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At least 649 records · Page 36
All sourcesNASA NTRSDOE OSTI
DOE OSTI2019

Industrial Control System Risk

Risk is integrated into all business processes, and leaders work to limit risk to as low as reasonable within their systems. Within Industrial Control System networks, risk is especially challenging due to the second- and third-order effects that an attack can incur. We present a new equation for risk and analyze its appropriateness in determining risk through Monte Carlo methods. We believe that this new equation has merit in allowing leadership to more quickly access and mitigate risk based off factors within the decision maker’s control, understanding how capable an attacker may be, how much impact an attack would have on the system, and how intensely an attacker may want to cause damage to the system. These variables will allow a leader to provide strategic vision to the business that he/she leads.

99 GENERAL AND MISCELLANEOUS↗
DOE OSTI2019

Adult height, body mass index change, and body shape change in relation to esophageal squamous cell carcinoma risk: A population‐based case‐control study in China

Abstract The relationship between risk of esophageal squamous cell carcinoma (ESCC) and adult height, changes in individual body mass index (BMI) and body shape is not established. We performed a large population‐based case‐control study, which enrolled a total of 1414 ESCC cases and 1989 controls in a high‐incidence area in China. Using face‐to‐face interview with a structured questionnaire, information on participants' heights, weights, and perceived body shapes at 20 years of age was collected. Additionally, data on weight and perceived body shape among the same participants 10 years prior to ascertainment were collected using the same method. Odd ratios (ORs) of ESCC risk in relation to BMI and body shape were estimated using unconditional logistic regression models. The adjusted results indicated that ESCC risk in adults rapidly rose as height increased, plateauing at 170 cm among men and 157 cm among women. Among participants who were underweight, normal weight, or thinner than body shape 4, body weight loss was associated with increased risk of ESCC, and body weight gain was associated with decreased incidence of ESCC (ORs ranging from 0.40 to 0.76). Notably, however, changes in body weight did not significantly affect ESCC risk among participants who were overweight, obese, or larger than body shape 3. Maintaining a fit body shape and a reasonable BMI is advisable and of vital importance to reduce the risk of ESCC, especially in high‐risk areas.

Yang, Xiaorong↗
DOE OSTI2019

Feasibility of using computed tomography texture analysis parameters as imaging biomarkers for predicting risk grade of gastrointestinal stromal tumors: comparison with visual inspection

Purpose: To evaluate the feasibility of using computed tomography texture analysis (CTTA) parameters for predicting malignant risk grade and mitosis index of gastrointestinal stromal tumors (GISTs), compared with visual inspection. Method and materials: CTTA was performed on portal phase CT images of 145 surgically confirmed GISTs (mean size: 42.9 ± 37.5 mm), using TexRAD software. Mean, standard deviation, entropy, mean of positive pixels (MPP), skewness, and kurtosis of CTTA parameters, on spatial scaling factor (SSF), 2–6 were compared by risk grade, mitosis rate, and the presence or absence of necrosis on visual inspection. CTTA parameters were correlated with risk grade. Diagnostic performance was evaluated with receiver operating characteristic curve analysis. Enhancement pattern, necrosis, heterogeneity, calcification, growth pattern, and mucosal ulceration were subjectively evaluated by two observers. Results: Three to four parameters at different scales were significantly different according to the risk grade, mitosis rate, and the presence or absence of necrosis (p < 0.041). MPP at fine or medium scale (r = − 0.547 to − 393) and kurtosis at coarse scale (r = 0.424–0.454) correlated significantly with risk grade (p < 0.001). HG-GIST was best differentiated from LG-GIST by MPP at SSF 2 (AUC, 0.782), and kurtosis at SSF 4 (AUC, 0.779) (all p < 0.001). CT features predictive of HG-GIST were density lower than or equal to that of the erector spinae muscles on enhanced images (OR 2.1; p = 0.037; AUC, 0.59), necrosis (OR, 6.1; p < 0.001; AUC, 0.70), heterogeneity (OR, 4.3; p < 0.001; AUC, 0.67), and mucosal ulceration (OR, 3.3; p = 0.002; AUC, 0.62). Conclusion: Using TexRAD, MPP and kurtosis are feasible in predicting risk grade and mitosis index of GISTs. CTTA demonstrated meaningful accuracy in preoperative risk stratification of GISTs.

62 RADIOLOGY AND NUCLEAR MEDICINE↗
DOE OSTI2016

Pneumothorax Complicating Coaxial and Non-coaxial CT-Guided Lung Biopsy: Comparative Analysis of Determining Risk Factors and Management of Pneumothorax in a Retrospective Review of 650 Patients

PurposeTo assess the scope and determining risk factors related to the development of pneumothorax throughout CT-guided biopsy of pulmonary lesions in coaxial and non-coaxial techniques and the outcome of its management.Materials and MethodsThe study included CT-guided percutaneous lung biopsies in 650 consecutive patients (407 males, 243 females; mean age 54.6 years, SD 5.2) from November 2008 to June 2013 in a retrospective design. Patients were classified according to lung biopsy technique into coaxial group (318 lesions) and non-coaxial group (332 lesions). Exclusion criteria for biopsy were lesions <5 mm in diameter, uncorrectable coagulopathy, positive-pressure ventilation, severe respiratory compromise, pulmonary arterial hypertension, or refusal of the procedure. Risk factors related to the occurrence of pneumothorax were classified into: (a) Technical risk factors, (b) patient-related risk factors, and (c) lesion-associated risk factors. Radiological assessments were performed by two radiologists in consensus. Mann–Whitney U test and Fisher’s exact tests were used for statistical analysis. p values <0.05 were considered statistically significant.ResultsThe incidence of pneumothorax complicating CT-guided lung biopsy was less in the non-coaxial group (23.2 %, 77 out of 332) than the coaxial group (27 %, 86 out of 318). However, the difference in incidence between both groups was statistically insignificant (p = 0.14). Significant risk factors for the development of pneumothorax in both groups were emphysema (p < 0.001 in both groups), traversing a fissure with the biopsy needle (p value 0.005 in non-coaxial group and 0.001 in coaxial group), small lesion, less than 2 cm in diameter (p value of 0.02 in both groups), location of the lesion in the basal or mid sections of the lung (p = 0.003 and <0.001 in non-coaxial and coaxial groups, respectively), and increased needle track path within the lung tissue of more than 2.5 cm (p = 0.01 in both groups). The incidence of pneumothorax in the non-coaxial group was significantly correlated to the number of specimens obtained (p = 0.006). This factor was statistically insignificant in the coaxial group (p = 0.45). The biopsy yield was more diagnostic and conclusive in the coaxial group in comparison to the non-coaxial group (p = 0.008). Simultaneous incidence of pneumothorax and pulmonary hemorrhage was 27.3 % (21/77) in non-coaxial group and in 30.2 % (26/86) in coaxial group. Conservative management was sufficient for treatment of 91 out of 101 patients of pneumothorax in both groups (90.1 %). Manual evacuation of pneumothorax was efficient in 44/51 patients (86.3 %) in both groups and intercostal chest tube was applied after failure of manual evacuation (7 patients: 13.7 %), from which one patient developed a persistent air leakage necessitating pleurodesis.ConclusionPneumothorax complicating CT-guided core biopsy of pulmonary lesions, showed the insignificant difference between coaxial and non-coaxial techniques. However, both techniques have the same significant risk factors including small and basal lesions, increased lesion’s depth from pleural surface, and increased length of aerated lung parenchyma crossed by biopsy needle and passing through pulmonary fissures in the needle tract.

62 RADIOLOGY AND NUCLEAR MEDICINE↗
DOE OSTI2018

Stochastic risk-sensitive market integration for renewable energy: Application to ocean wave power plants

With the expected increase of intermittent renewable energy resources on the electric power grid, short-term reserve markets can prove to be a critical reliability asset. This paper introduces and tests a potential market structure that includes a short-term reserve market for renewable resources where the realized energy is drawn within the bounds of the hourly capacity offered. The study presents a risk-aware stochastic model that determines, based on the day-ahead offer derived using a classic newsvendor formula, the best intraday offers for a renewable energy power plant. The stochastic approach takes into account the uncertainties of energy production and market prices. The proposed risk-sensitive model aims to maximize the renewable power plant's revenues and minimize potential risks of loss in a multi-product multi-timescale market setup. To demonstrate the effectiveness of the proposed formulation, we study the case of a hypothetical 750-kW wave power plant coupled with energy storage. The study shows that the risk of profit loss is not uniformly distributed across the risk-aversion factor space. We also find that the introduction of the short-term reserve market results in a wider range of conditional value at risk while inducing 5% profit increase and a lower profit reduction across the risk range. In addition, the study reveals that the short-term reserve market is profitable for both the system operator and the wave energy power plant considered.

24 POWER TRANSMISSION AND DISTRIBUTION↗
DOE OSTI2013

The social values at risk from sea-level rise

Analysis of the risks of sea-level rise favours conventionally measured metrics such as the area of land that may be subsumed, the numbers of properties at risk, and the capital values of assets at risk. Despite this, it is clear that there exist many less material but no less important values at risk from sea-level rise. This paper re-theorises these multifarious social values at risk from sea-level rise, by explaining their diverse nature, and grounding them in the everyday practices of people living in coastal places. It is informed by a review and analysis of research on social values from within the fields of social impact assessment, human geography, psychology, decision analysis, and climate change adaptation. From this we propose that it is the ‘lived values’ of coastal places that are most at risk from sea-level rise. We then offer a framework that groups these lived values into five types: those that are physiological in nature, and those that relate to issues of security, belonging, esteem, and self-actualisation. This framework of lived values at risk from sea-level rise can guide empirical research investigating the social impacts of sea-level rise, as well as the impacts of actions to adapt to sea-level rise. It also offers a basis for identifying the distribution of related social outcomes across populations exposed to sea-level rise or sea-level rise policies.

54 ENVIRONMENTAL SCIENCES↗
DOE OSTI2015

Metals exposure and risk of small-for-gestational age birth in a Canadian birth cohort: The MIREC study

Background: Lead, mercury, cadmium and arsenic are some of the most common toxic metals to which Canadians are exposed. The effect of exposure to current low levels of toxic metals on fetal growth restriction is unknown. Objective: The aim of this study was to examine relationships between exposure to lead, mercury, cadmium and arsenic during pregnancy, and risk of small for gestational age (SGA) birth. Methods: Lead, mercury, cadmium and arsenic levels were measured in blood samples from the first and third trimesters in 1835 pregnant women from across Canada. Arsenic species in first trimester urine were also assessed. Relative risks and 95% confidence intervals were estimated using log binomial multivariate regression. Important covariates including maternal age, parity, pre-pregnancy BMI, and smoking, were considered in the analysis. An exploratory analysis was performed to examine potential effect modification of these relationships by single nucleotide polymorphisms (SNPs) in GSTP1 and GSTO1 genes. Results: No association was found between blood lead, cadmium or arsenic and risk for SGA. We observed an increased risk for SGA for the highest compared to the lowest tertile of exposure for mercury (>1.6 µg/L, RR=1.56.; 95% CI=1.04–2.58) and arsenobetaine (>2.25 µg/L, RR=1.65; 95% CI=1.10–2.47) after adjustment for the effects of parity and smoking. A statistically significant interaction was observed in the relationship between dimethylarsinic acid (DMA) levels in urinary arsenic and SGA between strata of GSTO1 A104A (p for interaction=0.02). A marginally significant interaction was observed in the relationship between blood lead and SGA between strata of GSTP1 A114V (p for interaction=0.06). Conclusions: These results suggest a small increase in risk for SGA in infants born to women exposed to mercury and arsenic. Given the conflicting evidence in the literature this warrants further investigation in other pregnant populations. - Highlights: • Metals measured in blood or urine of pregnant women. • No association between blood lead, cadmium or arsenic and SGA. • Small increased risk for highest tertile of blood mercury. • Small increased risk for highest tertile of urinary arsenobetaine. • Further research needed to confirm observed associations.

54 ENVIRONMENTAL SCIENCES↗
DOE OSTI2018

Survey on the micro-pollutants presence in surface water system of northern Serbia and environmental and health risk assessment

Highlights: • First survey on the occurrence of 940 substances in the middle part of the Danube Basin. • Micro-pollutants from canals water had higher abundance of contaminants that from river. • High level of sterols indicated dominant effect of untreated domestic wastewater. • Correlations among the groups of micro-pollutants indicated their common origin. • Ecological risk suggesting a potential for adverse effects on fish. This study demonstrates the occurrence of 940 organic micro-pollutants in surface water of four rivers, one irrigation canal system, and two lakes in Vojvodina Province, the northern part of Serbia, summing in total eighteen samples. The number of detected chemicals ranged from 22 to 84, with 127 micro-pollutants detected at least once, representing 13% of the studied substances. The targeted compounds include n-alkanes, sterols, polycyclic aromatic hydrocarbons (PAHs), organochlorine pesticides polychlorinated biphenyls, pesticides, pharmaceutical active compounds, industrial chemicals, plasticizers, etc. Among the analysed compounds, sterols were the most dominant with maximum quantified concentrations. The substances which were quantified with frequency over 50% were two PAHs (2-methylnaphthalene, benzo(ghi)perylene), five sterols (cholesterol, cholestanol, stigmasterol, fucosterol, beta-sitosterol), three pharmaceuticals and personal care products (L-menthol, diethyltoluamide, caffeine), and ten household chemicals (4-tert-octylphenol, dimethyl phthalate, methyl palmitate, phenylethyl alcohol, 1-nonanol, alpha-terpineol, 2-phenoxy-ethanol, methyl myristate, acetophenone, and 2-ethyl-1-hexanol). The list of priority substances under the European Union Directive 2013/39/EU includes 49 priority substances (PSs) out of which 34 were analysed. Among these, eleven PSs were quantified, and only two compounds (fluoranthene and benzo (a) pyrene) exceeded EU Environmental Quality Standards targeted values. The obtained results were compared with the previously published data that dealt with the same targeted number of micro-pollutants in sediment samples. This revealed connections between the same sampling locations. Environmental risk assessment showed the existence of potential ecological risk as 72% of the obtained values for the ecological hazard index (HI) at investigated locations were higher that the targeted value (HI > 1). Estimated values for hazard quotient (HQ) and hazard index (HI) for non-carcinogenic risk were lower than the targeted value, indicating no non-carcinogenic risk through dermal contact and non-intentional ingestion of water. Estimated values for cancer risk were all below 1 × 10{sup −6}, which is not considered to pose significant human health risk.

54 ENVIRONMENTAL SCIENCES↗
DOE OSTI2015

Influence of Pulmonary Nodules on Chest Computed Tomography and Risk of Recurrence in Stage IV Wilms Tumor

Purpose: Chest computed tomography (CT) is currently accepted as the main modality for initial disease staging and response assessment in Wilms tumor (WT). However, there is great variability in the number and size of lung metastases at the time of diagnosis and after induction chemotherapy. There is a lack of clinical evidence as to how this variability in tumor burden affects choice of therapy and disease outcome. This study sought to evaluate a previously proposed lung metastases risk stratification system based on CT findings and clinical outcomes in stage IV WT patients. Methods and Materials: Thirty-five pediatric patients with a diagnosis of stage IV WT with evaluable pre- and postdiagnosis CT scans between 1997 and 2012 were included in the analysis. Patients were divided into low-, intermediate-, and high-risk categories based on the size and number of pulmonary metastases before and after 6 weeks of chemotherapy. Association of the lung risk groups with lung recurrence-free survival and overall survival at each time point was analyzed with relevant covariates. Results: Risk group distribution both at diagnosis and after induction chemotherapy was not influenced by tumor histology. Initial risk grouping suggested an association with disease-free survival at 5 years (P=.074); however, the most significant correlation was with postinduction chemotherapy disease status (P=.027). In patients with an intermediate or high burden of disease after 6 weeks of chemotherapy, despite receiving whole-lung and boost irradiation, survival outcomes were poorer. Conclusions: Pulmonary tumor burden in stage IV WT on chest CT can predict disease outcome. Patients with intermediate- or low-risk disease, especially after induction therapy, have a higher risk for recurrence. After prospective validation, this method may become a valuable tool in adaptation of therapy to improve outcome.

62 RADIOLOGY AND NUCLEAR MEDICINE↗
DOE OSTI2015

Quantifying Unnecessary Normal Tissue Complication Risks due to Suboptimal Planning: A Secondary Study of RTOG 0126

Purpose: The purpose of this study was to quantify the frequency and clinical severity of quality deficiencies in intensity modulated radiation therapy (IMRT) planning in the Radiation Therapy Oncology Group 0126 protocol. Methods and Materials: A total of 219 IMRT patients from the high-dose arm (79.2 Gy) of RTOG 0126 were analyzed. To quantify plan quality, we used established knowledge-based methods for patient-specific dose-volume histogram (DVH) prediction of organs at risk and a Lyman-Kutcher-Burman (LKB) model for grade ≥2 rectal complications to convert DVHs into normal tissue complication probabilities (NTCPs). The LKB model was validated by fitting dose-response parameters relative to observed toxicities. The 90th percentile (22 of 219) of plans with the lowest excess risk (difference between clinical and model-predicted NTCP) were used to create a model for the presumed best practices in the protocol (pDVH{sub 0126,top10%}). Applying the resultant model to the entire sample enabled comparisons between DVHs that patients could have received to DVHs they actually received. Excess risk quantified the clinical impact of suboptimal planning. Accuracy of pDVH predictions was validated by replanning 30 of 219 patients (13.7%), including equal numbers of presumed “high-quality,” “low-quality,” and randomly sampled plans. NTCP-predicted toxicities were compared to adverse events on protocol. Results: Existing models showed that bladder-sparing variations were less prevalent than rectum quality variations and that increased rectal sparing was not correlated with target metrics (dose received by 98% and 2% of the PTV, respectively). Observed toxicities were consistent with current LKB parameters. Converting DVH and pDVH{sub 0126,top10%} to rectal NTCPs, we observed 94 of 219 patients (42.9%) with ≥5% excess risk, 20 of 219 patients (9.1%) with ≥10% excess risk, and 2 of 219 patients (0.9%) with ≥15% excess risk. Replanning demonstrated the predicted NTCP reductions while maintaining the volume of the PTV receiving prescription dose. An equivalent sample of high-quality plans showed fewer toxicities than low-quality plans, 6 of 73 versus 10 of 73 respectively, although these differences were not significant (P=.21) due to insufficient statistical power in this retrospective study. Conclusions: Plan quality deficiencies in RTOG 0126 exposed patients to substantial excess risk for rectal complications.

62 RADIOLOGY AND NUCLEAR MEDICINE↗
DOE OSTI2016

High-Dose-Rate Brachytherapy as Monotherapy for Intermediate- and High-Risk Prostate Cancer: Clinical Results for a Median 8-Year Follow-Up

Purpose: To present mature results of high-dose-rate brachytherapy (HDR-BT) as monotherapy for intermediate- and high-risk prostate cancer. Methods and Materials: From 1995 through 2012, 190 patients, 79 with intermediate-risk and 111 with high-risk prostate cancer, were treated with HDR-BT alone using 48 Gy/8 fractions, 54 Gy/9 fractions, or 45.5 Gy/7 fractions over 4 to 5 days. Neoadjuvant with or without adjuvant androgen deprivation therapy was administered to 139 patients, 35 intermediate- and 104 high-risk. Results: Median follow-up time was 92 months (range, 10-227 months), with a minimum of 2 years for surviving patients. Respective rates of cause-specific survival, overall survival, metastasis-free survival, and biochemical no evidence of disease for the intermediate-risk patients were 100%, 100%, 96%, and 93% at 5 years, and 100%, 96%, 91%, and 91% at 8 years. Corresponding rates for the high-risk patients were 97%, 93%, 84%, and 81% at 5 years, and 93%, 81%, 74%, and 77% at 8 years. The cumulative incidence of late grade 2 to 3 genitourinary toxicity was 5% at 5 years and 10% at 8 years, and that of late grade 3 was 0 at 5 years and 1% at 8 years. The cumulative incidence of late grade 2-3 gastrointestinal toxicity was 4% at 5 years and 6% at 8 years, and that of late grade 3 was 0 at 5 years and 2% at 8 years. No grade 4 or 5 toxicity was detected. Conclusions: Our single-institution study with a median 8-year follow-up showed that HDR-BT as monotherapy was safe and effective for patients with intermediate- and high-risk prostate cancer.

62 RADIOLOGY AND NUCLEAR MEDICINE↗
DOE OSTI2016

Distribution of Cervical Lymph Node Metastases From Squamous Cell Carcinoma of the Oropharynx in the Era of Risk Stratification Using Human Papillomavirus and Smoking Status

Purpose/Objective(s): To investigate the factors contributing to the clinical presentation of oropharyngeal squamous cell carcinoma (OPSCC) in the era of risk stratification using human papilloma virus (HPV) and smoking status. Methods and Materials: All patients with OPSCC presenting to our institutional multidisciplinary clinic from January 2009 to June 2015 were reviewed from a prospective database. The patients were grouped as being at low risk, intermediate risk, and high risk in the manner described by Ang et al. Variance in clinical presentation was examined using χ{sup 2}, Kruskal-Wallis, Mann-Whitney, and logistic regression analyses. Results: The rates of HPV/p16 positivity (P<.001), never-smoking (P=.016), and cervical lymph node metastases (P=.023) were significantly higher for patients with OPSCC of the tonsil, base of tongue (BOT), or vallecula subsites when compared with pharyngeal wall or palate subsites. Low-risk patients with tonsil, base of tongue, or vallecula primary tumors presented with nodal stage N2a at a much higher than expected frequency (P=.007), and high-risk patients presented with tumor stage T4 at a much higher than expected frequency (P=.003). Patients with BOT primary tumors who were never-smokers were less likely to have clinically involved ipsilateral neck disease than were former smokers (odds ratio 1.8; P=.038). The distribution of cervical lymph node metastases was not associated with HPV/p16 positivity, risk group, or subsite. When these data were compared with those in historical series, no significant differences were seen in the patterns of cervical lymph node metastases for patients with OPSCC. Conclusions: For patients with OPSCC differences in HPV status, smoking history and anatomic subsite were associated with differences in clinical presentation but not with distribution of cervical lymph node metastases. Historical series describing the patterns of cervical lymph node metastases in patients with OPSCC remain clinically relevant.

62 RADIOLOGY AND NUCLEAR MEDICINE↗
DOE OSTI2014

Radiobiologic comparison of helical tomotherapy, intensity modulated radiotherapy, and conformal radiotherapy in treating lung cancer accounting for secondary malignancy risks

The aim of the present study is to examine the importance of using measures to predict the risk of inducing secondary malignancies in association with the clinical effectiveness of treatment plans in terms of tumor control and normal tissue complication probabilities. This is achieved by using radiobiologic parameters and measures, which may provide a closer association between clinical outcome and treatment delivery. Overall, 4 patients having been treated for lung cancer were examined. For each of them, 3 treatment plans were developed based on the helical tomotherapy (HT), multileaf collimator-based intensity modulated radiation therapy (IMRT), and 3-dimensional conformal radiation therapy (CRT) modalities. The different plans were evaluated using the complication-free tumor control probability (p{sub +}), the overall probability of injury (p{sub I}), the overall probability of control/benefit (p{sub B}), and the biologically effective uniform dose (D{sup ¯¯}). These radiobiologic measures were used to develop dose-response curves (p-D{sup ¯¯} diagram), which can help to evaluate different treatment plans when used in conjunction with standard dosimetric criteria. The risks for secondary malignancies in the heart and the contralateral lung were calculated for the 3 radiation modalities based on the corresponding dose-volume histograms (DVHs) of each patient. Regarding the overall evaluation of the different radiation modalities based on the p{sub +} index, the average values of the HT, IMRT, and CRT are 67.3%, 61.2%, and 68.2%, respectively. The corresponding average values of p{sub B} are 75.6%, 70.5%, and 71.0%, respectively, whereas the average values of p{sub I} are 8.3%, 9.3%, and 2.8%, respectively. Among the organs at risk (OARs), lungs show the highest probabilities for complications, which are 7.1%, 8.0%, and 1.3% for the HT, IMRT, and CRT modalities, respectively. Similarly, the biologically effective prescription doses (D{sub B}{sup ¯¯}) for the HT, IMRT, and CRT modalities are 64.0, 60.9, and 60.8 Gy, respectively. Regarding the risk for secondary cancer, for the heart, the lowest average risk is produced by IMRT (0.10%) compared with the HT (0.17%) and CRT (0.12%) modalities, whereas the 3 radiation modalities show almost equivalent results regarding the contralateral lung (0.8% for HT, 0.9% for IMRT, and 0.9% for CRT). The use of radiobiologic parameters in the evaluation of different treatment plans and estimation of their expected clinical outcome is shown to provide very useful clinical information. The radiobiologic analysis of the response probabilities showed that different radiation modalities appear to be more effective in different patient geometries and target sizes and locations. Furthermore, there is not a clear pattern between the plans that appear to be more effective for the treatment and the risk of secondary malignancy. It seems that radiobiologically based treatment planning taking into account the risk of secondary cancer can be established as an effective clinical tool for a more clinically relevant treatment optimization.

61 RADIATION PROTECTION AND DOSIMETRY↗
DOE OSTI2017

DMARD use is associated with a higher risk of dementia in patients with rheumatoid arthritis: A propensity score-matched case–control study

Background: Patients with rheumatoid arthritis (RA) exhibit an increased risk of dementia. Disease-modifying antirheumatic drugs (DMARDs) are commonly used to slow RA progression, but studies investigating the relationship between DMARDs and dementia in patients with RA are lacking. We investigated the relationship between DMARDs and dementia in patients with RA. Methods: Using the National Health Insurance Research Database, patients aged ≥ 20 years, who were newly diagnosed with RA between 2000 and 2011 were identified. Patients with RA who had dementia comprised the dementia group, and patients with RA who did not have dementia comprised the control group. The groups were matched at a 1:1 ratio by the propensity score. DMARDs were categorized into conventional synthetic DMARDs (csDMARDs) and biological DMARDs (bDMARDs). Logistic regression models were used to calculate the odds ratio and 95% confidence interval (CI) to evaluate the association between DMARD use and the risk of dementia in patients with RA. Results: A total of 957 patients with RA and dementia, and 957 patients with RA but not dementia, were enrolled. The risk of dementia was determined to be 1.63-fold higher in patients with RA with csDMARD use than in those without csDMARD use (95% CI = 1.33–2.00). No significant risk of dementia was observed in patients with RA who used bDMARDs compared with their counterparts. However, patients with RA who used hydroxychloroquine, methotrexate, and sulfasalazine exhibited significant risks of dementia, irrespective of cumulative exposure days. Conclusion: Patients with RA who used csDMARDs exhibit significant association with dementia. - Highlights: • Patients with RA who used csDMARDs exhibited a 1.63-fold higher risk of dementia than did those who did not use csDMARDs. • No significant risk of dementia was observed in patients with RA who used bDMARDs. • The use of csDMARDs was significantly associated with vascular dementia (OR = 1.78, 95% CI = 1.21–2.61).

60 APPLIED LIFE SCIENCES↗
DOE OSTI2022

Toward More Actionable Flood‐Risk Information

Abstract The increasingly urgent need to develop knowledge and practices to manage flood risks drives innovative information design. However, experts often disagree about design practices. As a result, flood‐risk estimates can diverge, leading to different conclusions for decision‐making. Using examples of household‐scale fluvial (riverine) flood‐risk information in the United States, we assess design features and risk communication approaches that may lead to more actionable information for decision‐making. We argue that increased attention to uncertainty characterization and model diagnostics is a critical intermediate step for developing simpler approaches for designing flood‐risk information. Simpler frameworks are desirable because flood risks change over time, and simpler frameworks are less costly to update. Developing frameworks for large spatial domains require collaboration grounded in principles of open science. Finally, systematically evaluating how decision‐makers access and use information can provide new insights to guide risk communication and information design.

54 ENVIRONMENTAL SCIENCES↗
DOE OSTI2021

Near-term transition and longer-term physical climate risks of greenhouse gas emissions pathways

Policy, business, finance and civil society stakeholders are increasingly looking to compare future emissions pathways across both their associated physical climate risks stemming from increasing temperatures and their transition climate risks stemming from the shift to a low-carbon economy. Herein, we present an integrated framework to explore near-term (to 2030) transition risks and longer-term (to 2050) physical risks, globally and in specific regions, for a range of plausible greenhouse gas emissions and associated temperature pathways, spanning 1.5–4 °C levels of long-term warming. By 2050, physical risks deriving from major heatwaves, agricultural drought, heat stress and crop duration reductions depend greatly on the temperature pathway. By 2030, transition risks most sensitive to temperature pathways stem from economy-wide mitigation costs, carbon price increases, fossil fuel demand reductions and coal plant capacity reductions. Considering several pathways with a 2 °C target demonstrates that transition risks also depend on technological, policy and socio-economic factors.

54 ENVIRONMENTAL SCIENCES↗
DOE OSTI2026

Unlocking the benefits of transparent and reusable science for climate-risk management

People around the world seek climate-risk information to guide their decisions. For instance, projections about future flood risk inform where households choose to live, how lenders manage credit risks, and which communities receive federal funding. Yet data limitations and fundamental validation challenges raise important concerns about the reliability of such projections. The principles of transparency and reusability help address these concerns by enabling scrutiny of assumptions and methods, development of foundational data and tools, and consistent application of evaluation standards. While there is ongoing debate about how much transparency commercial climate-risk services should provide, many expect non-commercial actors to lead the way on operationalizing transparency and reusability to fulfill their knowledge-building role in the climate-risk ecosystem. However, despite prominent success stories, we find a substantial gap between principles and practice: only four percent of the most-cited peer-reviewed climate-risk studies in recent years fully share their data and code despite this being a widely accepted minimum standard for transparency. We highlight low-cost measures that non-commercial researchers can take now to improve transparency and reusability. We also emphasize that transformative progress requires substantial investment, cross-sector collaboration, and careful consideration of tradeoffs, data rights, and multiple perspectives on equity. We hope this perspective accelerates both immediate actions and longer-term conversations to improve the ability of science to effectively support timely, evidence-based, and sound climate-risk management.

Open Science↗
DOE OSTI2014

TU-F-16A-01: Communicating Risk

The radiobiological risks associated with medical imaging are generally considered to be small, if existent. However, the public view of the risk of medical radiation at diagnostic levels can be substantially different from the clinical reality. Radiation science is not taught to the general public, and so perception of radiation risks can be based on a variety sources, including some that may be misleading, incorrect, or sensationalized. Consequently, patients can have significant concerns about procedures they or their loved ones might have had or that might be needed in their medical care. It is the responsibility of the physicist to be able to communicate risk in a manner that is clear, understandable, and respectful. This session will present a number of real life scenarios of patient or family concern about radiation risks. The panel will, through demonstration or discussion, present various options for handling each situation. The audience will be involved in discussion and critique of the approaches presented. Learning Objectives: To gain insight to the patients perspective on radiation risk and how to respond professionally to their concerns. To learn basic principles for effectively communicating with patients about radiation risk. To gain tools and approaches for addressing a wide range of patient concerns.

60 APPLIED LIFE SCIENCES↗