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At least 1,261 records · Page 70
All sourcesNASA NTRSDOE OSTI
DOE OSTI2020

The direct and indirect effects of copper on vector-borne disease dynamics

Metal pollution is a growing concern that affects the health of humans and animals globally. Copper is an essential insect micronutrient required for respiration, pigmentation and oxidative stress protection but can also act as a potentially toxic trace element. While several studies have focused on the negative fitness effects of copper on the aquatic larvae of mosquitoes, the effects of larval copper exposure on adult mosquito fitness (i.e., survival and fecundity) and their ability to transmit parasites (i.e., vector competence) remains unclear. Here, using a well-studied model vector-parasite system, the mosquito Aedes aegypti and parasite Dirofilaria immitis, we show that sublethal copper exposure in larval mosquitoes alters adult female fecundity and vector competence. Specifically, mosquitoes exposed to copper had a hormetic fecundity response and mosquitoes exposed to 600 μg/L of copper had significantly fewer infective parasite larvae than control mosquitoes not exposed to copper. Therefore, exposure of mosquito larvae to copper levels far below EPA-mandated safe drinking water limits (1300 μg/L) can impact vector-borne disease dynamics not only by reducing mosquito abundance (through increased larval mortality), but also by reducing parasite transmission risk. Our results also demonstrated that larval copper is retained through metamorphosis to adulthood in mosquitoes, indicating that these insects could transfer copper from aquatic to terrestrial foodwebs, especially in urban areas where they are abundant. To our knowledge this is the first study to directly link metal exposure with vector competence (i.e., ability to transmit parasites) in any vector-parasite system. Additionally, it also demonstrates unequivocally that mosquitoes can transfer contaminants from aquatic to terrestrial ecosystems. These results have broad implications for public health because they directly linking contaminants and vector-borne disease dynamics, as well as linking mosquitoes and contaminant dynamics.

54 ENVIRONMENTAL SCIENCES↗
DOE OSTI2011

The relationship between body iron stores and blood and urine cadmium concentrations in US never-smoking, non-pregnant women aged 20-49 years

Background: Cadmium is a ubiquitous environmental pollutant associated with increased risk of leading causes of mortality and morbidity in women, including breast cancer and osteoporosis. Iron deficiency increases absorption of dietary cadmium, rendering women, who tend to have lower iron stores than men, more susceptible to cadmium uptake. We used body iron, a measure that incorporates both serum ferritin and soluble transferrin receptor, as recommended by the World Health Organization, to evaluate the relationships between iron status and urine and blood cadmium. Methods: Serum ferritin, soluble transferrin receptor, urine and blood cadmium values in never-smoking, non-pregnant, non-lactating, non-menopausal women aged 20-49 years (n=599) were obtained from the 2003-2008 National Health and Nutrition Examination Surveys. Body iron was calculated from serum ferritin and soluble transferrin receptor, and iron deficiency defined as body iron <0 mg/kg. Robust linear regression was used to evaluate the relationships between body iron and blood and urine cadmium, adjusted for age, race, poverty, body mass index, and parity. Results: Per incremental (mg/kg) increase in body iron, urine cadmium decreased by 0.003 {mu}g/g creatinine and blood cadmium decreased by 0.014 {mu}g/L. Iron deficiency was associated with 0.044 {mu}g/g creatinine greater urine cadmium (95% CI=0.020, 0.069) and 0.162 {mu}g/L greater blood cadmium (95% CI=0.132, 0.193). Conclusions: Iron deficiency is a risk factor for increased blood and urine cadmium among never-smoking, pre-menopausal, non-pregnant US women, independent of age, race, poverty, body mass index and parity. Expanding programs to detect and correct iron deficiency among non-pregnant women merits consideration as a potential means to reduce the risk of cadmium associated diseases. - Highlights: {yields} Body iron was calculated from serum ferritin and soluble transferrin receptor. {yields} Body iron was inversely associated with blood and urine cadmium in US women. {yields} Inverse associations with blood cadmium were evident in all race/ethnic subsamples. {yields} Inverse associations with urine cadmium were evident in women of other/multi-race. {yields} Black women had lower mean body iron compared to white women.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

Evaluation of the use of common sculpin (Myoxocephalus scorpius) organ histology as bioindicator for element exposure in the fjord of the mining area Maarmorilik, West Greenland

The former Black Angel lead–zinc mine in Maarmorilik, West Greenland, is a historic example of how mining activity may result in a significant impact on the surrounding fjord system in terms of elevated concentrations of especially lead (Pb) and zinc (Zn) in seawater, sediments and surrounding biota. In order to shed light on the present contamination and possible effects in the fjord we initiated a range of studies including a pilot study on gill and liver morphology of common sculpins (Myoxocephalus scorpius) around Maarmorilik. Sculpins were caught and sampled at five different stations known to represent a gradient of Pb concentrations. Fish livers from all specimens were analyzed for relevant elements in the area: Fe, Zn, As, Cu, Se, Cd, Pb, Ag, Hg, Co and Ni. Lead, As and Hg showed significant differences among the five stations. For 20% of the sculpins, Hg concentrations were in the range of lowest observed effect dose (LOED) of 0.1–0.5 μg/g ww for toxic threshold on reproduction and subclinical endpoints. Likewise LOEDs for tissue lesions, LOEDs for biochemistry, growth, survival and reproduction were exceeded for Cd (0.42–1.8 μg/g ww) and for As (11.6 μg/g ww) in 28% and 85% of the sculpins, respectively. Similar to this, the no observed effect dose (NOED) for biochemistry was exceeded for Pb (0.32 μg/g ww) and for growth, mortality and reproduction for Zn (60–68 μg/g ww) in 33% and 24% of the sculpins, respectively. For all sculpins, females were significantly larger than males and for five of the elements (Fe, Co, Ni, Cu, Se) females had higher concentrations. The chronic lesions observed in liver (mononuclear cell infiltrates, necrosis, vacuolar hepatocytes, portal fibrosis, bile duct hyperplasia, active melanomacrophage centers) and gills (fusion and edema of secondary lamellae, laminar telangiectasis, mononuclear cell infiltrates, blebs) were similar to those in the literature studies for both wild and laboratory exposed sculpins and other fish species carrying similar or higher Hg concentrations. Ignoring sex and size, specimens with hepatic cell infiltrates had the highest concentrations of most elements, a relation that was also found for gill telangiectasis and Hg (all p<0.05). When controlling for sex and size, the prevalence of vacuolar hepatocytes and endoparasites was significantly highest at the three most contaminated stations and similar differences were found for liver necrosis. We suggest that beside exposure to mining-related elements, other environmental factors, such as parasites, might be co-factors in the development of the observed liver and gill lesions. Therefore, sculpin liver and gill pathology are likely to be suitable health indicators when biomonitoring gradients of mining and other element related activity effects; while a larger study is required to fully evaluate the relationships. - Highlights: • Black Angel Pb–Zn mine in West Greenland has led to significant metal pollution. • Gill and liver morphology of common sculpins was evaluated as bioindicators. • Significant pathologies were found and were related to metal concentrations. • Sculpin pathology may be suitable health indicators for mining activity effects. • These should be enrolled in EIAs of raw material industrialization in the Arctic.

54 ENVIRONMENTAL SCIENCES↗
DOE OSTI2015

Self-rated health and chronic conditions are associated with blood concentrations of persistent organic pollutants in the general population of Catalonia, Spain

Background: Self-rated health (SRH) is a powerful predictor of mortality, morbidity, and need for health services. SRH generally increases with educational level, and decreases with age, number of chronic conditions, and body mass index (BMI). Because human concentrations of most persistent organic pollutants (POPs) also vary by age, education, and BMI, and because of the physiological and clinical effects of POPs, we hypothesized that body concentrations of POPs are inversely associated with SRH. Objectives: To analyze the relation between serum concentrations of POPs and SRH in the general population of Catalonia, Spain, taking into account sociodemographic factors and BMI, as well as chronic health conditions and mental disorders, measured by the General Health Questionnaire-12 (GHQ-12). Methods: POP serum concentrations were measured by gas chromatography with electron-capture detection in 919 participants of the Catalan Health Interview Survey. Results: Individuals with higher concentrations of POPs had significantly poorer SRH; e.g., the median concentration of HCB in subjects with poor SRH was twice as high as in subjects with excellent SRH (366 ng/g vs. 169 ng/g, respectively; p-value<0.001). In crude models and in models adjusted for sex and BMI, the POPs-SRH association was often dose-dependent, and the likelihood of poor or regular SRH was 2 to 4-times higher in subjects with POP concentrations in the top quartile. In models adjusted for age or for chronic conditions virtually all ORs were near unity. No associations were found between POP levels and GHQ-12. Conclusions: Individuals with higher concentrations of POPs had significantly poorer SRH, an association likely due to age and chronic conditions, but not to sex, education, social class, BMI, or mental disorders. - Highlights: • The relation between POPs and self-rated and mental health has seldom been studied. • Subjects with higher POP levels had poorer self-rated health (SRH) (dose-dependent). • The number of chronic conditions was positively related to POP levels. • The POPs-SRH association was likely due to age (or birth cohort), and to chronic conditions. • Causal or not, the fact is that people with poorer SRH often have higher levels of POPs.

54 ENVIRONMENTAL SCIENCES↗
DOE OSTI2017

A cost-benefit analysis of a pellet boiler with electrostatic precipitator versus conventional biomass technology: A case study of an institutional boiler in Syracuse, New York

Background: Biomass facilities have received increasing attention as a strategy to increase the use of renewable fuels and decrease greenhouse gas emissions from the electric generation and heating sectors, but these facilities can potentially increase local air pollution and associated health effects. Comparing the economic costs and public health benefits of alternative biomass fuel, heating technology, and pollution control technology options provides decision-makers with the necessary information to make optimal choices in a given location. Methods: For a case study of a combined heat and power biomass facility in Syracuse, New York, we used stack testing to estimate emissions of fine particulate matter (PM{sub 2.5}) for both the deployed technology (staged combustion pellet boiler with an electrostatic precipitator) and a conventional alternative (wood chip stoker boiler with a multicyclone). We used the atmospheric dispersion model AERMOD to calculate the contribution of either fuel-technology configuration to ambient primary PM{sub 2.5} in a 10 km×10 km region surrounding the facility, and we quantified the incremental contribution to population mortality and morbidity. We assigned economic values to health outcomes and compared the health benefits of the lower-emitting technology with the incremental costs. Results: In total, the incremental annualized cost of the lower-emitting pellet boiler was $190,000 greater, driven by a greater cost of the pellet fuel and pollution control technology, offset in part by reduced fuel storage costs. PM{sub 2.5} emissions were a factor of 23 lower with the pellet boiler with electrostatic precipitator, with corresponding differences in contributions to ambient primary PM{sub 2.5} concentrations. The monetary value of the public health benefits of selecting the pellet-fired boiler technology with electrostatic precipitator was $1.7 million annually, greatly exceeding the differential costs even when accounting for uncertainties. Our analyses also showed complex spatial patterns of health benefits given non-uniform age distributions and air pollution levels. Conclusions: The incremental investment in a lower-emitting staged combustion pellet boiler with an electrostatic precipitator was well justified by the population health improvements over the conventional wood chip technology with a multicyclone, even given the focus on only primary PM{sub 2.5} within a small spatial domain. Our analytical framework could be generalized to other settings to inform optimal strategies for proposed new facilities or populations. - Highlights: • PM{sub 2.5} emissions vary greatly across alternative biomass fuels and technologies. • A pellet boiler had a factor of 23 lower emissions than a conventional alternative. • The incremental annualized cost of the lower-emitting technology was $190,000. • The monetary value of annual health benefits of reduced emissions was $1.7 million. • Our analytical framework provides insight about optimal biomass technologies.

09 BIOMASS FUELS↗
DOE OSTI2017

Enhanced vasculotoxic metal excretion in post-myocardial infarction patients following a single edetate disodium-based infusion

Toxic metals have been associated with cardiovascular mortality and morbidity. We have hypothesized that enhanced excretion of vasculotoxic metals might explain the positive results of the Trial to Assess Chelation Therapy (TACT). The purpose of this study was to determine whether a single infusion of the edetate disodium- based infusion used in TACT led to enhanced excretion of toxic metals known to be associated with cardiovascular events. Methods: Twenty six patients (post-MI, age > 50 years, serum creatinine ≤ 2.0 mg/dL) were enrolled in this open-label study. Urinary levels of 20 toxic metals normalized to urinary creatinine concentrations were measured at baseline in overnight urine collections, for 6 h following a placebo infusion of 500 mL normal saline and 1.2% dextrose, and for 6 h following a 3 g edetate disodium-based infusion. Self-reported metal exposure, smoking status, food frequency, occupational history, drinking water source, housing and hobbies were collected at baseline by a metal exposure questionnaire. Results: The mean age was 65 years (range 51–81 years). All patients were male. 50% had diabetes mellitus and 58% were former smokers. Mean (SD) serum creatinine was 0.95 (0.31) mg/dL. Toxic metals were detected in the baseline urine of >80% of patients. After placebo infusion there were no significant changes in total urinary metal levels. After edetate infusion, total urinary metal level increased by 71% compared to baseline (1500 vs. 2580 µg/g creatinine; P<0.0001). The effect of edetate was particularly large for lead (3835% increase) and cadmium (633% increase). Conclusions: Edetate disodium-based infusions markedly enhanced the urinary excretion of lead and cadmium, toxic metals with established epidemiologic evidence and mechanisms linking them to coronary and vascular events. - Highlights: • Lead and cadmium are associated with a higher incidence of adverse cardiovascular outcomes. • An EDTA-based infusion increases the urinary excretion of lead and cadmium. • MI survivors randomized to EDTA chelation demonstrated improved cardiac outcomes compared to placebo. • Lead and cadmium may be modifiable risk factors for cardiovascular disease. • TACT2 seeks to replicate the results of TACT and investigate mechanisms, including establishing a biorepository.

54 ENVIRONMENTAL SCIENCES↗
DOE OSTI2018

Acute particulate matter affects cardiovascular autonomic modulation and IFN-γ methylation in healthy volunteers

Highlights: • In healthy subjects, acute exposure to PM affects vagal autonomic control of the heart. • PM exposure increases methylation of a pro-inflammatory gene, i.e. methylation of interferon γ (IFN- γ). • PM per se is able to trigger autonomic deregulation and inflammation in a dose-dependent manner. Air particulate matter (PM) is associated with increased cardiovascular morbidity and mortality. Altered autonomic functions play a key role in PM-induced cardiovascular disease. However, previous studies have not address the impact of PM on sympathetic and parasympathetic control of heart function, independently, and using controlled conditions, i.e., increasing titration of PM of known composition, in absence of other potential confounding factors. To fill this gap, here we used symbolic analysis that is capable of detecting non-mutual changes of the two autonomic branches, thus considering them as independent, and concentrations of PM as they could be measured at peak levels in Milan during a polluted winter day.

54 ENVIRONMENTAL SCIENCES↗
DOE OSTI2018

The association between whole blood concentrations of heavy metals in pregnant women and premature births: The Japan Environment and Children's Study (JECS)

Highlights: • This is the first large-cohort study associating heavy metals with preterm births. • Serum concentrations of Cd in pregnant women are related to early preterm births. • Pb, Hg, Se and Mn concentrations did not seem to be related with preterm births. Heavy metals are widely distributed in the environment. Recent reports have demonstrated the risk of preterm birth following heavy metal exposure. Preterm births are classified as early and late, depending on the duration of pregnancy, and are associated with increased risk of congenital illnesses such as heart failure, asthma, etc. Particularly, early preterm births carry a higher risk of mortality; however, the differential effects of heavy metal exposure on early and late preterm births are unknown.

54 ENVIRONMENTAL SCIENCES↗
DOE OSTI2023

Community vulnerability is the key determinant of diverse energy burdens in the United States

Low-income households generally experience a high energy burden; however, the factors influencing energy burdens are beyond socio-economics. This study explores the relationships between the multidimensionality of community vulnerability factors and energy burden across multiple geospatial levels in the United States. Our study found the distribution of energy burden in 2020 showed a great deal of variety, ranging from a minimum of 2.93 % to a maximum of 30.45 % across 3142 counties. The results of non-spatial and spatial regressions showed that the vulnerability ranks of socioeconomic, household composition and disability, minority and language, household type and transportation, and COVID mortality rate are significant predictors of energy burdens at the national level. However, at the regional level, only socioeconomic, minority and language significantly influence energy burdens. Minority and language negatively impact energy burdens except for the South East-Central region. Additionally, our analyses highlight the need to consider community vulnerability indicators' spatial homogeneity and heterogeneity. At the national level, only the epidemiological factors index is a spatially homogeneous predictor; on the regional and state level, the spatially homogeneous predictors such as socioeconomic status, household composition and disability, and household type and transportation vary by region. Such a region-sensitive relationship between energy burden and the predictors indicates spatial heterogeneity. Here this study suggests policy recommendations through the lens of the multidimensionality of community vulnerability factors. Implementing flexible national energy policies while making particular energy assistance policies for the vulnerable population at the regional or state levels is essential.

32 ENERGY CONSERVATION, CONSUMPTION, AND UTILIZATI↗
DOE OSTI2020

Long-term effects of thinning and woody control on longleaf pine plantation development, understory abundance, and tree damage from an ice storm

Longleaf pine (Pinus palustris) plantations have been established across the southeastern United States as the first step in restoring the declining savanna ecosystem, yet their long-term stability and development to open canopied woodlands may depend on early density and vegetation management treatments. Commercial thinning (CT) was applied in 2012 (year 18) to a long-term study of longleaf pine community restoration at the Savannah River Site near Aiken, SC to increase abundance of herb species. Although precommercial thinning (PCT) and woody vegetation control increased herb species cover during the first five years of the study, measurements from years 17 to 22 indicated a continuing decline in their cover since year 9 despite application of CT in year 18. Herb species richness, however, increased from 21 to 43 species per 100 m2 area during the last six years of the study, likely a result of disturbances associated with CT and an ice storm in year 20. Application of PCT in 1994, when the plantations were 8–11 years old, reduced their susceptibility to stem bending and breakage from the ice storm, which occurred 20 years later in 2014. Measured 5 months before the storm, pine height: dbh ratio (HD) averaged 78 and 90 for trees growing with and without PCT, respectively, and stem breakage (% of trees) from the ice storm increased linearly (r2 = 0.53) with HD. Pine mortality from the combined effects of glaze ice and wind differed with (28%) versus without (45%) PCT, indicating that long-term stability of longleaf pine plantations depends on early density management.

54 ENVIRONMENTAL SCIENCES↗
DOE OSTI2022

Drivers and ecological impacts of a wildfire outbreak in the southern Appalachian Mountains after decades of fire exclusion

During one of the warmest and driest droughts of the last century, the southern Appalachian Mountains experienced a regional outbreak of over a dozen large wildfires in late fall of 2016. We provide a synthesis of long-term forest changes leading up to the 2016 wildfires, examine the climatic setting and patterns of burn severity in relationship to topography, and discuss the ecological and management implications of these and future fires. During the pre- and post-European settlement periods, frequent low- and mixed-severity wildfires interacted with complex topographic gradients and maintained heterogenous landscapes dominated by several species of oak (Quercus spp.), pine (Pinus spp.), and the American chestnut (Castanea dentata). Land-use changes associated with European settlement, loss of the American chestnut, and 20th century fire exclusion resulted in large scale shifts towards mesic, fire-intolerant species (i.e. mesophication). Wildfire activity began increasing in the early 1980s, but most fires in the region are small (<1,000 ha). In Fall of 2016, deciduous tree leaf fall occurred concurrently with a period of anomalously dry and warm weather, creating ideal conditions for fire ignition and spread. Thousands of ignitions across the region strained suppression resources and eight fires grew to greater than 5,000 ha. The 2016 fires were larger and burned more area than in the previous three decades combined. In one unique landscape setting, the Chimney Tops 2 Fire, a synoptic wind event drove extreme fire behavior and burned large, high-severity patches resulting in devastating effects in the wildland urban interface. However, immediate post-fire burn severity mosaics for other fires were composed primarily of low- (73 %) and moderate-severity (21 %) fire effects. High-severity fire comprised only 6 % of the area burned, and occurred mostly on steep upper slopes and ridges on south-facing aspects, reflecting the importance of bottom-up topographic drivers in this region. Although the fires will likely enhance biodiversity by restoring fire-dependent species and creating early seral habitat, invasions of non-native plant species, delayed mortality of mature pines and oaks, and rapid re-sprouting of pyrophyllic shrubs pose significant management challenges. Although similar large fire outbreaks may become more common under future climatic conditions, they are unlikely to reverse the effects of mesophication and significantly alter forest dynamics at broad spatial scales. Furthermore, the 2016 fires exposed the vulnerability of the region to wildfire during acute fall drought and demonstrate the potential ecological effects of future wildfires in mixed pine-hardwood landscapes of the southern Appalachians.

54 ENVIRONMENTAL SCIENCES↗
DOE OSTI2023

Salinity exposure affects lower-canopy specific leaf area of upland trees in a coastal deciduous forest

Sea level rise and increasing storm surges are likely to affect the canopy physiology, ecology, and structure of coastal forests, even well in advance of tree mortality. Laboratory and greenhouse studies have documented that saltwater exposure can trigger changes in leaf-level physiology and morphology, but few in situ studies have examined how tree-specific leaf area (SLA), the ratio of leaf area to mass and a crucial trait and model parameter, is affected by saline soils. We conducted an observational study of SLA in a mid-Atlantic (USA) coastal deciduous forest, taking advantage of a natural gradient in salinity along a tidal creek. Measured SLA of the 239 trees and seven species sampled ranged from Carya glabra (N = 6 trees, mean SLA = 277.9±36.3cm 2 /g) to Fagus grandifolia (N=60, 321.9±62.9cm 2 g); as expected, trees species and canopy position (sun versus shade) significantly affected SLA. For trees (N=100) directly exposed to the tidal creek, salinity was highly significant after accounting for species (P<0.001), with trees in the lower reaches of the creek having lower SLA. Leaf area index (LAI), computed from SLA and litter traps, ranged from 4.8 to 15.8 and was inversely related to salinity exposure; the spatial variability in leaf litter production contributed much more to LAI uncertainty than did SLA variability. These in situ results are correlative but consistent with the hypothesis, based on previous greenhouse studies, that the stress of chronic salinity exposure changes species’ leaf morphology. Our findings are useful for understanding the growing effects of saltwater intrusion into upland forests, as well as parameterizing and testing ecosystem-scale models simulating forest stressors and disturbances at the terrestrial-aquatic interface.

54 ENVIRONMENTAL SCIENCES↗
DOE OSTI2023

Effects of head-starting on multi-year space use and survival of an at-risk tortoise

A major challenge in the recovery of long-lived at-risk taxa like turtles is low juvenile recruitment. Head-starting—the raising of juveniles to larger sizes to improve survival—is one tool that can be used in circumstances where juvenile recruitment is limited. Due to declining populations and difficulty detecting juveniles, however, lack of knowledge of the ecology of juveniles can hinder efforts to develop and evaluate head-starting programs for many turtle species. We sought to inform recovery efforts of Mojave desert tortoises by quantifying multi-year space use and survival of head-started juveniles after release. We radio-tracked tortoises head-started under three different husbandry treatments that varied in rearing duration (from two to over six years) and whether head-starting included an indoor rearing component the first year. We compared postrelease space use and survival as a function of treatment, release size, and time since release. We found that space use, including home range size and site fidelity, varied by husbandry treatment, with smaller and younger tortoises having smaller home ranges and higher site fidelity. Additionally, home range size decreased and site fidelity increased with time since release across treatments. Tortoises with an indoor-rearing component experiencing increased risk of mortality as movement increased compared to tortoises reared solely outdoors. Nevertheless, survival did not differ among treatments or with tortoise age or size. Regardless of husbandry treatment, head-started tortoises exhibited similar space-use and survival overall. Our study provides insight into juvenile tortoise behavior and head-starting as a tool for tortoise conservation.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2018

A minimal set of physiomarkers in continuous high frequency data streams predict adult sepsis onset earlier

Purpose: We report that sepsis is a life-threatening condition with high mortality rates and expensive treatment costs. To improve short- and long-term outcomes, it is critical to detect at-risk sepsis patients at an early stage. Methods: A data-set consisting of high-frequency physiological data from 1161 critically ill patients was analyzed. 377 patients had developed sepsis, and had data at least 3 h prior to the onset of sepsis. A random forest classifier was trained to discriminate between sepsis and non-sepsis patients in real-time using a total of 132 features extracted from a moving time-window. The model was trained on 80% of the patients and was tested on the remaining 20% of the patients, for two observational periods of lengths 3 and 6 h prior to onset.Results: The model that used continuous physiological data alone resulted in sensitivity and F1 score of up to 80% and 67% one hour before sepsis onset. On average, these models were able to predict sepsis 294.19 ± 6.50 min (5 h) before the onset. Conclusions: Lastly, the use of machine learning algorithms on continuous streams of physiological data can allow for early identification of at-risk patients in real-time with high accuracy.

59 BASIC BIOLOGICAL SCIENCES↗
DOE OSTI2010

Timing of Salvage Hormonal Therapy in Prostate Cancer Patients With Unfavorable Prognosis Treated With Radiotherapy: A Secondary Analysis of Radiation Therapy Oncology Group 85-31

Purpose: Radiation Therapy Oncology Group 85-31 was a randomized trial comparing radiotherapy (RT) alone vs. RT plus adjuvant androgen suppression for life in unfavorable-prognosis carcinoma of the prostate. We examined the impact of early initiation of salvage hormonal therapy (HT) in relapsing patients randomized to RT alone arm. Methods and Materials: Patients were divided into two groups: early salvage HT and late salvage HT. The early salvage group was defined as receiving HT with a prostate-specific antigen (PSA) level of less than 10 ng/mL, and the late salvage HT group had a PSA level of 10 ng/mL or greater. The outcomes were overall survival (OS), cause-specific mortality (CSM), and local failure (LF). The Kaplan-Meier estimation and log-rank test were used for OS, and the cumulative incidence estimation and Gray's test were used for CSM and LF. Proportional hazards regression models were used to compare the outcomes adjusted for other covariates. Results: The median follow-up times of surviving patients in the early and late salvage HT groups were about 11 and 13 years, respectively. The late salvage HT group had significantly more post-prostatectomy patients and patients with high Gleason scores. After adjustment for all covariates, OS was significantly longer in the early salvage HT group (hazard ratio, 1.5; p = 0.01). However, there were no statistically significant differences in LF or CSM between the groups. Conclusions: The early introduction of salvage HT resulted in improved OS but not improved CSM and LF. A randomized trial to define the optimal salvage hormonal timing is warranted in this group of patients with PSA recurrence after RT.

62 RADIOLOGY AND NUCLEAR MEDICINE↗
DOE OSTI2011

Mature Follow-Up for High-Risk Stage I Non-Small-Cell Lung Carcinoma Treated With Sublobar Resection and Intraoperative Iodine-125 Brachytherapy

Purpose: To update the Allegheny General Hospital experience of high-risk Stage I non-small-cell lung cancer patients treated with sublobar resection and intraoperative {sup 125}I Vicryl mesh brachytherapy. Methods and Materials: Between January 5, 1996 and February 19, 2008, 145 patients with Stage I non-small-cell lung cancer who were not lobectomy candidates because of cardiopulmonary compromise underwent sublobar resection and placement of {sup 125}I seeds along the resection line. The {sup 125}I seeds embedded in Vicryl suture were attached with surgical clips to a sheet of Vicryl mesh, inserted over the target area, and prescribed to a 0.5-cm planar margin. Results: The mean target area, total activity, number of seeds implanted, and prescribed total dose was 33.3 cm{sup 2} (range, 18.0-100.8), 20.2 mCi (range, 11.1-29.7), 46 (range, 30-100), and 117 Gy (range, 80-180), respectively. The median length of the surgical stay was 6 days (range, 1-111), with a perioperative mortality rate of 3.4%. At a median follow-up of 38.3 months (range, 1-133), 6 patients had developed local recurrence (4.1%), 9 had developed regional failure (6.2%), and 25 had distant failure (17.2%). On multivariate analysis, no patient- or tumor-specific factors or surgical or dosimetric factors were predictive of local recurrence. The overall median survival was 30.5 months with a 3- and 5-year overall survival rate of 65% and 35%, respectively. Conclusion: {sup 125}I brachytherapy for high-risk, Stage I non-small-cell lung cancer after sublobar resection is well tolerated and associated with a low local failure rate.

62 RADIOLOGY AND NUCLEAR MEDICINE↗
DOE OSTI2011

Secondary Malignancies From Prostate Cancer Radiation Treatment: A Risk Analysis of the Influence of Target Margins and Fractionation Patterns

Purpose: This study explores the implications for cancer induction of treatment details such as fractionation, planning target volume (PTV) definition, and interpatient variations, which are relevant for the radiation treatment of prostate carcinomas. Methods and Materials: Treatment planning data from 100 patients have been analyzed with a risk model based on the United Nations Scientific Committee on the Effects of Atomic Radiation competition model. The risk model can account for dose heterogeneity and fractionation effects characteristic for modern radiotherapy. Biologically relevant parameters from clinical and experimental data have been used with the model. Results: The results suggested that changes in prescribed dose could lead to a modification of the risks for individual organs surrounding the clinical target volume (CTV) but that the total risk appears to be less affected by changes in the target dose. Larger differences are observed for modifications of the margins between the CTV and the PTV because these have direct impact onto the dose level and dose heterogeneity in the healthy tissues surrounding the CTV. Interpatient anatomic variations also have to be taken into consideration for studies of the risk for cancer induction from radiotherapy. Conclusions: The results have shown the complex interplay between the risk for secondary malignancies, the details of the treatment delivery, and the patient heterogeneity that may influence comparisons between the long-term effects of various treatment techniques. Nevertheless, absolute risk levels seem very small and comparable to mortality risks from surgical interventions, thus supporting the robustness of radiation therapy as a successful treatment modality for prostate carcinomas.

62 RADIOLOGY AND NUCLEAR MEDICINE↗