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At least 73 records · Page 4

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NASA NTRS1991

Man-machine interfaces in health care

The surgeon, like the pilot, is confronted with an ever increasing volume of voice, data, and image input. Simultaneously, the surgeon must control a rapidly growing number of devices to deliver care to the patient. The broad disciplines of man-machine interface design, systems integration, and teleoperation will play a role in the operating room of the future. The purpose of this communication is to report the incorporation of these design concepts into new surgical and laser delivery systems. A review of each general problem area and the systems under development to solve the problems are presented.

Charles, Steve↗

DOE OSTI2023

Characteristics of Veterans With Depression Who Use the Veterans Choice Program of the Veterans Health Administration

Objective: The Veterans Choice Program (VCP) of the Veterans Health Administration (VHA) allowed eligible veterans to use their benefits with participating providers outside the VHA. The authors aimed to identify characteristics of veterans with depression who used or did not use mental health care through the VCP. Methods: In this cross-sectional study, the authors analyzed secondary data from the national VHA Corporate Data Warehouse. VHA administrative data were linked with VCP claims to examine characteristics of VCP-eligible veterans with depression. Further, the study sample included 595,943 unique veterans who were enrolled in the VHA before 2013, were eligible for the VCP in 2016, were alive in 2018, and had an assessed Patient Health Questionnaire–9 (PHQ-9) score or depressive disorder diagnosis documented in the VHA between 2016 and 2018. Results: Veterans who used the VCP had lower medical comorbidity scores and lived in less socioeconomically disadvantaged counties, compared with veterans who received only VHA care. VCP veterans were also more likely to have a PHQ-9 score assessment and to have higher mean depression scores. Mean counts of annual mental health visits per 1,000 veterans were markedly higher for direct VHA care than for care provided via the VCP. As a percentage of the total counts of visits per 1,000 veterans across the VCP and VHA, residential programs and outpatient procedures were the services that were most frequently delivered through the VCP. Conclusions: Between 2016 and 2018, the VCP was used primarily to augment mental health care provided by the VHA, rather than to fill a gap in care.

60 APPLIED LIFE SCIENCES↗

NASA NTRS2014

Exploration Medical System Demonstration

BACKGROUND: Exploration class missions will present significant new challenges and hazards to the health of the astronauts. Regardless of the intended destination, beyond low Earth orbit a greater degree of crew autonomy will be required to diagnose medical conditions, develop treatment plans, and implement procedures due to limited communications with ground-based personnel. SCOPE: The Exploration Medical System Demonstration (EMSD) project will act as a test bed on the International Space Station (ISS) to demonstrate to crew and ground personnel that an end-to-end medical system can assist clinician and non-clinician crew members in optimizing medical care delivery and data management during an exploration mission. Challenges facing exploration mission medical care include limited resources, inability to evacuate to Earth during many mission phases, and potential rendering of medical care by non-clinicians. This system demonstrates the integration of medical devices and informatics tools for managing evidence and decision making and can be designed to assist crewmembers in nominal, non-emergent situations and in emergent situations when they may be suffering from performance decrements due to environmental, physiological or other factors. PROJECT OBJECTIVES: The objectives of the EMSD project are to: a. Reduce or eliminate the time required of an on-orbit crew and ground personnel to access, transfer, and manipulate medical data. b. Demonstrate that the on-orbit crew has the ability to access medical data/information via an intuitive and crew-friendly solution to aid in the treatment of a medical condition. c. Develop a common data management framework that can be ubiquitously used to automate repetitive data collection, management, and communications tasks for all activities pertaining to crew health and life sciences. d. Ensure crew access to medical data during periods of restricted ground communication. e. Develop a common data management framework that allows for scalability, extensibility, and interoperability of data sources and data users. f. Lower total cost of ownership for development and sustainment of peripheral hardware and software that use EMSD for data management. g. Provide a better standard of healthcare for crew members through reductions in the time required by crew and ground personnel to provide medical treatment and the number of crew errors experienced during treatment.

Rubin, D. A.↗

NASA NTRS2013

Overview of an Integrated Medical System for Exploration Missions

The Exploration Medical Capability (ExMC) element of the NASA Human Research Program (HRP) is charged with addressing the risk of unacceptable health and mission outcomes due to limitations of inflight medical capabilities. The Exploration Medical System Demonstration (EMSD) is a project within the ExMC element aimed at reducing this risk by improving the medical capabilities available for exploration missions. The EMSD project will demonstrate, on the ground and on ISS, the integration of several components felt to be essential to the delivery of medical care during long ]duration missions outside of low Earth orbit. The components of the EMSD include the electronic medical record, assisted medical procedure software, medical consumables tracking technology and RFID ] tagged consumables, video conferencing capability, ultrasound device and probes (ground demonstration only), peripheral biosensors, and the software to allow communication among the various components (middleware). This presentation seeks to inform our international partners of the goals and objectives of the EMSD and to foster collaboration opportunities related to this and future projects.

Watkins, Sharmila↗

NASA NTRS1992

A prototype Crew Medical Restraint System (CMRS) for Space Station Freedom

The Crew Medical Restrain System (CMRS) is a prototype system designed and developed for use as a universally deployable medical restraint/workstation on Space Station Freedom (SSF), the Shuttle Transportation System (STS), and the Assured Crew Rescue Vehicle (ACRV) for support of an ill or injured crewmember requiring stabilization and transportation to Earth. The CMRS will support all medical capabilities of the Health Maintenance Facility (HMF) by providing a restraint/interface system for all equipment (advance life support packs, defibrillator, ventilator, portable oxygen supply, IV pump, transport monitor, transport aspirator, and intervenous fluids delivery system) and personnel (patient and crew medical officers). It must be functional within the STS, ACRV, and all SSF habitable volumes. The CMRS will allow for medical capabilities within CPR, ACLS and ATLS standards of care. This must all be accomplished for a worst case transport time scenario of 24 hours from SSF to a definitive medical care facility on Earth. A presentation of the above design prototype with its subsequent one year SSF/HMF and STS/ACRV high fidelity mock-up ground based simulation testing will be given. Also, parabolic flight and underwater Weightless Test Facility evaluations will be demonstrated for various medical contingencies. The final design configuration to date will be discussed with future space program impact considerations.

Johnston, S. L.↗

NASA NTRSDate not supplied

Human Monitoring for Medical Operator Assistance

Measurement of multiple biologic and non-biologic signals can be exploited for the task of monitoring the physiological status of individuals - either as patients during and following illness or injury or as those engaged in operational activities. Assessing physiological status is accomplished by measuring vital signs and wellness measures that support clinical decision-making for physical optimization, illness/injury prevention and treatment, recovery progression, and general delivery of care, or monitoring an operator's moment-to-moment personal "readiness" state. Physiological measures are beneficial for monitoring the medical state of vehicle operators, for example, through the detection of incapacitation in the realm of transportation safety. Measuring physiological signals or control inputs can also be beneficial for monitoring operator state to optimize human-autonomy-teaming performance for safety and efficiency. Similarly, monitoring a health care provider during the performance of medical procedures could provide valuable feedback on optimizing human-robot interactions and human teaming with autonomous systems. In this sense, the provider can be seen as a "Medical Operator" in the same way other "operators" drive, aviate, or control vehicles by performing manual, attention-demanding tasks during safety-critical activities.

Neuroergonomics↗

NASA NTRS1989

Medical care delivery in space

Consideration is given to the delivery of medical care in space. The history of aviation medicine is reviewed. Medical support for the early space programs is discussed, including the Mercury, Gemini, Apollo, and Skylab programs. The process of training crew members for basic medical procedures for the Space Shuttle program is briefly described and medical problems during the Shuttle program are noted. Plans for inflight medical care on the Space Station are examined, including the equipment planned for the Health Maintenance Facility, the use of exercise to help prevent medical problems.

Stewart, Don F.↗

NASA NTRSDate not supplied

A Prognostics Framework for Battery Health Monitoring Integrated with Thermal Modeling

Urban Air Mobility (UAM) promises to revolutionize transportation in major cities, offering passenger travel, cargo delivery, and emergency medical services through a network of electric vertical takeoff and landing (eVTOL) aircraft. However, the limited range of current eVTOLs, due to the low specific energy of lithium-ion batteries along with a possibility of thermal runaway conditions poses significant safety concerns, leading to potentially compromising operational safety. To address this critical challenge, researchers are actively evaluating the impact of flight and environmental conditions on onboard lithium-ion battery health. This involves carefully assessing the performance of battery packs under laboratory and operational conditions for developing models to estimate future health using prognostics framework. This study examines the effectiveness of evaluating battery degradation leading to catastrophic failures under varying operational conditions in laboratory. These are captured using physics based models of underlying phenomenons and integrated into the prognostics framework. A fully charged battery undergoes controlled discharge cycles at varying C-rates based on the simulated power draw profile, with current and voltage, temperature data recorded throughout the experiment. The observed data provides valuable insights into how different operating conditions and mission profiles affect battery performance. This information is crucial for developing strategies to optimize battery systems, enhance range, and ultimately ensure the safe and reliable operation of UAM vehicles.

Thermal Modeling↗

NASA NTRSDate not supplied

A Prognostics Framework for Battery Health Monitoring Integrated with Thermal Modeling

Thermal Modeling↗

NASA NTRSDate not supplied

A Prognostics Framework for Battery Health Monitoring Integrated with Thermal Modeling

Thermal Modeling↗

DOE OSTI2024

Sequential Inference of Hospitalization Electronic Health Records Using Probabilistic Models

In the dynamic hospital setting, decision support can be a valuable tool for improving patient outcomes. Data-driven inference of future outcomes is challenging in this dynamic setting, where long sequences such as laboratory tests and medications are updated frequently. This is due in part to heterogeneity of data types and mixed-sequence types contained in variable length sequences. In this work we design a probabilistic unsupervised model for multiple arbitrary-length sequences contained in hospitalization Electronic Health Record (EHR) data. The model uses a latent variable structure and captures complex relationships between medications, diagnoses, laboratory tests, neurological assessments, and medications. It can be trained on original data, without requiring any lossy transformations or time binning. Inference algorithms are derived that use partial data to infer properties of the complete sequences, including their length and presence of specific values. We train this model on data from subjects receiving medical care in the Kaiser Permanente Northern California integrated healthcare delivery system. The results are evaluated against held-out data for predicting the length of sequences and presence of Intensive Care Unit (ICU) in hospitalization bed sequences. Our method outperforms a baseline approach, showing that in these experiments the trained model captures information in the sequences that is informative of their future values.

97 MATHEMATICS AND COMPUTING↗

DOE OSTI2022

Unsupervised probabilistic models for sequential Electronic Health Records

We develop an unsupervised probabilistic model for heterogeneous Electronic Health Record (EHR) data. Utilizing a mixture model formulation, our approach directly models sequences of arbitrary length, such as medications and laboratory results. This allows for subgrouping and incorporation of the dynamics underlying heterogeneous data types. The model consists of a layered set of latent variables that encode underlying structure in the data. These variables represent subject subgroups at the top layer, and unobserved states for sequences in the second layer. We train this model on episodic data from subjects receiving medical care in the Kaiser Permanente Northern California integrated healthcare delivery system. The resulting properties of the trained model generate novel insight from these complex and multifaceted data. In addition, we show how the model can be used to analyze sequences that contribute to assessment of mortality likelihood.

59 BASIC BIOLOGICAL SCIENCES↗

DOE OSTI2020

Modeling efficient and equitable distribution of COVID-19 vaccines

Producing and distributing COVID-19 vaccine during the pandemic is a major logistical challenge requiring careful planning and efficient execution. This report presents information on logistical, policy and technical issues relevant to rapidly fielding a COVID-19 vaccination program. For this study we (a) conducted literature review and subject matter expert elicitation to understand current vaccine manufacturing and distribution capabilities and vaccine allocation strategies, (b) designed a baseline vaccine distribution strategy and modeling strategy to provide insight into the potential for targeted distribution of limited initial vaccine supplies, and (c) developed parametric interfaces to enable vaccine distribution scenarios to be analyzed in depth with Sandias Adaptive Recovery Model that will allow us evaluate the additional sub- populations and alternative distribution scenarios from a public health benefit and associated economic disruption Principal issues, challenges, and complexities that complicate COVID-19 vaccine delivery identified in our literature and subject matter expert investigation include these items: The United States has not mounted an urgent nationwide vaccination campaign in recent history. The existing global manufacturing and distribution infrastructure are not able to produce enough vaccine for the population immediately. Vaccines, once available will be scarce resources. Prioritization for vaccine allocation will be built on existing distribution networks. Vaccine distribution may not have a universal impact on disease transmission and morbidity because of scarcity, priority population demographics, and underlying disease transmission rates. Considerations for designing a vaccine distribution strategy are discussed. A baseline distribution strategy is designed and tested using the Adaptive Recovery Model, which couples a deterministic compartmental epidemiological model and a stochastic network model. We show the impact of this vaccine distribution strategy on hospitalizations, mortality, and contact tracing requirements. This model can be used to quantitatively evaluate alternative distribution scenarios, guiding policy decisions as vaccine candidates are narrowed down.

59 BASIC BIOLOGICAL SCIENCES↗

NASA NTRS2002

Mobile Router Developed and Tested

The NASA Glenn Research Center, under a NASA Space Act Agreement with Cisco Systems, has been performing joint networking research to apply Internet-based technologies and protocols to space-based communications. As a result of this research, NASA performed stringent performance testing of the mobile router, including the interaction of routing and the transport-level protocol. In addition, Cisco Systems developed the mobile router for both commercial and Government markets. The code has become part of the Cisco Systems Internetworking Operating System (IOS) as of release 12.2 (4) T--which will make this capability available to the community at large. The mobile router is software code that resides in a network router and enables entire networks to roam while maintaining connectivity to the Internet. This router code is pertinent to a myriad of applications for both Government and commercial sectors, including the "wireless battlefield." NASA and the Department of Defense will utilize this technology for near-planetary observation and sensing spacecraft. It is also a key enabling technology for aviation-based information applications. Mobile routing will make it possible for information such as weather, air traffic control, voice, and video to be transmitted to aircraft using Internet-based protocols. This technology shows great promise in reducing congested airways and mitigating aviation disasters due to bad weather. The mobile router can also be incorporated into emergency vehicles (such as ambulances and life-flight aircraft) to provide real-time connectivity back to the hospital and health-care experts, enabling the timely application of emergency care. Commercial applications include entertainment services, Internet protocol (IP) telephone, and Internet connectivity for cruise ships, commercial shipping, tour buses, aircraft, and eventually cars. A mobile router, which is based on mobile IP, allows hosts (mobile nodes) to seamlessly "roam" among various IP subnetworks. This is essential in many wireless networks. A mobile router, unlike a mobile IP node, allows entire networks to roam. Hence, a device connected to the mobile router does not need to be a mobile node because the mobile router provides the roaming capabilities. There are three basic elements in the mobile IP: the home agent, the foreign agent, and the mobile node. The home agent is a router on a mobile node's home network that tunnels datagrams for delivery to the mobile node when it is away from home. The foreign agent is a router on a remote network that provides routing services to a registered mobile node. The mobile node is a host or router that changes its point of attachment from one network or subnetwork to another. In mobile routing, virtual communications are maintained by the home agent, which forwards all packets for the mobile networks to the foreign agent. The foreign agent passes the packets to the mobile router, which then forwards the packets to the devices on its networks. As the mobile router moves, it will register with its home agent on its whereabouts via the foreign agent to assure continuous connectivity.

Ivancic, William D.↗

DOE OSTI2022

Six-Month Outcomes of Infants Born to People With SARS-CoV-2 in Pregnancy

OBJECTIVES To assess the 6-month incidence of laboratory-confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, postnatal care, hospitalization, and mortality among infants born to people with laboratory-confirmed SARS-CoV-2 infection during pregnancy by timing of maternal infection. METHODS Using a cohort of liveborn infants from pregnancies with SARS-CoV-2 infections in the year 2020 from 10 United States jurisdictions in the Surveillance for Emerging Threats to Mother and Babies Network, we describe weighted estimates of infant outcomes from birth through 6 months of age from electronic health and laboratory records. RESULTS Of 6601 exposed infants with laboratory information through 6 months of age, 1.0% (95% confidence interval: 0.8–1.1) tested positive, 19.1% (17.5–20.6) tested negative, and 80.0% (78.4–81.6) were not known to be tested for SARS-CoV-2. Among those ≤14 days of age, SARS-CoV-2 infection occurred only with maternal infection ≤14 days before delivery. Of 3967 infants with medical record abstraction, breastmilk feeding initiation was lower when maternal infection occurred ≤14 days before delivery compared with >14 days (77.6% [72.5–82.6] versus 88.3% [84.7–92.0]). Six-month all-cause hospitalization was 4.1% (2.0–6.2). All-cause mortality was higher among infants born to people with infection ≤14 days (1.0% [0.4–1.6]) than >14 days (0.3% [0.1–0.5]) before delivery. CONCLUSIONS Results are reassuring, with low incidences of most health outcomes examined. Incidence of infant SARS-CoV-2, breastmilk feeding initiation, and all-cause mortality differed by timing of maternal infection. Strategies to prevent infections and support pregnant people with coronavirus disease 2019 may improve infant outcomes.

Pediatrics↗

DOE OSTI2026

The Next Stage for Smart Cities: Metrics to Spur an Evolution from Technology for Efficiency to Technology for People's Needs

The Smart Cities movement is about a decade old, energized by the USDOT Smart Cities grant that sparked cities to dream big. Now, 10 years later, and multitudes of conferences and papers later, the biggest question regarding Smart Cities is whether any progress has been made? Smart Cities forums are typically led by the technology sector, either telecommunications, internet access, or most recently artificial intelligence (AI) concerns. Each of these areas have grown and found new applications in the context of Smart Cities, however, these technology applications are just tools toward ends. Do digital communications and assistance enable or foster improved access to real, tactile, non-virtual goods and services such as transportation, food, housing, trash removal, health care, education, social interaction? These and other topics are not 'big tech', but are each critical to quality of life outcomes and are day-to-day necessities, comprising many of the touch points through which citizens interact with municipal agencies. Regarding Smart Cities, relationships have not been fully refined as to how best to merge the emerging generation of technology and related trends with more mundane but essential requirements of tactile services. How should municipal managers and operators bring the range of new technology tools (e.g. on-demand transit, automated vehicles, digital connectivity) to bear to improve functions serving real- physical- non-virtual needs? How do we make cities more efficient in providing access to services and opportunities for improved quality of life? This paper examines the current Smart City movement, emerging trends, and the need to put metrics with respect to the delivery, access, and provision of real-life needs. Using a few case studies of past, present, and projected future scenarios, this paper attempts to bring Smart Cities into the real cities domain, perhaps pushing the moniker away from 'Smart' to 'Efficient' - something that can be measured, counted, and assessed. Through the consideration of the next stage of the evolution of cities from 'Smart' to 'Efficient', the combined efforts and experience of multiple researchers at the NREL and their network of collaborators highlights the need for updates metrics that can be used to start guiding efforts toward productive initiatives to improve quality of life.

29 ENERGY PLANNING, POLICY, AND ECONOMY↗

NASA NTRS2023

Exploring the Complexities of Drug Formulation Selection, Storage, and Shelf-Life for Exploration Spaceflight

Medications have been a part of space travel dating back as far as the Apollo missions. Currently, medical kits aboard the ISS contain medications and supplies to help crew members cope with a variety of possible medical events. NASA reported that 1,867 medical events occurred from 1981 to 1998 on space shuttle flights, STS-1 to STS-89; 498 out of the 508 crewmembers on those flights reported experiencing a medical event other than space motion sickness. In 2000, the Institute of Medicine (IOM) convened a committee of experts, Committee on Creating a Vision for Space Medicine during Travel beyond Earth Orbit, to examine the issues surrounding astronaut health and safety for long duration space missions. The primary theme of the committee’s final report is that there is not enough known about the risks to human health during long-duration missions beyond Earth’s orbit and ways to effectively mitigate those risks in an environment of deep space. In 2014, the IOM convened the Committee on Ethics Principles and Guidelines for Health Standards for Long Duration and Exploration Spaceflights and released a report emphasizing the importance of prevention, mitigation, and treatment of major risks to human health during exploration spaceflight. NASA’s Human Research Program has organized five distinct categories of spaceflight hazards summarized by the acronym “RIDGE” (Space Radiation, Isolation and Confinement, Distance from Earth, Gravity fields, and Hostile/Closed Environments) that astronauts may encounter during exploration spaceflight. From those hazards, NASA further derived 30 of the most critical human health and performance risks, including limits to medical care resulting from pharmaceutical degradation. As we prepare for more distant exploration missions to Mars and beyond, risk management planning for astronaut healthcare should include the assembly of a medication formulary that is comprehensive enough to prevent or treat anticipated medical events, remains safe and chemically stable, and retains sufficient potency to last for the duration of the mission. The present editorial will summarize the current state of knowledge regarding innovative formulary optimization strategies, pharmaceutical stability assessment techniques, and storage and packaging solutions that could enhance drug safety and efficacy for future exploration spaceflight missions.

drug degradation risk assessment↗

DOE OSTI2020

Los Alamos National Laboratory Hazardous Waste Facility Permit Community Relations Plan

The requirements of the Hazardous Waste Facility Permit are fulfilled through execution of LANL's fourth strategic goal: “Enabling mission delivery through next-generation facility, infrastructure, and operational excellence.” With input from our stakeholders, we will continue to fulfill those requirements and to improve our waste operations. In 2015, the Laboratory purpose statement focused waste management efforts by directing delivery of mission success through operational effectiveness and scientific excellence. This Plan advances that purpose through community involvement. In the process of achieving our national security mission, Los Alamos National Laboratory generates some hazardous and mixed waste. Hazardous waste is solid waste that is dangerous or potentially harmful to human health or the environment. Hazardous wastes can be liquids, solids, gases, or sludges. They can be discarded as commercial products, such as cleaning fluids or pesticides, or as the byproducts of operations. Specific substances are listed in 40 Code of Federal Regulations (CFR), Part 261: 40 CFR Part 261. Hazardous waste management activities are regulated by the U. S. Environmental Protection Agency and the New Mexico Environment Department (NMED) pursuant to New Mexico Hazardous Waste Act (HWA; Chapter 74, Article 4 NMSA 1978) and regulations under the Act. In 1989, NMED issued the Hazardous Waste Facility Permit (EPA ID Number NM0890010515-1) that established standards for the Laboratory to manage, store, and treat hazardous wastes on-site and to undertake the closure, post closure care, and cleanup as necessary, of permitted waste management units. On November 30, 2010, NMED renewed the Hazardous Waste Facility Permit (the Permit). In June 2020 the Permittees submitted a permit renewal application to the NMED for their review and approval. The Hazardous Waste Facility Permit Community Relations Plan (CRP) describes the scope of public involvement in the activities of the Permit. The CRP is specifically designed to facilitate the community outreach, engagement, and relations activities concerning the Laboratory’s Hazardous Waste Facility Permit and coordinates with but does not include public involvement for other Laboratory programs, initiatives, or environmental activities.

12 MANAGEMENT OF RADIOACTIVE AND NON-RADIOACTIVE W↗