A Data Mining Project to Identify Cardiovascular Related Factors That May Contribute to Changes in Visual Acuity Within the US Astronaut Corps

Many of the cardiovascular-related adaptations that occur in the microgravity environment are due, in part, to a well-characterized cephalad-fluid shift that is evidenced by facial edema and decreased lower limb circumference. It is believed that most of these alterations occur as a compensatory response necessary to maintain a "normal" blood pressure and cardiac output while in space. However, data from both flight and analog research suggest that in some instances these microgravity-induced alterations may contribute to cardiovascular-related pathologies. Most concerning is the potential relation between the vision disturbances experienced by some long duration crewmembers and changes in cerebral blood flow and intra-ocular pressure. The purpose of this project was to identify cardiovascular measures that may potentially distinguish individuals at risk for visual disturbances after long duration space flight. Toward this goal, we constructed a dataset from Medical Operation tilt/stand test evaluations pre- (days L-15-L-5) and immediate post-flight (day R+0) on 20 (3 females, 17 males). We restricted our evaluation to only crewmembers who participated in both shuttle and space station missions. Data analysis was performed using both descriptive and analytical methods (Stata 11.2, College Station, TX) and are presented as means +/- 95% CI. Crewmembers averaged 5207 (3447 - 8934) flight hours across both long (MIR-23 through Expedition16) and short (STS-27 through STS-101) duration missions between 1988 and 2008. The mean age of the crew at the time of their most recent shuttle flight was 41 (34-44) compared to 47 (40-54) years during their time on station. In order to focus our analysis (we did not have codes to separate out subjects by symptomotology) , we performed a visual inspection of each cardiovascular measures captured during testing and plotted them against stand time, pre- to post-flight, and between mission duration. It was found that pulse pressure most clearly differentiated the two mission types. Statistical analysis confirmed that pulse pressure was significantly higher before [45.6; (42.1 to 49.1)] and after [50.7; (46.9 to 54.6)] time on station compared with their most recent shuttle flight [31.6 (27.8 to 35.4), and 32.2 (28.3 to 36.0) respectively] even after correcting differences in age and cumulative number of mission hours. Without knowing the identity of which long duration crewmembers demonstrated visual changes, we were limited to examining whether certain crew regulate components of pulse pressure, systolic and diastolic blood pressure, differently due to microgravity exposure. To that end, we stratified crew into tertiles based on either their pre-flight measure of systolic or diastolic blood pressure. Those crew in the highest tertile for both systolic (lower tertile (n=8; 103-111), middle tertile (n=7; 113-121), and upper tertile (n=5; 125-136) and diastolic blood pressure (lower tertile (n=8; 58-64), middle tertile (n=7; 67-73), and upper tertile (n=5; 75-81) demonstrated less variability in pulse pressure between R+0 and L-10 (Figure 2). Interestingly, those crewmembers with the highest resting systolic blood pressure demonstrated either no change or in some instances an increase in total peripheral resistance, where those in the lower tertiles had lower values of total peripheral resistance compared to pre-flight levels. In this study, it was found that crewmembers in the highest tertile for both systolic and diastolic blood pressure demonstrated less variability in pulse pressure and that the decrease in variability was due in part to lower levels of compliance as indicated by similar or higher levels of total peripheral resistance after compared with before flight levels. Whether there is a relation between blood pressure regulation and total peripheral resistance in crew presenting with negative changes in visual acuity remains unknown

Midodrine as a Countermeasure for Post-Spaceflight Orthostatic Hypotension

One possible mechanism for post-spaceflight orthostatic hypotension, which affects approximately 30% of astronauts after short duration shuttle missions, is inadequate norepinephrine release during upright posture. We performed a two phased study to determine the effectiveness of an alpha1-adrenergic agonist, midodrine, as a countermeasure to post-spaceflight orthostatic hypotension. The first phase of the study examined the landing day orthostatic responses of six veteran astronauts after oral midodrine (10 mg) administered on the ground within approximately two hours of wheel stop. One female crewmember exhibited orthostatic hypotension in a previous flight but not after midodrine. Five male crewmembers, who did not exhibit orthostatic hypotension during previous flights, also did not show signs of orthostatic hypotension after midodrine. Additionally, phase one showed that midodrine did not cause hypertension in these crewmembers. In the second phase of this study, midodrine is ingested inflight (near time of ignition, TIG) and orthostatic responses are determined immediately upon landing via an 80 degree head-up tilt test performed on the crew transport vehicle (CTV). Four of ten crewmembers have completed phase two of this study. Two crewmembers completed the landing day tilt tests, while two tests were ended early due to presyncopal symptoms. All subjects had decreased landing day stroke volumes and increased heart rates compared to preflight. Midodrine appears to have increased total peripheral resistance in one crewmember who was able to complete the landing day tilt test. The effectiveness of midodrine as a countermeasure to immediate post-spaceflight orthostatic hypotension has yet to be determined; interpretation is made more difficult due to low subject number and the lack of control subjects on the CTV

Use of Minute-by-Minute Cardiovascular Measurements During Tilt Tests to Strengthen Inference on the Effect of Long-Duration Space Flight on Orthostatic Hypotension

Typical methodology for evaluating the effects of spaceflight on orthostatic hypotension (OH) has been survival analysis of tolerance times from 80 head-up tilt tests. However when scheduled test durations are short, there may not be enough failures to allow survival analysis to adequately estimate and compare the effects of flight phase (e.g. pre-flight, number of days post-flight), flight duration, and their interaction, as well as interactions with effects of interventions or countermeasures. The problem is exacerbated in the presence of a repeated measures design, in which subjects participate in tilt tests during various flight phases. Here we show how it is possible to dramatically improve the efficiency of statistical inference in this setting by making use of the additional information contained in minute-by-minute observations of cardiovascular parameters thought to be reflective of progression towards presyncope during tilt testing. Methods: We retrospectively examined operational tilt test (OTT; 10 -min 80 head-up tilt) data from 20 International Space Station (ISS) and 66 Shuttle astronauts 10 d before launch (L-10), on landing day (R+0) and during recovery (R+1, R+3, R+6-10) depending on the level of participation. Data from 5 ISS astronauts tested on R+0 or R+1 who used non-standard countermeasures were excluded. In addition to OTT survival time, 8 cardiovascular parameters (CP: heart rate, systolic, diastolic, and mean arterial blood pressure, pulse pressure, stroke volume, cardiac output, and total peripheral resistance) that might be predictive of progression towards presyncope were measured every minute of each OTT. Statistical analysis was predicated on a two ]stage model of causation. In the first stage, flight duration and time from landing affect the astronauts' degree of OH, which is manifested in the time trends and variation of the above CPs during OTTs. In the second stage, the behavior of these parameters directly affects OTT survival time. Actual analysis proceeded in the opposite direction. First we identified those CPs or linear combinations that best predicted OTT survival regardless of what spaceflight conditions led to OTT completion or presyncope. From these, we calculated a summary statistic (one per OTT) that best predicted survival. We then used mixed ]model regression analysis to relate changes in the summary statistic to flight phase and duration. Inference on the effects of phase, duration, and their interaction on OH follows directly from this second analysis. Results: A linear combination (W) of diastolic blood pressure (DBP) and stroke volume (SV) was found to be the best predictor of OTT survival using the complete data set of minute-by-minute observations of CPs for each OTT. Furthermore, the log-transformed standard deviation of W (Z = log SW) was found to be a strong predictor of survival in the reduced data set consisting of one observation per OTT. In other words, this measure of variability of W during an OTT was the best indicator of whether or not the subject could complete the 10-min test, with higher variability (i.e. higher values of Z) being associated with greater probability of failure. In the mixed-model regression analysis where Z was now treated as a outcome with flight phase and duration groups (ISS and STS) as predictors, we found that there was a significantly more variability in W (higher values of Z) for both groups at R+0, but with no evidence of an interaction until R+3, when the ISS group still had inflated variability, but not the STS group. Conclusions: Variability of the cardiovascular index W recovers more slowly after long-compared to short-duration spaceflight. Since high variability of W has also been shown to be predictive of OTT failure, a primary manifestation of OH, a logical conclusion is that recovery from OH also is slower after long-duration compared to short-duration spaceflights

Orthostatic Hypotension After Long-Duration Space Flight: NASA's Experiences from the International Space Station

Our laboratory previously reported that the incidence of orthostatic hypotension (OH) was greater after long- than short-duration spaceflight in astronauts who participated in Mir Space Station and Space Shuttle missions. To confirm and extend these findings, we retrospectively examined tilt test data from International Space Station (ISS) and Shuttle astronauts. We anticipated that the proportion of ISS astronauts experiencing OH would be high on landing day and the number of days to recover greater after long- than short-duration missions. Methods: Twenty ISS and 66 Shuttle astronauts participated in 10-min 80? head-up tilt tests 10 d before launch (L-10), on landing day (R+0) or 1 d after landing (R+1). Data from 5 ISS astronauts tested on R+0 or R+1 who used non-standard countermeasures were excluded. Many astronauts repeated the test 3 d (R+3) after landing. Fisher?s Exact Test was used to compare the ability of ISS and Shuttle astronauts to complete the tilt test on R+0. Cox regression was used to identify cardiovascular parameters that were associated with test completion across all tests, and mixed model analysis was used to compare the change and recovery rates between ISS and Shuttle astronauts. In these analyses, ISS data from R+0 and R+1 were pooled to provide sufficient statistical power. Results: The proportion of astronauts who completed the tilt test on R+0 without OH was less in ISS than in Shuttle astronauts (p=0.03). On R+0, only 2 of 6 ISS astronauts completed the test compared to 53 of 66 (80%) Shuttle astronauts. However, 8 of 9 ISS astronauts completed the test on R+1. On R+3, 13 of 15 (87%) of the ISS and 19 of 19 (100%) of the Shuttle astronauts completed the 10-min test. An index comprised of stroke volume and diastolic blood pressure provided a very good prediction of overall tilt survival. This index was altered by spaceflight similarly for both groups soon after landing (pooled R+0 and R+ 1), but ISS astronauts did not recover at the same rate as Shuttle astronauts (p=0.007). Conclusions: The proportion of ISS astronauts who could not complete the tilt test on R+0 due to OH (4 of 6) is similar to that reported in astronauts who flew on Mir (5 of 6). Further, cardiovascular parameters most closely associated with OH recover more slowly after long- compared to short-duration spaceflight

Healing Spaces: Feasibility of a Multisensory Experience for Older Adults with Advanced Dementia and their Caregivers

Healing Spaces proposes a new approach to multisensory interventions that show potential in ameliorating the behavioral and psychological symptoms of advanced dementia in older adults. Using smart technology, the project combines both digital and physical components to transform spaces and create unified, curated sensory experiences that provide meaningful context for interaction, and are easy for caregivers to deliver. A usability study was conducted for the Healing Spaces app followed by a feasibility evaluation of the full experience in a memory care facility recruiting caregivers, and residents in advanced stages of dementia. The feasibility evaluation successfully illuminated strengths as well as areas for improvement for the Healing Spaces experience in a memory care setting with older adults with advanced dementia. Caregivers and facility managers expressed interest in continuing to use Healing Spaces with the residents of the facility. Lessons learned about the technical and logistical implementation of Healing Spaces are discussed, as well as future directions for study design and potential therapeutic value of the experience.Comment: PETRA 20: Proceedings of the 13th ACM International Conference on PErvasive Technologies Related to Assistive Environments. June 2020. Article No 24. Pages 1 to

Intertidal No. 1

For the first year ever, Intertidal has surfaced to showcase the art of Cal Poly\u27s students and faculty. An \u27intertidal zone\u27 is an area where the ocean meets the land--hidden during the high tide and exposed during the low. Our journal embodies the moment where the tide recedes, revealing stories previously hidden

Are Patterns of Public Governance Changing? A Study of Immigration, Migrant Education, and Bilingual Education Policies in the United States and the European Union

Abstract The emergence of new tools and mechanisms whereby governments enable and assist collective action on behalf of societal goals and community interests has led many scholars to claim that governance in economically-advanced democracies is being transformed. The boundaries between the state and civil society, they claim, are becoming blurred and are shifting toward enlarged roles in societal steering by the private sector, both non-profit and for-profit. Systematic, analytically-framed empirical evidence to support such claims is lacking, however. This paper reports the results of using a research design that provides insights into mechanisms and trajectories of governance in the United States and in the European Union and its member countries over the last three decades in three domains of public policy domains: immigration, migrant education, and bilingual education with overlapping constituencies but varied patterns of governance. The evidence presented here suggests that narratives of transformation based on examples of emergent mechanisms of societal steering tend to obscure the complex, multidirectional political and path-dependent dynamics of societal governance and its evolution. An important insight is that patterns of change in the relative influence of the three sectors of society is more often than not driven by each sector's pursuit of its own distinctive interests, which may be, but often are not, conducive to the kinds of collaborations celebrated in narratives of transformation. 1 In recent decades, the literature on public governance in economically advanced democracies has featured narratives of transformation. 1 The hierarchical state is being displaced, so the arguments go, by more pluralistic and decentralized forms of societal steering. Influence and authority over the formulation and implementation of public policies are being redistributed away from central governments toward devolved conjoinings of the public and private sectors: civil society and competitive markets. Some have suggested a future that relies on "governance without government". Though the research literature on public governance documents the emergence of new tools and mechanisms whereby governments enable and assist collective action on behalf of societal goals and community interests, convincing evidence that these changes constitute a fundamental transformation of governance is lacking (Lynn 2012). The purpose of this paper is to report new evidence on the evolution of societal governance in advanced democratic societies as well as to demonstrate an approach to the study of governance that will further enlarge that body of evidence. We employ a research design that provides insights into and mechanisms and trajectories of governance in the United States and in the European Union and its member countries over the last three decades. We use this design to study governance in three domains of public policy which have overlapping constituencies but with patterns of governance and political dynamics that differ in significant ways: immigration, which is state-centric, migrant education, which originates in both national and civil society initiatives but with a narrow constituency, and 2 bilingual education, which also reflects both government and private sector initiatives but has broader and more diverse constituencies. Immigration is often a contentious policy issue, as it affects elements of society such as its demographic characteristics, labor markets, and social mobility. In contrast, migrant education is an issue of relatively limited political salience, even when migrant students constitute a large segment of the population and their substandard living, health, safety, and education conditions -consequences of low wages, frequent relocation, and limited legal rights - We identified published articles, books, and research reports for each of these policy domains that contain empirical evidence, largely qualitative, on how patterns and mechanisms or tools of governance have been employed during this period. We analyzed the content of this literature using a conceptual framework that enabled us to identify and compare how governance is organized and whether and how the trajectories and the boundaries between societal sectors, has been changing over time. The evidence presented in this paper suggest that narratives of transformation based on examples of emergent, often multi-sectoral mechanisms of societal steering tend to obscure the 3 complex, multi-directional political and path-dependent dynamics of societal governance and its evolution, which can vary widely across public policy domains and political jurisdictions. Societal Governance: An Analytic Framework Governance has traditionally been regarded within the field of public administration as synonymous with government: the formulation and implementation of public policies intended to achieve societal goals as expressed through duly constituted democratic institutions. From this perspective, governance means the promulgation and implementation of laws and regulations which are enforced by public authorities. Beginning in the late 1980s, however, this view of governance came to be seen as descriptively inaccurate. While rationales for and processes of formulating and implementing public policies reflect state interests and the execution of inherently governmental functions, especially with respect to such societal interests national security, immigration, public health, education, and law enforcement, societal steering was becoming more diffuse. In recent decades, societal steering has increasingly been recognized as reflecting, directly or indirectly, the purposeful and organized activities of civil society and of the proprietary business sector. In particular, activities within the two private spheres, while necessarily in compliance with the rule of law, have often been undertaken independently of direct government sponsorship, regulation, or direction. In many other cases, the three sectors become actively engaged with one another through principal-agent relationships, resource dependencies, political advocacy and lobbying, and voluntary, self-organized coordination of activities. The relative importance of each type of governance, the relative influence of the sectors when engaged with each other in the hybrid types of governance, and the tools of governance that are employed in each type of governance are, we believe, important determinants of whether and how the boundaries among the three sectors might be changing, for example, whether the private sectors are gaining influence in societal steering relative to the state and its governments. These dynamics are depicted in the schematic "model of public governance" in figure 2. 7 Figure 2. A Model of Public Governance Using this framework, we are able to assess, based on a content analysis of empirical governance literature, the relative influence of the three sectors on collective outcomes and whether or not and how patterns of relative influence seem to have been changing in recent decades. Analyzing the Literature: Methodology We conducted a content analysis of published research for each of our three policy domains-immigration, migrant education, and bilingual education in the European Union and in the United States from the 1970s, when many new tools of governance were emerging, through 2012. This time period included the creation of the governing structures of the European 8 Union, significant changes in national governing philosophies in the United States, and a variety of socioeconomic developments in the US and the EU that would be expected to affect policies and their implementation in our three policy domains. Constructing the Database The analysis was disciplined by defining the objects of concern in each policy domain: immigrants, migrants, and students eligible for bilingual education opportunities. In general, these definitions follow those in official use in the US and the EU, with allowance made for variations in definitions used by private sector entities. • An immigrant is a non-native person who has moved across a border, either documented or undocumented, into a country for purposes of taking up residence in that country for an indefinite period of time. • A migrant is a person who has immigrated in order to perform temporary seasonal labor. The US government (PL 107-110, Title I, Part C) defines a migrant child as a child whose parent or guardian is a migratory worker in the agricultural, dairy, lumber, or fishing industries and whose family has moved during the past three years. A "qualifying" move can range from moving across school district boundaries or from one state to another for the purpose of finding temporary or seasonal employment. A young adult may also qualify if he or she has moved on his own for the same reasons. The eligibility period is 36 months from the date of the last move (United States Congress 2002). • The European Union has defined migrants as children of all persons living in an EU country where they were not born, irrespective of whether they are third-country nationals, citizens of another EU Member State or subsequently became nationals of th