Evidence-based Approach to Establish Space Suit Carbon Dioxide Limits

A literature survey was conducted to assess if published data (evidence) could help inform a space suit carbon dioxide (CO2) limit. The search identified more than 120 documents about human interaction with elevated CO2. Until now, the guiding philosophy has been to drive space suit CO2 as low as reasonably achievable. NASAs EVA Office requested an evidencebased approach to support a new generation of exploration-class extravehicular activity (EVA) space suits. Specific literature data about CO2 are not available for EVA in microgravity because EVA is an operational activity and not a research platform. However, enough data from groundbased research are available to facilitate a consensus of expert opinion on space suit CO2 limits. The compilation of data in this report can answer many but not all concerns about the consequences of hypercapnic exercise in a space suit. Inspired partial pressure of CO2 (PICO2) and not dry-gas partial pressure of CO2 (PCO2) is the appropriate metric for hypercapnic dose to establish space suit CO2 limits. The reduction of inspired gas partial pressures by saturation of the inspired gases with water vapor at 37C is a significant factor under conditions of hypobaric space suit operation. Otherwise healthy EVA astronauts will exhibit wide variability in responses to acute hypercapnia while at rest and during exercise. What is clear from the literature is the absence of prospective (objective) accept or reject criteria for CO2 exposure in general, and no such criteria exist for operating a space suit. There is no absolute Gold Standard for an acceptable acute hypercapnic limit, just a gradual decrease in performance as CO2 increases. Acceptable CO2 exposure limits are occupation, situation (learned or novel tasks), and personspecific. Investigators who measured hypercapnic physiology rarely correlated those changes to neurocognitive symptoms, and those that measured hypercapnic neurocognition rarely correlated those changes with physiology. Some answers about changes in neurocognition and functional EVA performance during hypercapnic exercise in a space suit await new research

COVID-19-related school closures and patterns of hospital admissions with stress-related presentations in secondary school-aged adolescents: weekly time series

This study examines health service indicators of stress-related presentations (relating to pain, mental illness, psychosomatic symptoms and self-harm) in adolescents of secondary school age, using Hospital Episode Statistics data for England. We examined weekly time series data for three academic years spanning the time before (2018-2019) and during the COVID-19 pandemic (2019-2020 and 2020-2021), including the first lockdown when schools were closed to the majority of pupils. For all secondary school children, weekly stress presentations dropped following school closures. However, patterns of elevated stress during school terms re-established after reopening, with girls aged 11-15 showing an overall increase compared with pre-pandemic rates

Investigating bullying as a predictor of suicidality in a clinical sample of adolescents with Autism Spectrum Disorder

For typically developing adolescents, being bullied is associated with increased risk of suicidality. Although adolescents with autism spectrum disorder (ASD) are at increased risk of both bullying and suicidality, there is very little research that examines the extent to which an experience of being bullied may increase suicidality within this specific population. To address this, we conducted a retrospective cohort study to investigate the longitudinal association between experiencing bullying and suicidality in a clinical population of 680 adolescents with ASD. Electronic health records of adolescents (13–17 years), using mental health services in South London, with a diagnosis of ASD were analyzed. Natural language processing was employed to identify mentions of bullying and suicidality in the free text fields of adolescents' clinical records. Cox regression analysis was employed to investigate the longitudinal relationship between bullying and suicidality outcomes. Reported experience of bullying in the first month of clinical contact was associated with an increased risk suicidality over the follow‐up period (hazard ratio = 1.82; 95% confidence interval = 1.28–2.59). In addition, female gender, psychosis, affective disorder diagnoses, and higher intellectual ability were all associated with suicidality at follow‐up. This study is the first to demonstrate the strength of longitudinal associations between bullying and suicidality in a clinical population of adolescents with ASD, using automated approaches to detect key life events within clinical records. Our findings provide support for identifying and dealing with bullying in schools, and for antibullying strategy's incorporation into wider suicide prevention programs for young people with ASD. Autism Res 2020, 13: 988‐997. © 2020 The Authors. Autism Research published by International Society for Autism Research published by Wiley Periodicals, Inc. LAY SUMMARY: We investigated the relationship between bullying and suicidality in young people with autism spectrum disorder (ASD). We examined the clinical records of adolescents (aged 13–18 years old) with ASD in South London who were receiving treatment from Child and Adolescent Mental Health Services. We found that if they reported being bullied in the first month after they were first seen by mental health services, they were nearly twice as likely to go on to develop suicidal thoughts or behaviors

School performance trajectories and young adult offending: Findings from a national administrative data linkage, United Kingdom

Objectives Criminal offending and re-offending comes at a significant social and economic cost. Offending prevention therefore presents a high priority policy area. Low educational attainment is a known risk factor for offending, but little is understood about how changes in school performance over time might be associated with offending. Methods We investigated this in a large sample of n~4.3 million pupils using an administrative data linkage between two routinely-collected national datasets: the National Pupil Database (NPD) and the Police National Computer (PNC). First, we conducted growth mixture modelling using NPD data over three statutory testing years (School Years 2, 6 and 11). We then investigated the association between membership of these trajectories and subsequent conviction or caution for any criminal offence between Year 11 and age 21. Results We derived five school performance trajectories: (1) Average Consistent (n=3,497,167, 81.0%), (2) Average Increasing (n=66,383, 1.5%), (3) Average Declining (n=373,117, 8.6%), (4) Low Increasing (n=98,805, 2.3%), and (5) Low Consistent (n=281,964, 6.5%). The Average Declining group had the highest proportion of individuals who went on to be convicted or cautioned for any first offence up to age 21 (9.8%), followed by the Low Consistent (8.5%), Low Increasing (5.6%), Average Consistent (4.2%) and Average Increasing (1.5%) groups. Furthermore, as the number of offending days between Year 11 and age 21 increased (indicating repeat offending), the likelihood of having been in the Average Declining or Low Consistent groups also increased. We will also present findings from multilevel models accounting for school clustering, different offence types, and interactions. Conclusion Tentatively, findings suggest that changes in school performance could help to identify pupils who are struggling and at increased risk of criminal justice involvement, and therefore might be in need of additional support

Guidance for researchers wanting to link NHS data using non-consent approaches:a thematic analysis of feedback from the Health Research Authority Confidentiality Advisory Group

Introduction: The use of linked data and non-consent methodologies is a rapidly growing area of health research due to the increasing detail, availability and scope of routinely collected electronic health records data. However, gaining the necessary legal and governance approvals to undertake data linkage is a complex process in England. / Objectives: We reflect on our own experience of establishing lawful basis for data linkage through Section 251 approval, with the intention to build a knowledgebase of practical advice for future applicants. / Methods: Thematic analysis was conducted on a corpus of Section 251 feedback reports from the NHS Health Research Authority Confidentiality Advisory Group. / Results: Four themes emerged from the feedback. These were: (a) Patient and Public Involvement, (b)~Establishing Rationale, (c) Data maintenance and contingency, and the need to gain (d) Further Permissions from external authorities prior to full approval. / Conclusions: Securing Section 251 approval poses ethical, practical and governance challenges. However, through a comprehensive, planned approach Section 251 approval is possible, enabling researchers to unlock the potential of linked data for the purposes of health research