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All sourcesNASA NTRSDOE OSTI
NASA NTRSDate not supplied

Spaceflight Medical Evacuation Risk Assessment Principles - A Qualitative Investigation

BACKGROUND Future human space exploration beyond Low Earth Orbit (LEO) will require innovative solutions in many areas, primarily those that provide direct medical support to crew on long-duration missions and optimize their health and performance. The associated challenges therein will be numerous, including but not necessarily limited to extended one-way or "asynchronous" communication delays, minimal to non-existent resupply, and a prolonged transit time to "definitive care" ranging from 3-days to 9-months. At the same time, long-duration exploration spacecraft and crew will face restrictions on mass, power, volume, and data far more significant than that seen in current LEO settings. Given these limitations, medical risk assessment is of primary importance, especially evaluating the implications of a medical evacuation of an ill or injured crewmember. Such evacuations are complicated, potentially dangerous, and well may be impossible in certain phases of the mission. Regardless, such issues must be weighed against the risks of the injured crew remaining aboard a spacecraft with limited medical resources. OBJECTIVE This qualitative study drew from the experiences of subject matter experts (SMEs) in spaceflight and appropriate analog environments (i.e., military, disaster, and extreme environment fields) to identify unique principles common amongst medical evacuation considerations helpful in informing future risk assessment tools. Appropriate analog environments included austere operational settings where multiple factors (weather, logistics/limited resupply, denied/extreme environments, and patient condition) resulted in a limited ability to provide definitive local medical care. The fundamental principles in question revolved around scenarios where evacuation became a complicating yet necessary consideration and where life-threatening medical concerns had to be weighed against critical mission objective(s). The primary authors collected semi-structured data gathered through in-depth interviews with 16 subject matter experts (SMEs). Interview questions investigated how these SMEs consider and weigh the attendant risks present in medical evacuation scenarios. Among the critical questions posed were those that sought to understand how the SME balanced the challenges and requirements of medical evacuation (or keeping an injured patient "on-site" aka: "prolonged field care") against the evacuation operation's risks on impacting overarching mission success. The team analyzed interview transcripts for common themes and principles using the qualitative methods of thematic analysis based on consensus, co-occurrence, and comparison. As a result, nine primary risk consideration themes and nine contributing factor themes emerged, all of which will ideally inform future medical evacuation decision-making tools and operational decision-making for exploration class missions. Specific aims for this study included: 1. Identification of common principles used to assess risks and benefits of medical evacuations in extreme environments 2. Identification of common points of friction or complication and challenges in extreme environment evacuations

A T Almand↗
NASA NTRS2024

Ensuring Safe Decision-Making on the Moon and Mars: Cognitive Performance Assessment for Exploration Class Mission EVA

Extravehicular activity (EVA) is one of the most dangerous and cognitively demanding actions that astronauts can execute, and the cognitive demands associated with future partial gravity EVA on the Moon and Mars are expected to be higher compared to microgravity EVA currently conducted from the International Space Station (ISS). Decrements in cognitive performance present an important risk to crew safety during exploration mission class EVA. Yet there is currently insufficient data to characterize cognitive performance prior to, during, and following EVA. Furthermore, it is still unclear which cognitive domains are most important for conducting mission critical decisions with crew safety implications. To address this gap, we conducted a cognitive task analysis (CTA) of EVA to characterize the procedures, the cognitive demands required, and the critical safety decisions associated with decrements in cognitive performance. We used the applied cognitive task analysis method as outlined by Militello and Hutton (1998) and conducted interviews with subject matter experts (SMEs) in EVA at NASA Johnson Space Center in summer 2024. Interviews focused on exploration EVA and elicited feedback from SMEs on the cognitive skills required for specific EVA tasks including cognitive strategies, critical cues, and decision-making strategies. A cognitive demands table was assembled to consolidate and synthesize the information from all interviews. The information from this cognitive task analysis will inform ongoing work to identify the key cognitive domains for safe decision-making during exploration mission class EVA on the Moon and Mars. This work will importantly provide a link between cognitive domains identified in the cognitive task analysis and operationally-relevant performance metrics collected during spaceflight and simulation EVA that can be tracked and assessed by NASA mission operations. Ultimately, this work will aid in the development and application of exploration class cognitive performance monitoring capabilities to improve safe decision-making and inform EVA planning on future spaceflight missions to the Moon and Mars.

Steven R Anderson↗
NASA NTRSDate not supplied

Assessment of the State of Communication Delay Research in Preparation for Missions Beyond Low Earth Orbit

NASA’s mission-operations paradigm, established during Project Mercury and minimally evolving through the Apollo Program, Space Shuttle Program, and ISS missions, has primarily depended on real-time support from a ground team of experts. This ground team has served as the safety net for crewed spaceflight missions over the past 60 years, managing the combined state of the mission, vehicle, and crew. However, this operational paradigm, which has seen little change in its Human-Systems Integration Architecture (HSIA), will face challenges during long-duration exploration missions beyond low Earth orbit. Lunar missions may experience one-way communication latencies ranging from 3 to 14 seconds, while Mars missions will encounter up to a 44-minute round-trip latency at a maximum distance from Earth. Communication delays negatively impact the behavioral health and performance of individuals and crews operating across the multi-team space-to-ground system. Previous research indicates that increased isolation and the challenges posed by delayed communication lead to heightened stress, frustration, adverse behavioral symptoms, and reduced individual performance. NASA has investigated the nature and effectiveness of managing this shift in complex operations since early 2000, but additional research is necessary to assess the issues associated with communication latencies and identify effective countermeasures. This work aimed to examine the evidence from 20 years of research on comm delays. We systematically reviewed the past 20 years of communication delay literature, focusing on how this research aligns with relevant, high-priority needs in the HSIA, Team, and BMed Risks. This type of panoramic review has not been done since 2013; a current, aggregated picture of what has been studied and how is needed to inform additional studies and mitigation development. Additional perspectives were gained from interviews with the research participants, operations experts, and communication delay researchers. Results from this effort will help characterize the risk posed by communication latency for upcoming Artemis missions and point toward potential mitigations. The final results will be presented. For the literature review, we formed a search term seed set drawing from languages used in two papers representative of the previous state of knowledge and supplemented it with additional search terms. We conducted literature searches on Google Scholar, PubMed, and Web of Science and searched NASA project archives for output from NASA-sponsored research. This search yielded 150 papers, of which 48 were relevant. SME interviews provided perspective on key communication delay issues and concerns and what is being worked on to mitigate those issues. Preliminary results of the literature review have been presented. Final results to be presented include the results of the literature review and findings from the interviews.

literature review↗
DOE OSTI2019

Vulnerable to misinformation? Verifi!

We present Verifi2, a visual analytic system to support the investigation of misinformation on social media. On the one hand, social media platforms empower individuals and organizations by democratizing the sharing of information. On the other hand, even well-informed and experienced social media users are vulnerable to misinformation. To address the issue, various models and studies have emerged from multiple disciplines to detect and understand the effects of misinformation. However, there is still a lack of intuitive and accessible tools that help social media users distinguish misinformation from verified news. In this paper, we present Verifi2, a visual analytic system that uses state-of-the-art computational methods to highlight salient features from text, social network, and images. By exploring news on a source level through multiple coordinated views in Verifi2, users can interact with the complex dimensions that characterize misinformation and contrast how real and suspicious news outlets differ on these dimensions. To evaluate Verifi2, we conduct interviews with experts in digital media, journalism, education, psychology, and computing who study misinformation. Our interviews show promising potential for Verifi2 to serve as an educational tool on misinformation. Furthermore, our interview results highlight the complexity of the problem of combating misinformation and call for more work from the visualization community.

Karduni, Alireza↗
DOE OSTI2022

Commercial Building Sensors and Controls Systems: Barriers, Drivers, and Costs

Building sensors and controls systems, including building automation systems, consists of the sensor-based devices installed in buildings and the control and automation of those devices. Optimized sensors and controls systems could lead to 29% annual energy savings in commercial buildings and are integral to the growth of grid-interactive efficient buildings. Only 8% of small commercial buildings, however, have installed sensors and controls systems. This is largely due to cost barriers. This work seeks to increase the transparency of system costs and identify specific barriers and drivers for increased adoption. To gather industry insights, the team reached out to building owners, vendors, and contractors and conducted 20 interviews with the goal of collecting cost data and market characteristics regarding building sensors and controls. The qualitative interview data was analyzed using grounded theory to identify overarching concepts, such as barriers, drivers, and future directions on the field. From this analysis, primary barriers were found to be complexity, a lack of knowledge, and money. Primary drivers were found to be the knowledge of data, savings, and remote access. The qualitative cost data was collected in the form of invoices during the interviews. The cost values were used to develop a percentage-based cost stack which identifies the average fraction of the total cost attributed to each category (hardware, software, labor, fees, and taxes). This greater understanding of costs and barriers associated with commercial building sensors and controls systems lays the groundwork for future steps in increasing system adoption, reducing energy consumption, and market transformation.

advanced building controls↗
DOE OSTI2023

Failure Modes and Effects Analysis of Biorefinery Pathways

This talk provides an overview of failure modes and effects analysis (FMEA) development and implementation as a systematic criticality and risk assessment tool for biorefinery pathways within the FCIC. This supports a quality by design (QbD) approach, and this talk provides a high-level overview of the results for the FMEA evaluation focused on the generation of pine residue materials for high-temperature pyrolysis conversion. the FMEA interviews included two approaches. The first approach was based around the entire system of unit operations giving a wholistic system level view. The second approach used detailed interviews from individual unit operation within the system allowing for specific failures for individual system components. These two approaches provide different resolutions of information about the reliability and risk. The FMEA results focused on failures associated with meeting critical quality attributes (CQAs) identified for the high temperature conversion of loblolly pine residues and were supplemented with experimental data supporting process upsets and reliability also collected within the consortium. Estimations of risk scores for meeting each given CQA specification, identification of the impacts for not meeting a CQA specification, capturing causes associated with material attributes and process parameters for each failure, identification of current detection methods, and speculation of potential mitigation strategies for decreasing a failure’s risk score were gathered through the FMEA interviews, and were combined to understand the overall process risk metrics and where technology, process, and knowledge improvements are needed in order to de-risk emerging biorefineries.

09 BIOMASS FUELS↗
DOE OSTI2021

Research challenges and directions in HVAC fault prevalence

This study provides a review of the current state of knowledge, gaps, and potential value in research on the prevalence of faults in commercial buildings. Two separate efforts were made in this study: (1) we performed a literature review to determine the extent of currently available fault prevalence data for heating, ventilation, and air-conditioning (HVAC) systems, and (2) we conducted dozens of interviews with subject matter experts and stakeholders to determine the HVAC fault data that would be of greatest value. Through the literature review and interviews, we discovered unmet needs for empirical data on the prevalence of faults at the desired level of granularity, consistency, and scale; this lack of data leads us to recommend future work studying commercial buildings’ HVAC fault prevalence, with robust fault taxonomy and a variety of meaningful fault prevalence metrics.

32 ENERGY CONSERVATION, CONSUMPTION, AND UTILIZATI↗
DOE OSTI2026

Barriers and Opportunities for Energy Technology Adoption in Juneau, Alaska

This report presents findings from a qualitative study examining barriers and opportunities for air source heat pump (ASHP) and electric vehicle (EV) adoption in Juneau, Alaska, with a particular focus on manufactured and multifamily housing. The analysis draws on community insights from end users and middle actors to better understand how technology adoption unfolds in contexts with distinct logistical, infrastructural, and housing constraints. The report is organized according to key barriers and opportunities identified through stakeholder input, providing a structured understanding of adoption dynamics across technologies and housing types. These insights are intended to inform program design and support more effective electrification strategies tailored to local conditions. The study team employed qualitative methods to capture both in-depth and high-level perspectives on technology adoption. Data collection included: 1) two 2-hour focus groups with a total of five end users and seven middle actors, enabling detailed and structured discussion and 2) ten semistructured interviews with manufactured home owners, multifamily landlords, and one tenant, providing complementary insights across housing contexts. Focus groups captured accounts of shared challenges and opportunities while interviews offered more concise reflections on individual experiences. Together, these methods enabled a more comprehensive understanding of both systemic barriers and lived experiences with ASHPs and EVs. The findings reveal that adoption of electrification technologies is shaped by a combination of economic, logistical, and informational factors that vary across housing types, technology characteristics, user groups, and other demographic factors. Addressing these factors requires tailored strategies that reflect local conditions and user experiences. The insights in this report can provide a foundation for organizations such as AEL&P to refine program design, support more effective outreach, and anticipate shifts in energy demand associated with increased electrification. More broadly, the study highlights the importance of incorporating community perspectives when developing electrification initiatives to ensure they are both practical and responsive to real-world constraints.

32 ENERGY CONSERVATION, CONSUMPTION, AND UTILIZATI↗
DOE OSTI2024

Expert and operator perspectives on barriers to energy efficiency in data centers

Abstract It was last estimated in 2016 that data centers (DCs) comprise approximately 2% of total US electricity consumption. However, this estimate is currently being updated to account for the massive increase in computing needs due to streaming, cryptocurrency, and artificial intelligence (AI). To prevent energy consumption that tracks with increasing computing needs, it is imperative we identify energy efficiency strategies and investments beyond the low-hanging fruit solutions. In a two-phased research approach, we ask: What non-technical barriers still impede energy efficiency (EE) practices and investments in the data center sector, and what can be done to overcome these barriers? In particular, we are focused on social and organizational barriers to EE. In Phase I, we performed a literature review and found that technical solutions are abundant in the literature, but fail to address the top-down cultural shifts that need to take place in order to adapt new energy efficiency strategies. In Phase II, reported here, we interviewed 16 data center operators/experts to ground-truth our literature findings. Our interview protocols focus on three aspects of DC decision-making: procurement practices, metrics and monitoring, and perceived barriers to energy efficiency. We find that vendors are the key drivers of procurement decisions, advanced efficiency metrics are facility-specific, and there is convergence in the design of advanced facilities due to the heat density of parallelized infrastructure. Our ultimate goals for our research are to design DC decarbonization policies that target organizational structure, empower individual staff, and foster a supportive external market.

32 ENERGY CONSERVATION, CONSUMPTION, AND UTILIZATI↗
DOE OSTI2023

Taming the wild edge of smart grid – Lessons from transactive energy market deployments

For two decades, the idea of using market-based approaches in field deployments that coordinate the flexible operation of electricity customer assets has occupied the efforts of transactive energy practitioners. While the purported benefits of this distributed decision-making approach have been well explored, the practical aspects of implementing such a system to address real-world problems are just beginning to emerge. This report surveyed 24 field-deployed programs and interviewed experts instrumental in these deployments. The results of the survey and interviews reveal the diversity of designs and applications. They highlight the technical promise of the approaches as well as challenges with system integration, sustainable business strategy, and regulatory policy obstacles. Insights from the survey offer considerations to direct future effort and investment.

24 POWER TRANSMISSION AND DISTRIBUTION↗
DOE OSTI2022

Provider Perspectives: Identification and Follow-up of Infants who Are Deaf or Hard of Hearing

Objective Without timely screening, diagnosis, and intervention, hearing loss can cause significant delays in a child's speech, language, social, and emotional development. In 2019, Texas had nearly twice the average rate of loss to follow-up (LFU) or loss to documentation (LTD; i.e., missing documentation of services received) among infants who did not pass their newborn hearing screening compared to the United States overall (51.1 vs. 27.5%). We aimed to identify factors contributing to LFU/LTD among infants who do not pass their newborn hearing screening in Texas. Study Design Data were collected through semistructured qualitative interviews with 56 providers along the hearing care continuum, including hospital newborn hearing screening program staff, audiologists, primary care physicians, and early intervention (EI) program staff located in three rural and urban public health regions in Texas. Following recording and transcription of the interviews, we used qualitative data analysis software to analyze themes using a conventional content analysis approach. Results Frequently cited barriers included problems with family access to care, difficulty contacting patients, problems with communication between providers and referrals, lack of knowledge among providers and parents, and problems using the online reporting system. Providers in rural areas more often mentioned problems with family access to care and contacting families compared to providers in urban areas. Conclusion These findings provide insight into strategies that public health professionals and health care providers can use to work together to help further increase the number of children identified early who may benefit from EI services. Key Points

Obstetrics & Gynecology↗
DOE OSTI2026

A path to intelligent watersheds: coordinating the data to decision pipeline

Operations of multi-reservoir systems are challenged in-part by the interplay of complex physical processes functioning within the watershed. The employment of intelligent systems can be of aid by linking environmental sensing, information technology, data analytics, simulation and decision support to achieve a data-to-decision flow of information. A further challenge is that watershed resources are managed for multiple purposes requiring some level of coordination among numerous resource managers, asset operators and users. System intelligence in this context relies on shared community platforms (data portals, community models), and coordinated communication between decision makers. Opportunities to enrich watershed intelligence has been the subject of a roadmapping exercise for the Department of Energy’s Water Power Technologies Office which has relied on broad stakeholder engagement. Initial phases of engagement involved personal interviews and a series of virtual group meetings, which focused on identifying opportunities to improve the intelligence of the physical infrastructure within our watersheds—examples of feedback include improved sensing of snowpack and runoff, data standards for facilitated data sharing, and better forecasting tools. The latter phase of engagement involved the conduct of a case study in the Upper Colorado River basin where key stakeholders were interviewed to map how their decisions are informed by intelligence from other basin stakeholders. Our presentation will highlight the interdisciplinary flow of information in complex watershed systems and identify physical and institutional opportunities toward the strategic operation of water infrastructure.

Colorado River↗
DOE OSTI2022

User-Focused Tools to Enhance IT/OT Cyber Resilience within the Power Grid

The power grid is undergoing several changes that are increasing its complexity as nexuses between electric-gas, transmission-distribution, and energy-communications continue to become increasingly critical. This system is heavily dependent on communication infrastructure and controls, and it relies on humans in operational technology (OT) and information technology (IT) roles to manage the increasing breadth, depth, and speed of data. Many technical challenges have presented themselves and will need to be addressed to provide reliable grid operations. With increased reliance on distributed controls and communication infrastructure, cybersecurity becomes an inherent requirement. When considering current cyber-physical security solutions for the power grid, one can notice a clear divide between information technology and operation technology networks. However, in real-life applications, these networks are interdependent. This work presents results of interviews with key utility cybersecurity personnel, analyzes the results, and makes recommendations towards solution of existing technical and operational challenges realized. Existing workflows are presented, wireframe interviews are discussed, and tool requirements are described. The existence of easy-to-implement solutions, based on existing energy management systems, highlight the potential for real-life applications.

cybersecurity, resilience, user-centered design, p↗
DOE OSTI2023

Tigers at a crossroads: Shedding light on the role of Bangladesh in the illegal trade of this iconic big cat

Abstract Unsustainable wildlife trade is a major threat to many species, but quantifying trade remains challenging, as seizure data provides an incomplete understanding. For this reason, integrating multiple types of information, including interviews with actors involved in trade, is crucial if we are to understand the problem better. Hence, in this study, we digitized Bangladesh Forest Department tiger seizure records to identify trade routes and interviewed 163 individuals involved in trafficking tigers through Bangladesh's air, sea and land ports, including poachers, smugglers, and traders. We identified six ports used to import tigers, 14 ports used for tiger export and three ports showing bi‐directional trade. Elite Bangladeshis were the most important consumer group, and tigers were sourced from populations in NE India, Myanmar and Bangladesh Sundarbans to supply domestic demand. Tiger products were exported to 14 countries, including seven G20 nations, with Bangladeshi expatriates as the consumer group in three countries (United Kingdom, Germany and Qatar). Rising economic development in Bangladesh over the last decade, combined with deep‐rooted cultural ties to tiger consumption, has led to a rise in domestic demand. Additionally, rapid growth in international transport links has increased smuggling and connected local traders with global markets, increasing the complexity of global trade. These findings suggest Bangladesh is poised to play a pivotal role in tiger conservation over the next decade, requiring strong national strategies to reduce trade opportunities, disrupt networks and weaken demand.

Uddin, Nasir↗
DOE OSTI2022

Clinical practice gaps and challenges in non‐alcoholic steatohepatitis care: An international physician needs assessment

Abstract Background and aims Even as several pharmacological treatments for non‐alcoholic steatohepatitis (NASH) are in development, the incidence of NASH is increasing on an international scale. We aim to assess clinical practice gaps and challenges of hepatologists and endocrinologists when managing patients with NASH in four countries (Germany/Italy/United Kingdom/United States) to inform educational interventions. Methods A sequential mixed‐method design was used: qualitative semi‐structured interviews followed by quantitative online surveys. Participants were hepatologists and endocrinologists practising in one of the targeted countries. Interview data underwent thematic analysis and survey data were analysed with chi‐square and Kruskal‐Wallis tests. Results Most interviewees ( n = 24) and surveyed participants (89% of n = 224) agreed that primary care must be involved in screening for NASH, yet many faced challenges involving and collaborating with them. Endocrinologists reported low knowledge of which blood markers to use when suspecting NASH (56%), when to order an MRI (65%) or ultrasound/FibroScan® (46%), and reported sub‐optimal skills interpreting alanine aminotransferase (ALT, 37%) and aspartate aminotransferase (AST, 38%) blood marker test results, causing difficulty during diagnosis. Participants believed that more evidence is needed for upcoming therapeutic agents; yet, they reported sub‐optimal knowledge of eligibility criteria for clinical trials. Knowledge and skill gaps when managing comorbidities, as well as skill gaps facilitating patient lifestyle changes were reported. Conclusions Educational interventions are needed to address the knowledge and skill gaps identified and to develop strategies to optimize patient care, which include implementing relevant care pathways, encouraging referrals and testing, and multidisciplinary collaboration, as suggested by the recent Global Consensus statement on NAFLD.

Lazure, Patrice↗
DOE OSTI2021

The best of both worlds – entering the nursing profession with support of a transition programme

Abstract Background Transition into clinical practice for newly graduated nurses is a difficult time, with high stress levels defined by a demanding period of personal and professional acclimatisation. Transitions are complicated and multi‐dimensional, and to understand this process, it is crucial to identify the factors that facilitate or stand in the way of a healthy transition. Aim The phenomenological study aimed to describe newly graduated nurses’ expectations of transitioning into the nursing profession at the start of a clinical nursing introduction programme, including education, supervision, and critical reflection with peers. Method The study was based on seven group interviews with newly graduated nurses. The interviews utilised open‐ended and follow‐up questions and were carried out as a dialogue to enable reflection on the phenomenon of interest. This was explored and illuminated using the reflective lifeworld research approach, based on phenomenological epistemology. Findings “Expectations of transition into the nursing profession via the Clinical Nursing Introduction Programme” is signified by an oscillating movement between uncertainty, security, challenge, and growth on the threshold of a new identity. The phenomenon is constituted by the courage to grow, responsibility and fear, belonging and vulnerability, and support and challenge. Conclusion Transitioning into the nursing profession via the Clinical Nursing Introduction Programme means having the best of both worlds. Newly graduated nurses have the opportunity to receive education and structured support at the same time as they work independently in clinical practice.

Berglund, Mia↗
DOE OSTI2024

Drug providers’ perspectives on antibiotic misuse practices in eastern Ethiopia: a qualitative study

Objective Antibiotic misuse includes using them to treat colds and influenza, obtaining them without a prescription, not finishing the prescribed course and sharing them with others. Although drug providers are well positioned to advise clients on proper stewardship practices, antibiotic misuse continues to rise in Ethiopia. It necessitates an understanding of why drug providers failed to limit such risky behaviours. This study aimed to explore drug providers’ perspectives on antibiotic misuse practices in eastern Ethiopia. Setting The study was conducted in rural Haramaya district and Harar town, eastern Ethiopia. Design and participants An exploratory qualitative study was undertaken between March and June 2023, among the 15 drug providers. In-depth interviews were conducted using pilot-tested, semistructured questions. The interviews were transcribed verbatim, translated into English and analysed thematically. The analyses considered the entire dataset and field notes. Results The study identified self-medication pressures, non-prescribed dispensing motives, insufficient regulatory functions and a lack of specific antibiotic use policy as the key contributors to antibiotic misuse. We found previous usage experience, a desire to avoid extra costs and a lack of essential diagnostics and antibiotics in public institutions as the key drivers of non-prescribed antibiotic access from private drug suppliers. Non-prescribed antibiotic dispensing in pharmacies was driven by client satisfaction, financial gain, business survival and market competition from informal sellers. Antibiotic misuse in the setting has also been linked to traditional and ineffective dispensing audits, inadequate regulatory oversights and policy gaps. Conclusion This study highlights profits and oversimplified access to antibiotics as the main motivations for their misuse. It also identifies the traditional antibiotic dispensing audit as an inefficient regulatory operation. Hence, enforcing specific antibiotic usage policy guidance that entails an automated practice audit, a responsible office and insurance coverage for persons with financial limitations can help optimise antibiotic use while reducing resistance consequences.

General & Internal Medicine↗
DOE OSTI2019

Performance of a Nonelectric Infant Warmer in Rwandan Health Centers

Background: Neonatal hypothermia remains a challenge in resource-limited settings. Methods. We conducted a prospective mixed-methods cohort study in rural Rwandan health centers to assess the performance of an infant warmer we designed for low-resource settings. All hypothermic infants were eligible for enrollment. Outcomes. Safety: incidence of adverse reactions. Effectiveness: attainment of euthermia, rate of temperature rise. Feasibility: correct use of warmer, signs of wear. Interviews of caregivers and nurses. Findings. Of 102 encounters, there were no adverse reactions. Of 80 encounters for hypothermia when infants on warmer for ≥1 hour, 79 achieved euthermia; 73 in ≤2 hours. Of the 80 encounters, 64 had temperature rise ≥0.5°C/h. Of the 102 encounters, there were no instances of the warmer being prepared, used, or cleaned incorrectly. Five out of the 12 warmers exhibited wear. Interview participants were predominantly positive; some found time for readiness of warmer challenging. Interpretation. The warmer performed well. It is appropriate to study in larger scale.

60 APPLIED LIFE SCIENCES↗