Conceptual Design of the Space Station Fluids Module

The purpose of this paper is to describe the conceptual design of the Fluids Module for the International Space Station Alpha (ISSA). This module is part of the Space Station Fluids/Combustion Facility (SS FCF) under development at the NASA Lewis Research Center. The Fluids/Combustion Facility is one of several science facilities which are being developed to support microgravity science investigations in the US Laboratory Module of the ISSA. The SS FCF will support a multitude of fluids and combustion science investigations over the lifetime of the ISSA and return state-of-the-art science data in a timely and efficient manner to the scientific communities. This will be accomplished through modularization of hardware, with planned, periodic upgrades; modularization of like scientific investigations that make use of common facility functions; and use of orbital replacement units (ORU's) for incorporation of new technology and new functionality. Portions of the SS FCF are scheduled to become operational on-orbit in 1999. The Fluids Module is presently scheduled for launch to orbit and integration with the Fluids/Combustion Facility in 2001. The objectives of this paper are to describe the history of the Fluids Module concept, the types of fluids science investigations which will be accommodated by the module, the hardware design heritage, the hardware concept, and the hardware breadboarding efforts currently underway

Outcome following mini-open lower limb fasciotomy for chronic exertional compartment syndrome

PURPOSE: The aim of this study was to report outcomes following mini-open lower limb fasciotomy (MLLF) in active adults with chronic exertional compartment syndrome (CECS). METHODS: From 2013–2018, 38 consecutive patients (mean age 31 years [16–60], 71% [n = 27/38] male) underwent MLLF. There were 21 unilateral procedures, 10 simultaneous bilateral and 7 staged bilateral. There were 22 anterior fasciotomies, five posterior and 11 four-compartment. Early complications were determined from medical records of 37/38 patients (97%) at a mean of four months (1–19). Patient-reported outcomes (including EuroQol scores [EQ-5D/EQ-VAS], return to sport and satisfaction) were obtained via postal survey from 27/38 respondents (71%) at a mean of 3.7 years (0.3–6.4). RESULTS: Complications occurred in 16% (n = 6/37): superficial infection (11%, n = 4/37), deep infection (3%, n = 1/37) and wound dehiscence (3%, n = 1/37). Eight per cent (n = 3/37) required revision fasciotomy for recurrent leg pain. At longer-term follow-up, 30% (n = 8/27) were asymptomatic and another 56% (n = 15/27) reported improved symptoms. The mean pain score improved from 6.1 to 2.5 during normal activity and 9.1 to 4.7 during sport (both p < 0.001). The mean EQ-5D was 0.781 (0.130–1) and EQ-VAS 77 (33–95). Of 25 patients playing sport preoperatively, 64% (n = 16/25) returned, 75% (n = 12/16) reporting improved exercise tolerance. Seventy-four per cent (n = 20/27) were satisfied and 81% (n = 22/27) would recommend the procedure. CONCLUSION: MLLF is safe and effective for active adults with CECS. The revision rate is low, and although recurrent symptoms are common most achieve symptomatic improvement, with reduced activity-related leg pain and good health-related quality of life. The majority return to sport and are satisfied with their outcome

Activity-based costing of health-care delivery, Haiti

Abstract Objective: To evaluate the implementation of a time-driven activity-based costing analysis at five community health facilities in Haiti. Methods: Together with stakeholders, the project team decided that health-care providers should enter start and end times of the patient encounter in every fifth patient’s medical dossier. We trained one data collector per facility, who manually entered the time recordings and patient characteristics in a database and submitted the data to a cloud-based data warehouse each week. We calculated the capacity cost per minute for each resource used. An automated web-based platform multiplied reported time with capacity cost rate and provided the information to health-facilities administrators. Findings: Between March 2014 and June 2015, the project tracked the clinical services for 7162 outpatients. The cost of care for specific conditions varied widely across the five facilities, due to heterogeneity in staffing and resources. For example, the average cost of a first antenatal-care visit ranged from 6.87 United States dollars (US$) at a low-level facility to US$ 25.06 at a high-level facility. Within facilities, we observed similarly variation in costs, due to factors such as patient comorbidities, patient arrival time, stocking of supplies at facilities and type of visit. Conclusion: Time-driven activity-based costing can be implemented in low-resource settings to guide resource allocation decisions. However, the extent to which this information will drive observable changes at patient, provider and institutional levels depends on several contextual factors, including budget constraints, management, policies and the political economy in which the health system is situated