded by the pharmaceutical industry compared with neurotransmitter or other RCTs (anti-amyloid or anti-tau, 68 of 71 [95.8%]; neurotransmitter, 52 of 69 [77.6%]; other, 33 of 52 [63.5%]). RCT transparency improved, with more frequent data accessibility statements, registered reports, and better reporting on race and ethnicity. Conclusions and Relevance This methodology research of AD RCTs highlights substantial changes in key features of AD clinical trials from 1992 to 2024. AD RCTs have become larger and longer, such that they are powered to detect smaller clinical differences. The increased sample sizes and duration should enable the detection of smaller and more slowly occurring outcomes, which may lead to successful RCTs of therapies with slower and more subtle efficacy.

General & Internal Medicine↗
DOE OSTI2024

The POINTER Imaging baseline cohort: Associations between multimodal neuroimaging biomarkers, cardiovascular health, and cognition

Abstract INTRODUCTION The U.S. Study to Protect Brain Health Through Lifestyle Intervention to Reduce Risk (U.S. POINTER) is evaluating lifestyle interventions in older adults at risk for cognitive decline and dementia. Here we characterize the baseline data set of the POINTER Imaging ancillary study. METHODS Participants underwent health and cognitive assessments and neuroimaging with multimodal positron emission tomography (PET) (beta‐amyloid [Aβ] and tau) and magnetic resonance imaging (MRI). Framingham risk score (FRS) was used to quantify cardiovascular disease (CVD) risk. RESULTS A total of 1052 participants (31% from underrepresented ethnoracial groups) were enrolled. Compared to Aβ−, Aβ+ (29%) participants were older, had higher apolipoprotein E (APOE) ε4 carriage rate and white matter hyperintensity volume, and greater temporal tau. FRS was related to MRI measures, but not AD biomarkers. FRS and tau had independent effects on cognition. DISCUSSION In this heterogenous, at‐risk cohort, CVD risk was related to more abnormal brain structure and poorer cognition, representing a putative non‐AD (Alzheimer's disease) pathway to brain injury and cognitive decline. Highlights The U.S. Study to Protect Brain Health Through Lifestyle Intervention to Reduce Risk (U.S. POINTER) cohort is enriched for cardiovascular disease (CVD) and poor lifestyle POINTER Imaging collected multimodal neuroimaging data in this unique, at‐risk cohort Amyloid burden was related to age, apolipoprotein E (APOE) ε4 carriage, and measures of disease progression Associations between amyloid and tau, and tau and cognition, were relatively weak CVD risk and tau pathology were independently related to memory

Neurosciences & Neurology↗
DOE OSTI2022

Broccoli seed extract rich in polysaccharides and glucoraphanin ameliorates DSS ‐induced colitis via intestinal barrier protection and gut microbiota modulation in mice

Abstract BACKGROUND Broccoli has received widespread attention because of its anti‐inflammatory and antioxidant effects. The present study aimed to explore the composition of broccoli seed extract (BSE) and its effect on colitis induced by dextran sulfate sodium (DSS). RESULTS BSE mainly comprises glucoraphanin and polysaccharides composed of arabinose, galactose, glucose and mannose. Animal experiments suggested that BSE intervention effectively reversed body weight loss, suppressed the levels of proinflammatory interleukin‐6, tumor necrosis factor‐α and interleukin‐1β, and elevated the levels of anti‐inflammatory interleukin‐10 and the activities of superoxide dismutase and glutathione in DSS‐induced colitis mice. According to histopathologic and immunohistochemical analysis of colon tissue, BSE intervention may repair the intestinal barrier by upregulating mRNA levels and the expression of tight junction proteins (claudin‐1, occludin and zonula occludens‐1). Gas chromatography–mass spectrometry (MS) analysis demonstrated that cecal short‐chain fatty acids in mice with BSE administration were significantly increased compared with the model group. Sulforaphane and sulforaphane‐ N ‐acetylcysteine were only detected in BSE group mice by ultra‐performance liquid chromatography‐MS analysis. In addition, BSE intervention evidently increased the abundance of Alistipeds , Coriobacteriaceae UCG‐002 and Bifidobacterium and decreased the abundance of Escheichia‐Shinella , Lachnospiraceae others , Parabacteroides , Ruminococcaceae others and Turicibacter , which possibly promoted carbohydrate metabolism and short‐chain fatty acid production. CONCLUSION The present study aimed to elucidate the effect of BSE on colitis and found that BSE, as a novel food ingredient, has great potential for the improvement of colitis. © 2022 Society of Chemical Industry.

Wu, Jiaying↗
DOE OSTI2021

Safety and effectiveness of a non-electric infant warmer for hypothermia in Rwanda: A cluster-randomized stepped-wedge trial

Background: Neonatal hypothermia is a common source of morbidity and mortality in low resource settings. We developed the Dream Warmer, a low cost, re-usable non-electric infant warmer to prevent and treat hypothermia. Methods: We conducted a cluster-randomized stepped-wedge trial. The primary aim was to assess the effect on overall euthermia rates of introducing the warmer compared to standard of care in rural Rwandan hospitals. The secondary aims were to assess effects of warmer introduction on mortality, as well as the safety and feasibility of the warmer. Ten district hospitals participated in the study from November 19th 2019 to July 15th 2020. Patients were eligible to use the warmer if they were 1) hypothermic (temp < 36·5 °C) or 2) or at risk of hypothermia (weight < 2·5 kg or estimated post menstrual age < 35 weeks) when Kangaroo Mother Care was not available. An encounter was defined as the data from an individual infant on a single day. Trial of a Non Electric Infant Warmer for Prevention and Treatment of Hypothermia in Rwanda [NCT03890211]. Findings: Over the study period, 3179 patients were enrolled across the ten neonatal wards, yielding 12,748 encounters; 464 unique infants used the warmer 892 times, 79% eligible due to hypothermia. Because of limited study nurse resources, the warmer was used in only 18% of eligible encounters. Despite this low rate of warmer use, the rate of euthermia rose from 51% (95% CI 50–52%) of encounters pre-intervention to 67% (66–68%) post-intervention; p < 0·0001. Among the encounters in which the warmer was used, only 11% (9–13%) remained hypothermic. While mortality rates pre- and post-intervention did not change, mortality rate among those who used the warmer was significantly lower than among those who did not (0·9% vs 2·8%, p = 0·01). Use of the warmer did not affect hyperthermia rates. There were no safety concerns or instances of incorrect warmer use. Interpretation: Introduction of the warmer increased rates of euthermia with no associated safety concerns.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2026

Cascading economic losses from port disruptions under capacity constrained multimodal freight networks

This study quantifies how throughput disruptions at major seaports cascade through capacity-constrained multimodal freight networks and interregional production systems. We couple an agent-based model (ABM) multimodal freight simulation that resolves rerouting, terminal queueing, and inventory drawdown under binding modal and facility capacities with a multiregional output loss input-output (MRIIM) model that propagates realized delivery shortfalls across regions and sectors. The framework is demonstrated for the Port of Los Angeles using Freight Analysis Framework flows and Bureau of Economic Analysis input-output accounts and is evaluated over a 52-week horizon under deterministic sector targeted shocks and stochastic disruption realizations with uncertain severity and duration. Results indicate nonlinear amplification: realized national losses concentrate in manufacturing and transportation/warehousing even when exogenous port shocks are dispersed, suggesting that congestion spillback and limited short-run substitution can dominate the initial shock allocation. We further evaluate a tabular reinforcement-learning (Q-learning) intervention layer that selects among a small set of implementable system level levers (truck-to-rail and truck-to-barge shift settings) without overriding shipper routing, finding that such interventions reduce total losses for moderate disruptions but yield diminishing returns once substitute modes approach capacity. By linking operational freight behavior to system wide impacts under uncertainty, the proposed ABM-MRIIM pipeline provides a reusable workflow for port disruption stress testing, identification of structurally critical sectors/corridors, and evaluation of resilience interventions under realistic capacity limits.

42 ENGINEERING↗
DOE OSTI2021

Intervening alcohol marketing to reduce harmful alcohol use and lessons learned from the theory of changes: Case studies in Thailand

Objectives Globally, the burden of disease caused by alcohol use has been steadily increasing, including in Thailand. In this study, we aim to test the effectiveness of Anderson et al.‘s suggested three approaches to change the collective social norms, which comprise of: (1) providing information and an understanding about alcohol use behaviour, its causes and distribution; (2) focusing strategies on groups rather than individuals; and (3) strengthening supportive laws, regulations and approaches. Study design We employed a mixed-methods approach. Evidence was gathered from literature review and in-depth interviews with key individuals who are responsible for community-based interventions to alcohol marketing strategies in Thailand. Methods We chose to focus on two case studies in Nan and Surin provinces, where hospital-based longitudinal data (8 years) were available. Changes in casualties related to the harmful use of alcohol, resulting from interactions between community-based interventions and alcohol marketing during the time of annual festivals were investigated. We employed the theory of change (ToC) defined by Vogel to guide the data collection and analysis. We reviewed literature from online databases and grey literature to generate causal-loop diagrams. Results We created a causal-loop diagram to describe the complexity of harmful alcohol use, its related factors, context, interventions and outcomes. Over the decade between 2006 and 2015, community-based strategies led to a substantial reduction of casualties (initially a 50% reduction, rising to an 80–90% reduction by the end of the study period) during the time of the festivals. Conclusions The reduction in injuries and fatalities could be a result of the concerted actions, including legal sanctions of alcohol beverage sales and advertisement, and public education to raise awareness and impart knowledge of the harmful use of alcohol. The actions were organised by a coalition of civil society, health professionals, public authorities and community leaders using hospital-based data on the adverse effects of harmful alcohol use to mobilise political support at the provincial level. The availability of long-term financial support as a catalytic source of funds and the presence of a comprehensive alcohol control act enabled framing and mobilisation of local resources and political support.

60 APPLIED LIFE SCIENCES↗