Customer Utilization Requirements and Their Impact for Space Station Capabilities

This is a summary of work presented to the Level B Space Station Program Office at Johnson Space Center related to customer requirements definition and their impact for Space Station design. The study was global in scope, querying the range of potential Station users for their ranked requirements for access to Station capabilities. User groups are identified based on their common set of functional requirements for Station services, and group needs were ranked according to level of utility for each unique Space Station capability. Analysis of the design drivers identified by the utility scores was conducted, resulting in a determination of which Station capabilities are in greatest demand, and where major technical commonalities and incompatibilities exist between user groups. This analysis provides a mechanism whereby NASA managers can evaluate the impact of design tradeoffs for the Station\u27s customer community. Major conclusions of the study include: 1) the need to base design choices on functional user group needs in order to account for currently unknown users; 2) emphasizing operational flexibility and minimizing life cycle costs in order to provide a user-friendly system; 3) scarring the Station to allow for potential external resource enhancements provided by international partners or commercial firms; and 4) establishing an IOC operating envelope based on the identified core capabilities with the greatest utility to the widest user community. In particular, this means optimizing for users who have a primary requirement for manned interaction on the Station, and providing for users whose requirements are not met within the IOC envelope through growth configurations or logistical support for their activities outside the core manned facility

The beliefs and attitudes of UK registered osteopaths towards chronic pain and the management of chronic pain sufferers ::a cross-sectional questionnaire based survey

Objectives: This study investigated the beliefs and attitudes of UK registered osteopaths towards chronic pain and the management of chronic pain sufferers. Methods: A cross-sectional questionnaire based survey of UK registered osteopaths was performed to test the hypothesis that osteopaths have a more biopsychosocial approach to treating and managing chronic pain patients than other healthcare professionals. Sociodemographic determinants of the participants were explored and the original HC-PAIRS and the PABS-PT used as measurement tools. They assess practitioners' attitudes and beliefs towards perceived harmfulness of physical activities for patients with cLBP and participants' knowledge of pain. International meta-analyses were performed with both measurement tools to allow comparison with other healthcare professionals. Results: UK registered osteopaths (n=216) had mean PABS-PT subscale scores of 31.37 ± 6.26 [CI95% 30.53–32.21] (biomedical) and 32.72 ± 4.29 [CI95% 32.14–33.29] (biopsychosocial). The mean HC-PAIRS total score was 45.45 ± 10.05 [CI95% 44.11–46.8]. These indicate a wide spread of beliefs and knowledge towards chronic pain with a tendency to agree that physical activity is not necessarily harmful for patients with cLBP. Post-graduate education had a significant positive effect on questionnaire results. Meta-analyses revealed that UK registered osteopaths have significantly better HC-PAIRS scores than most physiotherapy students, nurses and pharmacists, and had similar PABS-PT scores to most other healthcare professionals. Conclusions: The hypothesis of UK registered osteopaths having a more biopsychosocial approach to treating and managing chronic pain patients in comparison to other healthcare providers has been rejected. This seems in contrast to the typically claimed unique concepts of osteopathy. Nevertheless, this study supports their ability to engage with psychosocial factors of the patients' pain experience, but shows that it can be improved. This paper suggests that training is needed to increase osteopaths' expertise in knowledge of chronic pain, and their attitudes towards the management of chronic pain sufferers

Temporal Trends in Low-Dose Aspirin Use (from the CoLaus|PsyCoLaus Study).

Although established in secondary prevention, the use of low-dose aspirin for primary cardiovascular prevention remains uncertain. We assessed the temporal trend of low-dose aspirin use in people at primary and secondary prevention over 14 years. We used data from the population-based CoLaus|PsyCoLaus study. A baseline survey was conducted from 2003 to 2006, involving 6,733 participants. The first and second follow-up investigations were performed from 2009 to 2012 and 2014 to 2017, respectively. Low-dose aspirin use was defined as ≤300 mg/daily oral administration or administration of an anticoagulant for similar indications. For primary prevention analysis, 6,555, 4,695, and 3,893 participants were included in the analysis at baseline, first and second follow-ups, respectively. Overall, low-dose aspirin use doubled between baseline (4.1%) and second follow-up (8.1%). Appropriate use of low-dose aspirin rose from 32% at baseline to 64% at the second follow-up for primary prevention. In secondary prevention, 71.8%, 75.9%, and 71.7% of participants were taking low-dose aspirin at baseline, first, and second follow-up, respectively. On the basis of a population-based cohort, the appropriateness of low-dose aspirin use increased over a 10-year follow-up in primary prevention, but its inappropriate use still concerned 44% of subjects. In secondary prevention, a quarter of individuals were not taking low-dose aspirin which remained stable over the analyzed period

Hutchison Medallist 1. Wave-Dominated to Tide-Dominated Coastal Systems: A Unifying Model for Tidal Shorefaces and Refinement of the Coastal- Environments Classification Scheme

Coastal depositional systems are normally classified based on the relative input of wave, tide, and river processes. While wave- through to river-dominated environments are well characterized, environments along the wave-to-tide continuum are relatively poorly understood and this limits the reliability and utility of coastal classification schemes. Two tidal shoreface models, open-coast tidal flats (OCTF) and tidally modulated shorefaces (TMS), have been introduced for mixed wave-tide coastal settings. Following nearly two decades of research on tidal shorefaces, a number of significant insights have been derived, and these data are used here to develop a unified model for such systems. First, OCTFs are components of larger depositional environments, and in multiple published examples, OCTFs overlie offshore to lower shoreface successions that are similar to TMS. Consequently, we combine OCTFs and TMSs into a single tidal shoreface model where TMS (as originally described) and TMS-OCTF successions are considered as variants along the wave-tide continuum. Second, tidal shoreface successions are preferentially preserved in low- to moderate-wave energy environments and in progradational to aggradational systems. It is probably difficult to distinguish tidal shorefaces from their storm-dominated counterparts. Third, tidal shorefaces, including both TMSs and OCTFs, should exhibit tidally modulated storm deposits, reflecting variation in storm-wave energy at the sea floor resulting from the rising and falling tide. They may also exhibit interbedding of tidally generated structures (e.g. double mud drapes or bidirectional current ripples), deposited under fairweather conditions, and storm deposits (e.g. hummocky cross-stratification) through the lower shoreface and possibly into the upper shoreface.The development of the tidal shoreface model sheds light on the limitations of the presently accepted wave-tide-river classification scheme of coastal environments and a revised scheme is presented. In particular, tidal flats are components of larger depositional systems and can be identified in the rock record only in settings where intertidal and supratidal deposits are preserved; consequently, they should not represent the tide-dominated end-member of coastal systems. Instead, we suggest that tide-dominated embayments should occupy this apex. Tide-dominated embayments exhibit limited wave and river influence and include a wide range of geomorphological features typically associated with tidal processes, including tidal channels, bars and flats.Les systèmes de dépôts côtiers sont normalement classés en fonction de l’apport relatif des processus liés à la houle, aux marées et aux rivières. Si les environnements dominés par la houle et les rivières sont bien caractérisés, les environnements le long du continuum houle-marée sont relativement mal compris, ce qui limite la fiabilité et l’utilité des systèmes de classification des côtes. Deux modèles d’avant-plages tidales, les estrans ouverts (open-coast tidal flats; OCTF) et les avant-plages modulées par la marée (tidally modulated shoreface; TMS), ont été introduits pour les milieux côtiers mixtes, houle-marée. Suite à près de deux décennies de recherche sur les avant-plages tidales, un certain nombre d’informations importantes ont été obtenues et ces données sont utilisées ici pour développer un modèle unifié pour ces systèmes. Tout d’abord, les OCTF sont les composants de systèmes de dépôt plus vastes et, dans de nombreux exemples publiés, les OCTF recouvrent des successions sédimentaires allant du large à l’avant-plage inférieure, similaires à celle des TMS. Par conséquent, nous combinons les OCTF et les TMS en un seul modèle d’avant-plage tidale où les TMS (tel que décrit à l’origine) et les successions TMS-OCTF sont considérés comme des variantes le long du continuum houle-marée. Deuxièmement, les successions d’avant-plages tidales sont préférentiellement préservées dans des environnements ayant une houle faible à modérée et dans des systèmes progradant et aggradant. Il est probablement difficile de distinguer les avant-plages tidales de leurs homologues dominés par les tempêtes. Troisièmement, les avant-plages tidales, incluant à la fois les TMS et les OCTF devraient présenter des dépôts de tempête modulés par la marée, reflétant ainsi la variation de l’énergie des vagues de tempête sur le fond marin liée à la marée montante et descendante. Les avant-plages tidales peuvent également présenter une interstratification de structures générées par la marée (par exemple, des doubles drapages argileux ou des rides de courants bidirectionnelles) déposées pendant des conditions de beau temps, et des dépôts de tempête (par exemple, des stratifications en mamelons) au niveau de l’avant-plage inférieure et éventuellement de l’avant-plage supérieure.Le développement du modèle d’avant-plage tidale met en lumière les limites de la classification tripartite (houle-marée-rivière) des environnements côtiers actuellement acceptée et une classification révisée est présentée. En particulier, les OCTF et les estrans sont des composantes de systèmes dedépôt plus importants et ne peuvent être identifiés que dans le registre sédimentaire dans les milieux où les dépôts intertidaux et supratidaux sont préservés; par conséquent, ils ne devraient pas représenter le membre extrême des systèmes côtiers dominé par la marée. Nous suggérons plutôt que les baies dominées par la marée occupent cette place. Les baies dominées par les marées présentent une influence limitée des vagues et des rivières et comprennent un large éventail de caractéristiques géomorphologiques généralement associées aux processus de marée, notamment des chenaux, des barres et des platiers tidaux

Management of late-preterm and term infants with hyperbilirubinaemia in resource-constrained settings.

Hyperbilirubinaemia is a ubiquitous transitional morbidity in the vast majority of newborns and a leading cause of hospitalisation in the first week of life worldwide. While timely and effective phototherapy and exchange transfusion are well proven treatments for severe neonatal hyperbilirubinaemia, inappropriate or ineffective treatment of hyperbilirubinaemia, at secondary and tertiary hospitals, still prevails in many poorly-resourced countries accounting for a disproportionately high burden of bilirubin-induced mortality and long-term morbidity. As part of the efforts to curtail the widely reported risks of frequent but avoidable bilirubin-induced neurologic dysfunction (acute bilirubin encephalopathy (ABE) and kernicterus) in low and middle-income countries (LMICs) with significant resource constraints, this article presents a practical framework for the management of late-preterm and term infants (≥ 35 weeks of gestation) with clinically significant hyperbilirubinaemia in these countries particularly where local practice guidelines are lacking. Standard and validated protocols were followed in adapting available evidence-based national guidelines on the management of hyperbilirubinaemia through a collaboration among clinicians and experts on newborn jaundice from different world regions. Tasks and resources required for the comprehensive management of infants with or at risk of severe hyperbilirubinaemia at all levels of healthcare delivery are proposed, covering primary prevention, early detection, diagnosis, monitoring, treatment, and follow-up. Additionally, actionable treatment or referral levels for phototherapy and exchange transfusion are proposed within the context of several confounding factors such as widespread exclusive breastfeeding, infections, blood group incompatibilities and G6PD deficiency, which place infants at high risk of severe hyperbilirubinaemia and bilirubin-induced neurologic dysfunction in LMICs, as well as the limited facilities for clinical investigations and inconsistent functionality of available phototherapy devices. The need to adjust these levels as appropriate depending on the available facilities in each clinical setting and the risk profile of the infant is emphasised with a view to avoiding over-treatment or under-treatment. These recommendations should serve as a valuable reference material for health workers, guide the development of contextually-relevant national guidelines in each LMIC, as well as facilitate effective advocacy and mobilisation of requisite resources for the optimal care of infants with hyperbilirubinaemia at all levels

Meeting physicians' needs: a bottom-up approach for improving the implementation of medical knowledge into practice.

Multiple barriers to knowledge translation in medicine have been identified (ranging from information overload to abstraction of models), leading to important implementation gaps. This study aimed at assessing the suggestions of practicing physicians for possible improvements of knowledge translation (KT) effectiveness into clinical practice. We used a mixed methods design. French- German- and Italian-speaking general practitioners, psychiatrists, orthopaedic surgeons, cardiologists, and diabetologists practicing in Switzerland were interrogated through semi-structured interviews, focus group discussions, and an online survey. A total of 985 physicians from three regions of Switzerland participated in the online survey, whereas 39 participated in focus group discussions and 14 in face-to-face interviews. Physicians expressed limitations and difficulties related to KT into their daily practice. Several barriers were identified, including influence and pressure of pharmaceutical companies, non-publication of negative results, mismatch between guidelines and practice, education gaps, and insufficient collaboration between research and practice. Suggestions to overcome barriers were improving education concerning the evaluation of scientific publications, expanding applicability of guidelines, having free and easy access to independent journals, developing collaborations between research and practice, and creating tools to facilitate access to medical information. Our study provides suggestions for improving KT into daily medical practice, matching the views, needs and preferences of practicing physicians. Responding to suggestions for improvements brought up by physicians may lead to better knowledge translation, higher professional satisfaction, and better healthcare outcomes

Communication About Chronic Pain in Older Persons' Social Networks: Study Protocol of a Qualitative Approach.

A lack of social relations appears to impact on health and life expectancy among the older persons. The quality and diversity of social relations are correlated with good health and well-being in later life. Chronic pain is a crucial issue in aging population. Effective communication between the older persons with chronic pain, their relatives and the actors of the healthcare system facilitates the management of this condition. Studies on communication in later life generally do not consider the older persons' social network as a whole, focusing only a specific segment (e.g., family or medical staff). This lack of scientific data prevents the actors of the healthcare system from offering solutions to bridge clinically relevant communication gaps. As a consequence, our study has three objectives: (1) to identify how the older persons perceive communication about chronic pain with their social network; (2) to identify their unmet communication needs; (3) to develop recommendations that improve communication about chronic pain in later life. The study will be divided into two phases. The first phase will meet objectives 1 and 2. It will involve individual interviews with about 50 people over 75 years old suffering from chronic pain and without major cognitive or auditory troubles. In this phase, we will apply a multi-layered analysis. We will map the older persons' personal network and identify their communication practices and needs, by combining content and discourse analysis with social network theories. The second phase of the study will aim at recommendations based on the results of the first phase (objective 3). It will require focus groups with different sets of stakeholders (older persons, relative caregivers, health professionals, decision-makers). In the second phase, we will use content analysis to pinpoint the concerns and suggestions for action. The results will be disseminated on three levels: (1) to the scientific world (specialists in the field of health and aging and health communication); (2) to health practitioners working with older persons; (3) to society at large, with a focus on institutions and groups directly concerned by the issue

A new neuropsychological instrument measuring effects of age and drugs on fitness to drive: development, reliability, and validity of MedDrive

Background: Current guidelines underline the limitations of existing instruments to assess fitness to drive and the poor adaptability of batteries of neuropsychological tests in primary care settings. Aims: To provide a free, reliable, transparent computer based instrument capable of detecting effects of age or drugs on visual processing and cognitive functions. Methods: Relying on systematic reviews of neuropsychological tests and driving performances, we conceived four new computed tasks measuring: visual processing (Task1), movement attention shift (Task2), executive response, alerting and orientation gain (Task3), and spatial memory (Task4). We then planned five studies to test MedDrive's reliability and validity. Study-1 defined instructions and learning functions collecting data from 105 senior drivers attending an automobile club course. Study-2 assessed concurrent validity for detecting minor cognitive impairment (MCI) against useful field of view (UFOV) on 120 new senior drivers. Study-3 collected data from 200 healthy drivers aged 20-90 to model age related normal cognitive decline. Study-4 measured MedDrive's reliability having 21 healthy volunteers repeat tests five times. Study-5 tested MedDrive's responsiveness to alcohol in a randomised, double-blinded, placebo, crossover, dose-response validation trial including 20 young healthy volunteers. Results: Instructions were well understood and accepted by all senior drivers. Measures of visual processing (Task1) showed better performances than the UFOV in detecting MCI (ROC 0.770 vs. 0.620; p=0.048). MedDrive was capable of explaining 43.4% of changes occurring with natural cognitive decline. In young healthy drivers, learning effects became negligible from the third session onwards for all tasks except for dual tasking (ICC=0.769). All measures except alerting and orientation gain were affected by blood alcohol concentrations. Finally, MedDrive was able to explain 29.3% of potential causes of swerving on the driving simulator. Discussion and conclusions: MedDrive reveals improved performances compared to existing computed neuropsychological tasks. It shows promising results both for clinical and research purposes