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DOE OSTI2014

Assessing Interpersonal and Communication Skills in Radiation Oncology Residents: A Pilot Standardized Patient Program

Purpose: There is a lack of data for the structured development and evaluation of communication skills in radiation oncology residency training programs. Effective communication skills are increasingly emphasized by the Accreditation Council for Graduate Medical Education and are critical for a successful clinical practice. We present the design of a novel, pilot standardized patient (SP) program and the evaluation of communication skills among radiation oncology residents. Methods and Materials: Two case scenarios were developed to challenge residents in the delivery of “bad news” to patients: one scenario regarding treatment failure and the other regarding change in treatment plan. Eleven radiation oncology residents paired with 6 faculty participated in this pilot program. Each encounter was scored by the SPs, observing faculty, and residents themselves based on the Kalamazoo guidelines. Results: Overall resident performance ratings were “good” to “excellent,” with faculty assigning statistically significant higher scores and residents assigning lower scores. We found inconsistent inter rater agreement among faculty, residents, and SPs. SP feedback was also valuable in identifying areas of improvement, including more collaborative decision making and less use of medical jargon. Conclusions: The program was well received by residents and faculty and regarded as a valuable educational experience that could be used as an annual feedback tool. Poor inter rater agreement suggests a need for residents and faculty physicians to better calibrate their evaluations to true patient perceptions. High scores from faculty members substantiate the concern that resident evaluations are generally positive and nondiscriminating. Faculty should be encouraged to provide honest and critical feedback to hone residents' interpersonal skills.

62 RADIOLOGY AND NUCLEAR MEDICINE↗
DOE OSTI2015

Attracting Future Radiation Oncologists: An Analysis of the National Resident Matching Program Data Trends From 2004 to 2015

Purpose: A significant physician shortage has been projected to occur by 2025, and demand for oncologists is expected to outpace supply to an even greater degree. In response to this, many have called to increase the number of radiation oncology residency positions. The purpose of this study is to evaluate National Resident Matching Program (NRMP) data for the number of residency positions between 2004 and 2015 as well as the number and caliber of applicants for those positions and to compare radiation oncology to all residency specialties. Methods: NRMP data for all specialties participating in the match, including radiation oncology, were assessed over time examining the number of programs participating in the match, the number of positions offered, and the ratio of applicants to positions in the match from 2004 to 2015. Results: From 2004 to 2015, the number of total programs participating in the match has increased by 26.7%, compared to the increase of 28.6% in the number of radiation oncology programs from during the same time period. The total number of positions offered in the match increased by 53.4%, whereas radiation oncology positions increased by 56.3%, during the same time period. The ratio of applicants (defined as those selecting a specialty as their first or only choice) to positions for all specialties has fluctuated over this time period and has gone from 1.21 to 1.15, whereas radiation oncology experienced a decrease from 1.45 to 1.14. Conclusions: NRMP data suggest that senior medical student applications to radiation oncology are decreasing compared to those of other specialties. If we hope to continue to attract the best and brightest to enter our field, we must continue to support early exposure to radiation oncology, positive educational experiences, and dedicated mentorship to interested medical students.

62 RADIOLOGY AND NUCLEAR MEDICINE↗
DOE OSTI2016

PracticeCALM: Coaching Anxiety Lessening Methods for Radiation Therapists: A Pilot Study of a Skills-Based Training Program in Radiation Oncology

PracticeCALM is an 8-week on-the-job training program to teach radiation therapists (RTs) techniques for assisting patients who are experiencing treatment-related anxiety. Twelve clinical RTs in a regional oncology program were recruited on a volunteer basis to participate in the training. A mixed-method approach was undertaken to evaluate perceived benefits to clinical practice. The quantitative findings from the Perceived Stress Scale (PSS) showed there were no changes before and after training. Qualitative findings showed significant benefits to RTs, including (1) ability to empathically attune more effectively and earlier to signs of anxiety in patients; (2) improved confidence and self-efficacy for effectively intervening in difficult treatment situations; and (3) enhanced creative problem solving in partnership with patients to assist the acutely anxious patient. The PSS results suggest that intrinsic and extrinsic stressors are a variable but consistent part of the everyday reality of RT practice. A training program focusing on the therapeutic presence dimension of RT practice has a direct impact on effectiveness in assisting anxious patients undergoing RT. When embedded in the clinical life of a radiation therapy department, such a training program has the potential to capture the lived practice wisdom and creative skills of RTs, and effectively mediate these skills across a team through group discussions and documentation on patient charts.

62 RADIOLOGY AND NUCLEAR MEDICINE↗
DOE OSTI2014

Maternal glucocorticoid elevation and associated blood metabonome changes might be involved in metabolic programming of intrauterine growth retardation in rats exposed to caffeine prenatally

Our previous studies demonstrated that prenatal caffeine exposure causes intrauterine growth retardation (IUGR), fetuses are over-exposed to high levels of maternal glucocorticoids (GC), and intrauterine metabolic programming and associated metabonome alteration that may be GC-mediated. However, whether maternal metabonomes would be altered and relevant metabolite variations might mediate the development of IUGR remained unknown. In the present studies, we examined the dose- and time-effects of caffeine on maternal metabonome, and tried to clarify the potential roles of maternal GCs and metabonome changes in the metabolic programming of caffeine-induced IUGR. Pregnant rats were treated with caffeine (0, 20, 60 or 180 mg/kg · d) from gestational days (GD) 11 to 20, or 180 mg/kg · d caffeine from GD9. Metabonomes of maternal plasma on GD20 in the dose–effect study and on GD11, 14 and 17 in the time–course study were analyzed by {sup 1}H nuclear magnetic resonance spectroscopy, respectively. Caffeine administration reduced maternal weight gains and elevated both maternal and fetal corticosterone (CORT) levels. A negative correlation between maternal/fetal CORT levels and fetal bodyweight was observed. The maternal metabonome alterations included attenuated metabolism of carbohydrates, enhanced lipolysis and protein breakdown, and amino acid accumulation, suggesting GC-associated metabolic effects. GC-associated metabolite variations (α/β-glucoses, high density lipoprotein-cholesterol, β-hydroxybutyrate) were observed early following caffeine administration. In conclusion, prenatal caffeine exposure induced maternal GC elevation and metabonome alteration, and maternal GC and relevant discriminatory metabolites might be involved in the metabolic programming of caffeine-induced IUGR. - Highlights: • Prenatal caffeine exposure elevated maternal blood glucocorticoid levels. • Prenatal caffeine exposure altered maternal blood metabonomes. • Maternal metabonome alterations were associated with glucocorticoid elevation. • Maternal metabonomes were altered at early stage after caffeine exposure. • Maternal glucocorticoid and associated metabolites may be involved in fetal programming.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

Compound- and sex-specific effects on programming of energy and immune homeostasis in adult C57BL/6JxFVB mice after perinatal TCDD and PCB 153

Early life exposure to endocrine disrupting compounds has been linked to chronic diseases later in life, like obesity and related metabolic disorders. We exposed C57BL/6JxFVB hybrid mice to the aryl hydrocarbon receptor agonist 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) and the constitutive androstane receptor/pregnane X receptor agonist polychlorinated biphenyl 153 (PCB 153) in an experimental design relevant for human exposure. Exposure occurred during gestation and lactation via maternal feed to a wide dose range (TCDD: 10–10,000 pg/kg body weight/day; PCB 153: 0.09–1406 μg/kg body weight/d). Then exposure was ceased and offspring were followed up to 1 year of age. Metabolic parameters like body weight, fat pad weights, glucose tolerance, endocrine serum profile, and neurobehavioral and immunological parameters were determined. Body weight was transiently affected by both compounds throughout the follow-up. TCDD-exposed males showed decreased fat pad and spleen weights and an increase in IL-4 production of splenic immune cells. In contrast, females showed increased fat pad weights and production of IFNγ. PCB 153-exposed males showed an increase in glucose, whereas females showed an increase in glucagon, a decrease in pancreas weight, and an increase in thymus weight. In conclusion, early life exposure to TCDD appears to affect programming of energy and immune homeostasis in offspring, whereas the effects of perinatal PCB 153 were mainly on programming of glucose homeostasis. Both compounds act sex-specifically. Lowest derived BMDLs (lower bounds of the (two sided) 90%-confidence interval for the benchmark dose) for both compounds are not lower than current tolerable daily intakes. - Highlights: • Early life exposure to TCDD affects programming of energy and immune homeostasis. • Early life exposure to PCB 153 affects programming of energy homeostasis. • Both compounds act sex-specifically. • Lowest derived BMDLs for both TCDD and PCB 153 are not lower than current tolerable daily intakes.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2026

Evaluating technology upgrades as a complement to traditional bill assistance programs

State programs to improve energy affordability and reduce energy burden (the share of income spent on energy) could mitigate concerns about rising electricity prices. Many states offer bill assistance and rebates for weatherization and rooftop solar to income-qualifying households. Here, we analyse how these approaches may complement one another to improve energy affordability. Results illustrate trade offs between program costs and energy burden reduction, as well as between a program’s upfront and ongoing costs. Generally, the three strategies complement one another to improve energy affordability at lower net present cost than bill assistance alone, with varying effects across regions. Weatherization can reduce the solar installation capacity needed, and both together can reduce or eliminate ongoing reliance on bill assistance. Under full uptake among cost-effective households, fully rebated weatherization and solar rebated at $0.48/Watt, combined with bill assistance, yield the same modelled net present cost as bill assistance alone while reducing the share of low-income owner-occupied households with high energy burdens from 66% to 19%, compared with 34% under bill assistance alone. Absent tax credits, weatherization still reduces energy burden and bill assistance program costs, whereas solar may not be cost-competitive.

Forrester, Sydney P↗
DOE OSTI2019

CMS Computing Resources: Meeting the demands of the high-luminosity LHC physics program

The high-luminosity program has seen numerous extrapolations of its needed computing resources that each indicate the need for substantial changes if the desired HL-LHC physics program is to be supported within the current level of computing resource budgets. Drivers include large increases in event complexity (leading to increased processing time and analysis data size) and trigger rates needed (5-10 fold increases) for the HL-LHC program. The CMS experiment has recently undertaken an effort to merge the ideas behind short-term and long-term resource models in order to make easier and more reliable extrapolations to future needs. Near term computing resource estimation requirements depend on numerous parameters: LHC uptime and beam intensities; detector and online trigger performance; software performance; analysis data requirements; data access, management, and retention policies; site characteristics; and network performance. Longer term modeling is affected by the same characteristics, but with much larger uncertainties that must be considered to understand the most interesting handles for increasing the "physics per computing dollar" of the HL-LHC. In this presentation, we discuss the current status of long term modeling of the CMS computing resource needs for HL-LHC with emphasis on techniques for extrapolations, uncertainty quantification, and model results. We illustrate potential ways that high-luminosity CMS could accomplish its desired physics program within today's computing budgets.

97 MATHEMATICS AND COMPUTING↗
DOE OSTI2025

Establishment of a Nationwide Plasma Science and Fusion Energy Certification and Apprenticeship Programs

Here we propose the establishment of a national Plasma Science and Fusion Energy training program that will combine professional development certification courses with hands-on apprenticeship opportunities. The program should be developed by a collaboration of stakeholders (academia, national laboratories, and industry) and should offer pathways for students from community colleges (CCs), minority-serving institutions (MSIs), high school graduates, and veterans. We argue that certification courses offer fast and flexible discipline-specific education that can be rapidly translated into marketable skills through hands-on apprenticeship opportunities. Furthermore, we first list major findings and recommendations related to the fusion workforce and discuss how to address them through the establishment of the proposed training program. We then highlight the appropriateness of this format for engagement with CCs, MSIs, high schools, and veteran employment services. In the final section, we provide a strategy for the establishment of the program, along with a tentative timeline and projected costs.

Certification↗
DOE OSTI2022

The scientific potential and technological challenges of the High-Luminosity Large Hadron Collider program

Here, we present an overview of the High-Luminosity (HL-LHC) program at the Large Hadron Collider (LHC), its scientific potential and technological challenges for both the accelerator and detectors. The HL-LHC program is expected to start circa 2027 and aims to increase the integrated luminosity delivered by the LHC by an order of magnitude at the collision energy of 14 TeV. This requires upgrades to the injector system, accelerator complex and luminosity levelling. The two experiments, ATLAS and CMS, require substantial upgrades to most of their systems in order to cope with the increased interaction rate, and much higher radiation levels than at the current LHC. We present selected examples based on novel ideas and technologies for applications at a hadron collider. Both experiments will replace their tracking systems. We describe the ATLAS pixel detector upgrade featuring novel tilted modules, and the CMS Outer Tracker upgrade with a new module design enabling use of tracks in the level-1 trigger system. CMS will also install state-of-the-art highly segmented calorimeter endcaps. Finally, we describe new picosecond precision timing detectors of both experiments. In addition, we discuss how the upgrades will enhance the physics performance of the experiments, and solve the computing challenges posed by the expected large data sets. The physics program of the HL-LHC is focused on precision measurements probing the limits of the Standard Model (SM) of particle physics and discovering new physics. We present a selection of studies that have been carried out to motivate the HL-LHC program. A central topic of exploration will be the characterization of the Higgs boson. The large HL-LHC data samples will extend the sensitivity of searches for new particles or new interactions whose existence has been hypothesized in order to explain shortcomings of the SM. Finally, we comment on the nature of large scientific collaborations.

72 PHYSICS OF ELEMENTARY PARTICLES AND FIELDS↗
DOE OSTI2021

New developments including X-ray standing waves in the dynamical Bragg diffraction program of X-ray Server

X-ray Server (https://x-server.gmca.aps.anl.gov) is a collection of programs for online modelling of X-ray diffraction and scattering. Additionally, the dynamical diffraction program is the second most popular Server program, contributing 34% of total Server usage. It models dynamical X-ray diffraction from strained crystals and multilayers for any Bragg-case geometry including grazing incidence and exit. This paper reports on a revision of equations used by the program, which yields ten times faster calculations in most use cases, on implementing calculations of X-ray standing waves and on adding new options for modelling diffraction from monolayers.

36 MATERIALS SCIENCE↗
DOE OSTI2025

DXRD : a user-friendly suite of two- and multiple-beam dynamical X-ray diffraction programs

The DXRD program suite consisting of a series of dynamical theory programs is introduced for computing dynamical X-ray diffraction from single crystals. Its interactive graphical user interfaces (GUIs) allow general users to make complicated calculations with minimal effort. It can calculate plane-wave Darwin curves of single crystals (or multiple crystals) for both the Bragg and Laue cases, including grazing-incidence diffraction and backward diffraction (with Bragg angles approaching 90°). It is also capable of simulating rocking curves for divergent incident X-ray beams with finite bandwidths. A unique feature of DXRD is that it provides a convenient GUI-based multiple-beam diffraction program that can accurately compute arbitrary N-beam diffraction of any geometry using a universal 4N × 4N matrix method. DXRD also provides a mapping program for plotting all the multiple-beam diffraction lines (monochromator glitches) in the azimuth–energy coordinate system. All these functions make DXRD a convenient and powerful software tool for designing crystal-based synchrotron/X-ray optics (monochromators, analyzers, polarizers, phase plates etc.) and for crystal characterization, X-ray spectroscopy and X-ray diffraction teaching.

Bragg reflection↗
DOE OSTI2025

Enabling Scientific Applications with Performance-Portability and High-Productivity for Multi-GPU Programming with JACC.Multi

This work bridges the gap between multi-GPU computing and high-productivity, performance-portable programming solutions. Our goal is to enhance scientific applications with a productive and portable solution—program once, deploy everywhere—for multi-GPU programming with no cost to programmability. To accomplish this, we implemented JACC.Multi, which is part of the Julia for ACCelerators (JACC) performance-portable framework. JACC. Multi is the only high-level, portable metaprogramming solution that targets multi-GPU environments and is integrated in a readily accessible programming language (e.g., Julia language). With transparent GPU-to-GPU communication, JACC. Multi is optimized for scientific application workloads and is portable for NVIDIA and AMD accelerators. For the evaluation, we use two modern multi-GPU systems: Hudson, which features two NVIDIA H100 Hopper GPUs per node, and Frontier, which features four AMD MI250X GPUs per node, each with two Graphics Compute Dies (GCDs) for a total of eight GCDs per node. Additionally, as part of the evaluation, we use JACC (one GPU), MPI+JACC, and JACC. Multi codes that implement well-known and widely used scientific algorithms/kernels such as the conjugate gradient algorithm and an explicit forward Euler solver that requires GPU-to-GPU communication. Overall, JACC. Multi codes achieve better performance than MPI+JACC codes and significant speedups over JACC (one GPU), with up to 1.9× on Hudson and 6× on Frontier.

Valero Lara, Pedro [ORNL] (ORCID:0000000214794310)↗
DOE OSTI2021

IRIS: A Portable Runtime System Exploiting Multiple Heterogeneous Programming Systems

Across embedded, mobile, enterprise, and HPC systems, computer architectures are becoming more heterogeneous and complex. This complexity is causing a crisis in programming systems and performance portability. Several programming systems are working to address these challenges, but the increasing architectural diversity is forcing software stacks and applications to specialize for each architecture. As we show, all of these approaches critically depend on their runtime system for discovery, execution, scheduling, and data orchestration. To address this challenge, we believe that a more agile and proactive runtime system is essential to increase performance portability and improve user productivity. In this regard, we have designed and implemented IRIS: a portable runtime system exploiting multiple heterogeneous programming systems. IRIS can discover available resources, manage multiple diverse programming systems (e.g., CUDA, Hexagon, HIP, Level Zero, OpenCL, OpenMP) simultaneously in the same execution, respect data dependencies, orchestrate data movement proactively, and provide for user-configurable scheduling. Our evaluation on three architectures, ranging from Qualcomm Snapdragon to a Summit supercomputer node, shows that IRIS improves portability across a wide range of diverse heterogeneous architectures with negligible overhead.

Kim, Jungwon↗
DOE OSTI2017

SharP: Towards Programming Extreme-Scale Systems with Hierarchical Heterogeneous Memory

The pre-exascale systems are expected to have a significant amount of hierarchical and heterogeneous on-node memory, and this trend of system architecture in extreme-scale systems is expected to continue into the exascale era. Along with hierarchical-heterogeneous memory, the system typically has a high-performing network and a compute accelerator. This system architecture is not only effective for running traditional High Performance Computing (HPC) applications (Big-Compute), but also running data-intensive HPC applications and Big-Data applications. As a consequence, there is a growing desire to have a single system serve the needs of both Big-Compute and Big-Data applications. Though the system architecture supports the convergence of the Big-Compute and Big-Data, the programming models have yet to evolve to support either hierarchical-heterogeneous memory systems or the convergence. In this work, we propose and develop the programming abstraction called SHARed data-structure centric Programming abstraction (SharP) to address both of these goals, i.e., provide (1) a simple, usable, and portable abstraction for hierarchical-heterogeneous memory and (2) a unified programming abstraction for Big-Compute and Big-Data applications. To evaluate SharP, we implement a Stencil benchmark using SharP, port QMCPack, a petascale-capable application, and adapt Memcached ecosystem, a popular Big-Data framework, to use SharP, and quantify the performance and productivity advantages. Additionally, we demonstrate the simplicity of using SharP on different memories including DRAM, High-bandwidth Memory (HBM), and non-volatile random access memory (NVRAM).

97 MATHEMATICS AND COMPUTING↗
DOE OSTI2012

Early Evaluation of Directive-Based GPU Programming Models for Productive Exascale Computing

Graphics Processing Unit (GPU)-based parallel computer architectures have shown increased popularity as a building block for high performance computing, and possibly for future Exascale computing. However, their programming complexity remains as a major hurdle for their widespread adoption. To provide better abstractions for programming GPU architectures, researchers and vendors have proposed several directive-based GPU programming models. These directive-based models provide different levels of abstraction, and required different levels of programming effort to port and optimize applications. Understanding these differences among these new models provides valuable insights on their applicability and performance potential. In this paper, we evaluate existing directive-based models by porting thirteen application kernels from various scientific domains to use CUDA GPUs, which, in turn, allows us to identify important issues in the functionality, scalability, tunability, and debuggability of the existing models. Our evaluation shows that directive-based models can achieve reasonable performance, compared to hand-written GPU codes.

Lee, Seyong↗
DOE OSTI2024

Toward Automated Detection of Portability Bugs in Kokkos Parallel Programs

Performance-portable programming frameworks provide abstractions for parallel execution to allow easily porting an application to multiple backend programming models, such as CUDA, HIP, and OpenMP. However, programs may still have portability bugs that manifest only on specific backends. Traditional testing is ineffective in discovering these bugs, as it would require concrete execution on all supported hardware configurations for a potentially infinite set of inputs. To mitigate this issue, we focused on a specific programming framework, Kokkos, and identified several categories of common portability bugs. We then developed Klokkos, a static analysis approach based on symbolic execution that can run on commodity hardware, before execution on supercomputers. As a proof-of-concept, we ran Klokkos on examples encoding the identified bugs. Our results show that Klokkos is effective, efficient, and precise: it detected all the considered bugs, quickly, and without any false positives. Although preliminary, our results motivate further research and development in this direction.

Kale, Vivek↗
DOE OSTI2022

Economic evaluation of the Hepatitis C virus elimination program in the country of Georgia, 2015 to 2017

Abstract Background and Aims In 2015, the country of Georgia launched an elimination program aiming to reduce the prevalence of Hepatitis C virus (HCV) infection by 90% from 5.4% prevalence (~150 000 people). During the first 2.5 years of the program, 770 832 people were screened, 48 575 were diagnosed with active HCV infection, and 41 483 patients were treated with direct‐acting antiviral (DAA)‐based regimens, with a >95% cure rate. Methods We modelled the incremental cost‐effectiveness ratio (ICER) of HCV screening, diagnosis and treatment between April 2015 and November 2017 compared to no treatment, in terms of cost per quality‐adjusted life year (QALY) gained in 2017 US dollars, with a 3% discount rate over 25 years. We compared the ICER to willingness‐to‐pay (WTP) thresholds of US$4357 (GDP) and US$871 (opportunity cost) per QALY gained. Results The average cost of screening, HCV viremia testing, and treatment per patient treated was $386 to the provider, $225 to the patient and $1042 for generic DAAs. At 3% discount, 0.57 QALYs were gained per patient treated. The ICER from the perspective of the provider including generic DAAs was $2285 per QALY gained, which is cost‐effective at the $4357 WTP threshold, while if patient costs are included, it is just above the threshold at $4398/QALY. All other scenarios examined in sensitivity analyses remain cost‐effective except for assuming a shorter time horizon to the end of 2025 or including the list price DAA cost. Reducing or excluding DAA costs reduced the ICER below the opportunity‐cost WTP threshold. Conclusions The Georgian HCV elimination program provides valuable evidence that national programs for scaling up HCV screening and treatment for achieving HCV elimination can be cost‐effective.

Tskhomelidze, Irina↗
DOE OSTI2013

The US DOE EM international program

The U.S. Department of Energy (DOE) Office of Environmental Management (EM) conducts international collaboration activities in support of U.S. policies and objectives regarding the accelerated risk reduction and remediation of environmental legacy of the nations' nuclear weapons program and government sponsored nuclear energy research. The EM International Program supported out of the EM Office of the Associate Principal Deputy Assistant Secretary pursues collaborations with foreign government organizations, educational institutions and private industry to assist in identifying technologies and promote international collaborations that leverage resources and link international experience and expertise. In fiscal year (FY) 2012, the International Program awarded eight international collaborative projects for work scope spanning waste processing, groundwater and soil remediation, deactivation and decommissioning (D and D) and nuclear materials disposition initiatives to seven foreign organizations. Additionally, the International Program's scope and collaboration opportunities were expanded to include technical as well as non-technical areas. This paper will present an overview of the on-going tasks awarded in FY 2012 and an update of upcoming international activities and opportunities for expansion into the remainder of FY 2013 and beyond. (authors)

12 MANAGEMENT OF RADIOACTIVE AND NON-RADIOACTIVE W↗