Space biology initiative program definition review. Trade study 2: Prototype utilization in the development of space biology hardware

The objective was to define the factors which space flight hardware developers and planners should consider when determining: (1) the number of hardware units required to support program; (2) design level of the units; and (3) most efficient means of utilization of the units. The analysis considered technology risk, maintainability, reliability, and safety design requirements for achieving the delivery of highest quality flight hardware. Relative cost impacts of the utilization of prototyping were identified. The development of Space Biology Initiative research hardware will involve intertwined hardware/software activities. Experience has shown that software development can be an expensive portion of a system design program. While software prototyping could imply the development of a significantly different end item, an operational system prototype must be considered to be a combination of software and hardware. Hundreds of factors were identified that could be considered in determining the quantity and types of prototypes that should be constructed. In developing the decision models, these factors were combined and reduced by approximately ten-to-one in order to develop a manageable structure based on the major determining factors. The Baseline SBI hardware list of Appendix D was examined and reviewed in detail; however, from the facts available it was impossible to identify the exact types and quantities of prototypes required for each of these items. Although the factors that must be considered could be enumerated for each of these pieces of equipment, the exact status and state of development of the equipment is variable and uncertain at this time

Space biology initiative program definition review. Trade study 1: Automation costs versus crew utilization

A significant emphasis upon automation within the Space Biology Initiative hardware appears justified in order to conserve crew labor and crew training effort. Two generic forms of automation were identified: automation of data and information handling and decision making, and the automation of material handling, transfer, and processing. The use of automatic data acquisition, expert systems, robots, and machine vision will increase the volume of experiments and quality of results. The automation described may also influence efforts to miniaturize and modularize the large array of SBI hardware identified to date. The cost and benefit model developed appears to be a useful guideline for SBI equipment specifiers and designers. Additional refinements would enhance the validity of the model. Two NASA automation pilot programs, 'The Principal Investigator in a Box' and 'Rack Mounted Robots' were investigated and found to be quite appropriate for adaptation to the SBI program. There are other in-house NASA efforts that provide technology that may be appropriate for the SBI program. Important data is believed to exist in advanced medical labs throughout the U.S., Japan, and Europe. The information and data processing in medical analysis equipment is highly automated and future trends reveal continued progress in this area. However, automation of material handling and processing has progressed in a limited manner because the medical labs are not affected by the power and space constraints that Space Station medical equipment is faced with. Therefore, NASA's major emphasis in automation will require a lead effort in the automation of material handling to achieve optimal crew utilization

Space biology initiative program definition review. Trade study 6: Space Station Freedom/spacelab modules compatibility

The differences in rack requirements for Spacelab, the Shuttle Orbiter, and the United States (U.S.) laboratory module, European Space Agency (ESA) Columbus module, and the Japanese Experiment Module (JEM) of Space Station Freedom are identified. The feasibility of designing standardized mechanical, structural, electrical, data, video, thermal, and fluid interfaces to allow space flight hardware designed for use in the U.S. laboratory module to be used in other locations is assessed

Space biology initiative program definition review. Trade study 3: Hardware miniaturization versus cost

The optimum hardware miniaturization level with the lowest cost impact for space biology hardware was determined. Space biology hardware and/or components/subassemblies/assemblies which are the most likely candidates for application of miniaturization are to be defined and relative cost impacts of such miniaturization are to be analyzed. A mathematical or statistical analysis method with the capability to support development of parametric cost analysis impacts for levels of production design miniaturization are provided

Space biology initiative program definition review. Trade study 4: Design modularity and commonality

The relative cost impacts (up or down) of developing Space Biology hardware using design modularity and commonality is studied. Recommendations for how the hardware development should be accomplished to meet optimum design modularity requirements for Life Science investigation hardware will be provided. In addition, the relative cost impacts of implementing commonality of hardware for all Space Biology hardware are defined. Cost analysis and supporting recommendations for levels of modularity and commonality are presented. A mathematical or statistical cost analysis method with the capability to support development of production design modularity and commonality impacts to parametric cost analysis is provided

An Evaluation of the Healthiness of the Indian Packaged Food and Beverage Supply

Availability of less-healthy packaged food and beverage products has been implicated as an important driver of obesity and diet-related disease. An increasing number of packaged foods and beverages are sold in India. Our objective was to evaluate the healthiness of packaged foods sold by India’s largest manufacturers. Healthiness was assessed using the Australian Health Star Rating (HSR) system and the World Health Organization’s European Regional Office (WHO Euro) Nutrient Profile Model. Sales-value-weighted mean healthiness and the proportions of “healthy” products (using a validated HSR cut-off of ≥3.5, and products meeting WHO Euro criteria as healthy enough to market to children) were calculated overall, by company and by food category. Nutrient information for 943 products sold by the 11 largest Indian manufacturers was obtained from nutrient labels, company websites or directly from the manufacturer. Healthiness was low overall (mean HSR 1.8 out of 5.0 stars) with a low proportion defined as “healthy” by both HSR (17%) and also by WHO Euro criteria (8%). There were marked differences in the healthiness of similar products within food categories. Substantial variation between companies (minimum sales-value-weighted mean HSR 0.5 for Company G, versus maximum HSR 3.0 for Company F) was a result of differences in the types of products sold and the nutritional composition of individual products. There are clear opportunities for India’s largest food companies to improve both the nutritional quality of individual products and to improve their product mix to include a greater proportion of healthy products

Diagnosing early-onset neonatal sepsis in low-resource settings: development of a multivariable prediction model

OBJECTIVE: To develop a clinical prediction model to diagnose neonatal sepsis in low-resource settings. DESIGN: Secondary analysis of data collected by the Neotree digital health system from 1 February 2019 to 31 March 2020. We used multivariable logistic regression with candidate predictors identified from expert opinion and literature review. Missing data were imputed using multivariate imputation and model performance was evaluated in the derivation cohort. SETTING: A tertiary neonatal unit at Sally Mugabe Central Hospital, Zimbabwe. PATIENTS: We included 2628 neonates aged <72 hours, gestation ≥32+0 weeks and birth weight ≥1500 g. INTERVENTIONS: Participants received standard care as no specific interventions were dictated by the study protocol. MAIN OUTCOME MEASURES: Clinical early-onset neonatal sepsis (within the first 72 hours of life), defined by the treating consultant neonatologist. RESULTS: Clinical early-onset sepsis was diagnosed in 297 neonates (11%). The optimal model included eight predictors: maternal fever, offensive liquor, prolonged rupture of membranes, neonatal temperature, respiratory rate, activity, chest retractions and grunting. Receiver operating characteristic analysis gave an area under the curve of 0.74 (95% CI 0.70-0.77). For a sensitivity of 95% (92%-97%), corresponding specificity was 11% (10%-13%), positive predictive value 12% (11%-13%), negative predictive value 95% (92%-97%), positive likelihood ratio 1.1 (95% CI 1.0-1.1) and negative likelihood ratio 0.4 (95% CI 0.3-0.6). CONCLUSIONS: Our clinical prediction model achieved high sensitivity with low specificity, suggesting it may be suited to excluding early-onset sepsis. Future work will validate and update this model before considering implementation within the Neotree

Clinical prediction models to diagnose neonatal sepsis: a scoping review protocol.

INTRODUCTION: Neonatal sepsis is responsible for significant morbidity and mortality worldwide. Diagnosis is often difficult due to non-specific clinical features and the unavailability of laboratory tests in many low-income and middle-income countries (LMICs). Clinical prediction models have the potential to improve diagnostic accuracy and rationalise antibiotic usage in neonatal units, which may result in reduced antimicrobial resistance and improved neonatal outcomes. In this paper, we outline our scoping review protocol to map the literature concerning clinical prediction models to diagnose neonatal sepsis. We aim to provide an overview of existing models and evidence underlying their use and compare prediction models between high-income countries and LMICs. METHODS AND ANALYSIS: The protocol was developed with reference to recommendations by the Joanna Briggs Institute. Searches will include six electronic databases (Ovid MEDLINE, Ovid Embase, Scopus, Web of Science, Global Index Medicus and the Cochrane Library) supplemented by hand searching of reference lists and citation analysis on included studies. No time period restrictions will be applied but only studies published in English or Spanish will be included. Screening and data extraction will be performed independently by two reviewers, with a third reviewer used to resolve conflicts. The results will be reported by narrative synthesis in line with the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews guidelines. ETHICS AND DISSEMINATION: The nature of the scoping review methodology means that this study does not require ethical approval. Results will be disseminated through peer-reviewed publications and conference presentations, as well as through engagement with peers and relevant stakeholders

Estimated Benefits and Risks of Using a Reduced-Sodium, Potassium-Enriched Salt Substitute in India: A Modeling Study

Background: Salt substitution (ie, replacement of table and cooking salt with potassium-enriched salt substitutes) is a promising strategy to reduce blood pressure and prevent cardiovascular disease, particularly in countries like India where there is high sodium intake, mainly from discretionary salt, and low potassium intake. Life-threatening hyperkalemia from increased potassium intake is a postulated concern for individuals with chronic kidney disease. methods: We used comparative risk assessment models to estimate the number of (1) cardiovascular deaths averted due to blood pressure reductions; (2) potential hyperkalemia-related deaths from increased potassium intake in individuals with advanced chronic kidney disease; and (3) net averted deaths from nationwide salt substitution in India. We evaluated a conservative scenario, based on a large, long-term pragmatic trial in rural China; and an optimistic scenario informed by our recent trial in India. Sensitivity analyses were conducted to assess the robustness of the findings. Results: In the conservative scenario, a nationwide salt substitution intervention was estimated to result in ≈214 000 (95% uncertainty interval, 92 764-353 054) averted deaths from blood pressure reduction in the total population and ≈52 000 (22 961-80 211) in 28 million individuals with advanced chronic kidney disease, while ≈22 000 (15 221-31 840) hyperkalemia-deaths might be caused by the intervention. The corresponding estimates for the optimistic scenario were ≈351 000 (130 470-546 255), ≈66 000 (24 925-105 851), and ≈9000 (4251-14 599). Net benefits were consistent across sensitivity analyses. Conclusions: Modeling nationwide salt substitution in India consistently estimated substantial net benefits, preventing around 8% to 14% of annual cardiovascular deaths. Even allowing for potential hyperkalemia risks there were net benefits estimated for individuals with chronic kidney disease

Risk factors of mortality in neonates with neonatal encephalopathy in a tertiary newborn care unit in Zimbabwe over a 12-month period

Neonatal encephalopathy (NE) accounts for ~23% of the 2.4 million annual global neonatal deaths. Approximately 99% of global neonatal deaths occur in low-resource settings, however, accurate data from these low-resource settings are scarce. We reviewed risk factors of neonatal mortality in neonates admitted with neonatal encephalopathy from a tertiary neonatal unit in Zimbabwe. A retrospective review of risk factors of short-term neonatal encephalopathy mortality was conducted at Sally Mugabe Central Hospital (SMCH) (November 2018 -October 2019). Data were gathered using a tablet-based data capture and quality improvement newborn care application (Neotree). Analyses were performed on data from all admitted neonates with a diagnosis of neonatal encephalopathy, incorporating maternal, intrapartum, and neonatal risk predictors of the primary outcome: mortality. 494/2894 neonates had neonatal encephalopathy on admission and were included. Of these, 94 died giving a neonatal encephalopathy-case fatality rate (CFR) of 190 per 1000 admitted neonates. Caesarean section (odds ratio (OR) 2.95(95% confidence interval (CI) 1.39-6.25), convulsions (OR 7.13 (1.41-36.1)), lethargy (OR 3.13 (1.24-7.91)), Thompson score "11-14" (OR 2.98 (1.08-8.22)) or "15-22" (OR 17.61 (1.74-178.0)) were significantly associated with neonatal death. No maternal risk factors were associated with mortality. Nearly 1 in 5 neonates diagnosed with neonatal encephalopathy died before discharge, similar to other low-resource settings but more than in typical high-resource centres. The Thompson score, a validated, sensitive and specific tool for diagnosing neonates with neonatal encephalopathy was an appropriate predictive clinical scoring system to identify at risk neonates in this setting. On univariable analysis time-period, specifically a period of staff shortages due to industrial action, had a significant impact on neonatal encephalopathy mortality. Emergency caesarean section was associated with increased mortality, suggesting perinatal care is likely to be a key moment for future interventions