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At least 649 records · Page 36

Fungal Spore Seasons Advanced Across the US Over Two Decades of Climate Change

Abstract Phenological shifts due to climate change have been extensively studied in plants and animals. Yet, the responses of fungal spores—organisms important to ecosystems and major airborne allergens—remain understudied. This knowledge gap limits our understanding of their ecological and public health implications. To address this, we analyzed a long‐term (2003–2022), large‐scale (the continental US) data set of airborne fungal spores collected by the US National Allergy Bureau. We first pre‐processed the spore data by gap‐filling and smoothing. Afterward, we extracted 10 metrics describing the phenology (e.g., start and end of season) and intensity (e.g., peak concentration and integral) of fungal spore seasons. These metrics were derived using two complementary but not mutually exclusive approaches—ecological and public health approaches, defined as percentiles of total spore concentration and allergenic thresholds of spore concentration, respectively. Using linear mixed‐effects models, we quantified annual shifts in these metrics across the continental US. We revealed a significant advancement in the onset of the spore seasons defined in both ecological (11 days, 95% confidence interval: 0.4–23 days) and public health (22 days, 6–38 days) approaches over two decades. Meanwhile, total spore concentrations in an annual cycle and in a spore allergy season tended to decrease over time. The earlier start of the spore season was significantly correlated with climatic variables, such as warmer temperatures and altered precipitations. Overall, our findings suggest possible climate‐driven advanced fungal spore seasons, highlighting the importance of climate change mitigation and adaptation in public health decision‐making.

Environmental Sciences & Ecology↗

The good, the bad, and the ugly: Data-driven load profile discord identification in a large building portfolio

Reducing the overall energy consumption and associated greenhouse gas emissions in the building sector is essential for meeting our future sustainability goals. Recently, smart energy metering facilities have been deployed to enable monitoring of energy consumption data with hourly or subhourly temporal resolution. This unprecedented data collection has created various opportunities for advanced data analytics involving load profiles (e.g., building energy benchmarking programs, building-to-grid integration, and calibration of urban-scale energy models). These applications often need preprocessing steps to detect daily load profile discords, such as: 1) outliers due to system malfunctions (the bad) and 2) irregular energy consumption patterns, such as those resulting from holidays (the ugly) compared to normal consumption patterns (the good). However, current preprocessing methods predominantly focus on filtering using statistical threshold values, which fail to capture the contextual discords of daily profiles. In addition, discord detection algorithms in building research are often aimed at finding individual building-level discords, which are not suitable at a large scale. Thus, here, we develop a method for automated load profile discord identification (ALDI) in a large portfolio of buildings (more than 100 buildings). Specifically, ALDI 1) uses the matrix profile (MP) method to quantify the similarities of daily subsequences in time series meter data, 2) compares daily MP values with typical-day MP distributions using the Kolmogorov-Smirnov test, and 3) identifies daily load profile discords in a large building portfolio. We evaluate ALDI using the metering data of both an academic campus and a residential neighborhood. Our results demonstrate that ALDI efficiently discovers measurement errors by system malfunctions and low energy consumption days in the academic campus portfolio, and it detects unique load shape patterns likely driven by occupant behavior and extreme weather conditions in the residential neighborhood.

32 ENERGY CONSERVATION, CONSUMPTION, AND UTILIZATI↗

Enhancers that direct gene expression to central nervous system vascular endothelial cells in vivo

CNS vascular endothelial cells (ECs) exhibit a distinctive gene expression program that is foundational for the blood-brain barrier (BBB). Previous research identified candidate cis-regulatory elements (CREs) that were hypothesized to control this program. In this work, transgenic mice and recombinant adeno-associated virus (rAAV) vectors have been used to interrogate these candidate CREs in vivo. These experiments show that an 850 bp genomic DNA segment ∼60 kb 5′ of Slc2a1 possesses enhancer activity that is (1) specific for BBB+ CNS ECs and (2) both necessary and sufficient for BBB+ EC gene expression. A screen of >8,000 genomic DNA segments from CNS EC-specific CRE candidates reveals several hundred with enhancer activity. Transcription factors ERG and LEF1 are shown to occupy sites in brain ECs that are highly enriched in candidate and experimentally validated CREs, lending strong support to a model in which canonical Wnt signaling activates the BBB program via LEF1.

CUT&RUN↗

Residential Natural Gas Demand Response Potential during Extreme Cold Events in Electricity-Gas Coupled Energy Systems

In regions where natural gas is used for both power generation and heating buildings, extreme cold weather events can place the electrical system under enormous stress and challenge the ability to meet residential heating and electric demands. Residential demand response has long been used in the power sector to curtail summer electric load, but these types of programs in general have not seen adoption in the natural gas sector during winter months. Natural gas demand response (NG-DR) has garnered interest given recent extreme cold weather events in the United States; however, the magnitude of savings and potential impacts—to occupants and energy markets—are not well understood. We present a case-study analysis of the technical potential for residential natural gas demand response in the northeast United States that utilizes diverse whole-building energy simulations and high-performance computing. Our results show that NG-DR applied to residential heating systems during extreme cold-weather conditions could reduce natural gas demand by 1–29% based on conservative and aggressive strategies, respectively. This indicates a potential to improve the resilience of gas and electric systems during stressful events, which we examine by estimating the impact on energy costs and electricity generation from natural gas. We also explore relationships between hourly indoor temperatures, demand response, and building envelope efficiency.

03 NATURAL GAS↗

The CanBikeCO Mini Pilot: Preliminary Results and Lessons Learned

In fall 2020, the Colorado Energy Office, as part of the State of Colorado’s “Can Do Colorado” initiative, initiated a project aimed at encouraging energy-efficient transportation during the COVID-19 pandemic. The initial mini-pilot provided e-bikes to 13 low-income households under an individual ownership model. This report assesses the impact of providing this additional mobility option on the travel behavior of participants. It also outlines the lessons learned from deploying a continuous monitoring platform to track the travel behavior. These lessons will influence the evaluation component for the full pilot, which will cover multiple geographic regions, starting in summer 2021, and run for 2 years. The continuous data collection was enabled by a customized version of the open-source e-mission platform, called CanBikeCO, configured with a behavioral gamification feature. The Colorado Energy Office used this system to collect a unique data set consisting of 3 months of partially automated travel diaries, combining sensed and surveyed data and linked with demographic information, from 12 participants. The data collection process worked well overall: users generally liked the app, appreciated the game, and did not complain about battery life. The long tracking period introduced behavioral challenges in user engagement, which we plan to address using repeated patterns and automated status checks for the full pilot. The analysis results, based on the subset of trips with user-reported labels (68%), indicate that the e-bike was the dominant commute mode share (31%), in sharp contrast to the census bicycle commute mode share (<1%). E-bike trips primarily replaced single-occupancy vehicle (SOV) trips (28%), followed closely by walking (24%) and regular bike (20%). The nonmotorized mode replacement corresponds to lower travel time and increased productivity enabled by the program. The emissions impact analysis of the program, computed using trip-level energy intensity factors, indicates savings of 1,367 lbs. of CO 2 . Although the results are strongly positive, the narrow demographic profile of study participants, their limited mobility alternatives, and nonuniform labeling indicate caution in broader interpretation. These preliminary results do suggest that such programs, supported by real-time education and support from program managers, can simultaneously meet equity and sustainability goals. The planned full pilot, addressing the data collection challenges and broadening the geographic scope, will provide additional insights into the generality of this approach.

32 ENERGY CONSERVATION, CONSUMPTION, AND UTILIZATI↗

The CanBikeCO Mini Pilot: Procedure and Preliminary Results

In fall 2020, the Colorado Energy Office, as part of the State of Colorado's "Can Do Colorado" initiative, initiated a project aimed at encouraging energy-efficient transportation during the COVID-19 pandemic. The initial mini-pilot provided e-bikes to 13 low-income households under an individual ownership model. This report assesses the impact of providing this additional mobility option on the travel behavior of participants. It also outlines the lessons learned from deploying a continuous monitoring platform to track the travel behavior. These lessons will influence the evaluation component for the full pilot, which will cover multiple geographic regions, start in summer 2021, and run for 2 years. The continuous data collection was enabled by a customized version of the open-source e-mission platform, called CanBikeCO, configured with a behavioral gamification feature. The Colorado Energy Office used this system to collect a unique data set consisting of 3 months of partially automated travel diaries, combining sensed and surveyed data and linked with demographic information, from 12 participants. The data collection process worked well overall: users generally liked the app, appreciated the game, and did not complain about battery life. The long tracking period introduced behavioral challenges in user engagement, which we plan to address using repeated patterns and automated status checks for the full pilot. The analysis results, based on the subset of trips with user-reported labels (68%), indicate that the e-bike was the dominant commute mode share (31%), in sharp contrast to the census bicycle commute mode share (<1%). E-bike trips primarily replaced single-occupancy vehicle (SOV) trips (28%), followed closely by walking (24%) and regular bike (20%). The non-motorized mode replacement corresponds to lower travel time and increased productivity enabled by the program. The emissions impact analysis of the program, computed using trip-level energy intensity factors, indicates savings of 1,367 lbs. of CO2. Although the results are strongly positive, the narrow demographic profile of study participants, their limited mobility alternatives, and nonuniform labeling indicate caution in broader interpretation. These preliminary results do suggest that such programs, supported by real-time education and support from program managers, can simultaneously meet equity and sustainability goals. The planned full pilot, addressing the data collection challenges and broadening the geographic scope, will provide additional insights into the generality of this approach.

ADVANCED PROPULSION SYSTEMS↗

Natural orbitals for the ab initio no-core configuration interaction approach

Ab initio no-core configuration interaction (NCCI) calculations for the nuclear many-body problem have traditionally relied upon an antisymmetrized product (Slater determinant) basis built from harmonic oscillator orbitals. The accuracy of such calculations is limited by the finite dimensions which are computationally feasible for the truncated many-body space. We therefore seek to improve the accuracy obtained for a given basis size by optimizing the choice of single-particle orbitals. Natural orbitals, which diagonalize the one-body density matrix, provide a basis which maximizes the occupation of low-lying orbitals, thus accelerating convergence in a configuration-interaction basis, while also possibly providing physical insight into the single-particle structure of the many-body wave function. We describe the implementation of natural orbitals in the NCCI framework and examine the nature of the natural orbitals thus obtained, the properties of the resulting many-body wave functions, and the convergence of observables. After taking 3 He as an illustrative testbed, we explore aspects of NCCI calculations with natural orbitals for the ground state of the p-shell neutron halo nucleus 6 He .

71 CLASSICAL AND QUANTUM MECHANICS, GENERAL PHYSIC↗

Simulating Buildings While the Design is Still in the Architect's Imagination

Very early in the design process, prior to drawing a single line, architects get information from their client or prospective client trying to understand the nature and requirements of the building that needs to be designed. The design of the building is completely fluid, as the architect considers many options in their imagination. The overall massing of the building, the general shape and form, are being considered during this early step. Even for a simple box-shaped building, the aspect ratio between the east-west and the north-south dimensions of the building can greatly impact energy consumption due to daylighting availability. The prevailing winds and building orientation can impact natural ventilation. The locations of high and low population density spaces can also impact energy use. Deciding the floor area per office workstation or the size of the auditorium will impact energy use. Does making a building two stories instead of one reduce energy impacts by reducing roof area or does the additional volume for stairs and elevators result in more energy use. Since certain types of spaces require more windows for occupants than others, the locations of those spaces will determine how much glazing each building orientation has impacting daylighting as well as heating and cooling energy. The project was an attempted first step toward creating a system tailored toward architects for this very early stage in the design process to help them understand the energy impacts of design options. The approach was not to be based on drawing the building, and instead, the main inputs would have been the size of each type of space in the building. This report describes information gathered during the development that might be of use to others developing similar software as well as some of the software that was developed during the project. Phase II funding to continue this work was not pursued due to intellectual property issues discovered during the development of the commercialization plan.

32 ENERGY CONSERVATION, CONSUMPTION, AND UTILIZATI↗

Using electronic health record metadata to predict housing instability amongst veterans

Housing instability is considered a significant life stressor and preemptive screening should be applied to identify those at risk for homelessness as early as possible so that they can be targeted for specialized care. We developed models to classify patient outcomes for an established VA Homelessness Screening Clinical Reminder (HSCR), which identifies housing instability, in the two months prior to its administration. Logistic Regression and Random Forest models were fit to classify responses using the last 18 months of document activity. We measure concentration of risk across stratifications of predicted probability and observe an enriched likelihood of finding confirmed false negative responses from veterans with diagnosed housing instability. Positive responses were 34 times more likely to be detected within the top 1 % of patients predicted at risk than from those randomly selected. There is a 1 in 4 chance of detecting false negatives within the top 1 % of predicted risk. Machine learning methods can classify between episodes of housing instability using a data-driven approach that does not rely on variables curated from domain experts. This method has the potential to improve clinicians’ ability to identify veterans who are experiencing housing instability but are not captured by HSCR.

60 APPLIED LIFE SCIENCES↗

Development and validation of a diabetes risk score among two populations

The purpose of this study was to assess the validity of a practical diabetes risk score amongst two heterogenous populations, a working population and a non-working population. Study population 1 (n = 2,089) participated in a large-scale screening program offered to retired workers to discover previously undetected/incipient chronic illness. Study population 2 (n = 3,293) was part of a Colorado worksite wellness program health risk assessment. We assessed the relationship between a continuous diabetes risk score at baseline and development of diabetes in the future using logistic regression. Receiver operating curves and sensitivity/specificity of the models were calculated. Across both study populations, we observed that participants with diabetes at follow-up had higher diabetes risk scores at baseline than participants who did not have diabetes at follow-up. On average, the odds ratio of developing diabetes in the future was 1.38 (95% CI: 1.26–1.50, p < 0.0001) for study population 1 and 1.68 (95% CI: 1.45–1.95, p-value < 0.0001) for study population 2. These findings indicate that the diabetes risk score may be generalizable to diverse individuals, and thus potentially a population level diabetes screening tool. Minimally-invasive diabetes risk scores can aid in the identification of sub-populations of individuals at risk for diabetes.

60 APPLIED LIFE SCIENCES↗

Refreshing Waste Tracking Software for the 2020's - 20059

The Waste Compliance and Tracking System (WCATS) is a software application designed to manage waste operations from cradle to grave. The system provides the support needed for characterization, generation, processing, and shipment of all waste generated or stored at Los Alamos National Laboratory (LANL). Waste is tracked with task records for containers in real-time via both desktop and mobile device applications. The software allows application administrators to configure sites with appropriate limits for Pu-239 equivalent Curies (PE-Ci), fissile gram equivalents (FGEs), volume limits, as well as custom limits for site-specific technical safety requirements (TSRs). WCATS was developed based on a need at Los Alamos National Laboratory for a modern, customizable waste tracking system that could support many different waste types. The application is built using Oracle{sup R} database and Oracle{sup R} ADF Swing application framework. The technologies and software frameworks selected for the system were finalized in 2006. Although Oracle{sup R} Database has proven to be robust, the user interface and application framework interface with the database have been deprecated and need to be replaced. The technologies selected for modernization follow the open-source model, which allows the WCATS team to more easily recruit developers, improve the speed of development, and ease the deployment and adoption of the system. The tools that support the re-engineering effort are Vue.js{sup R}, a JavaScript{sup R} framework, and Spring Boot{sup R}, an API (application programming interface) development tool written in Java{sup R}. An API allows for simplified communication from the database to the user interface of the application. In addition, legacy Crystal Reports{sup R} will be replaced with reports developed with the open source Pentaho{sup TM}f Report Designer community edition. Because the application uses HTML and JavaScript{sup R}, it builds upon tools that have been used for many years in web development. These tools have large community support and their proven track record will ensure that enhancements to WCATS can continue for years to come. (authors)

12 MANAGEMENT OF RADIOACTIVE AND NON-RADIOACTIVE W↗

Open Building Control

Best practice control sequences are often not implemented correctly, or are not implemented at all, in large commercial buildings. This typically leads to 10-30 percent energy waste, along with reduced occupant productivity and unnecessary equipment wear. The current process of designing and implementing such control sequences is a manual process that starts with designers who often don’t have adequate training, then requires controls programmers to interpret and program a verbose written sequence. This process has been shown to fail to deliver high performance control sequences at scale. The Open Building Control project digitizes the current control delivery process. The project is developing tools for system designers to select control sequences, assess their energy performance and load flexibility potential using whole building simulation, specify the sequence for implementation using machine-to-machine translation by a control provider and formally testing the as-installed sequences by a commissioning agent. The project developed tools for each stage of this delivery process. The key innovation of the project is the development of the Control Description Language, a language that allows such a digitized control delivery process with end-to-end verification. Libraries of control sequences have been implemented using the Control Description Language, and their performance has been demonstrated using whole building energy simulation. An automated translation of such sequences to a commercial control product line has been conducted using a prototype translator. Tools for formal verification of as-installed control sequences relative to their specification have been developed and demonstrated. The American Society of Heating, Refrigerating and Air-Conditioning Engineers (ASHRAE) started the process of forming a committee to make this language an ASHRAE/ANSI Standard. This new standard will complement existing and emerging ASHRAE standards for building communication and semantic modeling by providing a standard for expressing the control logic - the actual brain of the building. We expect this language and the process it enables to be an important contribution to the deployment of high performance building control sequences at scale because it allows taming the complexity of the control delivery process, which is continually increasing due to the need for higher performance and increased load flexibility to meet goals for net zero energy and increased renewable integration.

32 ENERGY CONSERVATION, CONSUMPTION, AND UTILIZATI↗

Porting the WAVEWATCH III (v6.07) wave action source terms to GPU

Abstract. Surface gravity waves play a critical role in several processes, including mixing, coastal inundation, and surface fluxes. Despite the growing literature on the importance of ocean surface waves, wind–wave processes have traditionally been excluded from Earth system models (ESMs) due to the high computational costs of running spectral wave models. The development of the Next Generation Ocean Model for the DOE’s (Department of Energy) E3SM (Energy Exascale Earth System Model) Project partly focuses on the inclusion of a wave model, WAVEWATCH III (WW3), into E3SM. WW3, which was originally developed for operational wave forecasting, needs to be computationally less expensive before it can be integrated into ESMs. To accomplish this, we take advantage of heterogeneous architectures at DOE leadership computing facilities and the increasing computing power of general-purpose graphics processing units (GPUs). This paper identifies the wave action source terms, W3SRCEMD, as the most computationally intensive module in WW3 and then accelerates them via GPU. Our experiments on two computing platforms, Kodiak (P100 GPU and Intel(R) Xeon(R) central processing unit, CPU, E5-2695 v4) and Summit (V100 GPU and IBM POWER9 CPU) show respective average speedups of 2× and 4× when mapping one Message Passing Interface (MPI) per GPU. An average speedup of 1.4× was achieved using all 42 CPU cores and 6 GPUs on a Summit node (with 7 MPI ranks per GPU). However, the GPU speedup over the 42 CPU cores remains relatively unchanged (∼ 1.3×) even when using 4 MPI ranks per GPU (24 ranks in total) and 3 MPI ranks per GPU (18 ranks in total). This corresponds to a 35 %–40 % decrease in both simulation time and usage of resources. Due to too many local scalars and arrays in the W3SRCEMD subroutine and the huge WW3 memory requirement, GPU performance is currently limited by the data transfer bandwidth between the CPU and the GPU. Ideally, OpenACC routine directives could be used to further improve performance. However, W3SRCEMD would require significant code refactoring to make this possible. We also discuss how the trade-off between the occupancy, register, and latency affects the GPU performance of WW3.

58 GEOSCIENCES↗

Unraveling the Hsp70-ROS-autophagy axis in pentachlorophenol-challenged lung and liver epithelial cells

Pentachlorophenol (PCP) was extensively utilized as an organochlorine pesticide and wood preservative in the United States from the 1930s until the Environmental Protection Agency (EPA) imposed restrictions due to concerns about its toxicity and potential carcinogenic properties. Although it is no longer widely used, PCP remains a concern due to its environmental persistence and potential for long-term health effects. Significant occupational and environmental exposures have likely occurred, with the health and economic costs of PCP exposure potentially being substantial given its known toxicity. Notably, PCP exhibits rapid absorption through both the skin and respiratory system and has been shown to cause hepatotoxicity, developmental toxicity, immunotoxicity, irritation, and carcinogenicity in laboratory animal studies. PCP exposure induces oxidative stress, a key mechanism underlying its inflammatory and toxic effects, which can activate cellular stress responses including upregulation of heat shock protein 70 (Hsp70). Previous studies in lung and liver epithelial cells have shown that Hsp70 and oxidative stress play pivotal roles in triggering autophagy. This study establishes the critical role of the Hsp70-reactive oxygen species (ROS)-autophagy axis in regulating cellular responses to PCP exposure in human alveolar (A549) and liver carcinoma (HepG2) epithelial cells. Our research elucidated the molecular mechanisms underlying PCP's cellular effects, demonstrating that its exposure resulted in increased expression of autophagy-related proteins (Beclin-1, LC3B, ATG12, and ATG16), subunits of NADPH oxidase (NCF-1, NCF-2, NOX2, and Rac), and antioxidant proteins (SOD and GPx) in both lung and liver cell types. Notably, PCP augmented the interaction between Hsp70 and the autophagy regulator Beclin-1. Pretreatment with the ROS inhibitor N-acetylcysteine or Hsp70 knockdown markedly reversed PCP-induced responses. Our in-silico protein–protein docking analysis and molecular dynamics simulation studies revealed enhanced interactions and/or stable confirmations maintained throughout the simulations for TLR4-Hsp70 and Hsp70-Beclin-1 complexes in the presence of PCP. These findings provide a strong foundation for future studies, employing in vivo experimental models and human populations to identify promising targets for PCP-induced toxicity and cellular injury. As a result, these findings may have far-reaching implications for public health and environmental policy, ultimately leading to the identification of biomarkers and the development of more effective interventions for environmentally induced toxicity and diseases.

97 MATHEMATICS AND COMPUTING↗

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

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

54 ENVIRONMENTAL SCIENCES↗

Risk Ratio and Risk Difference Estimation in Case-cohort Studies

Background: In case-cohort studies with binary outcomes, ordinary logistic regression analyses have been widely used because of their computational simplicity. However, the resultant odds ratio estimates cannot be interpreted as relative risk measures unless the event rate is low. The risk ratio and risk difference are more favorable outcome measures that are directly interpreted as effect measures without the rare disease assumption. Methods: We provide pseudo-Poisson and pseudo-normal linear regression methods for estimating risk ratios and risk differences in analyses of case-cohort studies. These multivariate regression models are fitted by weighting the inverses of sampling probabilities. Also, the precisions of the risk ratio and risk difference estimators can be improved using auxiliary variable information, specifically by adapting the calibrated or estimated weights, which are readily measured on all samples from the whole cohort. Finally, we provide computational code in R (R Foundation for Statistical Computing, Vienna, Austria) that can easily perform these methods. Results: Through numerical analyses of artificially simulated data and the National Wilms Tumor Study data, accurate risk ratio and risk difference estimates were obtained using the pseudo-Poisson and pseudo-normal linear regression methods. Also, using the auxiliary variable information from the whole cohort, precisions of these estimators were markedly improved. Conclusion: The ordinary logistic regression analyses may provide uninterpretable effect measure estimates, and the risk ratio and risk difference estimation methods are effective alternative approaches for case-cohort studies. These methods are especially recommended under situations in which the event rate is not low.

60 APPLIED LIFE SCIENCES↗

Improvised Field Expedient Method for Renal Replacement Therapy in a Porcine Model of Acute Kidney Injury

ABSTRACT Objective: Dialysis patients may not have access to conventional renal replacement therapy (RRT) following disasters. We hypothesized that improvised renal replacement therapy (ImpRRT) would be comparable to continuous renal replacement therapy (CRRT) in a porcine acute kidney injury model. Methods: Following bilateral nephrectomies and 2 hours of caudal aortic occlusion, 12 pigs were randomized to 4 hours of ImpRRT or CRRT. In the ImpRRT group, blood was circulated through a dialysis filter using a rapid infuser to collect the ultrafiltrate. Improvised replacement fluid, made with stock solutions, was infused pre-pump. In the CRRT group, commercial replacement fluid was used. During RRT, animals received isotonic crystalloids and norepinephrine. Results: There were no differences in serum creatinine, calcium, magnesium, or phosphorus concentrations. While there was a difference between groups in serum potassium concentration over time ( P < 0.001), significance was lost in pairwise comparison at specific time points. Replacement fluids or ultrafiltrate flows did not differ between groups. There were no differences in lactate concentration, isotonic crystalloid requirement, or norepinephrine doses. No difference was found in electrolyte concentrations between the commercial and improvised replacement solutions. Conclusion: The ImpRRT system achieved similar performance to CRRT and may represent a potential option for temporary RRT following disasters.

Public, Environmental & Occupational Health↗

Post-Combat-Injury Opioid Prescription and Alcohol Use Disorder in the Military

Previous studies have identified combat exposure and combat traumatic experience as problematic drinking risk factors. Increasing evidence suggests that opioid use increases the risk of alcohol use disorder. This study investigated the association between opioid prescription use after injury and (1) alcohol use disorder and (2) severity of alcohol use disorder among deployed military servicemembers. Deidentified health records data of 9,029 deployed servicemembers from a retrospective cohort study were analyzed. Data were randomly selected from the Department of Defense Trauma Registry and included servicemembers with combat injuries during deployment in Iraq or Afghanistan (2002–2016). Pharmacy records and International Classification of Diseases, Ninth and Tenth Revision diagnosis codes were used. Three groups were identified (no opioid prescription use, nonpersistent opioid prescription use, and persistent opioid prescription use) and were compared on the basis of alcohol use disorder risk using Cox proportional hazard models. Data analyses were performed in 2021. Of the 9,029 servicemembers with combat injury, 2,262 developed alcohol use disorder (1,322 developed severe alcohol use disorder). Compared with no opioid prescription use, increased alcohol use disorder risk was associated with persistent opioid prescription use, with a hazard ratio of 1.13 (95% CI=1.02, 1.26). After covariate adjustment, increased risk remained statistically significant (hazards ratio=1.24; 95% CI=1.10, 1.39). There was no significant difference in alcohol use disorder risk between no opioid prescription use and nonpersistent opioid prescription use. The risk of severe alcohol use disorder did not vary by opioid use among servicemembers with alcohol use disorder diagnosis. Furthermore, the findings of the study suggest that the incidence of alcohol use disorder was higher among injured servicemembers with persistent opioid prescription use than among those without opioid use. If replicated in prospective studies, the findings highlight the need for clinicians to consider the current and history of alcohol use of patients in initiating treatment involving opioids.

60 APPLIED LIFE SCIENCES↗