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All sourcesNASA NTRSDOE OSTI
DOE OSTI2024

AMIA KDDM Working Group Collaborative Workshop: Enriching Electronic Health Records with Social Determinants of Health to Improve Outcomes and Health Equity

Prior research has demonstrated that social determinants of health (SDoH) are major drivers of health outcomes and contributors to widespread health inequities. It was estimated that, in the United States, SDoH could be responsible for up to 40% of all preventable deaths, significantly higher than the 10-15% for which better medical care is responsible. Public health interventions that target SDoH are instrumental for improving health outcomes and reducing long-standing health inequities. Currently, most mainstream EHR vendors have implemented SDoH screeners in their EHR systems. However, the utility of the screeners is low, rendering patient-level SDoH still widely unavailable in the structured fields. SDoH are sometimes mentioned in free-text clinical notes (e.g., social context section) where natural language processing (NLP) can be applied to extract relevant information. Contextual-level SDoH can be identified from multiple data sources, many of which are publicly available and spatiotemporally linked to EHR data. As such, there is an opportunity for the KDDM research community to create innovative solutions to draw meaningful insights by creating and using rich data with SDoH to improve health outcomes while reducing disparities. In this workshop organized by AMIA Knowledge Discovery and Data Mining Working Group (AMIA KDDM WG), we will invite world-leading experts from academia, national laboratories, and life science industry with varied backgrounds in biomedical informatics, epidemiology, data science, machine learning, natural language processing, and pediatric cardiology to discuss the best practice of capturing, standardizing, and using SDoH information in various applications aiming at improving outcomes and health equity.

He, Zhe↗
DOE OSTI2021

EHS Health Assessment & Health Action Plan Report (CY 2020)

Sandia National Laboratories (SNL) Employee Health Services (EHS) program believes that good health is essential to getting the most out of life, which is why we offer a variety of worksite wellness programs that put employees in control of their own health. These programs are based on current research and strategies that are proven to minimize risk and decrease the impact of illness through early detection and treatment. Services includes Health Assessments, the Virgin Pulse (VP) online wellness platform, and Health Action Plans (HAP) which include one-on-one education, organizational health initiatives, a video library, an events calendar, onsite fitness facilities, and group fitness classes. Participation in these programs help employees and their spouses earn funding for their Health Reimbursement Accounts (HRAs). The EHS Health Action Plan (HAP) initiative targets the key health risks identified through the 8-15-80 model by engaging employees to change their own healthcare story. EHS identified the most prevalent of the health risks amongst our population through Health Risk Assessment (HRA) and used that data to build Health Action Plans (HAPs). The 2020 Health Action Plans addressed improving upon inadequate sleep, lack of energy, stress, weight, physical inactivity, cardiometabolic issues (hypertension, high cholesterol, diabetes), low back pain, allergies, asthma, digestive health, tobacco use, and living well to maintaining low risk for those individuals who do not have a chronic condition to manage. These plans connect employees with our onsite registered dietitians, fitness professionals, health coaches, physical therapists, and physicians as appropriate. In addition to addressing the physical aspects of health, the plans also emphasized pre/post-assessments to encourage building behavioral and emotional skills that promote health and facilitate lifestyle changes over a minimum of three months. Just one risk reduction or behavior change can make an impact on the health of the participant’s Division as well as Sandia’s overall risk levels and ultimately its healthcare costs. Sandia employees achieved an Overall Wellness Score of 69 based on the WellSource Health Assessment (the same as last year). A score of 70-100 is considered “Doing Well”, and a score of 40-69 is in the “Caution” category. Overall in CY 2019, Sandia saw a 34% participation rate in Health Action Plan (HAP) programs (up from 33% in CY 2019) with an 89% completion rate (4% lower than CY 2019). Overall, 5,039 (347 more than CY 2019) individuals participated in 8,329 HAPs, which is 1,005 more than the last calendar year (7,324).

59 BASIC BIOLOGICAL SCIENCES↗
DOE OSTI2025

Comparison of Expert Vocabulary Usage Patterns Between Mental Health and Nonmental Health Clinicians When Diagnosing Pediatric Anxiety Disorders

Objective: To compare the utilization patterns of expert vocabulary (EVo) in diagnosing pediatric anxiety between mental health and non-mental health clinical notes from electronic health records to understand the role of Evo in informing classification and decision-making in anxiety diagnoses. Study design: We conducted a retrospective study using a cohort less than age 25 from Cincinnati Children's Hospital including 897 685 patients with 61 586 446 notes. We analyzed EVo, collected from mental health clinicians, in both mental and nonmental health notes. We compared classification accuracy using EVo-based patient-level embedding from all clinical notes, mental-health notes, and nonmental health notes for 2 tasks: 1) pre-vs postdiagnosis anxiety patients, and 2) prediagnosis anxiety vs nonanxiety patients. Results: EVo usage was highest in prediagnosis anxiety, lower in nonanxiety, and lowest in post-diagnosis. Classification models using EVo features from all, mental-health, and non-mental health notes showed similar F1 scores for prediagnosis anxiety (0.70 ± 0.2 for 2 categories). For anxiety vs nonanxiety classification, all clinical and nonmental health notes had better F1 scores than mental-health notes (above 0.90 for 3 categories). There was a notable difference in class-wise performance across both tasks. Conclusions: There are significant differences in anxiety EVo use between mental health and nonmental health clinicians. Despite less anxiety-specific terminology, non-mental health notes still captured key aspects of patient presentations, emphasizing the importance of including all clinicians' notes in analysis. EVo's utility for anxiety classification is most effective in prediagnostic phases, suggesting the need for a dedicated diagnostic lexicon and further study before incorporating EVo into classification models.

feature engineering↗
DOE OSTI2022

How Management and Leadership Training Can Impact a Health System: Evaluation Findings From a Public Health Management Training Program in Cambodia

In 2017, the National Institute of Public Health in Cambodia collaborated with the U.S. Centers for Disease Control and Prevention to provide management and leadership training for 20 managers and senior staff from 10 health centers. We conducted a mixed methods evaluation of the program's outcomes and impact on the graduates and health centers. From June 2018 (baseline) to January 2019 (endpoint), we collected data from a competency assessment, observational visits, and interviews. From baseline to endpoint, all 20 participants reported increased competence in seven management areas. Comparing baseline and endpoint observational visits, we found improvements in leadership and governance, health workforce, water, sanitation, and hygiene, and health centers' use of medical products and technologies. When evaluating the improvements made by participants against the World Health Organization's key components of a well-functioning health system, the program positively contributed toward building four of the six components—leadership and governance, health information systems, human resources for health, and service delivery. While these findings are specific to the context of Cambodian health centers, we hope this evaluation adds to the growing body of research around the impact of skilled public health management on health systems.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2021

Lithium-ion battery physics and statistics-based state of health model

A pseudo-2d model using COMSOL Multiphysics® software is developed to simulate performance and performance degradation of Li-ion batteries consisting of layered and olivine cathodes with graphite anode when subjected to peak shaving grid service. Multiple degradation pathways are considered, including solid electrolyte interphase (SEI) formation and breakdown at the anode, cathode dissolution and its synergistic effect on SEI formation at the anode. The model is validated by simulating commercial cylindrical cell performance. A global model is developed to simulate performance across all chemistries, along with individual chemistry models using global model parameters as initial values. There is good agreement between these models for various optimization parameters such as SEI equilibrium potential, cathode dissolution exchange current density, solvent diffusivity in the SEI and SEI ionic conductivity. To circumvent time constraints related to the COMSOL model, a 0d global model is developed which fits data well and provides more clarity on differences in cathode dissolution exchange current density. Again, good agreement for various optimization parameters is obtained among the COMSOL global & individual chemistry models and the 0-d model. The lessons learned from the physics-based model is used to develop a top down statistics-based model using current, voltage and anode volumetric change per mole lithium intercalated, along with their interactions as degradation predictors. This model predicts out of sample degradation for multiple grid services and electric vehicle drive cycle with high accuracy and provides the pathway to develop an efficient battery management system combining machine learning and findings from physics-based computationally intensive algorithms.

Crawford, Aladsair J.↗
DOE OSTI2024

Generalizability of heat-related health risk associations observed in a large healthcare claims database of patients with commercial health insurance

Extreme ambient heat is unambiguously associated with higher risk of illness and death. The Optum Labs Data Warehouse (OLDW), a database of medical claims from US-based patients with commercial or Medicare Advantage health insurance, has been used to quantify heat-related health impacts. Whether results for the insured sub-population are generalizable to the broader population has to our knowledge not been documented. We sought to address this question, for the US population in California from 2012 to 2019. We examined changes in daily rates of emergency department (ED) encounters and in-patient hospitalization encounters for all-causes, heat-related outcomes, renal disease, mental/behavioral disorders, cardiovascular disease, and respiratory disease. OLDW was the source for health data for insured individuals in California, and health data for the broader population were gathered from the California Department of Health Care Access and Information (HCAI). We defined extreme heat exposure as any day in a group of 2 or more days with maximum temperatures exceeding the county-specific 97.5 th percentile and used a space-time-stratified case–crossover design to assess and compare the impacts of heat on health. Average incidence rates of medical encounters differed by dataset. However, rate ratios for ED encounters were similar across datasets for all causes (ratio of incidence rate ratios (rIRR) = 0.989; 95% confidence interval (CI) = 0.973, 1.011), heat-related causes (rIRR = 1.080; 95% CI = 0.999, 1.168), renal disease (rIRR = 0.963; 95% CI = 0.718, 1.292), and mental health disorders (rIRR = 1.098; 95% CI = 1.004, 1.201). Rate ratios for inpatient encounters were also similar. This work presents evidence that OLDW can continue to be a resource for estimating the health impacts of extreme heat.

54 ENVIRONMENTAL SCIENCES↗
DOE OSTI2023

The Field Epidemiology Training Program’s Contribution to Essential Public Health Functions in Seven National Public Health Institutes

Objective: This study explores how Field Epidemiology Training Programs (FETP) whose National Public Health Institutes (NPHI) are supported by U.S. Centers for Disease Control and Prevention (CDC) have contributed to strengthening essential public health functions. Methods: We conducted 96 semi-structured interviews with public health experts including NPHI staff, non-NPHI government staff, and staff from non-governmental and international organizations in Cambodia, Colombia, Liberia, Mozambique, Nigeria, Rwanda, and Zambia. We managed data using MAXQDA and employed direct content analysis to derive themes. Results: Three overarching themes emerged in relation to FETPs’ role within the NPHIs’ public health functions. These themes included contribution to improving country surveillance systems, role in providing leadership in outbreak responses, and strengthening countries’ and the NPHIs’ surveillance workforce capacity. Participants also shared challenges around FETPs’ implementation and suggestions for improvement. Conclusion: The results demonstrate the value of FETPs in strengthening public health systems through building workforce capacity and improving surveillance systems. By identifying the successes of FETPs in contributing to essential public health functions, our findings might inform current and future FETP implementation and its integration into NPHIs.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2026

Developing Scenario‐Based Strategies for Health, Climate, and Environmental Preparedness: The One Health, One Earth Approach

Climate change amplifies many threats to human health. Despite advances in understanding climate change dynamics and impacts, there remains a critical gap in translating scientific knowledge into equitable, and community-driven health interventions. The inaugural One Earth, One Health workshop sought to explore this gap through human-centered design exercises involving interdisciplinary researchers from climate and Earth sciences, engineering, epidemiology, microbiology, and environmental health. Although participants did not co-develop solutions with affected communities, they used stakeholder role-playing to guide ideation and lay groundwork for actionable plans. Through these methods, participants identified community needs and proposed prototype solutions to alleviate health threats exacerbated by global environmental change. Prototypes were organized around infectious diseases, extreme weather, and air quality, as illustrative themes rather than an exhaustive set of risks. Key solutions included strategies for anticipatory systems and early warning (e.g., integrating environmental signals with health data), inclusive communication and infrastructure needs for responding to extreme weather events, and integrated platforms visualizing air quality trends to support tailored, context-aware guidance beyond one-size-fits-all alerts. The workshop highlighted opportunities such as leveraging machine learning, Earth observation, and real-time surveillance to protect communities, but also noted barriers including data quality, technological redundancy, privacy, and governance challenges. Additionally, participants emphasized the need for interdisciplinary teams capable of collaborating across sectors, breaking down silos and addressing gaps in training and education. Overall, the workshop illustrates how process-driven, human-centered approaches can help surface user needs and generate testable prototype concepts, while underscoring the importance of direct community partnership for implementation.

Abadi, Azar M. [University of Alabama, Birmingham,↗
DOE OSTI2021

Biodiversity and Global Health: Intersection of Health, Security, and the Environment

One of the biggest consequences of large-scale environmental change is the loss of biodiversity. Recent studies predict a loss of 1 million species in the near future. Biodiversity loss and land use change through anthropogenic disturbance are known to affect disease exposure, disease severity, and disease impacts. It is becoming increasingly clear that biodiversity loss will lead to an increase in infectious diseases in certain regions. Changes in biodiversity may contain important signatures for prediction of infectious diseases and outbreaks. Here, we argue that areas of high or rapid biodiversity loss will be critical to monitor under the umbrella of global health security. Global Health Security consists of the actions and activities required to reduce the impact of public health events in populations living in different geographic regions and across international borders. Like infectious diseases, climate change and other causes of environmental changes do not respect international borders and are becoming more widespread in all parts of the world. Here, the relationships among biodiversity, climate and environmental changes, and pathogen prevalence are dynamic, context dependent, and complex. Accounting for this complexity requires the inclusion of the environment sector, presently missing, when evaluating the potential of global health security actions for mitigating disease risks.

59 BASIC BIOLOGICAL SCIENCES↗
DOE OSTI2022

The impacts of COVID-19 on clean energy labor markets: Evidence from multifaceted analysis of public health interventions and COVID-health factors

COVID-19 pandemic has affected clean energy labor market. Using real-time job vacancy data, this study analyzes the impacts of the pandemic on the U.S. clean energy labor market in 2020, including biomass, energy efficiency (EE), electric vehicle (EV), power/microgrid, solar, and wind industries. This study identifies how COVID-health factors and public health interventions influence clean energy job availability during the early COVID pandemic. Overall, California had the most energy jobs and experienced a significant decrease in April 2020. EV and solar had the highest percentages of job vacancies during the pandemic in general. Still, lockdowns had the most severe influence on EE and wind jobs. Stay-at-home orders negatively affected clean energy job vacancies in biomass, EV, power/microgrid, and wind. Social-gathering restrictions, however, did not have much influence. Increased COVID tests at the state level had the strongest and most positive influence on clean energy job postings, indicating the importance of a state's ability to manage public health infrastructure or crisis issues. COVID hospitalizations negatively influenced the job vacancies in biomass and wind but did not affect the other four sectors; conversely, as COVID death numbers increased, the number of jobs in biomass, EV, power grid, solar, and wind decreased, but not in EE jobs.

29 ENERGY PLANNING, POLICY, AND ECONOMY↗
DOE OSTI2020

Big data health physics: a case study in operational health physics

This paper, written as a two part project as required by Illinois Institute of Technology’s Phys597 Reading & Special Problems class and health physics professional master’s program, focuses on the results of a prototype data collection process implemented at a Los Alamos National Laboratory facility. In particular, this paper examines the data in a statistical context in an effort to optimize operational health physics processes at the Los Alamos National Laboratory.

46 INSTRUMENTATION RELATED TO NUCLEAR SCIENCE AND ↗
DOE OSTI2022

A Population-Level Summary of Health Care Utilization for the Management of Patellar Tendinopathy in the Military Health System

Abstract Patellar tendinopathy (PT) is a common nontraumatic orthopaedic disorder of the knee suffered by many service members. Understanding the make-up of usual care for PT at the system level can better frame current clinical gaps and areas that need improvement. Exercise therapy is recommended as a core treatment for PT, but it is unclear how often it is used as a part of usual care for PT within the Military Health System (MHS). The purpose of the study was to identify interventions used in the management of PT and the timing of these interventions. A secondary purpose was to determine if exercise therapy use was associated with reduced recurrence of knee pain. In total, 4,719 individuals aged 17 to 50 years in the MHS diagnosed with PT between 2010 and 2011 were included. Pharmacological and nonpharmacological interventions, visits to specialty providers, and imaging services were captured. Descriptive statistics were used to report the findings. Interventions were further categorized as being part of initial care (within the first 7 days), the initial episode of care (within the first 60 days), or the 2-year time period after diagnosis. Linear regression assessed the relationship between the number of exercise therapy visits in the initial episode of care and recurrences of knee pain. In total, 50.6% of this cohort had no more than one medical visit total for PT. Exercise therapy (18.2%) and nonsteroidal anti-inflammatory drugs (4.3%) were the two most used interventions in the initial episode of care. Radiographs were ordered for 23.1% of the cohort in the initial episode of care. The number of exercise therapy visits a patient received during the initial episode of care was not associated with recurrences of knee pain. Half of the individuals received no further care beyond an initial visit for the diagnosis of PT. Exercise therapy was the most common intervention used during the initial episode of care, but exercise therapy did not influence the recurrence of knee pain.

Orthopedics↗
DOE OSTI2025

Machine Learning Analysis of Temperature-Strain Relationships for Structural Health Monitoring of Pipes: Self-powered wireless sensor system for health monitoring of liquid-sodium cooled fast reactors

This report presents machine learning (ML) analysis of temperature-strain relationships for structural health monitoring of nuclear reactor stainless steel (SS) pipes with the strain gauge sensor directly printed on the pipe with a 3D conformal aerosol jet printer. We investigate correlations for two sensor pairs installed on the same SS304 pipe: commercial K-type thermocouple with a printed gold strain gauge (TC3-SG3), and commercial K-type thermocouple with commercial Kyowa strain gauge (TC0-SG0). The temperature ranges for the sensor pairs TC0-SG0 and TC3-SG3 are 20.00°C to 266.37°C and 39.95°C to 219.28°C respectively. ML algorithms in this study include Linear Regression (baseline method), Ridge Regression, Lasso Regression, and Gradient Boosting. Performance evaluation metrics include Root Mean Square Error (RMSE), Mean Square Error (MSE), Mean Absolute Error (MAE), R 2 Score, and Explained Variance. Using advanced feature engineering techniques, we extracted 27 temperature-based features and 30 strategic inclusion features. The best performance was obtained with the Gradient Boosting method, which achieves prediction accuracy of R 2 = 0.9999 and RMSE = 7.69 μStrain for TC0-SG0, and R 2 = 0.9998 and RMSE = 18.03 μStrain for TC3-SG3. While the temperature-strain correlations are weaker for the gauge directly printed on the pipe than for the commercial strain gauge, deployment-ready performance exceeding industry standards is achieved for both sensor pairs.

22 GENERAL STUDIES OF NUCLEAR REACTORS↗
DOE OSTI2020

Examining Perceptions of Spanish Language Health Information Among Hispanics Living in the United States: A Qualitative Study Assessing Videos, Brochures, and Websites

Background Nationally, Hispanics experience health disparities manifested as a higher prevalence of chronic diseases in comparison to non-Hispanic Whites. Factors that influence health disparities in this population include inadequate dissemination of culturally and linguistically appropriate health information. Method Our qualitative analysis is based on data obtained from three focus groups with Spanish-speaking Hispanic adults conducted at a clinic in Nebraska. Participants were asked about their perceptions of health information in the form of videos, brochures, and websites. We followed the consolidated criteria for reporting qualitative research and used the theoretical framework of content analysis. Results For videos, attributes associated with higher levels of trust included a friendly health professional, the logo or name of a health care institute, and a reference specifying “se habla Español.” For brochures, attributes associated with trust included use of visual aids, use of numerous colors and big font sizes, the year of printing, and a health care agency logo. For websites, characteristics associated with trust were inclusion of plain language, use of pictures and videos, and date of last update. In all focus groups, participants perceived the use of mixed English/Spanish language in health information from pamphlets and websites as unprofessional. The use of unknown governmental logos in health promotional videos and websites was perceived as untrustworthy information. Conclusions Spanish-speaking Hispanics prefer health information supported by a health care agency or delivered by a health care professional. Health communication strategies should avoid the use of mixed English/Spanish language in sensitive information especially when combined with governmental logos.

De Alba Rosales, Armando↗
DOE OSTI2023

Dataset Repository for Investigating Suicide Risk Using Social and Environmental Determinants of Health

Suicide is frequently modeled as a function of genetics and environment, where the latter refers to factors other than direct biological consequences, such as air quality, financial level, social connectivity, transportation and food access, and homelessness status. According to the World Health Organization, clean air, a stable climate, adequate water, sanitation and hygiene, safe chemical use, radiation protection, healthy and safe workplaces, sound agricultural practices, health-supportive cities and built environments, and a preserved natural environment are all prerequisites for good health. Understanding the relationships between these determinants and mental health outcomes requires standardized data that can be included in healthcare programs and health outcome models. There is a wealth of publicly available data on social and environmental factors provided by various US organizations that can benefit the design of health care systems and public health interventions, as well as improve our comprehension of factors that impact health. Such information would not only help improve the understanding of individual and community risk but also identify new risk factors that have not previously been therapeutically targeted, especially in terms of their impact on mental health. However, curating and standardizing such datasets is challenging because they are often recorded at numerous geographical and temporal resolutions and with varying spatial and temporal granularities. To address this challenge, we launched an endeavor in conjunction with the Veterans Health Administration to collect publicly available socioeconomic and environmental determinants of health statistics in the US. In this manuscript, we describe a social and environmental determinants of health (SEDH) datasets repository, data curation documentation, and a pipeline framework for data generation; This effort started in 2020, when we began constructing a scalable pipeline to automate the download, extraction, preparation, analysis, and production of datasets. These datasets have been made available to the VHA and may be shared upon agreement with collaborating organizations.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2022

Integrating air quality and health considerations into power sector decarbonization strategies

Climate change and public health are two interconnected societal challenges. Curbing fossil-based electricity generation reduces the emissions of both CO 2 and air pollutants, which brings tangible health benefits from improved air quality. The potential health benefits from decarbonizing the grid are enormous, immediate, and widespread. From renewable portfolio standards to carbon market, the health co-benefits from clean electricity policies often outweigh their policy costs. As climate action goes local, framing decarbonization around health benefits also makes it more personally relevant and economically attractive. Yet, to date, the health impacts have largely been viewed as ancillary benefits from decarbonization, rather than as a core consideration when energy strategies are formed, assessed and implemented. When strategic choices are made about retiring old infrastructure and building new ones, bringing public health to the center of the discussion can generate greater health benefits with more equitable distribution. Here we identify concrete ways to incorporate air quality and health considerations into power sector decarbonization strategies. We draw insights mainly from empirical and modeling evidence for the United States. These insights are generally applicable and could guide health-oriented decarbonization efforts in other countries as well.

32 ENERGY CONSERVATION, CONSUMPTION, AND UTILIZATI↗