Creating a Scenario Suitable for Multiple Caregivers

The HPS can be utilized for the training of a wide variety of caregivers, ranging from physicians to laypeople. Methods: A single scenario was developed and adapted for a number of clinical scenarios and operational environments, ranging from in-flight to the immediate postflight timeline. In this way, different caregivers, from astronauts to search and rescue forces to specialty-boarded physicians, could make use of a single clinical situation. Five crew medical officer analogs and sixty anesthesia residents, serving as flight surgeon analogs, and, were briefed on space medicine and physiology, then were exposed to the scenario and asked to manage the patient as if they were part of the in-flight or recovery team. Results: Basic themes, such as crisis resource management, were standard across the student audiences. Discussion: A single clinical script can easily be adapted for multiple uses

Creating Simulated Microgravity Patient Models

The Medical Operational Support Team (MOST) has been tasked by the Space and Life Sciences Directorate (SLSD) at the NASA Johnson Space Center (JSC) to integrate medical simulation into 1) medical training for ground and flight crews and into 2) evaluations of medical procedures and equipment for the International Space Station (ISS). To do this, the MOST requires patient models that represent the physiological changes observed during spaceflight. Despite the presence of physiological data collected during spaceflight, there is no defined set of parameters that illustrate or mimic a 'space normal' patient. Methods: The MOST culled space-relevant medical literature and data from clinical studies performed in microgravity environments. The areas of focus for data collection were in the fields of cardiovascular, respiratory and renal physiology. Results: The MOST developed evidence-based patient models that mimic the physiology believed to be induced by human exposure to a microgravity environment. These models have been integrated into space-relevant scenarios using a human patient simulator and ISS medical resources. Discussion: Despite the lack of a set of physiological parameters representing 'space normal,' the MOST developed space-relevant patient models that mimic microgravity-induced changes in terrestrial physiology. These models are used in clinical scenarios that will medically train flight surgeons, biomedical flight controllers (biomedical engineers; BME) and, eventually, astronaut-crew medical officers (CMO)

Transport of Dirac electrons in a random magnetic field in topological heterostructures

We consider the proximity effect between Dirac states at the surface of a topological insulator and a ferromagnet with easy plane anisotropy, which is described by the XY model and undergoes a Berezinskii-Kosterlitz-Thouless (BKT) phase transition. The surface states of the topological insulator interacting with classical magnetic fluctuations of the ferromagnet can be mapped onto the problem of Dirac fermions in a random magnetic field. However, this analogy is only partial in the presence of electron-hole asymmetry or warping of the Dirac dispersion, which results in screening of magnetic fluctuations. Scattering at magnetic fluctuations influences the behavior of the surface resistivity as a function of temperature. Near the BKT phase transition temperature we find that the resistivity of surface states scales linearly with temperature and has a clear maximum which becomes more pronounced as the Fermi energy decreases. Additionally at low temperatures we find linear resistivity, usually associated with non-Fermi liquid behavior, ho wever here it appears entirely within the Fermi-liquid picture

Electron-induced massive dynamics of magnetic domain walls

We study the dynamics of domain walls (DWs) in a metallic, ferromagnetic nanowire. We develop a Keldysh collective coordinate technique to describe the effect of conduction electrons on rigid magnetic structures. The effective Lagrangian and Langevin equations of motion for a DW are derived. The DW dynamics is described by two collective degrees of freedom: position and tilt-angle. The coupled Langevin equations therefore involve two correlated noise sources, leading to a generalized fluctuation-dissipation theorem (FDT). The DW response kernel due to electrons contains two parts: one related to dissipation via FDT, and another `inertial\u27 part. We prove that the latter term leads to a mass for both degrees of freedom, even though the intrinsic bare mass is zero. The electron-induced mass is present even in a clean system without pinning or specifically engineered potentials. The resulting equations of motion contain rich dynamical solutions and point toward a new way to control domain wall motion in metals via the electronic system properties. We discuss two observable co nsequences of the mass, hysteresis in the DW dynamics and resonant response to ac current

The thyroid secretion rate in the mouse and its relation to various physiological processes

Publication authorized may 12, 1948Digitized 2007 AES.Includes bibliographical references (pages 52-62)

Smart Ultrasound Remote Guidance Experiment (SURGE) Preliminary Findings

To date, diagnostic quality ultrasound images were obtained aboard the International Space Station (ISS) using the ultrasound of the Human Research Facility (HRF) rack in the Laboratory module. Through the Advanced Diagnostic Ultrasound in Microgravity (ADUM) and the Braslet-M Occlusion Cuffs (BRASLET SDTO) studies, non-expert ultrasound operators aboard the ISS have performed cardiac, thoracic, abdominal, vascular, ocular, and musculoskeletal ultrasound assessments using remote guidance from ground-based ultrasound experts. With exploration class missions to the lunar and Martian surfaces on the horizon, crew medical officers will necessarily need to operate with greater autonomy given communication delays (round trip times of up to 5 seconds for the Moon and 90 minutes for Mars) and longer periods of communication blackouts (due to orbital constraints of communication assets). The SURGE project explored the feasibility and training requirements of having non-expert ultrasound operators perform autonomous ultrasound assessments in a simulated exploration mission outpost. The project aimed to identify experience, training, and human factors requirements for crew medical officers to perform autonomous ultrasonography. All of these aims pertained to the following risks from the NASA Bioastronautics Road Map: 1) Risk 18: Major Illness and Trauna; 2) Risk 20) Ambulatory Care; 3) Risk 22: Medical Informatics, Technologies, and Support Systems; and 4) Risk 23: Medical Skill Training and Maintenance

Charged skyrmions on the surface of a topological insulator

We consider the interplay between magnetic skyrmions in an insulating thin film and the Dirac surface states of a 3D topological insulator (TI), coupled by proximity effect. The magnetic texture of skyrmions can lead to confinement of Dirac states at the skyrmion radius, where out of plane magnetization vanishes. This confinement can result in charging of the skyrmion texture. The presence of bound states is robust in an external magnetic field, which is needed to stabilize skyrmions. It is expected that for relevant experimental parameters skyrmions will have a few bound states that can be tuned using an external magnetic field. We argue that these charged skyrmions can be manipulated directly by an electric field, with skyrmion mobility proportional to the number of bound states at the skyrmion radius. Coupling skyrmionic thin films to a TI surface can provide a more direct and efficient way of controlling skyrmion motion in insulating materials. This provides a new dimension in the study of skyrmion manipulation

Kinetic theory of dark solitons with tunable friction

We study controllable friction in a system consisting of a dark soliton in a one-dimensional Bose-Einstein condensate coupled to a non-interacting Fermi gas. The fermions act as impurity atoms, not part of the original condensate, that scatter off of the soliton. We study semi-classical dynamics of the dark soliton, a particle-like object with negative mass, and calculate its friction coefficient. Surprisingly, it depends periodically on the ratio of interspecies (impurity-condensate) to intraspecies (condensate-condensate) interaction strengths. By tuning this ratio, one can access a regime where the friction coefficient vanishes. We develop a general theory of stochastic dynamics for negative mass objects and find that their dynamics are drastically different from their positive mass counterparts - they do not undergo Brownian motion. From the exact phase space probability distribution function (i.e. in position and velocity), we find that both the trajectory and lifetime of the soliton are altered by friction, and the soliton can only undergo Brownian motion in the presence of friction and a confining potential. These results agree qualitatively with experimental observations by Aycock, et. al. (PNAS, 2017) in a similar system with bosonic impurity scatterers

Development of Sub-optimal Airway Protocols for the International Space Station (ISS) by the Medical Operation Support Team (MOST)

Airway management techniques are necessary to establish and maintain a patent airway while treating a patient undergoing respiratory distress. There are situations where such settings are suboptimal, thus causing the caregiver to adapt to these suboptimal conditions. Such occurrences are no exception aboard the International Space Station (ISS). As a result, the NASA flight surgeon (FS) and NASA astronaut cohorts must be ready to adapt their optimal airway management techniques for suboptimal situations. Based on previous work conducted by the Medical Operation Support Team (MOST) and other investigators, the MOST had members of both the FS and astronaut cohorts evaluate two oral airway insertion techniques for the Intubating Laryngeal Mask Airway (ILMA) to determine whether either technique is sufficient to perform in suboptimal conditions within a microgravity environment. Methods All experiments were conducted in a simulated microgravity environment provided by parabolic flight aboard DC-9 aircraft. Each participant acted as a caregiver and was directed to attempt both suboptimal ILMA insertion techniques following a preflight instruction session on the day of the flight and a demonstration of the technique by an anesthesiologist physician in the simulated microgravity environment aboard the aircraft. Results Fourteen participants conducted 46 trials of the suboptimal ILMA insertion techniques. Overall, 43 of 46 trials (94%) conducted were properly performed based on criteria developed by the MOST and other investigators. Discussion The study demonstrated the use of airway management techniques in suboptimal conditions relating to space flight. Use of these techniques will provide a crew with options for using the ILMA to manage airway issues aboard the ISS. Although it is understood that the optimal method for patient care during space flight is to have both patient and caregiver restrained, these techniques provide a needed backup should conditions not present themselves in an ideal manner

Comparison of Bystander Cardiopulmonary Resuscitation (BCPR) Performance in the Absence and Presence of Timing Devices for Coordinating Delivery of Ventilatory Breaths and Cardiac Compressions in a Model of Adult Cardiopulmonary Arrest

Astronaut crew medical officers (CMO) aboard the International Space Station (ISS) receive 40 hours of medical training during the 18 months preceding each mission. Part of this training ilncludes twoperson cardiopulmonary resuscitation (CPR) per training guidelines from the American Heart Association (AHA). Recent studies concluded that the use of metronomic tones improves the coordination of CPR by trained clinicians. Similar data for bystander or "trained lay people" (e.g. CMO) performance of CPR (BCPR) have been limited. The purpose of this study was to evailuate whether use of timing devices, such as audible metronomic tones, would improve BCPR perfomance by trained bystanders. Twenty pairs of bystanders trained in two-person BCPR performled BCPR for 4 minutes on a simulated cardiopulmonary arrest patient using three interventions: 1) BCPR with no timing devices, 2) BCPR plus metronomic tones for coordinating compression rate only, 3) BCPR with a timing device and metronome for coordinating ventilation and compression rates, respectively. Bystanders were evaluated on their ability to meet international and AHA CPR guidelines. Bystanders failed to provide the recommended number of breaths and number of compressions in the absence of a timing device and in the presence of audible metronomic tones for only coordinating compression rate. Bystanders using timing devices to coordinate both components of BCPR provided the reco number of breaths and were closer to providing the recommended number of compressions compared with the other interventions. Survey results indicated that bystanders preferred to use a metronome for delivery of compressions during BCPR. BCPR performance is improved by timing devices that coordinate both compressions and breaths