Expiration analysis of the International Space Station formulary for exploration mission planning.

Effective medications will be required to maintain human health for long-duration space operations. Previous studies have explored the stability and potency of several of the medications used on the International Space Station (ISS). This study is a comprehensive analysis of the expected terrestrial shelf-lives of the entire 2023 ISS formulary using 4 international registries.

Causal diagramming for assessing human system risk in spaceflight.

For over a decade, the National Aeronautics and Space Administration (NASA) has tracked and configuration-managed approximately 30 risks that affect astronaut health and performance before, during and after spaceflight. The Human System Risk Board (HSRB) at NASA Johnson Space Center is responsible for setting the official risk posture for each of the human system risks and determining-based on evaluation of the available evidence-when that risk posture changes. The ultimate purpose of tracking and researching these risks is to find ways to reduce spaceflight-induced risk to astronauts.

Adequacy of in-mission training to treat tibial shaft fractures in mars analogue testing.

Long bone fractures are a concern in long-duration exploration missions (LDEM) where crew autonomy will exceed the current Low Earth Orbit paradigm. Current crew selection assumptions require extensive complete training and competency testing prior to flight for off-nominal situations. Analogue astronauts (n = 6) can be quickly trained to address a single fracture pattern and then competently perform the repair procedure.

Optimizing a Drone Network to Respond to Opioid Overdoses.

Effective out-of-hospital administration of naloxone in opioid overdoses is dependent on timely arrival of naloxone. Delays in emergency medical services (EMS) response time could potentially be overcome with drones to deliver naloxone efficiently to the scene for bystander use. Our objective was to evaluate a mathematical optimization simulation for geographical placement of drone bases in reducing response time to opioid overdose.

Updates to the NASA human system risk management process for space exploration.

This paper describes updates to NASA's approach for assessing and mitigating spaceflight-induced risks to human health and performance. This approach continues to evolve to meet dynamically changing risk environments: lunar missions are currently being designed and the ultimate destination will be Mars. Understanding the risks that astronauts will face during a Mars mission will depend on building an evidence base that informs not only how the humans respond to the challenges of the spaceflight environment, but also how systems and vehicles can be designed to support human capabilities and limitations.

FedScore: A privacy-preserving framework for federated scoring system development.

Objective: We propose FedScore, a privacy-preserving federated learning framework for scoring system generation across multiple sites to facilitate cross-institutional collaborations.

Materials And Methods: The FedScore framework includes five modules: federated variable ranking, federated variable transformation, federated score derivation, federated model selection and federated model evaluation. To illustrate usage and assess FedScore's performance, we built a hypothetical global scoring system for mortality prediction within 30 days after a visit to an emergency department using 10 simulated sites divided from a tertiary hospital in Singapore.

Development, Deployment, and Implementation of a Machine Learning Surgical Case Length Prediction Model and Prospective Evaluation.

Objective: To implement a machine learning model using only the restricted data available at case creation time to predict surgical case length for multiple services at different locations.

Background: The operating room is one of the most expensive resources in a health system, estimated to cost $22 to $133 per minute and generate about 40% of hospital revenue. Accurate prediction of surgical case length is necessary for efficient scheduling and cost-effective utilization of the operating room and other resources.

Estimating medical risk in human spaceflight.

NASA and commercial spaceflight companies will soon be retuning humans to the Moon and then eventually sending them on to Mars. These distant planetary destinations will pose new risks-in particular for the health of the astronaut crews. The bulk of the evidence characterizing human health and performance in spaceflight has come from missions in Low Earth Orbit.

Creation of an Automated Fluorescence Guided Tumor Ablation System.

Objective: Create a device that improves the identification and extent of resection at the interface between healthy and tumor tissue; ultimately, using this device would improve surgical outcomes for patients and increase survival.

Methods: We have created a contactless tumor removal system that utilizes endogenous fluorescence feedback to inform a laser ablation system to execute autonomous removal of phantom tumor tissue.

Results: This completely non-contact surgical system is capable of resecting the tumor boundary of a tissue phantom with an average root mean square error (RMSE) of approximately 1.

Effect of language interpretation modality on throughput and mortality for critical care patients: A retrospective observational study.

Objective: Limited data exist describing possible delays in patient transfer from the emergency department (ED) as a result of language barriers and the effects of interpretation services. We described the differences in ED length of stay (LOS) before intensive care unit (ICU) arrival and mortality based on availability of telephone or in-person interpretation services.

Methods: Using an ICU database from an urban academic tertiary care hospital, ED patients entering the ICU were divided into groups based on primary language and available interpretation services (in-person vs telephone).

Touch-Point Detection Using Thermal Video With Applications to Prevent Indirect Virus Spread.

Viral and bacterial pathogens can be transmitted through direct contact with contaminated surfaces. Efficient decontamination of contaminated surfaces could lead to decreased disease transmission, if optimized methods for detecting contaminated surfaces can be developed. Here we describe such a method whereby thermal tracking technology is utilized to detect thermal signatures incurred by surfaces through direct contact.

Development and Validation of Machine Learning Models to Predict Admission From Emergency Department to Inpatient and Intensive Care Units.

Study Objective: This study aimed to develop and validate 2 machine learning models that use historical and current-visit patient data from electronic health records to predict the probability of patient admission to either an inpatient unit or ICU at each hour (up to 24 hours) of an emergency department (ED) encounter. The secondary goal was to provide a framework for the operational implementation of these machine learning models.

Methods: Data were curated from 468,167 adult patient encounters in 3 EDs (1 academic and 2 community-based EDs) of a large academic health system from August 1, 2015, to October 31, 2018.

Ketamine in the Prehospital Environment: A National Survey of Paramedics in the United States.

Background: Use of ketamine in the prehospital setting may be advantageous due to its potent analgesic and sedative properties and favorable risk profile. Use in the military setting has demonstrated both efficacy and safety for pain relief. The purpose of this study was to assess ketamine training, use, and perceptions in the civilian setting among nationally certified paramedics (NRPs) in the United States.

Emergency Medical Considerations in a Space-Suited Patient.

The Stratex Project is a high altitude balloon flight that culminated in a freefall from 41,422 m (135,890 ft), breaking the record for the highest freefall to date. Crew recovery operations required an innovative approach due to the unique nature of the event as well as the equipment involved. The parachutist donned a custom space suit similar to a NASA Extravehicular Mobility Unit (EMU), with life support system mounted to the front and a parachute on the back.

Crew Recovery and Contingency Planning for a Manned Stratospheric Balloon Flight - the StratEx Program.

The StratEx program used a self-contained space suit and balloon system to loft pilot Alan Eustace to a record-breaking altitude and skydive from 135,897 feet (41,422 m). After releasing from the balloon and a stabilized freefall, the pilot safely landed using a parachute system based on a modified tandem parachute rig. A custom spacesuit provided life support using a similar system to NASA's (National Aeronautics and Space Administration; Washington, DC USA) Extravehicular Mobility Unit.

All-inside meniscal repair devices compared with their matched inside-out vertical mattress suture repair: introducing 10,000 and 100,000 loading cycles.

Background: All-inside arthroscopic meniscal repairs are favored by most clinicians because of their lower complication rate and decreased morbidity compared with inside-out techniques. Until now, only 1000 cycles have been used for biomechanical testing.

Hypothesis: All-inside meniscal repairs will show inferior biomechanical response to cyclic loading (up to 100,000 cycles) and load-to-failure testing compared with inside-out suture controls.

Meta-analysis on biomechanical properties of meniscus repairs: are devices better than sutures?

Purpose: Meniscal repair devices have been extensively tested during the past decades as reported in the literature. Reviewing the different meniscal repair devices and sutures with their respective biomechanical properties.

Methods: For this meta-analysis, we conducted a systematic online search using PubMed, EMBASE, CCTR, and CINAHL using the search terms Meniscus OR Meniscal AND Biomechanics AND Repair).

Long-term biomechanical outcomes after Achilles tendon ruptures.

Purpose: The ideal treatment for Achilles tendon ruptures is still unknown. Biomechanical were correlated to radiological and clinical parameters to study outcomes.

Methods: In this retrospective, assessor-blinded multi-centre cohort study, 52 patients with unilateral Achilles tendon rupture were assessed, each at least 3 years after injury.

Long-term outcomes of muscle volume and Achilles tendon length after Achilles tendon ruptures.

Purpose: The best treatment for Achilles tendon (AT) ruptures remains controversial. Long-term follow-up with radiological and clinical measurements is needed.

Methods: In this retrospective multicentre cohort study, patients (n = 52) were assessed at a mean of 91 months follow-up after unilateral AT rupture treated by open, percutaneous or conservative (non-surgical) treatment.