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An Independent Analysis of the Spitzer/IRAC Phase Curves of WASP43 b

We present here a reanalysis of the Spitzer Space Telescope phase curves of the hot Jupiter WASP43 b, using the wavelet pixel-independent component analysis, a blind signal-source separation method. The data analyzed were recorded with the Infrared Array Camera and consisted of two visits at 3.6 μm, and one visit at 4.5 μm, each visit covering one transit and two eclipse events. To test the robustness of our technique we repeated the analysis on smaller portions of the phase curves, and by employing different instrument ramp models. Our reanalysis presents significant updates of the planetary parameters compared to those reported in the original phase curve study of WASP43 b. In particular, we found (1) higher nightside temperatures, (2) smaller hotspot offsets, (3) a greater consistency (∼1σ) between the two 3.6 μm visits, and (4) a greater similarity with the predictions of the atmospheric circulation models. Our parameter results are consistent within 1σ with those reported by a recent reanalysis of the same data sets. For each visit we studied the variation of the retrieved transit parameters as a function of various sets of stellar limb-darkening coefficients, finding significant degeneracy between the limb-darkening models and the analysis output. Furthermore, we performed the analysis of the single transit and eclipse events, and we examined the differences between these results with the ones obtained with the whole phase curve. Finally we provide a formula useful to optimize the trade-off between precision and duration of observations of transiting exoplanets.

79 ASTRONOMY AND ASTROPHYSICS↗

Identifying Sociomarkers of Pediatric Asthma Patients at Risk of Hospital Revisiting

ObjectiveAsthma is one of the most common chronic childhood diseases in the United States [2, 3]. In addition to its pervasiveness, pediatric asthma shows high sensitivity to the environment. Combining medical-social dataset with machine learning methods we demonstrate how socio-markers play an important role in identifying patients at risk of hospital revisits due to pediatric asthma within a year.IntroductionA socio-marker is a measurable indicator of social conditions where a patient is embedded in and exposed to, being analogous with a biomarker indicating the severity or presence of some disease state. Social factors are one of the most clinical health determinants [1], which play a critical role in explaining health outcomes. Socio-markers can help medical practitioners and researchers to reliably identify high-risk individuals in a timely manner.MethodsWe collected data from three different sources: pediatric asthma encounter records from Jan 1st, 2016 to Dec 31st, 2016 at a children’s hospital, the 2010 U.S census data and neighborhood quality survey data by Memphis Property Hub. After merging these datasets we examine the effect of social features in identifying the patients who visited the hospital more than once during the observation period. We only use the first time visit (3,678 cases) to avoid over-counting of the same patients. In addition to demographic features (age, gender, insurance type, and race (African American and White)), we incorporate the social features such as the proportion of individuals living below the federal poverty level, blight prevalence, neighborhood quality, neighborhood quality inequality, trash dumping presence, the broken window pervasiveness within the zip code area of patients’ residence are included.We then implemented a Support Vector Machine (SVM) based classification model using abovementioned 11 social features. The classification outcome is either patient visits the hospital only one-time (class 0) or revisits the hospital within a year (class 1). Among 3,678 unique patients in the dataset, only 823 pediatric patients revisited hospital with asthma. So, to overcome the class imbalance issue, we have used 823 patients’ data (randomly selected in 1,000 iterations) from each class. Further, to avoid overfitting and ensure generalizability, we divided the dataset as training, test, and validation with a proportion of 60%, 20%, and 20%, respectively. The reported test (5-folds cross-validation using training and testing data) and validation accuracy of the SVM method are averaged over 1,000 iterations to avoid sampling error and bias.ResultsThe proposed socio-marker model resulted in an average classification accuracy of 63.70% for the test set and 63.67 % for the validation set. Further, the average specificity (the total true negative cases divided by the sum of true negative and false positive) and sensitivity (the total number of true positive cases divided by the sum of positive predicted cases) is found to be 62.79% and 64.77%, respectively for the test set and 62.79% and 64.83%, respectively for the validation set. Results of this study suggest that socio-marker features that are not directly related to a patient’s medical conditions can still predict whether the patient will come back to the hospital within a year or not with approximately 64% accuracy.ConclusionsBringing the socio-marker features in the surveillance system may ease the burden of detecting the patients at risk of revisiting the hospital. The results should be interpreted with caution because we only used 12-month period of observation and the visit beyond the observation window is not considered. Also the patients may have visited different hospitals which are not captured in the data.References1. Booske BC, Athens JK, Kindig DA, Park H, Remington PL: Different perspectives for assigning weights to determinants of health. University of Wisconsin: Population Health Institute 2010.2. Subbarao P, Mandhane PJ, Sears MR: Asthma: epidemiology, etiology and risk factors. Canadian Medical Association Journal 2009, 181(9):E181-E190.3. Gold DR, Wright R: Population disparities in asthma. Annu Rev Public Health 2005, 26:89-113.

Shin, Eun Kyong↗

HST/STIS Observations of Ganymede's Auroral Ovals at Eastern Elongation

We report on new Space Telescope Imaging Spectrograph (STIS) observations of Ganymede s auroral emissions obtained (to be obtained) during two visits with the Hubble Space Telescope (HST). The observations of the first visit, a five orbits, were obtained on November 19, 2010 and the second visit, also a five orbits, is scheduled for opposition in October/November 2011. We will present results of the full campaign, in case of a successful execution of the second visit. Our observations cover more than half a cycle of system III longitudes of Ganymede s positions within Jupiter s magnetosphere for each visit. We analyze the observations with respect to brightness and locations of Ganymede auroral ovals. Our goal is to set constrains on the interaction of Ganymede s mini-magnetosphere with Jupiter s magnetosphere, Ganymede s magnetic field and plasma environment, and if possible on Ganymede s neutral atmosphere.

Saur, J.↗

Design of Spacecraft Missions to Remove Multiple Orbital Debris Objects

The amount of hazardous debris in Earth orbit has been increasing, posing an evergreater danger to space assets and human missions. In January of 2007, a Chinese ASAT test produced approximately 2600 pieces of orbital debris. In February of 2009, Iridium 33 collided with an inactive Russian satellite, yielding approximately 1300 pieces of debris. These recent disastrous events and the sheer size of the Earth orbiting population make clear the necessity of removing orbital debris. In fact, experts from both NASA and ESA have stated that 10 to 20 pieces of orbital debris need to be removed per year to stabilize the orbital debris environment. However, no spacecraft trajectories have yet been designed for removing multiple debris objects and the size of the debris population makes the design of such trajectories a daunting task. Designing an efficient spacecraft trajectory to rendezvous with each of a large number of orbital debris pieces is akin to the famous Traveling Salesman problem, an NP-complete combinatorial optimization problem in which a number of cities are to be visited in turn. The goal is to choose the order in which the cities are visited so as to minimize the total path distance traveled. In the case of orbital debris, the pieces of debris to be visited must be selected and ordered such that spacecraft propellant consumption is minimized or at least kept low enough to be feasible. Emergent Space Technologies, Inc. has developed specialized algorithms for designing efficient tour missions for near-Earth asteroids that may be applied to the design of efficient spacecraft missions capable of visiting large numbers of orbital debris pieces. The first step is to identify a list of high priority debris targets using the Analytical Graphics, Inc. SOCRATES website and then obtain their state information from Celestrak. The tour trajectory design algorithms will then be used to determine the itinerary of objects and v requirements. These results will shed light on how many debris pieces can be visited for various amounts of propellant, which launch vehicles can accommodate such missions, and how much margin is available for debris removal system payloads.

Barbee, Brent W.↗

Expanding the Operational Use of Total Lightning Ahead of GOES-R

NASA's Short‐term Prediction Research and Transition Center (SPoRT) has been transitioning real‐time total lightning observations from ground‐based lightning mapping arrays since 2003. This initial effort was with the local Weather Forecast Offices (WFO) that could use the North Alabama Lightning Mapping Array (NALMA). These early collaborations established a strong interest in the use of total lightning for WFO operations. In particular the focus started with warning decision support, but has since expanded to include impact‐based decision support and lightning safety. SPoRT has used its experience to establish connections with new lightning mapping arrays as they become available. The GOES‐R / JPSS Visiting Scientist Program has enabled SPoRT to conduct visits to new partners and expand the number of operational users with access to total lightning observations. In early 2014, SPoRT conducted the most recent visiting scientist trips to meet with forecast offices that will used the Colorado, Houston, and Langmuir Lab (New Mexico) lightning mapping arrays. In addition, SPoRT met with the corresponding Center Weather Service Units (CWSUs) to expand collaborations with the aviation community. These visits were an opportunity to learn about the forecast needs of each office visited as well as to provide on‐site training for the use of total lightning, setting the stage for a real‐time assessment during May‐July 2014. With five lightning mapping arrays covering multiple geographic locations, the 2014 assessment has demonstrated numerous uses of total lightning in varying situations. Several highlights include a much broader use of total lightning for impact‐based decision support ranging from airport weather warnings, supporting fire crews, and protecting large outdoor events. The inclusion of the CWSUs has broadened the operational scope of total lightning, demonstrating how these data can support air traffic management, particularly in the Terminal Radar Approach Control Facilities (TRACON) region around an airport. These collaborations continue to demonstrate, from the operational perspective, the utility of total lightning and the importance of continued training and preparation in advance of the Geostationary Lightning Mapper.

GLM↗

Preliminary Evaluation of Removing Used Nuclear Fuel from Shutdown Sites

In this paper, a preliminary evaluation of removing used nuclear fuel (UNF) from 12 shutdown sites was conducted. Shutdown sites are defined as those commercial nuclear power reactor sites where the nuclear power reactors have been shut down and the site has been decommissioned or is undergoing decommissioning. The shutdown sites were Maine Yankee, Yankee Rowe, Connecticut Yankee, Humboldt Bay, Big Rock Point, Rancho Seco, Trojan, La Crosse, Zion, Crystal River, Kewaunee, and San Onofre. The evaluation was divided into four components: • characterization of the UNF and greater-than-Class C low-level radioactive waste (GTCC waste) inventory • a description of the on-site infrastructure and conditions relevant to transportation activities • an evaluation of the near-site transportation infrastructure and experience relevant to shipping transportation casks containing UNF from the shutdown sites, including gaps in information • an evaluation of the actions necessary to prepare for and remove UNF and GTCC waste from the shutdown sites. The primary sources for the inventory of UNF and GTCC waste are the DOE RW-859 used nuclear fuel inventory database, industry sources such as StoreFUEL and SpentFUEL, and government sources such as the NRC. The primary sources for the information on the site conditions and near-site transportation infrastructure and experience include site visits to the Maine Yankee, Yankee Rowe, Connecticut Yankee, Humboldt Bay, Big Rock Point, Rancho Seco, Trojan, La Crosse, and Zion sites; information provided by managers at the shutdown sites; Facility Interface Data Sheets compiled for DOE in 2005; Services Planning Documents prepared for DOE in 1993 and 1994; industry publications such as Radwaste Solutions; and Google Earth. State and Regional Group representatives, a Tribal representative, and a Federal Railroad Administration representative participated in six of the shutdown site visits. All sites were found to have at least one off-site transportation mode option for removing their UNF and GTCC waste, and some sites have two options. Large component removals during reactor decommissioning provided an important source of information in determining transportation mode options. Especially important in conducting the evaluation were site visits, through which information was obtained that would not have been available otherwise. Extensive photographs taken during the site visits proved to be particularly useful in documenting the current conditions at or near the sites. Additional conclusions from this evaluation include: • Although there are common aspects, each site has some unique features and/or conditions. • The 12 sites use designs from 4 different suppliers, including 9 different (horizontal and vertical) storage systems that would require 8 different transportation cask designs. • Although some regulatory actions will be required, all UNF at the initial 9 shutdown sites (Maine Yankee, Yankee Rowe, Connecticut Yankee, Humboldt Bay, Big Rock Point, Rancho Seco, Trojan, La Crosse, and Zion) is in licensed systems that can be transported, including a small amount of high-burnup fuel. • Each site indicated that 2-3 years of advanced time is required for preparations prior to pick-up. • Most sites have multiple transportation options, e.g., rail, barge, or heavy haul truck, as well as constraints and preferences. It is expected that additional site visits will be conducted to update the information used in the evaluation. Additional sites may be added to the evaluation if further site closures are announced.

shutdown sites, used nuclear fuel, NFST, Nuclear F↗

Decommissioning, Dismantling and Disarming: a Unique Information Showroom Inside the G2 Reactor at Marcoule Centre (France) - 12068

The paper aims at presenting the new information showroom called 'Escom G2' (for 'Espace Communication') inaugurated by the French Atomic Energy and Alternative Energies Commission (CEA) in spring 2011. This showroom is settled directly inside the main building of the G2 nuclear reactor: a facility formerly dedicated to weapon-grade plutonium production since the late 1950's at the Marcoule nuclear centre, in south of France. After its shutdown, and reprocessing of the last spent fuels, a first dismantling step was successfully completed from 1986 to 1996. Unique in France and in Europe, Escom G2 is focused on France dismantling expertise and its action for disarmament. This showroom comprises of a 300-square meters permanent exhibition, organized around four themes: France strategy for disarmament, decommissioning and dismantling technical aspects, uranium and plutonium production cycles. Each of these topics is illustrated with posters, photos, models and technical pieces from the dismantled plants. It is now used to present France's action in disarmament to highly ranked audiences such as: state representatives, diplomats, journalists... The paper explains the background story of this original project. As a matter of fact, in 1996 France was the first nuclear state to decide to shut down and dismantle its fissile material production facilities for nuclear weapons. First, the paper presents the history of the G2 reactor in the early ages of Marcoule site, its operating highlights as well as its main dismantling operations, are presented. In Marcoule, where the three industrial-scale reactors G1, G2 and G3 used to be operated for plutonium production (to be then reprocessed in the nearby UP1 plant), the initial dismantling phase has now been completed (in 1980's for G1 and in 1996 for G2 and G3). The second phase, aimed at completely dismantling these three reactors, will restart in 2020, and is directly linked to the opening of a future national storage facility for irradiated graphite waste. Then, the paper recalls communication events and official visits hosted in Pierrelatte and Marcoule, following a formal invitation from the French President Mr. Nicolas Sarkozy. These visits, which were organized in order to illustrate the irreversibility of these dismantling operations, allowed visitors to discovers places that used to be former highly classified areas. Three official visits were organized in 2008 and 2009 for representatives of the Conference on Disarmament Member States, non-governmental experts and journalists. All participants visited the dismantled uranium enrichment plant in Pierrelatte, the G2 reactor and the UP1 plant in Marcoule. The visits were successful and visitors were especially impressed by the G2 reactor and its massive industrial architecture, symbolic of the early ages of nuclear history. In late 2010, this feedback convinced CEA Military Application Directorate (CEA DAM) that a permanent showroom could be installed inside the reactor, making it possible to preserve the cultural value of this historical landmark, and to continue its ongoing effort of communication and outreach. The paper explains the design of this concept: the museography project with a professional designer, the communication material conception and the features of such an original place. (authors)

12 MANAGEMENT OF RADIOACTIVE AND NON-RADIOACTIVE W↗

Human Mobility to Parks Under the COVID-19 Pandemic and Wildfire Seasons in the Western and Central United States

In 2020, people's health suffered a great crisis under the dual effects of the COVID-19 pandemic and the extensive, severe wildfires in the western and central United States. Parks, including city, national, and cultural parks, offer a unique opportunity for people to maintain their recreation behaviors following the social distancing protocols during the pandemic. However, massive forest wildfires in western and central US, producing harmful toxic gases and smoke, pose significant threats to human health and affect their recreation behaviors and mobility to parks. In this study, we employed the geographically and temporally weighted regression (GTWR) Models to investigate how COVID-19 and wildfires jointly shaped human mobility to parks, regarding the number of visits per capita, dwell time, and travel distance to parks, during June - September 2020. We detected strong correlations between visitations and COVID-19 incidence in southern Montana, western Wyoming, Colorado, and Utah before August. However, the pattern was weakened over time, indicating the decreasing trend of the degree of concern regarding the pandemic. Moreover, more park visits and lower dwell time were found in parks further away from wildfires and less air pollution in Washington, Oregon, California, Colorado, and New Mexico, during the wildfire season, suggesting the potential avoidance of wildfires when visiting parks. This study provides important insights on people's responses in recreation and social behaviors when facing multiple severe crises that impact their health and wellbeing, which could support the preparation and mitigation of the health impacts from future pandemics and natural hazards.

54 ENVIRONMENTAL SCIENCES↗

Association Between Anticholinergic Medication Use and Cognition, Brain Metabolism, and Brain Atrophy in Cognitively Normal Older Adults

Importance of this Paper: The use of anticholinergic (AC) medication is linked to cognitive impairment and an increased risk of dementia. To our knowledge, this is the first study to investigate the association between AC medication use and neuroimaging biomarkers of brain metabolism and atrophy as a proxy for understanding the underlying biology of the clinical effects of AC medications. Objective: To assess the association between AC medication use and cognition, glucose metabolism, and brain atrophy in cognitively normal older adults from the Alzheimer’s Disease Neuroimaging Initiative (ADNI) and the Indiana Memory and Aging Study (IMAS). Design, Setting, and Participants: The ADNI and IMAS are longitudinal studies with cognitive, neuroimaging, and other data collected at regular intervals in clinical and academic research settings. For the participants in the ADNI, visits are repeated 3, 6, and 12 months after the baseline visit and then annually. For the participants in the IMAS, visits are repeated every 18 months after the baseline visit (402 cognitively normal older adults in the ADNI and 49 cognitively normal older adults in the IMAS were included in the present analysis). Participants were either taking (hereafter referred to as the AC + participants [52 from the ADNI and 8 from the IMAS]) or not taking (hereafter referred to as the AC - participants [350 from the ADNI and 41 from the IMAS]) at least 1 medication with medium or high AC activity. Data analysis for this study was performed in November 2015. Main Outcomes and Measures: Cognitive scores, mean fludeoxyglucose F 18 standardized uptake value ratio (participants from the ADNI only), and brain atrophy measures from structural magnetic resonance imaging were compared between AC + participants and AC - participants after adjusting for potential confounders. The total AC burden score was calculated and was related to target measures. The association of AC use and longitudinal clinical decline (mean [SD] follow-up period, 32.1 [24.7] months [range, 6-108 months]) was examined using Cox regression. Results: The 52 AC + participants (mean [SD] age, 73.3 [6.6] years) from the ADNI showed lower mean scores on Weschler Memory Scale–Revised Logical Memory Immediate Recall (raw mean scores: 13.27 for AC + participants and 14.16 for AC - participants; P = .04) and the Trail Making Test Part B (raw mean scores: 97.85 seconds for AC + participants and 82.61 seconds for AC - participants; P = .04) and a lower executive function composite score (raw mean scores: 0.58 for AC + participants and 0.78 for AC - participants; P = .04) than the 350 AC - participants (mean [SD] age, 73.3 [5.8] years) from the ADNI. Reduced total cortical volume and temporal lobe cortical thickness and greater lateral ventricle and inferior lateral ventricle volumes were seen in the AC + participants relative to the AC - participants. Conclusions and Relevance of this Paper: The use of AC medication was associated with increased brain atrophy and dysfunction and clinical decline. Thus and finally, use of AC medication among older adults should likely be discouraged if alternative therapies are available.

60 APPLIED LIFE SCIENCES↗

Endovascular Extra-Anatomic Femoro-Popliteal Bypass for Limb Salvage in Chronic Critical Limb Ischemia

Purpose: To report the initial clinical experience with fully endovascular extra-anatomic femoro-popliteal bypass (FPB) for limb salvage in patients with critical limb ischemia (CLI) and no traditional endovascular or surgical revascularization options. Methods: Between June 2013 and May 2018, endovascular procedure was proposed for limb salvage during multidisciplinary team meeting in fifteen hospitalized patients (median age 67 years; 73% men) with CLI and a high risk of major amputation. Primary outcome was amputation-free survival at 1 year. Secondary outcomes included mortality, cardiovascular (CV) events and major limb amputation at 1 year, primary/secondary bypass patency and wound healing at the last follow-up visit. Procedure-related complications (deaths, CV events, hemorrhages) were recorded through 30 days. Results: Technical procedure success rate was 100%. Major peri-procedural outcomes occurred in two patients (13%): One patient died secondary to cardiogenic shock; one patient suffered acute coronary syndrome associated with iliopsoas bleeding. No major amputation occurred through 30 days. Median follow-up period was 21.5 (18.25–45.5) months (last follow-up visits on April 2019). Amputation-free survival at 1-year and at the last follow-up visit was 80% and 53%, respectively. Cumulative mortality at 1-year and at the last follow-up visit was 13% and 33%, respectively. Primary and secondary bypass patency was 27% and 60%, respectively. Complete wound healing was achieved in 11 patients (73%). Conclusion: Endovascular extra-anatomic FPB represents an innovative approach for limb salvage in CLI with no traditional endovascular or surgical revascularization options. Our clinical experience highlights that this technique remains challenging because of frequent comorbidities and fragility of this patient population. Level of Evidence: Level 4, Case series.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

Evaluating the decisions of glioma patients regarding clinical trial participation: a retrospective single provider review

Clinical trial accrual is vital to advancing care. A single study elucidated demographic data correlating with glioma patients’ clinical trial enrollment. However, it did not investigate the underlying decision-making process for non-participation. In this study, we seek to understand this key aspect of patient accrual. All notes for glioma patients seen by a single neuro-oncologist from July 2010 to May 2017 were examined for mention of clinical trial offerings. When a trial was declined, the patient’s reasoning was recorded along with the following: diagnosis, KPS, extent of resection, age, gender, race, marital status, income group, religion, trial offered at initial visit versus subsequent, and distance from trial site. Of 279 consecutive glioma patients, 88 were eligible for and offered a clinical trial. Fifty-seven accepted (65%), and 31 (35%) declined participation (Fig. 1). Of those offered a clinical trial, patients with glioblastoma (GBM) were significantly more likely to accept (44 out of 57 (77%) vs. 13 out of 57 (23%), p =0.03). After we adjusted for gender and travel distance, GBM was the only significant predictor of clinical trial acceptance, with an odds ratio of 3.18 (95% CI 1.17, 8.61, p =0.02). Reasons cited for non-participation included: travel distance (39%), lack of interest (39%), visit frequency (16%), and fear of randomization (6%). This study clarified for the first time individual glioma patient rationale for non-participation and potential areas for improving enrollment. Allowing off-site treatment centers or telemedicine visits may entice rural patients to participate. Visit frequency should be carefully considered and minimized whenever possible. Further prospective study of rationale for non-participation may improve enrollment over time.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

Fat Composition Changes in Bone Marrow During Chemotherapy and Radiation Therapy

Purpose: To quantify changes in bone marrow fat fraction and determine associations with peripheral blood cell counts. Methods and Materials: In this prospective study, 19 patients received either highly myelotoxic treatment (radiation therapy plus cisplatin, 5-fluorouracil mitomycin C [FU/MMC], or cisplatin/5-FU/cetuximab) or less myelotoxic treatment (capecitabine-radiation therapy or no concurrent chemotherapy). Patients underwent MR imaging and venipuncture at baseline, midtreatment, and posttreatment visits. We performed mixed effects modeling of the mean proton density fat fraction (PDFF[%]) by linear time, treatment, and vertebral column region (lumbar [L]4-sacral [S]2 vs thoracic [T]10-L3 vs cervical[C]3-T9), while controlling for cumulative mean dose and other confounders. Spearman rank correlations were performed by white blood cell (WBC) counts versus the differences in PDFF(%) before and after treatment. Results: Cumulative mean dose was associated with a 0.43% per Gy (P=.004) increase in PDFF(%). In the highly myelotoxic group, we observed significant changes in PDFF(%) per visit within L4-S2 (10.1%, P<.001) and within T10-L3 (3.93%, P=.01), relative to the reference C3-T9. In the less myelotoxic group, we did not observe significant changes in PDFF(%) per visit according to region. Within L4-S2, we observed a significant difference between treatment groups in the change in PDFF(%) per visit (5.36%, P=.04). Rank correlations of the inverse log differences in WBC versus the differences in PDFF(%) overall and within T10-S2 ranged from 0.69 to 0.78 (P<.05). Rank correlations of the inverse log differences in absolute neutrophil counts versus the differences in PDFF(%) overall and within L4-S2 ranged from 0.79 to 0.81 (P<.05). Conclusions: Magnetic resonance imaging fat quantification is sensitive to marrow composition changes that result from chemoradiation therapy. These changes are associated with peripheral blood cell counts. This study supports a rationale for bone marrow-sparing treatment planning to reduce the risk of hematologic toxicity.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

Variations in Medicare Reimbursement in Radiation Oncology: An Analysis of the Medicare Provider Utilization and Payment Data Set

Purpose: The purposes of this study were to summarize recently published data on Medicare reimbursement to individual radiation oncologists and to identify the causes of variation in Medicare reimbursement in radiation oncology. Methods and Materials: The Medicare Provider Utilization and Payment Data: Physician and Other Supplier Public Use File (POSPUF), which details nearly all services provided by radiation oncologists in 2012, was used for this study. The data were filtered and analyzed by physician and by billing code. Statistical analysis was performed to identify differences in reimbursements based on sex, rurality, billing of technical services, or location in a certificate of need (CON) state. Results: There were 4135 radiation oncologists who received a total of $1,499,625,803 in payments from Medicare in 2012. Seventy-five percent of radiation oncologists were male. The median reimbursement was $146,453. The code with the highest total reimbursement was 77418 (radiation treatment delivery intensity modulated radiation therapy [IMRT]). The most commonly billed evaluation and management (E/M) code for new visits was 99205 (49%). The most commonly billed E/M code for established visits was 99213 (54%). Forty percent of providers billed none of their new office visits using 99205 (the highest E/M billing code), whereas 34% of providers billed all of their new office visits using 99205. For the 1510 radiation oncologists (37%) who billed technical services, median Medicare reimbursement was $606,008, compared with $93,921 for all other radiation oncologists (P<.001). On multivariate analysis, technical services billing (P<.001), male sex (P<.001), and rural location (P=.007) were predictive of higher Medicare reimbursement. Conclusions: The billing of technical services, with their high capital and labor overhead requirements, limits any comparison in reimbursement between individual radiation oncologists or between radiation oncologists and other specialists. Male sex and rural practice location are independent predictors of higher total Medicare reimbursements.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

Feasibility of Patient Reporting of Symptomatic Adverse Events via the Patient-Reported Outcomes Version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE) in a Chemoradiotherapy Cooperative Group Multicenter Clinical Trial

Purpose: To assess the feasibility of measuring symptomatic adverse events (AEs) in a multicenter clinical trial using the National Cancer Institute's Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE). Methods and Materials: Patients enrolled in NRG Oncology's RTOG 1012 (Prophylactic Manuka Honey for Reduction of Chemoradiation Induced Esophagitis-Related Pain during Treatment of Lung Cancer) were asked to self-report 53 PRO-CTCAE items representing 30 symptomatic AEs at 6 time points (baseline; weekly ×4 during treatment; 12 weeks after treatment). Reporting was conducted via wireless tablet computers in clinic waiting areas. Compliance was defined as the proportion of visits when an expected PRO-CTCAE assessment was completed. Results: Among 226 study sites participating in RTOG 1012, 100% completed 35-minute PRO-CTCAE training for clinical research associates (CRAs); 80 sites enrolled patients, of which 34 (43%) required tablet computers to be provided. All 152 patients in RTOG 1012 agreed to self-report using the PRO-CTCAE (median age 66 years; 47% female; 84% white). Median time for CRAs to learn the system was 60 minutes (range, 30-240 minutes), and median time for CRAs to teach a patient to self-report was 10 minutes (range, 2-60 minutes). Compliance was high, particularly during active treatment, when patients self-reported at 86% of expected time points, although compliance was lower after treatment (72%). Common reasons for noncompliance were institutional errors, such as forgetting to provide computers to participants; patients missing clinic visits; Internet connectivity; and patients feeling “too sick.” Conclusions: Most patients enrolled in a multicenter chemoradiotherapy trial were willing and able to self-report symptomatic AEs at visits using tablet computers. Minimal effort was required by local site staff to support this system. The observed causes of missing data may be obviated by allowing patients to self-report electronically between visits, and by using central compliance monitoring. These approaches are being incorporated into ongoing studies.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

Prescribed fires, smoke exposure, and hospital utilization among heart failure patients

Abstract Background Prescribed fires often have ecological benefits, but their environmental health risks have been infrequently studied. We investigated associations between residing near a prescribed fire, wildfire smoke exposure, and heart failure (HF) patients’ hospital utilization. Methods We used electronic health records from January 2014 to December 2016 in a North Carolina hospital-based cohort to determine HF diagnoses, primary residence, and hospital utilization. Using a cross-sectional study design, we associated the prescribed fire occurrences within 1, 2, and 5 km of the patients’ primary residence with the number of hospital visits and 7- and 30-day readmissions. To compare prescribed fire associations with those observed for wildfire smoke, we also associated zip code-level smoke density data designed to capture wildfire smoke emissions with hospital utilization amongst HF patients. Quasi-Poisson regression models were used for the number of hospital visits, while zero-inflated Poisson regression models were used for readmissions. All models were adjusted for age, sex, race, and neighborhood socioeconomic status and included an offset for follow-up time. The results are the percent change and the 95% confidence interval (CI). Results Associations between prescribed fire occurrences and hospital visits were generally null, with the few associations observed being with prescribed fires within 5 and 2 km of the primary residence in the negative direction but not the more restrictive 1 km radius. However, exposure to medium or heavy smoke (primarily from wildfires) at the zip code level was associated with both 7-day (8.5% increase; 95% CI = 1.5%, 16.0%) and 30-day readmissions (5.4%; 95% CI = 2.3%, 8.5%), and to a lesser degree, hospital visits (1.5%; 95% CI: 0.0%, 3.0%) matching previous studies. Conclusions Area-level smoke exposure driven by wildfires is positively associated with hospital utilization but not proximity to prescribed fires.

Raab, Henry↗

The La Mesa Fire: Studies and Observations from 1975 through 2012

In 1996, Swetnam and Baisan stated the following: “The 1977 La Mesa burn was a wake-up call to perhaps the most pressing forest health problem in Southwestern forests—historically anomalous, catastrophic wildfire in the ponderosa pine—created by many decades of fire exclusion.” However, the wake-up call was only momentary and was forgotten until the Dome Fire (1996), Oso Complex Fire (1998), and Cerro Grande Fire (2000) burned lands within the community of Los Alamos, Los Alamos National Laboratory (LANL), Bandelier National Monument (BNM), and Santa Fe National Forest (SFNF). After the Dome Fire, several initiatives were under way to understand the wildland-urban interface and the conditions that have brought the forests of the Pajarito Plateau dangerously close to multiple, large, and intense wildfires. After the Dome Fire, the Interagency Wildfire Management Team was formed, bringing together adjoining agencies to deal with the ever-increasing threat of conflagration that could result in loss of property and human life. This study is about the history before and after the La Mesa Fire—at the time, the first large wildfire on the Pajarito Plateau in over 80 years. It represents 37 years of research and observations that began when management of fire on the Pajarito Plateau was first being explored by BNM. It documents changes in vegetation composition since June 1977 and shows the progression of change in understanding fire’s essential place in the ecosystems of the Pajarito Plateau. The study began in 1975 and 1976, when Loren Potter and I examined previously burned areas to determine a fire frequency for the east Jemez Mountains. We had examined areas of 10 acres or more that had burned at various times, e.g., 1939, 1945, 1950, 1955, 1960, and 1976. A year and a half into the study, the La Mesa Fire ignited on Mesa del Rito, ultimately burning about 15,000 acres of BNM, SFNF, and LANL, including our established plots. After the fire, we set up 20- by 50-meter permanent plots along four ornithological transects established by ornithologist Roland Wauer. Wauer’s transects were mostly in ponderosa pine, with one in mixed conifer and one in the piñon-juniper woodland. Plots within the ponderosa pine were visited in 1977, 1978, 1985, 1992, 1998, 1999, 2010, 2011 and 2012. We mapped the standing trees, photographed each plot, and collected data on the understory components. Transects in the mixed conifer were visited in 1977, 1992, 1999, 2010 and 2012. Plots in the piñon-juniper were visited in 1977, 1999, and 2010 for taking photographs and data years after the fire. Additionally, plots were established in LANL Technical Area 49 as a control to post-fire seeding. We visited these plots in 1977, 1992, and 1998. Ironically, this study ends with another large fire burning over the plots we have followed all these years. In June 2011, the Las Conchas Fire became the largest fire in New Mexico’s history to that time and burned most of the area of the La Mesa Fire and the plots studied over the years. In this report, we summarize information about the vegetation changes within the boundaries of the La Mesa Fire. Thirty-seven years of observations and studies have provided long-term data related to regeneration of trees, water relations of grasses and pines, the influence of seeding with non-native grasses, pyrodendrochronology, and plant succession as related to fire.

54 ENVIRONMENTAL SCIENCES↗

Development of Automated Software Program for the Analysis of Alzheimer's Disease Scans: Evaluation of PET imaging with PBR-111 in HV and AD subjects

Study goal: A Phase 1 evaluation of the kinetics, clearance and cerebral distribution of one novel peripheral benzodiazepine receptors(PBR)positron emission tomography (PET) imaging agent, 18F-PBR-111 following intravenous administration in healthy volunteers and Alzheimer's disease (AD) patients. Short title: Evaluation of PET imaging with PBR-111 in HV and AD subjects Proof of Mechanism. Primary Objective: To evaluate the cerebral distribution of PBR-111 positron emission tomography (PET) for detection/exclusion of microglial activation in patients with Alzheimer's disease subjects compared to healthy volunteers. Secondary objectives: - To assess the dynamic uptake and washout of [18F]PBR-111, a potential imaging bio-marker for inflammatory changes in brain, using positron emission tomography in subjects with Alzheimer's disease (AD) and healthy volunteers (HV). - To perform blood metabolite characterization of [18F]PBR-111 in subjects with AD and HV to determine the nature of metabolites in assessment of [18F]-PBR-111 as a PET brain imaging agent. Name of radioactive drug substance: PBR-111 Dose(s): The applied PBR-111 radioactive dose will be up to 5.0 mCi, diluted in a maximum of 10 ml of saline. The radioligand will be administered as a slow intravenous bolus injection (i.e., 6 sec/ml) into a large vein (e.g., antecubital vein). Route of administration: Intravenous injection Duration of treatment: Single administration of a diagnostic agent Indication: PBR-111 positron emission tomography (PET) imaging has the potential to detect microglial activation. In the presence of PBR-111 uptake (representative of microglial activation), inflammation in the brain can be detected. Diagnosis and main criteria for inclusion: Study participants will be HVs and patients diagnosed with probable AD. HVs must be 18 years of age (at least four subjects 50 years of age) and have no evidence of cognitive impairment or other neurologic disease by medical history. The lack of cognitive impairment will also be based on a Clinical Dementia Rating (CDR) of 0. Patients with probable AD must be 50 years of age and must fulfill the National Institute of Neurological and Communicative Disorders and Stroke, Alzheimer's Disease and Related Disorders Association [NINCDS-ADRDA] criteria for probable AD. The CDR score must be 1.0 and 2.0 and have a modified Hachinski of 4. All HVs and all patients with probable AD must be able to comply with all study procedures. Study design: This is a Phase 1, open-label, single-center, non-randomized single dose study to assess the kinetics, clearance and cerebral distribution of PBR-111 PET imaging in detecting microglial activation in the brain in patients with probable AD compared to HVs. All aspects related to image acquisition, processing, and visual as well as quantitative evaluation will be developed, optimized, and validated (where required). Each subject will be required to visit the study center during the screening phase and on the PBR-111 PET imaging day (baseline). A telephone follow-up visit will be performed 7 days (± 3 days) after PBR-111 PET administration. At the screening visit, each subject (or caregiver in the case of AD subjects) will be asked to provide written informed consent or assent. During the screening phase (maximum duration of 60 days) subject medical, neurological, and surgical history, clinical assessments, and a neuro-psychiatric evaluation will be performed on all eligible subjects. Subjects will be allowed to leave the center after all evaluations have been completed. During this period an MRI of the brain will be performed during the screening period. If an MRI of the brain has been performed within six months of the imaging visit using the methods described in the protocol, and there has been no medically significant events in the interim, the previous MRI may be used. During the PBR-111 PET imaging day, all subjects will receive a single intravenous injection of PBR-111 and scanning will be performed over a 3.5 hour period. Each subject will have a telephone follow-up 7 days (± 3 days) thereafter to assess for adverse events. Methodology: - Assessments to provide clinical characterization of the AD subjects will be performed. - After administration of PBR-111, images will be generated with state-of-the-art PET imaging. Images will be assessed quantitatively for the presence of microglial activation by a nuclear physician blinded to clinical data. - Total radioactivity and estimation of the fraction of radioactivity associated to the un-metabolized tracer will be determined. In addition, the metabolite patterns of PBR-111 are determined in venous plasma and arterial samples based on high-performance liquid chromatography (HPLC) analyses. - Arterial sampling will be acquired in the initial two AD and two HV subjects and modeling will be assessed to determine if additional arterial sampling is necessary.

97 MATHEMATICS AND COMPUTING↗

EERE Showcase Event (Solar Decathlon 2015)

The goal of the Orange County Great Park Corporation (Great Park) is to successfully host the U.S. Department of Energy Solar Decathlon 2015. In furtherance of that goal, tasks to be performed within the current reporting period include the following: Task 1.0 Arrange Site Team Visits for January 2015 The Great Park arranged appropriate meeting space for the site team visits over a three-day period, January 8, 2015 through January 10, 2015. Instead of a meeting in Hanger 244, the DOE requested a different meeting space. The working team met in the Operations offices on January 8th. The student teams were welcomed at the City of Irvine’s Lakeview Senior Center on January 9th, and came back on January 10th for breakout sessions. Task 2.0 Outreach Activities The following outreach activities related to the U.S. Department of Energy Solar Decathlon 2015 occurred during and prior to the event: • Promoted the return of the Solar Decathlon 2015 on the City’s website. (cityofirvine.org) • Promoted the return of the Solar Decathlon 2015 through the City’s and Great Park’s social media channels, including Facebook and Twitter. (facebook.com/cityofirvine, facebook.com/orangecountygreatpark, twitter.com/City_of_Irvine, twitter.com/ocgreatpark) • Promoted the return of the Solar Decathlon 2015 and student visit through a City Council Announcement. • Worked to set-up meetings between the U.S. Department of Energy team and potential donors/key stakeholders in Irvine. • Began ICTV filming and coverage of the Solar Decathlon 2015 teams. This includes student team interviews, interview with Richard King and b-roll footage. • Facilitated an interview with Sarah Farrar and the Orange County Register during the recent student visit in January • Information in May was provided to Irvine Unified School District and Tustin Unified School District promoting the three Education Days that the DOE will host during the event. More DOE information is due in August, which will be forwarded to the school districts that will provide important information for school tours. • A promotional ICTV video has been sent through the Irvine Chamber of Commerce and to dozens of businesses in Irvine promoting the Solar Decathlon 2015 and inviting attendance. • Cover story of Fall Inside Irvine magazine detailed teams competing in Solar Decathlon. Magazine goes to more than 100,000 Irvine residences. • Produced public service announcement with KPCC radio to air 9/28-10/16. Outreach also included a web banner on the station’s website. • Full-page advertisements in special sections of the Orange County Register, including UCI 50th Anniversary magazine that went to over 1 million readers of the Register, the Riverside Press Enterprise and the L.A. Times; Best of Orange County magazine; and Solar Decathlon special section. • Full-page ad in Urban Land magazine Sept./Oct. issue. • Produced ad for Irvine Global Village Festival brochure (tens of thousands in attendance at event.) • Ten posters displayed at Irvine Company properties throughout the City, including the Irvine Spectrum Center. • Rack cards promoting Solar Decathlon displayed at Irvine Spectrum Center, Discovery Science Center, Orange County Farm Bureau (at farmers markets) and at City facilities. • Tote bags promoting Solar Decathlon filled with magnets and rack cards on the event distributed at Irvine Global Village Festival, Great Park farmers market and UCI Festival of Discovery; some 8,000 bags handed out. • E-blast from City of Irvine Community Services Department included information on Solar Decathlon. (List contains 51,000 recipients.) • E-blast to Irvine Co. mailing list sent out 9/30. Web banner posted at shopirvinespectrumcenter.com. • E-blast sent to Orange County Register mailing list on 10/6. • Web banner posted on Orange County Register’s homepage. • E-blast sent by Irvine Chamber of Commerce on 10/9. • E-blast using City’s GovDelivery to 2,100 on 10/12. • Produced additional ads for the Orange County Register to fulfill the in-kind agreement between the DOE and the Register: Friday, Oct. 9, Local front page strip ad; Saturday, Oct. 10, half-page Home & Garden section ad; Sunday, Oct. 11, full page Local section ad; Wednesday, Oct. 14, ½ page Main or Local ad; Friday, Oct. 16, full Local or Main section ad; Saturday, Oct. 17, half-page Home & Garden section ad; Sunday Oct. 18, full page Local or Main ad. • Produced two additional Register ads promoting final days of the event: Full page Main or Local ad for Thursday, Oct. 15 and full page ad in Irvine World News weekly publication. • Produced separate press releases on Solar Decathlon, Volunteer Effort, Children’s Activities Area and Final Days. • Produced and distributed Children’s Activities Days rack cards. • Continued to promote the event on the City’s webpage, Great Park webpage and social media channels. • ICTV produced the “Solar Decathlon Minute” videos, which were posted on the City’s YouTube channel and the solardecathlon.gov website. • Four-minute video promoting Solar Decathlon shown on iShuttles in the City in weeks leading up to event. • Promoted a “Business Day” to local businesses in which businesses could sign up for tour led by Solar Decathlon docents. • Access Irvine Special Event Button running 9/28-10/18/15. • Access Irvine Push Notification on 10/15/15. • Facebook ad boost 10/13-10/18.

14 SOLAR ENERGY↗