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At least 1,207 records · Page 67
All sourcesNASA NTRSDOE OSTI
NASA NTRSDate not supplied

In-Situ Surface Construction of Infrastructure

In situ resources offer an opportunity to reduce the amount of items brought from Earth when exploring moons and planets. Utilizing those resources requires energy that comes with a cost. In the case of human missions to Mars, trading surface power for launch mass is beneficial for propellant and consumables required to sustain human pioneering and settlement on the planet’s surface. However, In Situ Resource Utilization (ISRU) can mean far more than propellant production and consumables replacement for missions beyond Low Earth Orbit. NASA’s Systems Capability Leader-ship Team (SCLT) for ISRU created a work break-down structure based on functions identified in roadmaps pertaining to human exploration. That WBS includes Prospecting, Extraction, Processing, Construction, Manufacturing, and Energy. Over the years, NASA has developed some capabilities and technologies for prospecting, extraction, and processing carbon dioxide and water on Mars into propellants and life support consumables. However, that is a small subset of the ISRU needs that are coming to light with NASA’s push to return to the Moon for extended periods of time. For instance, astronauts require shielding from Ga-lactic Cosmic Rays and nuclear radiation and protection from the low temperatures and pressures in Space. Surface assets including crew, landers, and ascent modules can be damaged by surface ejecta during landing and launch operations on the Moon and Mars. Creating shielding, berms, and pads requires movement of large volumes and stabilization of regolith in the context of a civil engineering construction project. Because of the multi-disciplinary nature of the aerospace systems needed for human exploration, SCLT on ISRU created an ISRU Construction Integrated Steering Group that combines expertise among several NASA Principal Technologists and Capabilities Leaders for exploring options, assessing opportunities, and developing requirements for construction and manufacturing on the Moon and Mars NASA’s new program to develop Lunar landers for small, mid, and large payload deliveries to the Lunar surface leading to human missions by 2025 spawned an investigation into plume surface interactions caused by the lander during descent and ascent. The trade space to resolve this issue includes regolith stabilization via landing pad construction techniques and lander nozzles characteristics due to vehicle systems design. Some data exists from the Apollo missions but more is required for the missions ahead. The purpose of this paper [1] is to outline an approach for developing requirements that can guide systems designs while taking advantage of flight opportunities in NASA’s plans to return to the Moon.

In-Situ↗
NASA NTRS2020

Bubble Mapping with the Square Kilometre Array - I. Detecting Galaxies with Euclid, JWST, WFIRST, and ELT within Ionized Bubbles in the Intergalactic medium at z > 6

The Square Kilometre Array (SKA) is expected to provide the first tomographic observations of the neutral intergalactic medium at redshifts z > 6 and pinpoint the locations of individual ionized bubbles during early stages of cosmic reionization. In scenarios where star-forming galaxies provide most of the ionizing photons required for cosmic reionization, one expects the first ionized bubbles to be centred on overdensities of such galaxies. Here, we model the properties of galaxy populations within isolated, ionized bubbles that SKA-1 should be able to resolve at z ≈ 7–10, and explore the prospects for galaxy counts within such structures with various upcoming near-infrared telescopes. We find that, for the bubbles that are within reach of SKA-1 tomography, the bubble volume is closely tied to the number of ionizing photons that have escaped from the galaxies within. In the case of galaxy-dominated reionization, galaxies are expected to turn up above the spectroscopic detection threshold of JWST and ELT in even the smallest resolvable bubbles at z ≤ 10. The prospects of detecting galaxies within these structures in purely photometric surveys with Euclid, WFIRST, JWST, or ELT are also discussed. While spectroscopy is preferable towards the end of reionization to provide a robust sample of bubble members, multiband imaging may be a competitive option for bubbles at z ≈ 10, due to the very small number of line-of-sight interlopers expected at these redshifts.

Erik Zackrisson↗
NASA NTRS2021

Developing Compelling and Science-Focused Mission Concepts for NASA Competed Mission Proposals

Since the mid 1990s, NASA has used a competitive selection process to initiate new mission concepts. These competed missions are motivated by high-value science with low implementation and cost risks. Selectable mission concepts require highly focused science approaches—delivering high quality science “on a budget.” Prospective Principal Investigators (PIs) need to convince NASA that the science they are proposing is both compelling and has high programmatic value. Unfortunately, many of these PIs are not trained in the communication skills needed for “selling” a mission concept to stakeholders. This requires a proposal that presents an investigation in an accessible, relatable, authentic, and believable way. It is the onus of the proposing PI to convince NASA of the value of their particular science concept in a competitive environment, addressing any pre-conceived notions reviewers might have about the concept’s value, complexities, urgency, and other impediments to understanding.The importance of this can be seen in the NASA-sponsored PI Launchpad (Nov 2019 & Jun 2021)1 which was designed to help early career scientists understand the skills, methods, processes, and resources needed to develop compelling science mission concepts; as well as in JPL’s update to their concept maturity model (Jan 2020) which included the addition of Story and Strategy dimensions. This paper provides guidance to assist prospective PIs in developing compelling, science-focused mission concepts. It will provide direction for communicating concepts more clearly to make science objectives more relatable to both reviewers and a broader audience, improving the probability of selection.

Ziemer, John↗
NASA NTRSDate not supplied

The Potential of Medical Drones: An Analysis of Current and Future Use Cases

Modern Application of Medical-Based Drone Delivery Drones have been used advantageously by militaries for nearly a century, but their uses in civilian life are still mostly cutting-edge, if not theoretical. After a decade of bold proclamations, Amazon’s “PrimeAir” drone delivery system is still in the stage of “preparing” for deliveries, while the public awaits for start ups like SkyDrop (formerly Flirtey) to follow through on impressive promises. Despite the well-publicized disappointment so far in commercial drone delivery, medical drone delivery has already proven itself practical and cheap in several countries, and it promises to expand in the coming years. Drones are uniquely suited to make valuable and urgent deliveries to remote areas, quickly transporting medical supplies where road transportation is prohibitively slow or not available at all. Drones have been used notably to deliver AEDs for out-of-hospital cardiac arrest, frequently beating first-responders to the scene; to deliver blood when there is none on hand at hospitals; to deliver vaccines to an island nation with little transportation infrastructure; and to respond flexibly to medical emergencies in a war zone. Economics make the delivery of food and other cheap goods by drone unattractive in the near-term, but the value and time-sensitivity of medical deliveries mean that drones are already saving lives in healthcare. “We believe the value of new technology is most valuable where it is clearly needed...that’s why we wanted to focus on drones delivering medicine and not delivering pizzas, ”said one executive of a drone system manufacturer. The immediate prospects for the expansion of medical drone use are many; however, they do not exist without their own drawbacks and challenges. Most obvious is the limited range of current commercially-available drones, most of which are isolated to a perimeter of roughly 18 miles. Technological know-how presents another barrier to integration of medical drones on a larger scale. Reports from the United Nations frequently cite a“skill deficit”—a prohibitively low number of qualified drone operators in low-and moderate-income countries (LMICs). Another perhaps more discreet speed bump in global drone development and usage are the various regulations on drone usage. Drone technology has developed so quickly that many states, out of an excess of caution, have nearly snuffed out the fledgling industry with regulation. There also exist significant concerns over the security of private citizens, the efficacy of medical deliveries, and the costs of drone operation. It is these last three barriers which this study will seek to overcome. Put simply, the prospect for human development in LMICs from drone-based medical delivery is far too great to disregard. As of 2020, 3.4 billion people live in rural communities, containing fewer than 5,000 people/km^2. Often lacking infrastructure, these communities are largely isolated from their more populated, urban counterparts. In drones lies the potential to reshape the geographic and developmental distinctions that divide the global population. This development must, therefore, begin first and foremost with advancement in regional well-being and life expectancy. Life expectancy makes up a key facet of human development. The United Nations relies on it as a key indicator of a state’s health. Lars Kunze of the Dortmund University Department of Economic sex plains this as a matter of physical capital accumulation. The longer people live, the more they save as opposed to spend. The more they save, the more which eventually gets invested in themselves and the community as a whole. In providing medical products via drone, it is the intention of this study to enable communities with the means and incentives for long-run savings and investment for future economic development. Through a close analysis of Vanuatu, Rwanda, Tanzania, and Ukraine—four states where drones are currently used to deliver medical supplies—this study develops a framework that LMICs in general and Mexico and particular can adopt and to use medical drones in difficult-to-reach communities for the sake of long-run human developmental initiatives.

Ryan Teoh↗
NASA NTRS2024

Enabling the Assimilation of CrIS Shortwave Infrared Observations in Global NWP at NOAA. Part II: OSEs and Results

The assimilation of data from hyperspectral infrared sounders in global data assimilation systems has historically been focused on observations in the longwave infrared (LWIR) region of the spectrum (650-1100 cm−1), despite the often concurrent availability of measurements from the shortwave infrared (SWIR) region of the spectrum (2150-2550 cm−1), because issues (like solar effects) have generally prevented the assimilation of SWIR observations. Recent advances in radiative transfer models have worked to address some of the previous challenges in simulating SWIR observations, and the assimilation of SWIR data (e.g. from potential future small-satellites) is now a feasible prospect. Still, a better understanding of how these observations perform in a data assimilation system and impact resulting analyses and NWP forecasts is necessary. In this study, the value of SWIR observations in global NWP is assessed by assimilating SWIR observations from the Cross-track Infrared Sounder (CrIS) in NOAA’s Global Data Assimilation System (GDAS). The methodologies used to enable the assimilation of these observations, including the implementation of a scene-dependent observation error and the enhancement of quality control procedures, are discussed, as are the results of Observing System Experiments (OSEs) conducted to evaluate the impact of assimilating SWIR observations on forecast skill. The overall results show that SWIR assimilation produces similar forecast impacts to LWIR assimilation. The ability to demonstrate that the assimilation or SWIR observations in NWP is a realistic prospect may help to shape future constellations of small-satellites to serve as a beneficial complement to the current constellation if hyperspectral IR sounders.

Erin Jones↗
DOE OSTI2020

A Tool for the Risk-Informed Management of Critical Mission Resilience

We describe a methodology and tool for the risk-informed management and planning of mission resilience. By mapping concepts of resilience onto the elements of a streamlined risk model we are able to tap the substantial portfolio of established risk concepts to provide rapid insights in the evaluation and high-level screening of prospective resilience enhancement measures. This provides a risk-informed, levelized basis for the comparison of disparate resilience solutions and the means of establishing preferences. The methodology begins with identification of critical missions met by a site, and establishment of the supporting physical assets. Scenarios that would result in failure of these assets are systematically identified. Each scenario comprises three elements: realization of a hazard or threat resulting in loss of resources (the current focus being on power, natural gas, and water) to the asset, failure of measures in place to protect the asset against those losses, and realization of the consequent impacts. These scenarios are quantified in terms of their probabilities of occurrence and the magnitude of the resultant consequences (mission outage time), allowing risk-prioritization to focus resilience enhancement considerations. What-If? analyses are conducted through adjusting elements of the risk calculation to reflect the deployment of prospective resilience measures, by which means the efficacies of each of those measures can be compared using common risk metrics across diverse resilience strategies. This paper will also describe the insights from example applications.

resilience, risk, risk assesment, energy, water↗
DOE OSTI2021

Multicriterion benefit evaluation methodology for safety enhancements in nuclear power plants and application for FLEX strategies

Here we propose a multicriterion benefit evaluation (MCBE) methodology for evaluating costs and benefits of implementing safety enhancements in nuclear power plants. The MCBE methodology establishes a comprehensive evaluation scope using multiple evaluation criteria (including public risk, occupational risk, plant revenue, and plant cost) and multiple contexts (including plant normal operations, incidents, and accidents). The MCBE methodology formulates a benefit or cost element as the product of a monetary consequence and its occurrence-likelihood change. The MCBE methodology also incorporates a decision maker’ preferences toward occurrence likelihood and monetary consequence into cost and benefit estimations through a modified usage of cumulative prospect theory. This paper applies the MCBE methodology to the implementation of diverse and flexible coping strategy (FLEX) in a generic nuclear power plant as an illustrative example. The FLEX benefits are evaluated through three types of influence paths: plant safety enhancement, risk-informed activities, and potential additional credit of FLEX in supporting plant operation and maintenance-efficiency improvement. The benefit-to-cost ratio (BCR) of FLEX implementation is calculated. Sensitivity analyses are conducted to examine the impacts of modeling assumptions and input parameter values on the BCR.

98 NUCLEAR DISARMAMENT, SAFEGUARDS, AND PHYSICAL P↗
NASA NTRS2003

Noninvasive, near infrared spectroscopic-measured muscle pH and PO2 indicate tissue perfusion for cardiac surgical patients undergoing cardiopulmonary bypass

OBJECTIVE: To determine whether near infrared spectroscopic measurement of tissue pH and Po2 has sufficient accuracy to assess variation in tissue perfusion resulting from changes in blood pressure and metabolic demand during cardiopulmonary bypass. DESIGN: Prospective clinical study. SETTING: Academic medical center. SUBJECTS: Eighteen elective cardiac surgical patients. INTERVENTION: Cardiac surgery under cardiopulmonary bypass. MEASUREMENTS AND MAIN RESULTS: A near infrared spectroscopic fiber optic probe was placed over the hypothenar eminence. Reference Po2 and pH sensors were inserted in the abductor digiti minimi (V). Data were collected every 30 secs during surgery and for 6 hrs following cardiopulmonary bypass. Calibration equations developed from one third of the data were used with the remaining data to investigate sensitivity of the near infrared spectroscopic measurement to physiologic changes resulting from cardiopulmonary bypass. Near infrared spectroscopic and reference pH and Po2 measurements were compared for each subject using standard error of prediction. Near infrared spectroscopic pH and Po2 at baseline were compared with values during cardiopulmonary bypass just before rewarming commenced (hypotensive, hypothermic), after rewarming (hypotensive, normothermic) just before discontinuation of cardiopulmonary bypass, and at 6 hrs following cardiopulmonary bypass (normotensive, normothermic) using mixed-model analysis of variance. Near infrared spectroscopic pH and Po2 were well correlated with the invasive measurement of pH (R2 =.84) and Po2 (R 2 =.66) with an average standard error of prediction of 0.022 +/- 0.008 pH units and 6 +/- 3 mm Hg, respectively. The average difference between the invasive and near infrared spectroscopic measurement was near zero for both the pH and Po2 measurements. Near infrared spectroscopic Po2 significantly decreased 50% on initiation of cardiopulmonary bypass and remained depressed throughout the bypass and monitored intensive care period. Near infrared spectroscopic pH decreased significantly during cardiopulmonary bypass, decreased significantly during rewarming, and remained depressed 6 hrs after cardiopulmonary bypass. Diabetic patients responded differently than nondiabetic subjects to cardiopulmonary bypass, with lower muscle pH values (p =.02). CONCLUSIONS: Near infrared spectroscopic-measured muscle pH and Po2 are sensitive to changes in tissue perfusion during cardiopulmonary bypass.

Non-NASA Center↗
NASA NTRS2003

T-wave alternans negative coronary patients with low ejection and benefit from defibrillator implantation

In a trial of prophylactic implantation of a defibrillator, a mortality benefit was seen among patients with previous myocardial infarction and a left-ventricular ejection fraction of 0.30 or less. We identified 129 similar patients from two previously published clinical trials in which microvolt T-wave alternans testing was prospectively assessed. At 24 months of follow-up, no sudden cardiac death or cardiac arrest was seen among patients who tested T-wave alternans negative, compared with an event rate of 15.6% among the remaining patients. Testing of T-wave alternans seems to identify patients who are at low risk of ventricular tachyarrhythmic event and who may not benefit from defibrillator therapy.

NASA Discipline Cardiopulmonary↗
NASA NTRS2003

Polyomavirus JCV excretion and genotype analysis in HIV-infected patients receiving highly active antiretroviral therapy

OBJECTIVE: To assess the frequency of shedding of polyomavirus JC virus (JCV) genotypes in urine of HIV-infected patients receiving highly active antiretroviral therapy (HAART). METHODS: Single samples of urine and blood were collected prospectively from 70 adult HIV-infected patients and 68 uninfected volunteers. Inclusion criteria for HIV-infected patients included an HIV RNA viral load < 1000 copies, CD4 cell count of 200-700 x 106 cells/l, and stable HAART regimen. PCR assays and sequence analysis were carried out using JCV-specific primers against different regions of the virus genome. RESULTS: JCV excretion in urine was more common in HIV-positive patients but not significantly different from that of the HIV-negative group [22/70 (31%) versus 13/68 (19%); P = 0.09]. HIV-positive patients lost the age-related pattern of JCV shedding (P = 0.13) displayed by uninfected subjects (P = 0.01). Among HIV-infected patients significant differences in JCV shedding were related to CD4 cell counts (P = 0.03). Sequence analysis of the JCV regulatory region from both HIV-infected patients and uninfected volunteers revealed all to be JCV archetypal strains. JCV genotypes 1 (36%) and 4 (36%) were the most common among HIV-infected patients, whereas type 2 (77%) was the most frequently detected among HIV-uninfected volunteers. CONCLUSION: These results suggest that JCV shedding is enhanced by modest depressions in immune function during HIV infection. JCV shedding occurred in younger HIV-positive persons than in the healthy controls. As the common types of JCV excreted varied among ethnic groups, JCV genotypes associated with progressive multifocal leukoencephalopathy may reflect demographics of those infected patient populations.

Non-NASA Center↗
NASA NTRS2001

Recovery from vestibular ototoxicity

OBJECTIVE: Determine whether subjects with documented vestibular ototoxicity recover vestibular function and, if so, investigate the recovery dynamics. STUDY DESIGN: Prospective and retrospective reviews and repeated measures. SETTING: Clinical research and technology center. SUBJECTS: Twenty-eight subjects who received vestibulotoxic medications were followed for at least 12 months after initial treatment. CONTROLS: Our subject sample was compared with a published database of normal individuals. INTERVENTIONS: All 28 subjects received systemically administered medications known to be ototoxic. The subjects' treating physicians controlled medication, dosage, and administration schedules. MAIN OUTCOME MEASURES: Tests of horizontal canal vestibulo-ocular function were performed. Subjects' auditory and vestibular symptoms were recorded. RESULTS: Eleven subjects (39%) showed changes in horizontal canal vestibulo-ocular gain constant (GC) and/or time constant (TC) consistent with vestibular ototoxicity. When tested 1 year after ototoxic drug administration, eight of the nine subjects who experienced ototoxic decrease in GC showed a recovery of GC to normal limits. Only one of the eight subjects who experienced ototoxic decrease in TC showed recovery of TC to within normal limits. Ototoxicity onset and recovery were independent of baseline vestibular function, and ototoxicity onset did not correlate with cumulative dose of ototoxic medication. There was no relationship between subjective symptoms and ototoxicity onset. CONCLUSIONS: Recovery of GC after vestibular ototoxicity is more commonly observed than recovery of TC. Because ototoxic changes developed and continued in an unpredictable time and manner in relation to ototoxic drug administration, we propose that once ototoxic changes in vestibulo-ocular reflex are detected, ototoxic medications should be discontinued as soon as possible.

NASA Discipline Neuroscience↗
NASA NTRS2001

Determining the amount of physical activity needed for long-term weight control

OBJECTIVE: To evaluate prospectively the influence of habitual physical activity on body weight of men and women and to develop a model that defines the role of physical activity on longitudinal weight change. DESIGN AND SETTING: Occupational cohort study conducted for a mean of 5.5 y. SUBJECTS: A total of 496 (341 male and 155 female) NASA/Johnson Space Center employees who completed the 3 month education component of the employee health-related fitness program and remained involved for a minimum of 2 y. MEASUREMENTS: Body weights were measured at baseline (T1) and follow-up (T2), and habitual physical activity was obtained from the mean of multiple ratings of the 11-point (0-10) NASA Activity Scale (NAS) recorded quarterly between T1 and T2. Other measures included age, gender, VO(2 max) obtained from maximal treadmill testing, body mass index (BMI), and body fat percentage. RESULTS: Multiple regression demonstrated that mean NAS, T1 weight, aging and gender all influence long-term T2 weight. T1 age was significant for the men only. Independently, each increase in mean NAS significantly (P<0.01) reduced T2 weight in men (b=-0.91 kg; 95% CI:-1.4 to-0.42 kg) and women (b=-2.14 kg; 95% CI:-2.93 to-1.35 kg). Mean NAS had a greater effect on T2 weight as T1 weight increased, and the relationship was dose-dependent. CONCLUSIONS: Habitual physical activity is a significant source of long-term weight change. The use of self-reported activity level is helpful in predicting long-term weight changes and may be used by health care professionals when counseling patients about the value of physical activity for weight control.

Exercise↗
NASA NTRS2001

Neocytolysis on descent from altitude: a newly recognized mechanism for the control of red cell mass

BACKGROUND: Studies of space-flight anemia have uncovered a physiologic process, neocytolysis, by which young red blood cells are selectively hemolyzed, allowing rapid adaptation when red cell mass is excessive for a new environment. OBJECTIVES: 1) To confirm that neocytolysis occurs in another situation of acute plethora-when high-altitude dwellers with polycythemia descend to sea level; and 2) to clarify the role of erythropoietin suppression. DESIGN: Prospective observational and interventional study. SETTING: Cerro de Pasco (4380 m) and Lima (sea level), Peru. PARTICIPANTS: Nine volunteers with polycythemia. INTERVENTIONS: Volunteers were transported to sea level; three received low-dose erythropoietin. MEASUREMENTS: Changes in red cell mass, hematocrit, hemoglobin concentration, reticulocyte count, ferritin level, serum erythropoietin, and enrichment of administered(13)C in heme. RESULTS: In six participants, red cell mass decreased by 7% to 10% within a few days of descent; this decrease was mirrored by a rapid increase in serum ferritin level. Reticulocyte production did not decrease, a finding that establishes a hemolytic mechanism.(13)C changes in circulating heme were consistent with hemolysis of young cells. Erythropoietin was suppressed, and administration of exogenous erythropoietin prevented the changes in red cell mass, serum ferritin level, and(13)C-heme. CONCLUSIONS: Neocytolysis and the role of erythropoietin are confirmed in persons with polycythemia who descend from high altitude. This may have implications that extend beyond space and altitude medicine to renal disease and other situations of erythropoietin suppression, hemolysis, and polycythemia.

Non-NASA Center↗
NASA NTRS2000

Outcome analysis of individualized vestibular rehabilitation protocols

OBJECTIVE: To determine the outcome of vestibular rehabilitation protocols in subjects with peripheral vestibular disorders compared with normal and abnormal control subjects. STUDY DESIGN: Prospective study using repeated measure, matched control design. Subjects were solicited consecutively according to these criteria: vestibular disorder subjects who had abnormal results of computerized dynamic posturography (CDP) sensory organization tests (SOTs) 5 and 6 and underwent rehabilitation; vestibular disorder subjects who had abnormal results of SOTs 5 and 6 and did not undergo rehabilitation; and normal subjects (normal SOTs). SETTING: Tertiary neurotology clinic. SUBJECTS: Men and women over age 18 with chronic vestibular disorders and chief complaints of unsteadiness, imbalance, and/or motion intolerance, and normal subjects. INTERVENTIONS: Pre- and post-rehabilitation assessment included CDP, vestibular disability, and activities of daily living questionnaires. Individualized rehabilitation plans were designed and implemented to address the subject's specific complaints and functional deficits. Supervised sessions were held at weekly intervals, and self-administered programs were devised for daily home use. MAIN OUTCOME MEASURES: CDP composite and SOT scores, number of falls on CDP, and self-assessment questionnaire results. RESULTS: Subjects who underwent rehabilitation (Group A) showed statistically significant improvements in SOTs, overall composite score, and reduction in falls compared with abnormal (Group B) control groups. Group A's performances after rehabilitation were not significantly different from those of normal subjects (Group C) in SOTs 3 through 6, and close to normal on SOTs 1 and 2. Subjects in Group A also reported statistically significant symptomatic improvement. CONCLUSIONS: Outcome measures of vestibular protocol physical therapy confirmed objective and subjective improvement in subjects with chronic peripheral vestibular disorders. These findings support results reported by other investigators.

NASA Discipline Neuroscience↗
NASA NTRS1999

Patients' choice of portable folding chairs to reduce symptoms of orthostatic hypotension

Patients with neurogenic orthostatic hypotension may use portable folding chairs to prevent or reduce symptoms of low blood pressure. However, a concomitant movement disorder may limit the use of these chairs in daily living. In this prospective study, 13 patients with orthostatic hypotension, balance disturbance associated with motor disability, or both examined three commercially available portable folding chairs. A questionnaire was used to document the characteristics in chair design that were relevant for satisfactory use to these patients. Armrests, seat width, and an adjustable sitting height were found to be important features of a portable folding chair. One chair was selected by 11 of 13 patients to fit most needs.

NASA Discipline Cardiopulmonary↗
NASA NTRS1998

Diagnostic yield and optimal duration of continuous-loop event monitoring for the diagnosis of palpitations. A cost-effectiveness analysis

BACKGROUND: Continuous-loop event recorders are widely used for the evaluation of palpitations, but the optimal duration of monitoring is unknown. OBJECTIVE: To determine the yield, timing, and incremental cost-effectiveness of each week of event monitoring for palpitations. DESIGN: Prospective cohort study. PATIENTS: 105 consecutive outpatients referred for the placement of a continuous-loop event recorder for the evaluation of palpitations. MEASUREMENTS: Diagnostic yield, incremental cost, and cost-effectiveness for each week of monitoring. RESULTS: The diagnostic yield of continuous-loop event recorders was 1.04 diagnoses per patient in week 1, 0.15 diagnoses per patient in week 2, and 0.01 diagnoses per patient in week 3 and beyond. Over time, the cost-effectiveness ratio increased from $98 per new diagnosis in week 1 to $576 per new diagnosis in week 2 and $5832 per new diagnosis in week 3. CONCLUSIONS: In patients referred for evaluation of palpitations, the diagnostic yield of continuous-loop event recording decreases rapidly after 2 weeks of monitoring. A 2-week monitoring period is reasonably cost-effective for most patients and should be the standard period for continuous-loop event recording for the evaluation of palpitations.

NASA Discipline Cardiopulmonary↗
NASA NTRS1992

Axial and appendicular bone density predict fractures in older women

To determine whether measurement of hip and spine bone mass by dual-energy x-ray absorptiometry (DEXA) predicts fractures in women and to compare the predictive value of DEXA with that of single-photon absorptiometry (SPA) of appendicular sites, we prospectively studied 8134 nonblack women age 65 years and older who had both DEXA and SPA measurements of bone mass. A total of 208 nonspine fractures, including 37 wrist fractures, occurred during the follow-up period, which averaged 0.7 years. The risk of fracture was inversely related to bone density at all measurement sites. After adjusting for age, the relative risks per decrease of 1 standard deviation in bone density for the occurrence of any fracture was 1.40 for measurement at the proximal femur (95% confidence interval 1.20-1.63) and 1.35 (1.15-1.58) for measurement at the spine. Results were similar for all regions of the proximal femur as well as SPA measurements at the calcaneus, distal radius, and proximal radius. None of these measurements was a significantly better predictor of fractures than the others. Furthermore, measurement of the distal radius was not a better predictor of wrist fracture (relative risk 1.64: 95% CI 1.13-2.37) than other sites, such as the lumbar spine (RR 1.56; CI 1.07-2.26), the femoral neck (RR 1.65; CI 1.12-2.41), or the calcaneus (RR 1.83; CI 1.26-2.64). We conclude that the inverse relationship between bone mass and risk of fracture in older women is similar for absorptiometric measurements made at the hip, spine, and appendicular sites.

Multicenter Study↗
NASA NTRS2004

Month-to-month and year-to-year reproducibility of high frequency QRS ECG signals

High frequency electrocardiography analyzing the entire QRS complex in the frequency range of 150 to 250 Hz may prove useful in the detection of coronary artery disease, yet the long-term stability of these waveforms has not been fully characterized. Therefore, we prospectively investigated the reproducibility of the root mean squared voltage, kurtosis, and the presence versus absence of reduced amplitude zones in signal averaged 12-lead high frequency QRS recordings acquired in the supine position one month apart in 16 subjects and one year apart in 27 subjects. Reproducibility of root mean squared voltage and kurtosis was excellent over these time intervals in the limb leads, and acceptable in the precordial leads using both the V-lead and CR-lead derivations. The relative error of root mean squared voltage was 12% month-to-month and 16% year-to-year in the serial recordings when averaged over all 12 leads. Reduced amplitude zones were also reproducible up to a rate of 87% and 81%, respectively, for the month-to-month and year-to-year recordings. We conclude that 12-lead high frequency QRS electrocardiograms are sufficiently reproducible for clinical use.

Coronary Disease/diagnosis↗