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At least 505 records · Page 28

Validation of the BERT Point Source Inversion Scheme Using the Joint Urban 2003 Tracer Experiment Dataset (Final Report)

A terrorist attack in a U.S. city utilizing biological weapons could have severe consequences. A biological agent could be aerosolized and emitted into the air in the middle of a city, invisibly traveling with the winds, and dosing an unknowing populace. The magnitude of the problem would only be revealed as sick people started arriving several days later at hospitals with symptoms, many already too ill to be saved. A national program has deployed a network of biological agent collectors in U.S. cities to provide early detection of a bio-weapon attack, thereby hastening medical intervention and potentially saving many thousands of lives. In fact, the most effective treatment takes place prior to infection or in its early stages and early warning might reduce the disease progression and, consequently, the possibility of an outbreak. If a biological attack were to occur in a city, one or more collectors may register hits with specific dosages and the city would be alerted that an attack had taken place. This piece of information alone, however, would not be enough to determine how serious the attack was, i.e., how much biological agent was released into the air and where the bio-plume traveled. The first responders and public health communities will want to know what regions were impacted, how many persons might get sick, which people most need medical supplies, and where to clean up. The law enforcement community will want to look for forensic evidence at the release location. The Bio-Agent Event Reconstruction Tool (BERT) has been developed in order to recreate what might have happened during an airborne biological agent attack based on biological agent collector measurements and wind collectors mounted around a city. The tool can be used to estimate possible release areas while eliminating other areas, and can estimate bounds on the amount of material released. The tool can then be used to project forward from the possible source areas to estimate potential hazard zones. Due to a unique source inversion technique - called the upwind collector footprint approach - the tool runs fast and the source regions can be determined in a few minutes. In this report, we provide an overview of the BERT framework, followed by a description of the source inversion technique. The Joint URBAN 2003 field experiment held in Oklahoma City that was used to validate BERT is then described. Subsequent sections describe the metrics used for evaluation, the comparison of the experimental data and BERT output, and under what conditions the BERT tool succeeds and performs poorly. Results are aggregated in different ways (e.g., daytime vs. nighttime releases, 1 vs. 2 vs. 3 hit collectors) to determine if BERT shows any systematic errors. Finally, recommendations are given for how to improve the code and procedures for optimizing performance in operational mode.

45 MILITARY TECHNOLOGY, WEAPONRY, AND NATIONAL DEF↗

NREL Recommends Ways to Cut Building Energy Costs in Half (Fact Sheet)

Building designers and operators could cut energy use by 50% in large office buildings, hospitals, schools, and a variety of stores -- including groceries, general merchandise outlets, and retail outlets -- by following the recommendations of NREL researchers. The innovative energy-saving recommendations are contained in technical support documents and Advanced Energy Design Guides compiled by NREL.

32 ENERGY CONSERVATION, CONSUMPTION, AND UTILIZATI↗

Advanced Energy Retrofit Guide (AERG): Practical Ways to Improve Energy Performance; Healthcare Facilities (Book)

The Advanced Energy Retrofit Guide for Healthcare Facilities is part of a series of retrofit guides commissioned by the U.S. Department of Energy. By presenting general project planning guidance as well as detailed descriptions and financial payback metrics for the most important and relevant energy efficiency measures (EEMs), the guides provide a practical roadmap for effectively planning and implementing performance improvements in existing buildings. The Advanced Energy Retrofit Guides (AERGs) are intended to address key segments of the U.S. commercial building stock: retail stores, office buildings, K-12 schools, grocery stores, and healthcare facilities. The guides' general project planning considerations are applicable nationwide; the energy and cost savings estimates for recommended EEMs were developed based on energy simulations and cost estimates for an example hospital tailored to five distinct climate regions. These results can be extrapolated to other U.S. climate zones. Analysis is presented for individual EEMs, and for packages of recommended EEMs for two project types: existing building commissioning projects that apply low-cost and no-cost measures, and whole-building retrofits involving more capital-intensive measures.

32 ENERGY CONSERVATION, CONSUMPTION, AND UTILIZATI↗

Healthcare Energy End-Use Monitoring

NREL partnered with two hospitals (MGH and SUNY UMU) to collect data on the energy used for multiple thermal and electrical end-use categories, including preheat, heating, and reheat; humidification; service water heating; cooling; fans; pumps; lighting; and select plug and process loads. Additional data from medical office buildings were provided for an analysis focused on plug loads. Facility managers, energy managers, and engineers in the healthcare sector will be able to use these results to more effectively prioritize and refine the scope of investments in new metering and energy audits.

30 DIRECT ENERGY CONVERSION↗

Massive Intrapelvic Hematoma after a Pubic Ramus Fracture in an Osteoporotic Patient

An 88-year-old female presented with a left thigh pain and dysuria. She visited our hospital 2 week after she noticed her symptoms. She stated that she might have a low-energy fall, but she could not identify the exact onset. Her radiograph of the pelvis (Figure 1) showed displaced left pubic ramus fracture. Her computed tomographic scanning of the pelvis (Figure 2) showed massive intrapelvic hematoma (axial size, 11 cm by 5 cm) around the fracture site, although she did not use any anticoagulants. Because her bone mineral density was 0.357 g/cm{sup 2}, and T score was -4.8 SD, she started a bisphosphonate therapy. She received a bed-rest physical therapy for 6 weeks, and the hematoma regressed spontaneously. She started full weight bearing after 6 weeks, and walked by a walker after 8 weeks. Although it is extremely rare to develop massive chronic intra-pelvic hematoma after a lowenergy pubic ramus fracture without any use of anticoagulants, it may occur in elderly and severely osteoporotic patient.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

50% Advanced Energy Design Guides: Preprint

This paper presents the process, methodology, and assumptions for the development of the 50% Energy Savings Advanced Energy Design Guides (AEDGs), a design guidance document that provides specific recommendations for achieving 50% energy savings above the requirements of ANSI/ASHRAE/IESNA Standard 90.1-2004 in four building types: 1. Small to medium office buildings, 2. K-12 school buildings, 3.Medium to big box retail buildings, 4. Large hospital buildings.

32 ENERGY CONSERVATION, CONSUMPTION, AND UTILIZATI↗

Installing Carport Solar Array

This case study describes how a Hampton Inn & Suites location installed a 102-kilowatt (kW) carport-mounted solar photovoltaic array and financed it using a Blackstone Hospitality Group Small Business Administration Green 504 loan.

Carport-mounted array, solar, solar photovoltaic, ↗

On-Site Commercial Solar PV Decision Guide for the Healthcare Sector

This document provides guidance for hospitals and healthcare facilities concerning the implementation and potential benefits of on-site solar photovoltaics (PV). It includes best practices and considerations for each step of the decision-making process.

Healthcare, Solar, PV, Photovoltaic, solar PV, Hos↗

A nano-structured ZnO film as diagnostic X-ray sensor

Currently some international organizations such as WHO and IAEA have shown concerns about the quality of diagnostic services in clinics and hospitals that use ionizing radiation. In fact, the IAEA recommend that the characteristics of the X-ray beam must be adjusted to obtain the highest quality of the radiographic image with the minimum exposure to the patient. Several types of detectors may be used for monitoring X-ray beams, such as: ionization chamber, photodiode, phototransistor, among others. Recently nano-structured films made of various types of metal oxide materials have been used for various technological applications. Accordingly, the purpose of this paper is to present a sort of device based on a nano-structured zinc oxide (ZnO) to operate as a diagnostic X-ray sensor. By depositing a thin film on the glass substrate some ZnO semiconductor samples were built by sputtering techniques and then mounted in a BNC type connector to perform the electrical characterization. To test the device, we choose a standard X-Ray beam, the RQR9 radiation quality, which is normally used as the tool and condition for calibrating diagnostic X-Ray instruments in the energy range of computed tomography, in accordance with the stated requirements of IEC 61267. A 6430 sub-femto-ammeter, Keithley, was used as electrometer to perform the output readings and simultaneously bias the ZnO sensor. Analysis of the angular dependence and the dose rate were performed to evaluate how the device responds under the RQR9 radiation spectra. Although the results have shown that the ZnO film presents a certain angular dependence, if an angle of incidence of photons is selected, the device displays reproducibility as X-ray sensor and has the feature of radiation hardness unlike other types of semiconductor electronic devices typically used as an X-ray detector. (authors)

46 INSTRUMENTATION RELATED TO NUCLEAR SCIENCE AND ↗

A new estimate of the China temperature anomaly series and uncertainty assessment in 1900–2006

While global warming during the last century has been well recognized, the magnitude of the climate warming in regions such as China over the past 100 years still has some uncertainty due to limited observations during the early years. Several series of temperature anomalies for the 20th century in China have been independently developed by different groups. The uncertainty arises mainly from the sparse observations before 1950, where statistics are sensitive to the small and potentially biased sample. In this study, BSHADE–MSN (Biased Sentinel Hospitals Areal Disease Estimation and Means of Stratified Nonhomogeneous Surface), a combination of two novel distinct statistical methods that are applicable with different sample situations to a spatial heterogeneous surface, is applied to estimate annual mean temperature anomalies for China. This method takes into account prior knowledge of geographical spatial autocorrelation and nonhomogeneity of target domains, remedies the biased sample, and maximizes an objective function for the best linear unbiased estimation (BLUE) of the regional mean quantity. For the period 1900–1999, the overall trend estimated by BSHADE–MSN is 0.80°C with a 95% confidential interval between 0.41°C and 1.18°C. This is significantly lower than that calculated by Climate Anomaly Method (CAM) and Block Kriging. The new temperature anomaly series for China exhibits slightly warmer conditions for the period before 1950 than existing studies. All the methods applied so far agree well with each other for the period after 1950, when there are sufficient stations across the country for the estimation of temperature anomaly series. Cross validation shows that the new regional mean temperature anomaly series has smaller estimation error variance and higher accuracy than those based on the other methods assessed in this study.

54 ENVIRONMENTAL SCIENCES↗

A nomogram for prediction of stage III/IV gastric cancer outcome after surgery: A multicenter population‐based study

Abstract Most patients with gastric cancer (GC) are first diagnosed at stage III‐IV and surgery resection remains the primary therapeutic modality for these patients. However, clinical staging used for prediction of those patients provides limited information. We collected clinicopathological data and disease‐progression information from 508 patients with stage III‐IV GC at three Chinese hospitals and 1298 patients from the Surveillance, Epidemiology, and End Results database. Based on the stepwise multivariate regression model, we constructed a novel nomogram to predict overall survival (OS). The performance of discrimination for this model was measured using Harrell's concordance index (C‐index) and receiver‐operating characteristic curve (ROC), and was validated using calibration plots. Multivariate Cox regression analyses showed that tumor size, age at diagnosis, N stage, tumor grade, and distant metastases were outstanding independent prognostic factors of stage III‐IV GC. We developed a nomogram based on these five prognostic predictors. In the training set, the C‐index of the nomogram was 0.645 (95% CI: 0.611‐0.679), which was higher than that of the American Joint Committee on Cancer TNM system alone (sixth TNM: 0.544; seventh TNM: 0.575; eighth TNM: 0.568). Similar results were observed in validation cohort. Moreover, calibration blots demonstrated good consistency between the actual and predicted OS probabilities. According to the nomogram, GC individuals could be classified into three groups (low‐, middle‐, and high‐risk) ( P < .001). Our nomogram complements the current staging system for prediction of individual prognosis with stage III‐IV GC, and may be helpful for making individualized treatment decisions.

Gao, Zhiying↗

Survival outcomes of patients with head and neck squamous cell cancer with hepatitis B virus infection: An analysis from an endemic tertiary center

Abstract Background Hepatitis B virus (HBV) affects the occurrence and survival outcome of various malignant disorders. The study aimed to evaluate the survival outcome of head and neck squamous cell cancer (HNSCC) patients with or without HBV infection. Methods This study included patients with HNSCC who visited Taichung Veterans General Hospital from 2007 to 2015. HBV infection was defined by hepatitis B surface antigen (HBsAg) seropositivity. By propensity score matching, we compared survival outcomes, including progression‐free survival (PFS) and overall survival (OS), among patients with or without HBV infection. Results The prevalence of HBV infection in our cohort was 12.3%. Among the 1,015 patients included in the matched analysis, a higher risk of baseline liver cirrhosis (11.3% vs. 3.4%, p < 0.001) and initial hepatic dysfunction (10.8% vs. 5.4%, p = 0.005) rates were observed than those without HBV infection at baseline. The 5‐year OS was 43.1% and 53.2% ( p < 0.001) and the 5‐year PFS was 37.4% and 42.3% ( p = 0.007) in patients with and without HBV infection, respectively. The incidence of subsequent hepatic dysfunction showed no difference between patients with and without HBV infection (29.6% vs. 26.8%, p = 0.439). Conclusions Patients with HNSCC and HBV infection were younger and had a higher risk of cirrhosis compared to those without HBV infection. Moreover, HBV infection significantly influenced the OS and PFS outcomes but not subsequent hepatic dysfunction in patients with HNSCC.

Lai, Cheng‐Lun↗

Development of a Translational Model to Assess the Impact of Opioid Overdose and Naloxone Dosing on Respiratory Depression and Cardiac Arrest

In response to a surge of deaths from synthetic opioid overdoses, there have been increased efforts to distribute naloxone products in community settings. Prior research has assessed the effectiveness of naloxone in the hospital setting; however, it is challenging to assess naloxone dosing regimens in the community/first‐responder setting, including reversal of respiratory depression effects of fentanyl and its derivatives (fentanyls). Here, we describe the development and validation of a mechanistic model that combines opioid mu receptor binding kinetics, opioid agonist and antagonist pharmacokinetics, and human respiratory and circulatory physiology, to evaluate naloxone dosing to reverse respiratory depression. Validation supports our model, which can quantitatively predict displacement of opioids by naloxone from opioid mu receptors in vitro , hypoxia‐induced cardiac arrest in vivo , and opioid‐induced respiratory depression in humans from different fentanyls. After validation, overdose simulations were performed with fentanyl and carfentanil followed by administration of different intramuscular naloxone products. Carfentanil induced more cardiac arrest events and was more difficult to reverse than fentanyl. Opioid receptor binding data indicated that carfentanil has substantially slower dissociation kinetics from the opioid receptor compared with nine other fentanyls tested, which likely contributes to the difficulty in reversing carfentanil. Administration of the same dose of naloxone intramuscularly from two different naloxone products with different formulations resulted in differences in the number of virtual patients experiencing cardiac arrest. This work provides a robust framework to evaluate dosing regimens of opioid receptor antagonists to reverse opioid‐induced respiratory depression, including those caused by newly emerging synthetic opioids.

Pharmacology & Pharmacy↗

A comparison study of the reporting systems for salivary gland fine needle aspirations: Are they really different?

Background Recently a new system for reporting salivary gland fine‐needle aspiration (FNA) cytology was proposed, the Milan System for Reporting Salivary Gland Cytopathology (MSRSGC). Herein, we evaluated diagnostic accuracy of salivary gland FNA, comparing the system previously used in our hospital with the Milan system. Methods Salivary gland specimens obtained between 2011 and 2017 were reclassified according to MSRSGC. Risk of malignancy for each diagnostic category was determined. Diagnostic yield of both classifications was evaluated. Results The cases ( n = 388) were classified according to the old system: nondiagnostic ( n = 28), benign ( n = 246), atypical ( n = 36), neoplastic ( n = 57), suspicious for malignancy ( n = 7) and malignant ( n = 14). The lesions were distributed according to the MSRSGC: nondiagnostic ( n = 28), non‐neoplastic ( n = 89), atypia of undetermined significance ( n = 39), benign neoplasm ( n = 156), neoplasm of uncertain malignant potential ( n = 55), suspicious for malignancy ( n = 7) and malignant ( n = 14). When considering only benign and malignant cases, both classifications showed the same sensitivity (62.5%), specificity (100%) and similar accuracy (95.8%). Comparison between the two systems showed no significant difference. Conclusions Salivary gland FNA has high diagnostic accuracy and assists clinical management independently of the reporting system used, however, in some cases, the use of Milan system could be beneficial, since it allows an enhanced category stratification.

Montezuma, Diana↗

Ceiling art in a radiation therapy department: its effect on patient treatment experience

A new initiative has been implemented at the Sunshine Hospital Radiation Therapy Centre, to provide a calming and comforting environment for patients attending radiation therapy treatment. As part of this initiative, the department's computed tomography (CT) room and radiation therapy bunkers were designed to incorporate ceiling art that replicates a number of different visual scenes. The study was undertaken to determine if ceiling art in the radiation therapy treatment CT and treatment bunkers had an effect on a patient's experience during treatment at the department. Additionally, the study aimed to identify which of the visuals in the ceiling art were most preferred by patients. Patients were requested to complete a 12-question survey. The survey solicited a patient's opinion/perception on the unit's unique ceiling display with emphasis on aesthetic appeal, patient treatment experience and the patient's engagement due to the ceiling display. The responses were dichotomised to ‘positive’ or ‘negative’. Every sixth patient who completed the survey was invited to have a general face-to-face discussion to provide further information about their thoughts on the displays. The results demonstrate that the ceiling artwork solicited a positive reaction in 89.8% of patients surveyed. This score indicates that ceiling artwork contributed positively to patients’ experiences during radiation therapy treatment. The study suggests that ceiling artwork in the department has a positive effect on patient experience during their radiation therapy treatment at the department.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

Feature‐shared adaptive‐boost deep learning for invasiveness classification of pulmonary subsolid nodules in CT images

Purpose In clinical practice, invasiveness is an important reference indicator for differentiating the malignant degree of subsolid pulmonary nodules. These nodules can be classified as atypical adenomatous hyperplasia (AAH), adenocarcinoma in situ (AIS), minimally invasive adenocarcinoma (MIA), or invasive adenocarcinoma (IAC). The automatic determination of a nodule's invasiveness based on chest CT scans can guide treatment planning. However, it is challenging, owing to the insufficiency of training data and their interclass similarity and intraclass variation. To address these challenges, we propose a two‐stage deep learning strategy for this task: prior‐feature learning followed by adaptive‐boost deep learning. Methods The adaptive‐boost deep learning is proposed to train a strong classifier for invasiveness classification of subsolid nodules in chest CT images, using multiple 3D convolutional neural network (CNN)‐based weak classifiers. Because ensembles of multiple deep 3D CNN models have a huge number of parameters and require large computing resources along with more training and testing time, the prior‐feature learning is proposed to reduce the computations by sharing the CNN layers between all weak classifiers. Using this strategy, all weak classifiers can be integrated into a single network. Results Tenfold cross validation of binary classification was conducted on a total of 1357 nodules, including 765 noninvasive (AAH and AIS) and 592 invasive nodules (MIA and IAC). Ablation experimental results indicated that the proposed binary classifier achieved an accuracy of with an AUC of 81.3 . These results are superior compared to those achieved by three experienced chest imaging specialists who achieved an accuracy of , , and , respectively. About 200 additional nodules were also collected. These nodules covered 50 cases for each category (AAH, AIS, MIA, and IAC, respectively). Both binary and multiple classifications were performed on these data and the results demonstrated that the proposed method definitely achieves better performance than the performance achieved by nonensemble deep learning methods. Conclusions It can be concluded that the proposed adaptive‐boost deep learning can significantly improve the performance of invasiveness classification of pulmonary subsolid nodules in CT images, while the prior‐feature learning can significantly reduce the total size of deep models. The promising results on clinical data show that the trained models can be used as an effective lung cancer screening tool in hospitals. Moreover, the proposed strategy can be easily extended to other similar classification tasks in 3D medical images.

Wang, Jun↗

A prototype scintillator real‐time beam monitor for ultra‐high dose rate radiotherapy

Background: FLASH Radiotherapy (RT) is an emergent cancer RT modality where an entire therapeutic dose is delivered at more than 1000 times higher dose rate than conventional RT. For clinical trials to be conducted safely, a precise and fast beam monitor that can generate out-of-tolerance beam interrupts is required. This paper describes the overall concept and provides results from a prototype ultra-fast, scintillator-based beam monitor for both proton and electron beam FLASH applications. Purpose: A FLASH Beam Scintillator Monitor (FBSM) is being developed that employs a novel proprietary scintillator material. The FBSM has capabilities that conventional RT detector technologies are unable to simultaneously provide: (1) large area coverage; (2) a low mass profile; (3) a linear response over a broad dynamic range; (4) radiation hardness; (5) real-time analysis to provide an IEC-compliant fast beam-interrupt signal based on true two-dimensional beam imaging, radiation dosimetry and excellent spatial resolution. Methods: The FBSM uses a proprietary low mass, less than 0.5 mm water equivalent, non-hygroscopic, radiation tolerant scintillator material (designated HM: hybrid material) that is viewed by high frame rate CMOS cameras. Folded optics using mirrors enable a thin monitor profile of ∼10 cm. A field programmable gate array (FPGA) data acquisition system generates real-time analysis on a time scale appropriate to the FLASH RT beam modality: 100–1000 Hz for pulsed electrons and 10–20 kHz for quasi-continuous scanning proton pencil beams. An ion beam monitor served as the initial development platform for this work and was tested in low energy heavy-ion beams ( 86 Kr +26 and protons). A prototype FBSM was fabricated and then tested in various radiation beams that included FLASH level dose per pulse electron beams, and a hospital RT clinic with electron beams. Results: Results presented in this report include image quality, response linearity, radiation hardness, spatial resolution, and real-time data processing. Furthermore, the HM scintillator was found to be highly radiation damage resistant. It exhibited a small 0.025%/kGy signal decrease from a 216 kGy cumulative dose resulting from continuous exposure for 15 min at a FLASH compatible dose rate of 237 Gy/s. Measurements of the signal amplitude versus beam fluence demonstrate linear response of the FBSM at FLASH compatible dose rates of >40 Gy/s. Comparison with commercial Gafchromic film indicates that the FBSM produces a high resolution 2D beam image and can reproduce a nearly identical beam profile, including primary beam tails. The spatial resolution was measured at 35–40 µm. Tests of the firmware beta version show successful operation at 20 000 Hz frame rate or 50 µs/frame, where the real-time analysis of the beam parameters is achieved in less than 1 µs. Conclusions: The FBSM is designed to provide real-time beam profile monitoring over a large active area without significantly degrading the beam quality. A prototype device has been staged in particle beams at currents of single particles up to FLASH level dose rates, using both continuous ion beams and pulsed electron beams. Using a novel scintillator, beam profiling has been demonstrated for currents extending from single particles to 10 nA currents. Radiation damage is minimal and even under FLASH conditions would require ≥50 kGy of accumulated exposure in a single spot to result in a 1% decrease in signal output. Beam imaging is comparable to radiochromic films, and provides immediate images without hours of processing. Real-time data processing, taking less than 50 µs (combined data transfer and analysis times), has been implemented in firmware for 20 kHz frame rates for continuous proton beams.

2D beam imaging↗