Space transportation systems, launch systems, and propulsion for the Space Exploration Initiative: Results from Project Outreach

A number of transportation and propulsion options for Mars exploration missions are analyzed. As part of Project Outreach, RAND received and evaluated 350 submissions in the launch vehicle, space transportation, and propulsion areas. After screening submissions, aggregating those that proposed identical or nearly identical concepts, and eliminating from further consideration those that violated known physical princples, we had reduced the total number of viable submissions to 213. In order to avoid comparing such disparate things as launch vehicles and electric propulsion systems, six broad technical areas were selected to categorize the submissions: space transportation systems; earth-to-orbit (ETO) launch systems; chemical propulsion; nuclear propulsion; low-thrust propulsion; and other. To provide an appropriate background for analyzing the submissions, an extensive survey was made of the various technologies relevant to the six broad areas listed above. We discuss these technologies with the intent of providing the reader with an indication of the current state of the art, as well as the advances that might be expected within the next 10 to 20 years

Facing hierarchy: a qualitative study of residents\u27 experiences in an obstetrical simulation scenario

BACKGROUND: Residents in surgical specialties face a steep hierarchy when managing medical crises. Hierarchy can negatively impact patient safety when team members are reluctant to speak up. Yet, simulation has scarcely been previously utilized to qualitatively explore the way residents in surgical specialities navigate this challenge. The study aimed to explore the experiences of residents in one surgical specialty, obstetrics and gynecology (Ob/Gyn), when challenging hierarchy, with the goal of informing future interventions to optimize resident learning and patient safety. METHODS: Eight 3rd- and 4th-year Ob/Gyn residents participated in a simulation scenario in which their supervising physician made an erroneous medical decision that jeopardized the wellbeing of the labouring mother and her foetus. Residents participated in 30-45 min semi-structured interviews that explored their approach to managing this scenario. Transcribed interviews were analysed using qualitative thematic inquiry by three research team members, finalizing the identified themes once consensus was reached. RESULTS: Study results show that the simulated scenario did create an experience of hierarchy that challenged residents. In response, residents adopted three distinct communication strategies while confronting hierarchy: (1) messaging - a mere reporting of existing clinical information; (2) interpretive - a deliberate construction of clinical facts aimed at swaying supervising physician\u27s clinical decision; and (3) advocative - a readiness to confront the staff physician\u27s clinical decision. Furthermore, residents utilized coping mechanisms to mitigate challenges related to confronting hierarchy, namely deflecting responsibility, diminishing urgency, and drafting allies. Both these communication strategies and coping mechanisms shaped their practice when challenging hierarchy to preserve patient safety. CONCLUSIONS: Understanding the complex processes in which residents engage when confronting hierarchy can serve to inform the development and study of curricular innovations. Informed by these processes, we must move beyond solely teaching residents to speak up and consider a broader curriculum that targets not only residents but also faculty physicians and the learning environment within the organization

Postdeployment military mental health training: Cross-national evaluations

Deployments increase risk for adjustment problems in service members. To mitigate this increased risk, mental health training programs have been developed and implemented in several nations. As part of a coordinated effort, three nations adapted a U.S. mental health training program that had been validated by a series of group randomized trials demonstrating improvement in postdeployment adjustment. Implementation of evidence-based programs in a new context is challenging: How much of the original program needs to remain intact in order to retain its utility? User satisfaction rates can provide essential data to assess how well a program is accepted. This article summarizes service member ratings of postdeployment mental health training and compares ratings from service members across four nations. The participating nations (Canada, New Zealand, United Kingdom, and the United States) administered mental health training to active duty military personnel in their respective nations. Following the training, military personnel completed an evaluation of the training. Overall, across the four nations, more than 70% of military personnel agreed or strongly agreed that they were satisfied with the mental health training. Although some differences in evaluations were observed across nations, components of training that were most important to overall satisfaction with the training were strikingly similar across nations. Fundamentally, it appears feasible that despite cultural and organizational differences, a mental health training program developed in one nation can be successfully adapted for use in other nations

From Zoom to the Clinic: Unique Student Challenges in Physical Therapy Clinical Education

While the abrupt shift in PT education (PTE) brought on by the pandemic created opportunities for educational innovation, it also brought relational separation and fragmented learning due to lockdowns, social distancing, face masks, and communication limited to virtual platforms. Academic programs increased use of virtual learning, rearranged curriculum, reduced lab and simulated learning time, and provided fewer, if any, opportunities for service learning and patient contact. Clinic sites paused clinic education experiences or hosted fewer students to maintain social distancing and limit disease exposure. As PTE returns to more typical curricular schedules and practices, it is important to be aware of the current challenges students may be facing. Common challenges include not only increased levels of anxiety and depression, but also problems with self-esteem and confidence, resilience, a growth mindset, and metacognition. This session will investigate the implications of the rise in prevalence of issues in internalizing professional identity and clinical competency for clinical education; the characteristics of unique mental health challenges, such as impostor phenomenon, compassion fatigue, and burnout; screening tools; and suggestions for successfully mentoring students who have low self-esteem, a lack of confidence, decreased resiliency, and imposter feelings

Nurses\u27 Alumnae Association Bulletin - Volume 16 Number 1

Alumnae Notes ANA Biennial Convention Cancer of the Cervix, Uterus and Ovaries Committee Reports Digest of Alumnae Association Meetings Greetings from Miss Childs Greetings from the President Graduation Awards - 1950 Isotopes and the Nurse - Dr. T.P. Eberhard Marriages Necrology New Arrivals Nursing Care in Heart Disease with Pulmonary Infarction Nursing Care of a Mitral Commissurotomy Physical Advances at Jefferson - 1950 Policies of the Private Duty Nurses\u27 Registry Staff Activities, 1950-1951 Students\u27 Corner The Department of Surgical Research - Drs. Templeton and Gibbon White Haven and Barton Memorial Division