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At least 199 records · Page 11
All sourcesNASA NTRSDOE OSTI
DOE OSTI2023

Standardized perioperative management in acute abdominal surgery: Swedish SMASH controlled study

Abstract Background Acute high-risk abdominal surgery is common, as are the attendant risks of organ failure, need for intensive care, mortality, or long hospital stay. This study assessed the implementation of standardized management. Methods A prospective study of all adults undergoing emergency laparotomy over an interval of 42 months (2018–2021) was undertaken; outcomes were compared with those of a retrospective control group. A new standardized clinical protocol was activated for all patients including: prompt bedside physical assessment by the surgeon and anaesthetist, interprofessional communication regarding location of resuscitation, elimination of unnecessary factors that might delay surgery, improved operating theatre competence, regular epidural, enhanced recovery care, and frequent early warning scores. The primary endpoint was 30-day mortality. Secondary endpoints were duration of hospital stay, need for intensive care, and surgical complications. Results A total of 1344 patients were included, 663 in the control group and 681 in the intervention group. The use of antibiotics increased (81.4 versus 94.7 per cent), and the time from the decision to operate to the start of surgery was reduced (3.80 versus 3.22 h) with use of the new protocol. Fewer anastomoses were performed (22.5 versus 16.8 per cent). The 30-day mortality rate was 14.5 per cent in the historical control group and 10.7 per cent in the intervention group (P = 0.045). The mean duration of hospital (11.9 versus 10.2 days; P = 0.007) and ICU (5.40 versus 3.12 days; P = 0.007) stays was also reduced. The rate of serious surgical complications (grade IIIb–V) was lower (37.6 versus 27.3 per cent; P = <0.001). Conclusion Standardized management protocols improved outcomes after emergency laparotomy.

Timan, Terje J.↗
DOE OSTI2022

Identification and distribution of pathogens coinfecting with Brucella spp., Coxiella burnetii and Rift Valley fever virus in humans, livestock and wildlife

Zoonotic diseases, such as brucellosis, Q fever and Rift Valley fever (RVF) caused by Brucella spp., Coxiella burnetii and RVF virus, respectively, can have devastating effects on human, livestock, and wildlife health and cause economic hardship due to morbidity and mortality in livestock. Coinfection with multiple pathogens can lead to more severe disease outcomes and altered transmission dynamics. These three pathogens can alter host immune responses likely leading to increased morbidity, mortality and pathogen transmission during coinfection. Developing countries, such as those commonly afflicted by outbreaks of brucellosis, Q fever and RVF, have high disease burden and thus common coinfections. A literature survey provided information on case reports and studies investigating coinfections involving the three focal diseases. Fifty five studies were collected demonstrating coinfections of Brucella spp., C. burnetii or RVFV with 50 different pathogens, of which 64% were zoonotic. While the literature search criteria involved ‘coinfection’, only 24/55 studies showed coinfections with direct pathogen detection methods (microbiology, PCR and antigen test), while the rest only reported detection of antibodies against multiple pathogens, which only indicate a history of co-exposure, not concurrent infection. These studies lack the ability to test whether coinfection leads to changes in morbidity, mortality or transmission dynamics. We describe considerations and methods for identifying ongoing coinfections to address this critical blind spot in disease risk management.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2023

COVID-19 Outcomes by Cancer Status, Site, Treatment, and Vaccination

Background: Studies have shown an increased risk of severe SARS-CoV-2–related (COVID-19) disease outcome and mortality for patients with cancer, but it is not well understood whether associations vary by cancer site, cancer treatment, and vaccination status. Methods: Using electronic health record data from an academic medical center, we identified a retrospective cohort of 260,757 individuals tested for or diagnosed with COVID-19 from March 10, 2020, to August 1, 2022. Of these, 52,019 tested positive for COVID-19 of whom 13,752 had a cancer diagnosis. We conducted Firth-corrected logistic regression to assess the association between cancer status, site, treatment, vaccination, and four COVID-19 outcomes: hospitalization, intensive care unit admission, mortality, and a composite “severe COVID” outcome. Results: Cancer diagnosis was significantly associated with higher rates of severe COVID, hospitalization, and mortality. These associations were driven by patients whose most recent initial cancer diagnosis was within the past 3 years. Chemotherapy receipt, colorectal cancer, hematologic malignancies, kidney cancer, and lung cancer were significantly associated with higher rates of worse COVID-19 outcomes. Vaccinations were significantly associated with lower rates of worse COVID-19 outcomes regardless of cancer status. Conclusions: Patients with colorectal cancer, hematologic malignancies, kidney cancer, or lung cancer or who receive chemotherapy for treatment should be cautious because of their increased risk of worse COVID-19 outcomes, even after vaccination. Impact: Additional COVID-19 precautions are warranted for people with certain cancer types and treatments. Further, significant benefit from vaccination is noted for both cancer and cancer-free patients.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2023

Human NCR3 gene variants rs2736191 and rs11575837 alter longitudinal risk for development of pediatric malaria episodes and severe malarial anemia

Background: Plasmodium falciparum malaria is a leading cause of pediatric morbidity and mortality in holoendemic transmission areas. Severe malarial anemia [SMA, hemoglobin (Hb) < 5.0 g/dL in children] is the most common clinical manifestation of severe malaria in such regions. Although innate immune response genes are known to influence the development of SMA, the role of natural killer (NK) cells in malaria pathogenesis remains largely undefined. As such, we examined the impact of genetic variation in the gene encoding a primary NK cell receptor, natural cytotoxicity-triggering receptor 3 (NCR3), on the occurrence of malaria and SMA episodes over time. Methods: Susceptibility to malaria, SMA, and all-cause mortality was determined in carriers of NCR3 genetic variants (i.e., rs2736191:C > G and rs11575837:C > T) and their haplotypes. The prospective observational study was conducted over a 36 mos. follow-up period in a cohort of children (n = 1,515, aged 1.9–40 mos.) residing in a holoendemic P. falciparum transmission region, Siaya, Kenya. Results: Poisson regression modeling, controlling for anemia-promoting covariates, revealed a significantly increased risk of malaria in carriers of the homozygous mutant allele genotype (TT) for rs11575837 after multiple test correction [Incidence rate ratio (IRR) = 1.540, 95% CI = 1.114–2.129, P = 0.009]. Increased risk of SMA was observed for rs2736191 in children who inherited the CG genotype (IRR = 1.269, 95% CI = 1.009–1.597, P = 0.041) and in the additive model (presence of 1 or 2 copies) (IRR = 1.198, 95% CI = 1.030–1.393, P = 0.019), but was not significant after multiple test correction. Modeling of the haplotypes revealed that the CC haplotype had a significant additive effect for protection against SMA (i.e., reduced risk for development of SMA) after multiple test correction (IRR = 0.823, 95% CI = 0.711–0.952, P = 0.009). Although increased susceptibility to SMA was present in carriers of the GC haplotype (IRR = 1.276, 95% CI = 1.030–1.581, P = 0.026) with an additive effect (IRR = 1.182, 95% CI = 1.018–1.372, P = 0.029), the results did not remain significant after multiple test correction. None of the NCR3 genotypes or haplotypes were associated with all-cause mortality. Conclusions: Variation in NCR3 alters susceptibility to malaria and SMA during the acquisition of naturally-acquired malarial immunity. These results highlight the importance of NK cells in the innate immune response to malaria.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2022

NSAID use and clinical outcomes in COVID-19 patients: a 38-center retrospective cohort study

Abstract Background Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used to reduce pain, fever, and inflammation but have been associated with complications in community-acquired pneumonia. Observations shortly after the start of the COVID-19 pandemic in 2020 suggested that ibuprofen was associated with an increased risk of adverse events in COVID-19 patients, but subsequent observational studies failed to demonstrate increased risk and in one case showed reduced risk associated with NSAID use. Methods A 38-center retrospective cohort study was performed that leveraged the harmonized, high-granularity electronic health record data of the National COVID Cohort Collaborative. A propensity-matched cohort of 19,746 COVID-19 inpatients was constructed by matching cases (treated with NSAIDs at the time of admission) and 19,746 controls (not treated) from 857,061 patients with COVID-19 available for analysis. The primary outcome of interest was COVID-19 severity in hospitalized patients, which was classified as: moderate, severe, or mortality/hospice. Secondary outcomes were acute kidney injury (AKI), extracorporeal membrane oxygenation (ECMO), invasive ventilation, and all-cause mortality at any time following COVID-19 diagnosis. Results Logistic regression showed that NSAID use was not associated with increased COVID-19 severity (OR: 0.57 95% CI: 0.53–0.61). Analysis of secondary outcomes using logistic regression showed that NSAID use was not associated with increased risk of all-cause mortality (OR 0.51 95% CI: 0.47–0.56), invasive ventilation (OR: 0.59 95% CI: 0.55–0.64), AKI (OR: 0.67 95% CI: 0.63–0.72), or ECMO (OR: 0.51 95% CI: 0.36–0.7). In contrast, the odds ratios indicate reduced risk of these outcomes, but our quantitative bias analysis showed E-values of between 1.9 and 3.3 for these associations, indicating that comparatively weak or moderate confounder associations could explain away the observed associations. Conclusions Study interpretation is limited by the observational design. Recording of NSAID use may have been incomplete. Our study demonstrates that NSAID use is not associated with increased COVID-19 severity, all-cause mortality, invasive ventilation, AKI, or ECMO in COVID-19 inpatients. A conservative interpretation in light of the quantitative bias analysis is that there is no evidence that NSAID use is associated with risk of increased severity or the other measured outcomes. Our results confirm and extend analogous findings in previous observational studies using a large cohort of patients drawn from 38 centers in a nationally representative multicenter database.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2021

Characterizing juvenile salmon predation risk during early marine residence

Predation mortality can influence the distribution and abundance of fish populations. While predation is often assessed using direct observations of prey consumption, potential predation can be predicted from co-occurring predator and prey densities under varying environmental conditions. Juvenile Pacific salmon Oncorhynchus spp. (i.e., smolts) from the Columbia River Basin experience elevated mortality during the transition from estuarine to ocean habitat, but a thorough understanding of the role of predation remains incomplete. We used a Holling type II functional response to estimate smolt predation risk based on observations of piscivorous seabirds (sooty shearwater [ Ardenna griseus ] and common murre [ Uria aalge ]) and local densities of alternative prey fish including northern anchovy ( Engraulis mordax ) in Oregon and Washington coastal waters during May and June 2010–2012. We evaluated predation risk relative to the availability of alternative prey and physical factors including turbidity and Columbia River plume area, and compared risk to returns of adult salmon. Seabirds and smolts consistently co-occurred at sampling stations throughout most of the study area (mean = 0.79 ± 0.41, SD), indicating that juvenile salmon are regularly exposed to avian predators during early marine residence. Predation risk for juvenile coho ( Oncorhynchus kisutch ), yearling Chinook salmon ( O . tshawytscha ), and subyearling Chinook salmon was on average 70% lower when alternative prey were present. Predation risk was greater in turbid waters, and decreased as water clarity increased. Juvenile coho and yearling Chinook salmon predation risk was lower when river plume surface areas were greater than 15,000 km 2 , while the opposite was estimated for subyearling Chinook salmon. These results suggest that plume area, turbidity, and forage fish abundance near the mouth of the Columbia River, all of which are influenced by river discharge, are useful indicators of potential juvenile salmon mortality that could inform salmonid management.

Phillips, Elizabeth M. (ORCID:0000000327752563)↗
DOE OSTI2021

COVID-19 Evidence Accelerator: A parallel analysis to describe the use of Hydroxychloroquine with or without Azithromycin among hospitalized COVID-19 patients

Background: The COVID-19 pandemic remains a significant global threat. However, despite urgent need, there remains uncertainty surrounding best practices for pharmaceutical interventions to treat COVID-19. In particular, conflicting evidence has emerged surrounding the use of hydroxychloroquine and azithromycin, alone or in combination, for COVID-19. The COVID-19 Evidence Accelerator convened by the Reagan-Udall Foundation for the FDA, in collaboration with Friends of Cancer Research, assembled experts from the health systems research, regulatory science, data science, and epidemiology to participate in a large parallel analysis of different data sets to further explore the effectiveness of these treatments. Methods: Electronic health record (EHR) and claims data were extracted from seven separate databases. Parallel analyses were undertaken on data extracted from each source. Each analysis examined time to mortality in hospitalized patients treated with hydroxychloroquine, azithromycin, and the two in combination as compared to patients not treated with either drug. Cox proportional hazards models were used, and propensity score methods were undertaken to adjust for confounding. Frequencies of adverse events in each treatment group were also examined. Results: Neither hydroxychloroquine nor azithromycin, alone or in combination, were significantly associated with time to mortality among hospitalized COVID-19 patients. No treatment groups appeared to have an elevated risk of adverse events. Conclusion: Administration of hydroxychloroquine, azithromycin, and their combination appeared to have no effect on time to mortality in hospitalized COVID-19 patients. Continued research is needed to clarify best practices surrounding treatment of COVID-19.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2022

Six-Month Outcomes of Infants Born to People With SARS-CoV-2 in Pregnancy

OBJECTIVES To assess the 6-month incidence of laboratory-confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, postnatal care, hospitalization, and mortality among infants born to people with laboratory-confirmed SARS-CoV-2 infection during pregnancy by timing of maternal infection. METHODS Using a cohort of liveborn infants from pregnancies with SARS-CoV-2 infections in the year 2020 from 10 United States jurisdictions in the Surveillance for Emerging Threats to Mother and Babies Network, we describe weighted estimates of infant outcomes from birth through 6 months of age from electronic health and laboratory records. RESULTS Of 6601 exposed infants with laboratory information through 6 months of age, 1.0% (95% confidence interval: 0.8–1.1) tested positive, 19.1% (17.5–20.6) tested negative, and 80.0% (78.4–81.6) were not known to be tested for SARS-CoV-2. Among those ≤14 days of age, SARS-CoV-2 infection occurred only with maternal infection ≤14 days before delivery. Of 3967 infants with medical record abstraction, breastmilk feeding initiation was lower when maternal infection occurred ≤14 days before delivery compared with >14 days (77.6% [72.5–82.6] versus 88.3% [84.7–92.0]). Six-month all-cause hospitalization was 4.1% (2.0–6.2). All-cause mortality was higher among infants born to people with infection ≤14 days (1.0% [0.4–1.6]) than >14 days (0.3% [0.1–0.5]) before delivery. CONCLUSIONS Results are reassuring, with low incidences of most health outcomes examined. Incidence of infant SARS-CoV-2, breastmilk feeding initiation, and all-cause mortality differed by timing of maternal infection. Strategies to prevent infections and support pregnant people with coronavirus disease 2019 may improve infant outcomes.

Pediatrics↗
DOE OSTI2022

FATES crown damage simulation outputs 2022

This dataset contains outputs from the Functionally Assembled Terrestrial Ecosystem Simulator (FATES) and accompanies the paper "Needham, J.F., Arellano, A., Davies, S.J., Fisher, R.A., Hammer, V., Knox, R., Mitre, D., Muller-Landau, H.C., Zuleta, D., Koven, C.D. Tree crown damage and its effects on forest carbon cycling in a tropical forest, 2022, Global Change Biology". Data are unprocessed netcdf file outputs from simulations that were run to test the effect of a new crown damage module in FATES. Specifically, this data package contains a sensitivity analysis to the carbon cushion parameter damage_Ccushion_ensemble_e1b5bd9_bf013ef_2021-09-02.h0.ensemble.sofar.nc, a sensitivity analysis to the root nitrogen stoichiometry parameter damage_Nstoich_ensemble_e1b5bd9_bf013ef_2021-09-02.h0.ensemble.sofar.nc, a sensitivity analysis to parameters controlling crown damage and recovery damage_recovery_ensemble_e1b5bd9_354f0b0_2021-09-02.h0.ensemble.sofar.nc, and a sensitivity analysis to the number of crown damage bins elm_fates_bci_*_damagebins.Eac53ccb80b-F8f994c29.2022-04-19.elm.h0.fullrun.nc. This data package also contains a high root nitrogen configuration of FATES, including both a control, and a crown damage simulation high_root_N_control_e1b5bd9_354f0b0_2021-09-02.clm2.h0.fullrun.nc and high_root_N_damage_e1b5bd9_354f0b0_2021-09-02.clm2.h0.fullrun.nc. There is an analogous low root nitrogen configuration of FATES, including a control, low_root_N_control_e1b5bd9_bf013ef_2021-09-02.clm2.h0.fullrun.nc a damage only simulation low_root_N_damageonly_e1b5bd9_bf013ef_2021-09-02.clm2.h0.fullrun.nc, a damage plus mortality simulation low_root_N_damage_mort_e1b5bd9_bf013ef_2021-09-02.clm2.h0.fullrun.nc, and a mortality only simulation low_root_N_mort_only_e1b5bd9_ef845c8_2021-09-02.clm2.h0.fullrun.nc. Finally, there is a two PFT simulation in which we test the effect of recovery on competitive dynamics, low_root_N_damage_two_pfts_stoichastic_e1b5bd9_bf013ef_2021-09-10.clm2.h0.fullrun.nc. These simulations test the effect of representing crown damage in FATES, compared with simulations that have an equivalent increase in mortality. Jupyter notebooks to analyse these files can be found at https://github.com/JessicaNeedham/Needham_etal_GCB_2022_FATES_crown_damage.

54 ENVIRONMENTAL SCIENCES↗
DOE OSTI2021

AmeriFlux FLUXNET-1F US-Mpj Mountainair Pinyon-Juniper Woodland

This is the AmeriFlux Management Project (AMP) created FLUXNET-1F version of the carbon flux data for the site US-Mpj Mountainair Pinyon-Juniper Woodland. This is the FLUXNET version of the carbon flux data for the site US-Mpj Mountainair Pinyon-Juniper Woodland produced by applying the standard ONEFlux (1F) software. Site Description - This site is located in central New Mexico on an extensive mesa approximately 25 km south of Mountainair, NM, owned by the Heritage Land Conservancy. The dominant tree species, Pinus edulis and Juniperus monosperma make up >95% of the area’s tree cover. Total tree is cover is ~60%. The dominant herbaceous plant at the site is the C4 perennial grass Bouteloua gracilis. In July 2013, we observed pinon mortality at the site, which continued through 2015. We have used a variety of techniques to document the rate of mortality. The mortality was triggered by a combination of drought (2011-2013) and Pinon ips bark beetle outbreak. Juniper was not affected.

Litvak, Marcy↗
DOE OSTI2022

Quantifying Impacts of Renewable Electricity Deployment on Air Quality and Human Health in Southeast Asia Based on Aims III Scenarios

Exposure to outdoor air pollution is the largest environmental risk factor for death and disease worldwide, associated with millions of cases of excess deaths (mortality) each year. Although there are many pollutants in the air that affect our health, the most important class of pollutants is fine particulate matter, PM 2.5 , which are airborne particles of diameter ≤2.5 micrometers (µm). These particles are small enough to deposit deep in the respiratory system where they can then enter the bloodstream, traveling and causing damage to other bodily systems. Exposure to outdoor (ambient) PM 2.5 has been found to be the most important environmental risk factor for mortality in Southeast Asia, associated with 130,000 - 320,000 excess deaths in Association of Southeast Asian Nations (ASEAN) member countries in 2019. Southeast Asia, especially its mega-cities, but also other areas, has some of the worst air quality in the world. Almost all human activity emits air pollutants. Fine particulate matter is both directly emitted and formed in the atmosphere through chemical reactions, the latter of which requires modeling to predict. Power generation is one of the major sources of air pollutants that lead to elevated concentrations of fine particulate matter, including in Southeast Asia. Fossil fuel combustion for power generation, especially coal but also diesel, is the main source of air pollutant emissions from power generation. While natural gas burns cleaner than coal or diesel, in the quantities combusted for power generation in Southeast Asia, it is also a significant emitter. This study augments the ASEAN Interconnection Masterplan Study III (AIMS III) by quantifying changes to air quality and human health that result from its renewable integration and transmission interconnection scenarios. Performing this analysis requires translation of the changes in projected generation from different power sector fuel sources in the AIMS III scenarios to changes in air pollutant emissions, developing what's known as an emissions inventory for each scenario and year evaluated. We then use for the first time a new global, reduced-complexity air quality model to transform the changes in emissions to changes in air pollutant concentration of the deadliest air pollutant for human health, fine particulate matter (or PM 2.5 ). The air quality model, Global InMAP, then utilizes the location of human population in ASEAN countries to calculate exposure to PM 2.5 concentration changes and translates that to estimates of excess mortality attributable to the AIMS III scenarios.

29 ENERGY PLANNING, POLICY, AND ECONOMY↗
DOE OSTI2023

Health Hazards of Exposures to Radioiodine

Iodine is a chemical element with atomic number 53. Iodine-127 is stable (non-radioactive) and commonly found in nature. Elemental iodine is a purple-colored solid at room temperature and pressure, but spontaneously sublimates (turns into vapor). Iodine is an essential element for life, and is required for proper functioning of the thyroid. Iodine is present in many foods, and is readily absorbed by the body and concentrated in the thyroid gland. A fraction of iodine ingested or inhaled is rapidly removed by the kidneys. The rest of the inhaled or ingested iodine is absorbed the by thyroid and retained for many months. Iodine has a biological half-life of approximately 120 days in health individuals. The biological half-life can be shorter in individuals with hyperthyroidism, and longer in individuals with hypothyroidism. Iodine has a number of radioactive isotopes, most of which have relatively short half-lives (days or weeks). Short half-life iodine isotopes are useful for a variety of medical applications, including imaging and cancer therapy. For example, Iodine-123 (half-life 13 hours) is commonly used for medical imaging of the thyroid, while iodine-131 (half-life 8 days) is used for suppressing thyroid function in individuals with hyperthyroidism or ablating (killing) thyroid cells to treat thyroid cancer. Iodine-125 (half-life 59 days) is produced in nuclear reactors, and has medical uses. Although iodine-125 can be used for thyroid imaging, Iodine-123 is more commonly used for that purpose because of its shorter half-life and higher-energy emissions. Iodine-125 is more commonly used for cancer treatment, and can be processed into small metal pellets (seeds) inserted directly into a tumor. Iodine-125 emits low-energy x-rays which can kill tumor cells and generally cannot escape the tumor, sparing other tissues. Medical iodine for imaging or treatment is typically administered orally in the form a pill or liquid solution. A typical adult thyroid scan using iodine-123 involves having the patient swallow between one and four 0.1 millicuries pills, with the exact dose dependent on the patient’s weight. This results in a whole-body committed effective dose of 80 – 320 mrem, and a thyroid equivalent dose of 1443 – 5772 mrem. Note that the whole-body effective dose relates to the overall cancer risk, while the larger equivalent dose to the thyroid only indicates that most of this risk is the result of exposure to the thyroid. These doses are considered safe, although the procedure is not recommended for pregnant or breastfeeding women. In contrast, the quantities of iodine-131 used for treatment of hyperthyroidism and thyroid cancers are much higher. For treatment of hyperthyroidism, 4 – 10 millicuries are administered, while for thyroid cancer the administration can range from 50 – 150 millicuries of I-131. In addition to medical exposures, large populations were exposed to radioiodine as result of the atomic bombings of Hiroshima and Nagasaki in Japan, and the Chernobyl nuclear accident. These populations have been carefully followed for many years to assess the effect of their radiation exposures on cancer risk. As a result, a great deal is known about the cancer risks associated with radioiodine exposure. Because iodine is concentrated in the thyroid, the principal risk of exposure to radioiodine is thyroid cancer. Children have the highest risk of thyroid cancer after exposure to radioactive iodine. According to a large study of Japanese atomic bomb survivors, an effective dose of one Sievert (100,000 mrem) has been observed to increase the risk of thyroid cancer by a factor of 9.5 in children aged zero to nine years old, by a factor of 3 in children aged 10 to 19 years old, and by barely detectable amounts in adults. Another way of quantifying the risk from radioiodine exposure is from risk coefficients, which provide the risk per unit intake of radionuclides in terms of both morbidity (any cancer) and mortality (death). Both morbidity (risk of cancer) and mortality (death) risks are shown in the table below. Note that because thyroid cancer is almost never fatal, the morbidity coefficients are much larger than the mortality coefficients.

61 RADIATION PROTECTION AND DOSIMETRY↗
DOE OSTI2024

Personalized, disease-stage specific, rapid identification of immunosuppression in sepsis

Introduction Data overlapping of different biological conditions prevents personalized medical decision-making. For example, when the neutrophil percentages of surviving septic patients overlap with those of non-survivors, no individualized assessment is possible. To ameliorate this problem, an immunological method was explored in the context of sepsis. Methods Blood leukocyte counts and relative percentages as well as the serum concentration of several proteins were investigated with 4072 longitudinal samples collected from 331 hospitalized patients classified as septic (n=286), non-septic (n=43), or not assigned (n=2). Two methodological approaches were evaluated: (i) a reductionist alternative, which analyzed variables in isolation; and (ii) a non-reductionist version, which examined interactions among six (leukocyte-, bacterial-, temporal-, personalized-, population-, and outcome-related) dimensions. Results The reductionist approach did not distinguish outcomes: the leukocyte and serum protein data of survivors and non-survivors overlapped. In contrast, the non-reductionist alternative differentiated several data groups, of which at least one was only composed of survivors (a finding observable since hospitalization day 1). Hence, the non-reductionist approach promoted personalized medical practices: every patient classified within a subset associated with 100% survival subset was likely to survive. The non-reductionist method also revealed five inflammatory or disease-related stages (provisionally named ‘early inflammation, early immunocompetence, intermediary immuno-suppression, late immuno-suppression, or other’). Mortality data validated these labels: both ‘suppression’ subsets revealed 100% mortality, the ‘immunocompetence’ group exhibited 100% survival, while the remaining sets reported two-digit mortality percentages. While the ‘intermediary’ suppression expressed an impaired monocyte-related function, the ‘late’ suppression displayed renal-related dysfunctions, as indicated by high concentrations of urea and creatinine. Discussion The data-driven differentiation of five data groups may foster early and non-overlapping biomedical decision-making, both upon admission and throughout their hospitalization. This approach could evaluate therapies, at personalized level, earlier. To ascertain repeatability and investigate the dynamics of the ‘other’ group, additional studies are recommended.

Immunology↗
DOE OSTI2024

Prognostic analysis of high-flow nasal cannula therapy and non-invasive ventilation in mild to moderate hypoxemia patients and construction of a machine learning model for 48-h intubation prediction—a retrospective analysis of the MIMIC database

Background This study aims to investigate the clinical outcome between high-flow nasal cannula (HFNC) and non-invasive ventilation (NIV) therapy in mild to moderate hypoxemic patients on the first ICU day and to develop a predictive model of 48-h intubation. Methods The study included adult patients from the MIMIC III and IV databases who first initiated HFNC or NIV therapy due to mild to moderate hypoxemia (100 < PaO2/FiO2 ≤ 300). The 48-h and 30-day intubation rates were compared using cross-sectional and survival analysis. Nine machine learning and six ensemble algorithms were deployed to construct the 48-h intubation predictive models, of which the optimal model was determined by its prediction accuracy. The top 10 risk and protective factors were identified using the Shapley interpretation algorithm. Result A total of 123,042 patients were screened, of which, 673 were from the MIMIC IV database for ventilation therapy comparison (HFNC n = 363, NIV n = 310) and 48-h intubation predictive model construction (training dataset n = 471, internal validation set n = 202) and 408 were from the MIMIC III database for external validation. The NIV group had a lower intubation rate (23.1% vs. 16.1%, p = 0.001), ICU 28-day mortality (18.5% vs. 11.6%, p = 0.014), and in-hospital mortality (19.6% vs. 11.9%, p = 0.007) compared to the HFNC group. Survival analysis showed that the total and 48-h intubation rates were not significantly different. The ensemble AdaBoost decision tree model (internal and external validation set AUROC 0.878, 0.726) had the best predictive accuracy performance. The model Shapley algorithm showed Sequential Organ Failure Assessment (SOFA), acute physiology scores (APSIII), the minimum and maximum lactate value as risk factors for early failure and age, the maximum PaCO 2 and PH value, Glasgow Coma Scale (GCS), the minimum PaO 2 /FiO 2 ratio, and PaO 2 value as protective factors. Conclusion NIV was associated with lower intubation rate and ICU 28-day and in-hospital mortality. Further survival analysis reinforced that the effect of NIV on the intubation rate might partly be attributed to the other impact factors. The ensemble AdaBoost decision tree model may assist clinicians in making clinical decisions, and early organ function support to improve patients’ SOFA, APSIII, GCS, PaCO 2 , PaO 2 , PH, PaO 2 /FiO 2 ratio, and lactate values can reduce the early failure rate and improve patient prognosis.

Fu, Wei↗
DOE OSTI2023

Genomic and phenotypic comparison of two variants of multidrug-resistant Salmonella enterica serovar Heidelberg isolated during the 2015–2017 multi-state outbreak in cattle

Salmonella enterica subspecies enterica serovar Heidelberg (Salmonella Heidelberg) has caused several multistate foodborne outbreaks in the United States, largely associated with the consumption of poultry. However, a 2015–2017 multidrug-resistant (MDR) Salmonella Heidelberg outbreak was linked to contact with dairy beef calves. Traceback investigations revealed calves infected with outbreak strains of Salmonella Heidelberg exhibited symptoms of disease frequently followed by death from septicemia. To investigate virulence characteristics of Salmonella Heidelberg as a pathogen in bovine, two variants with distinct pulse-field gel electrophoresis (PFGE) patterns that differed in morbidity and mortality during the multistate outbreak were genotypically and phenotypically characterized and compared. Strain SX 245 with PFGE pattern JF6X01.0523 was identified as a dominant and highly pathogenic variant causing high morbidity and mortality in affected calves, whereas strain SX 244 with PFGE pattern JF6X01.0590 was classified as a low pathogenic variant causing less morbidity and mortality. Comparison of whole-genome sequences determined that SX 245 lacked ~200 genes present in SX 244, including genes associated with the IncI1 plasmid and phages; SX 244 lacked eight genes present in SX 245 including a second YdiV Anti-FlhC(2)FlhD(4) factor, a lysin motif domain containing protein, and a pentapeptide repeat protein. RNA-sequencing revealed fimbriae-related, flagella-related, and chemotaxis genes had increased expression in SX 245 compared to SX 244. Furthermore, SX 245 displayed higher invasion of human and bovine epithelial cells than SX 244. These data suggest that the presence and up-regulation of genes involved in type 1 fimbriae production, flagellar regulation and biogenesis, and chemotaxis may play a role in the increased pathogenicity and host range expansion of the Salmonella Heidelberg isolates involved in the bovine-related outbreak.

59 BASIC BIOLOGICAL SCIENCES↗
DOE OSTI2021

Acoustic and Genetic Data Can Reduce Uncertainty Regarding Populations of Migratory Tree-Roosting Bats Impacted by Wind Energy

Wind turbine-related mortality may pose a population-level threat for migratory tree-roosting bats, such as the hoary bat (Lasiurus cinereus) in North America. These species are dispersed within their range, making it impractical to estimate census populations size using traditional survey methods. Nonetheless, understanding population size and trends is essential for evaluating and mitigating risk from wind turbine mortality. Using various sampling techniques, including systematic acoustic sampling and genetic analyses, we argue that building a weight of evidence regarding bat population status and trends is possible to (1) assess the sustainability of mortality associated with wind turbines; (2) determine the level of mitigation required; and (3) evaluate the effectiveness of mitigation measures to ensure population viability for these species. Long-term, systematic data collection remains the most viable option for reducing uncertainty regarding population trends for migratory tree-roosting bats. We recommend collecting acoustic data using the statistically robust North American Bat Monitoring Program (NABat) protocols and that genetic diversity is monitored at repeated time intervals to show species trends. There are no short-term actions to resolve these population-level questions; however, we discuss opportunities for relatively short-term investments that will lead to long-term success in reducing uncertainty.

17 WIND ENERGY↗
DOE OSTI2022

Longleaf Pine Seedlings Are Extremely Resilient to the Combined Effects of Experimental Fire and Drought

The longleaf pine ecosystem is dependent on frequent fire. Climate change is expected to influence moisture availability and it is unclear how drought conditions may interact with prescribed fire to influence management objectives associated with maintaining longleaf pine ecosystems. This study aimed to understand the impacts of drought, fire intensity and their interaction on P. palustris grass-stage seedlings. We used droughted and well-watered P. palustris seedlings burned at two different fire intensity levels at an indoor combustion facility. Needle fuel moisture content of burned seedlings was not different between droughted and well-watered groups. Mortality and resprouting only occurred at fire intensity levels exceeding 3.5 MJ m−2 in combination with drought that resulted in predawn water potentials more negative than −1.7 MPa. Our observations of minimal mortality after exposing P. palustris seedlings to a range of fire intensities in a burn lab contrast the higher mortality observed in field studies for the species. Compared to seedlings and saplings of Western US Pinus species, this study demonstrates that P. palustris is considerably more resistant to the combined effects of high surface fire intensity and drought.

59 BASIC BIOLOGICAL SCIENCES↗
DOE OSTI2024

Experimental trials of species-specific bat flight responses to an ultrasonic deterrent

Unintended consequences of increasing wind energy production include bat mortalities from wind turbine blade strikes. Ultrasonic deterrents (UDs) have been developed to reduce bat mortalities at wind turbines. Our goal was to experimentally assess the species-specific effectiveness of three emission treatments from the UD developed by NRG Systems. We conducted trials in a flight cage measuring approximately 60 m × 10 m × 4.4 m (length × width × height) from July 2020 to May 2021 in San Marcos, Texas, USA. A single UD was placed at either end of the flight cage, and we randomly selected one for each night of field trials. Trials focused on a red bat species group (Lasiurus borealis and Lasiurus blossevillii; n = 46) and four species: cave myotis (Myotis velifer; n = 57), Brazilian free-tailed bats (Tadarida brasiliensis; n = 73), evening bats (Nycteceius humeralis; n = 53), and tricolored bats (Perimyotis subflavus; n = 17). The trials occurred during three treatment emissions: low (emissions from subarrays at 20, 26, and 32 kHz), high (emissions from subarrays at 38, 44, and 50 kHz), and combined (all six emission frequencies). We placed one wild-captured bat into the flight cage for each trial, which consisted of an acclimation period, a control period with the UD powered off, and the three emission treatments (order randomly selected), each interspersed with a control period. We tracked bat flight using four thermal cameras placed outside the flight cage. We quantified the effectiveness of each treatment by comparing the distances each bat flew from the UD during each treatment vs. the control period using quantile regression. Additionally, we conducted an exploratory analysis of differences between sex and season and sex within season using analysis of variance. Broadly, UDs were effective at altering the bats’ flight paths as they flew farther from the UD during treatments than during controls; however, results varied by species, sex, season, and sex within season. For the red bat group, bats flew farther from the UD during all treatments than during the control period at all percentiles (p < 0.001), and treatments were comparable in effectiveness. For cave myotis, all percentile distances were farther from the UD during each of the treatments than during the control, except the 90th percentile distance during high, and low was most effective. For evening bats and Brazilian free-tailed bats, results were inconsistent, but high and low were most effective, respectively. For tricolored bats, combined and low were significant at the 10th–75th percentiles, high was significant at all percentiles, and combined was most effective. Results suggest UDs may be an effective means of reducing bat mortalities due to wind turbine blade strikes. We recommend that continued research on UDs focus on low emission treatments, which have decreased sound attenuation and demonstrated effectiveness across the bat species evaluated in this study.

17 WIND ENERGY↗