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At least 577 records · Page 32

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

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

60 APPLIED LIFE SCIENCES↗

Large-Scale Wind Disturbances Promote Tree Diversity in a Central Amazon Forest

Canopy gaps created by wind-throw events, or blowdowns, create a complex mosaic of forest patches varying in disturbance intensity and recovery in the Central Amazon. Using field and remote sensing data, we investigated the short-term (four-year) effects of large (>2000 m 2 ) blowdown gaps created during a single storm event in January 2005 near Manaus, Brazil, to study (i) how forest structure and composition vary with disturbance gradients and (ii) whether tree diversity is promoted by niche differentiation related to wind-throw events at the landscape scale. In the forest area affected by the blowdown, tree mortality ranged from 0 to 70%, and was highest on plateaus and slopes. Less impacted areas in the region affected by the blowdown had overlapping characteristics with a nearby unaffected forest in tree density (583±46 trees ha -1 ) (mean±99% Confidence Interval) and basal area (26.7±2.4 m 2 ha -1 ). Highly impacted areas had tree density and basal area as low as 120 trees ha -1 and 14.9 m 2 ha -1 , respectively. In general, these structural measures correlated negatively with an index of tree mortality intensity derived from satellite imagery. Four years after the blowdown event, differences in size-distribution, fraction of resprouters, floristic composition and species diversity still correlated with disturbance measures such as tree mortality and gap size. Our results suggest that the gradients of wind disturbance intensity encompassed in large blowdown gaps (>2000 m 2 ) promote tree diversity. Specialists for particular disturbance intensities existed along the entire gradient. The existence of species or genera taking an intermediate position between undisturbed and gap specialists led to a peak of rarefied richness and diversity at intermediate disturbance levels. A diverse set of species differing widely in requirements and recruitment strategies forms the initial post-disturbance cohort, thus lending a high resilience towards wind disturbances at the community level.

54 ENVIRONMENTAL SCIENCES↗

Do Biological and Bedsite Characteristics Influence Survival of Neonatal White-Tailed Deer?

Coyotes recently expanded into the eastern U.S. and potentially have caused localized white-tailed deer population declines. Research has focused on quantifying coyote predation on neonates, but little research has addressed the potential influence of bedsite characteristics on survival. In 2011 and 2012, we radiocollared 65 neonates, monitored them intensively for 16 weeks, and assigned mortality causes.We used Program MARK to estimate survival to 16 weeks and included biological covariates (i.e., sex, sibling status [whether or not it had a sibling], birth weight, and Julian date of birth). Survival to 16 weeks was 0.141 (95% CI = 0.075-0.249) and the top model included only sibling status, which indicated survival was lower for neonates that had a sibling. Predation was the leading cause of mortality (35 of 55; 64%) and coyotes were responsible for the majority of depredations (30 of 35; 86%). Additionally, we relocated neonates for the first 10 days of life and measured distance to firebreak, visual obstruction, and plant diversity at bedsites. Survival of predation to 10 days (0.726; 95% CI = 0.586-0.833) was weakly associated with plant diversity at bedsites but not related to visual obstruction. Our results indicate that neonate survival was low and coyote predation was an important source of mortality, which corroborates several recent studies from the region. Additionally, we detected only weak support for bedsite cover as a covariate to neonate survival, which indicates that mitigating effects of coyote predation on neonates may be more complicated than simply managing for increased hiding cover.

54 ENVIRONMENTAL SCIENCES↗

Characterizing juvenile salmon predation risk during early marine residence

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

Phillips, Elizabeth M. (ORCID:0000000327752563)↗

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

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

60 APPLIED LIFE SCIENCES↗

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

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

Pediatrics↗

FATES crown damage simulation outputs 2022

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

54 ENVIRONMENTAL SCIENCES↗

AmeriFlux US-Mpj Mountainair Pinyon-Juniper Woodland

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

Litvak, Marcy↗

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

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

Litvak, Marcy↗

A Synchronized Sensor Array for Remote Monitoring of Avian and Bat Interactions with Offshore Renewable Energy Facilities

Wind energy production in the U.S. is projected to increase to 35% of our nation’s energy by 2050. This substantial increase in the U.S. is only a portion of the global wind industry growth, as many countries strive to reduce greenhouse gas emissions. A major environmental concern and potential market barrier for expansion of wind energy is bird and bat mortality from impacts with turbine blades, towers, and nacelles. Carcass surveys are the standard protocol for quantifying mortality at onshore sites. This method is imperfect, however, due to survey frequency at remote sites, removal of carcasses by scavengers between surveys, searcher efficiency, and other biases as well as delays of days to weeks or more in obtaining information on collision events. Furthermore, carcass surveys are not feasible at offshore wind energy sites. Near-real-time detection and quantification of interaction rates is possible at both onshore and offshore wind facilities using an onboard, integrated sensor package with data transmitted to central processing centers. We developed and experimentally tested an array of sensors that continuously monitors for interactions (including impacts) of birds and bats with wind turbines. The synchronized array includes three sensor nodes: (1) vibration (accelerometers and contact microphones), (2) optical (visual and infrared spectrum cameras), and (3) bioacoustics (acoustic and ultrasonic microphones). Accelerometers and contact acoustic microphones are placed at the root of each blade to detect impact vibrations and sound waves propagating through the structure. On-board data processing algorithms using wavelet analysis detect impact signals exceeding background vibration. Stereo-visual and infrared cameras were placed on the nacelle to allow target tracking, distance, and size calculations. On-board image processing and target detection algorithms identify moving targets within the camera field of view. Bioacoustic recorders monitor vocalizations and echolocations to aid in identifying organisms involved in interactions. Data from all sensors are temporarily stored in ring (i.e., circular) buffers with a duration varying by sensor type. Detection of target presence or impact by any of the sensors can trigger the archiving of data from all buffers for transmission to a central data processing center for evaluation and post-processing. This mitigates the risk of “data mortgages” posed by continual recording and minimizes personnel time required to manually review event data. We first conducted individual component tests at laboratories and field sites in Corvallis and Newport, Oregon, and Seattle and Sequim, Washington. We conducted additional component tests on research wind turbines at the North American Wind Research and Training Center, Mesalands Community College (MCC; General Electric 1.5 MW turbine), New Mexico, and the National Wind Technology Center, National Renewable Energy Laboratory (NREL; Controls Advanced Research Turbines 3 [CART 3] 600 kW Westinghouse turbine), Colorado. We conducted fully integrated system tests at NREL in October 2014 and April 2015. We used only research wind turbines so that we could conduct controlled, experimentally generated impacts using empty and water-filled tennis balls shot from a compressed air cannon on the ground. The approx. 57-140 g tennis balls (depending on water content) were at the upper mass range for bats, but lower mass range for marine birds. Therefore, the ability to detect collisions of most seabirds is likely greater than our experiments demonstrate, but possibly lower for some bats depending on the background signal of a given turbine. Vibration data demonstrated that background signals of operating turbines varied markedly among the CART 3 under normal operation (greatest), GE (moderate), and CART 3 during idle rotation (generator not engaged; least). In total, we measured 63 experimental blade impacts on the two research turbines. Impaction detection was dependent on background signals, position of impact on the blade (a tip strike resulted in the strongest impact signal), and impact kinetics (velocity of ball and whether the ball struck the surface of the blade or the leading edge of the blade struck the ball). Overall detection percentage ranged from 100% for the “quietest” conditions (CART 3 idle rotation), down to 35% for the noisiest (CART 3 normal operation). Impact signals were detected from sensors on more than one blade (i.e., blades other than the blade struck) 50% - 75% of the time. Stereo imaging provided valuable metrics, but increased data processing and equipment cost. Given the cost of cameras with sufficient resolution for target identification, we suggest mounting cameras directly on the blades to continuously view the entire rotor swept area with the fewest number of cameras. Bioacoustic microphones provide taxonomic identification, as well as information on ambient noise levels. They also assist in identifying environmental conditions such as hail storms, high winds, thunder, lightning, etc., that may contribute to a collision or a false positive detection. We demonstrated a proof of concept for an integrated sensor array to detect and identify bird and bat collisions with wind turbines. The next phase of research and development for this system will miniaturize and integrate sensors from all three nodes into a single wireless package that can be attached directly to the blade. This next generation system would use all “smart” sensors capable of onboard data processing to drastically reduce data streams and processing time on a central computer. A provisional patent for the blade mounted system was submitted by Oregon State University and recorded by the U.S. Patent and Trademark Office (application no. 62313028). Eventually, technology and industry advances will allow this low cost monitoring system to be designed into materials during manufacturing so that all turbines could be monitored with either a subset or full suite of sensors. As standard equipment on all commercial turbines, the sensor suite would allow the industry to effectively monitor whether individual turbines were causing mortalities or not and under what circumstances. It would also provide real-time evaluation of mechanical and structural integrity of a turbine via vibration, image, and acoustic data streams, thereby permitting modifications in operation to limit environmental or mechanical damage.

17 WIND ENERGY↗

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

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

29 ENERGY PLANNING, POLICY, AND ECONOMY↗

Health Hazards of Exposures to Radioiodine

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

61 RADIATION PROTECTION AND DOSIMETRY↗

Atomic Bomb Survivors Life-Span Study: Insufficient Statistical Power to Select Radiation Carcinogenesis Model

The atomic bomb survivors life-span study (LSS) is often claimed to support the linear no-threshold hypothesis (LNTH) of radiation carcinogenesis. This paper shows that this claim is baseless. The LSS data are equally or better described by an s-shaped dependence on radiation exposure with a threshold of about 0.3 Sievert (Sv) and saturation level at about 1.5 Sv. A Monte-Carlo simulation of possible LSS outcomes demonstrates that, given the weak statistical power, LSS cannot provide support for LNTH. Even if the LNTH is used at low dose and dose rates, its estimation of excess cancer mortality should be communicated as 2.5% per Sv, i.e., an increase of cancer mortality from about 20% spontaneous mortality to about 22.5% per Sv, which is about half of the usually cited value. The impact of the “neutron discrepancy problem” – the apparent difference between the calculated and measured values of neutron flux in Hiroshima – was studied and found to be marginal. Major revision of the radiation risk assessment paradigm is required.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

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

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

Immunology↗

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

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

Fu, Wei↗

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

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

59 BASIC BIOLOGICAL SCIENCES↗

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

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

17 WIND ENERGY↗

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

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

59 BASIC BIOLOGICAL SCIENCES↗