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Search indexed NASA NTRS and DOE OSTI research on propulsion, heat transfer, battery materials and energy systems. Follow report and document links to the original sources.

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At least 37 records · Page 2
All sourcesNASA NTRSDOE OSTI
NASA NTRS2003

Monitoring Outpatient Care

Each year, health care costs for managing chronically ill patients increase as the life expectancy of Americans continues to grow. To handle this situation, many hospitals, doctors practices, and home care providers are turning to disease management, a system of coordinated health care interventions and communications, to improve outpatient care. By participating in daily monitoring programs, patients with congestive heart failure, chronic obstructive pulmonary disease, diabetes, and other chronic conditions requiring significant self-care are facing fewer emergency situations and hospitalizations. Cybernet Medical, a division of Ann Arbor, Michigan-based Cybernet Systems Corporation, is using the latest communications technology to augment the ways health care professionals monitor and assess patients with chronic diseases, while at the same time simplifying the patients interaction with technology. Cybernet s newest commercial product for this purpose evolved from research funded by NASA, the National Institute of Mental Health, and the Advanced Research Projects Agency. The research focused on the physiological assessment of astronauts and soldiers, human performance evaluation, and human-computer interaction. Cybernet Medical's MedStar Disease Management Data Collection System is an affordable, widely deployable solution for improving in-home-patient chronic disease management. The system's battery-powered and portable interface device collects physiological data from off-the-shelf instruments.

Source record↗
DOE OSTI2021

Predicting Intensive Care Unit Length of Stay and Mortality Using Patient Vital Signs: Machine Learning Model Development and Validation

Background: Patient monitoring is vital in all stages of care. In particular, intensive care unit (ICU) patient monitoring has the potential to reduce complications and morbidity, and to increase the quality of care by enabling hospitals to deliver higher-quality, cost-effective patient care, and improve the quality of medical services in the ICU. Objective: We here report the development and validation of ICU length of stay and mortality prediction models. The models will be used in an intelligent ICU patient monitoring module of an Intelligent Remote Patient Monitoring (IRPM) framework that monitors the health status of patients, and generates timely alerts, maneuver guidance, or reports when adverse medical conditions are predicted. Methods: We utilized the publicly available Medical Information Mart for Intensive Care (MIMIC) database to extract ICU stay data for adult patients to build two prediction models: one for mortality prediction and another for ICU length of stay. For the mortality model, we applied six commonly used machine learning (ML) binary classification algorithms for predicting the discharge status (survived or not). For the length of stay model, we applied the same six ML algorithms for binary classification using the median patient population ICU stay of 2.64 days. For the regression-based classification, we used two ML algorithms for predicting the number of days. We built two variations of each prediction model: one using 12 baseline demographic and vital sign features, and the other based on our proposed quantiles approach, in which we use 21 extra features engineered from the baseline vital sign features, including their modified means, standard deviations, and quantile percentages. Results: We could perform predictive modeling with minimal features while maintaining reasonable performance using the quantiles approach. The best accuracy achieved in the mortality model was approximately 89% using the random forest algorithm. The highest accuracy achieved in the length of stay model, based on the population median ICU stay (2.64 days), was approximately 65% using the random forest algorithm. Conclusions: The novelty in our approach is that we built models to predict ICU length of stay and mortality with reasonable accuracy based on a combination of ML and the quantiles approach that utilizes only vital signs available from the patient’s profile without the need to use any external features. This approach is based on feature engineering of the vital signs by including their modified means, standard deviations, and quantile percentages of the original features, which provided a richer dataset to achieve better predictive power in our models.

59 BASIC BIOLOGICAL SCIENCES↗
NASA NTRS1995

Influence of the helicopter environment on patient care capabilities: flight crew perceptions

INTRODUCTION: Flight crew perceptions of the effect of the rotary-wing environment on patient-care capabilities have not been subject to statistical analysis. We hypothesized that flight crew members perceived significant difficulties in performing patient-care tasks during air medical transport. METHODS: A survey was distributed to a convenience sample of flight crew members from 20 flight programs. Respondents were asked to compare the difficulty of performing patient-care tasks in rotary-wing and standard (emergency department or intensive care unit) settings. Demographic data collected on respondents included years of flight experience, flights per month, crew duty position and primary aircraft in which the respondent worked. Statistical analysis was performed as appropriate using Student's t-test, type III sum of squares, and analysis of variance. Alpha was defined as p < 0.05. RESULTS: Fifty-five percent of programs (90 individuals) responded. All tasks were significantly rated more difficult in the rotary-wing environment. Ratings were not significantly correlated with flight experience, duty position, flights per month or aircraft used. CONCLUSIONS: We conclude that the performance of patient-care tasks are perceived by air medical flight crew to be significantly more difficult during rotary-wing air medical transport than in hospital settings.

Noise, Transportation/adverse effects↗
DOE OSTI2025

Conceptualizing Coproduced Climate Research as Care: Practical Lessons Learned With Women Farmland‐Owners in the Central Midwest United States

ABSTRACT This article's team of interdisciplinary researchers and conservation educator‐practitioners learned with, and from, a group of women farmland‐owners regarding how to conceptualize coproduced climate research by putting “care” at the center—care for the soil, for relationships, for data. We outline the creation and evolution of a storytelling‐based conservation program that allowed our diverse group to discover how the language of care could integrate climate analysis, conservation, and relationship‐building to foster tangible solutions. As a result of the project, the women landowners took actions that supported social‐environmental resilience—from planting cover crops to fostering watershed/neighborhood relationships. Our diverse group of women landowners and researchers had very different experiences with conservation and often very different views on climate change itself, but, through storytelling and the language of care, we not only coproduced knowledge but also created relationships and action. This article outlines specific practices for how to inflect a coproduced process for climate resilience with practices that promote care and yield action projects.

Shenk, Linda [Department of English Iowa State Uni↗
DOE OSTI2021

Radiation Oncology in the Land of the Pyramids: How Sudan Continues to Push the Frontiers of Cancer Care in Eastern Africa

When faced with illness, Sudanese patients have traditionally relied primarily on folklore healers. In the recent past, Sudan increased its health care spending and placed ever-greater importance on medical education. Although traditional remedies still play an important role, Sudanese patients increasingly consult conventional medicine. Not only infectious diseases but also a rising burden of noncommunicable conditions, including cancer, represent major health care challenges. Therefore, Sudan will need to make the best out of the limited resources available and further increase investment in health care to confront these trends successfully. Sudan was one of the first African countries to recognize the importance of radiation oncology in multidisciplinary cancer care and began investing in it in the 1960s. Today, there are 4 comprehensive cancer centers in the country, which offer radiation therapy and employ 10 radiation therapy machines for a population of about 45 million people. This proportion is an indication that Sudan still has an underfunded health care system with a lack of infrastructure and human resources. The present manuscript intends to provide a well-rounded overview of radiation oncology in Sudan today.

62 RADIOLOGY AND NUCLEAR MEDICINE↗
DOE OSTI2021

Problematizing “Planning Ahead”: A Cross-Cultural Analysis of Vietnamese Health and Community Workers’ Perspectives on Advance Care Directives

Informed by values of autonomy and self-determination, advance care planning assumes that individuals should independently take control of their future health. In this article, we draw on research conducted with Vietnamese health and community workers to problematize individualized approaches to planning ahead, reframe notions of “cultural and linguistic barriers,” and expose how homogeneous messages about care at the end of life are not readily translatable within and across diverse groups. Anthropological and feminist critiques of inclusion and exclusion are used to reorientate Anglophone framings of the individual and of cultural and linguistic differences. In this article, we suggest that it is the narrow singularity of care for the self—rather than diverse relationalities of care—that should be overcome if aging and end-of-life care policy and practice is to be broadened and made relevant to migrant and non-English-speaking groups.

Nguyen, Nga↗
NASA NTRS1987

CARE 3 user-friendly interface user's guide

CARE 3 predicts the unreliability of highly reliable reconfigurable fault-tolerant systems that include redundant computers or computer systems. CARE3MENU is a user-friendly interface used to create an input for the CARE 3 program. The CARE3MENU interface has been designed to minimize user input errors. Although a CARE3MENU session may be successfully completed and all parameters may be within specified limits or ranges, the CARE 3 program is not guaranteed to produce meaningful results if the user incorrectly interprets the CARE 3 stochastic model. The CARE3MENU User Guide provides complete information on how to create a CARE 3 model with the interface. The CARE3MENU interface runs under the VAX/VMS operating system.

Martensen, A. L.↗
NASA NTRS1990

Ceramics Analysis and Reliability Evaluation of Structures (CARES). Users and programmers manual

This manual describes how to use the Ceramics Analysis and Reliability Evaluation of Structures (CARES) computer program. The primary function of the code is to calculate the fast fracture reliability or failure probability of macroscopically isotropic ceramic components. These components may be subjected to complex thermomechanical loadings, such as those found in heat engine applications. The program uses results from MSC/NASTRAN or ANSYS finite element analysis programs to evaluate component reliability due to inherent surface and/or volume type flaws. CARES utilizes the Batdorf model and the two-parameter Weibull cumulative distribution function to describe the effect of multiaxial stress states on material strength. The principle of independent action (PIA) and the Weibull normal stress averaging models are also included. Weibull material strength parameters, the Batdorf crack density coefficient, and other related statistical quantities are estimated from four-point bend bar or unifrom uniaxial tensile specimen fracture strength data. Parameter estimation can be performed for single or multiple failure modes by using the least-square analysis or the maximum likelihood method. Kolmogorov-Smirnov and Anderson-Darling goodness-of-fit tests, ninety percent confidence intervals on the Weibull parameters, and Kanofsky-Srinivasan ninety percent confidence band values are also provided. The probabilistic fast-fracture theories used in CARES, along with the input and output for CARES, are described. Example problems to demonstrate various feature of the program are also included. This manual describes the MSC/NASTRAN version of the CARES program.

Nemeth, Noel N.↗
NASA NTRS1991

A telemedicine health care delivery system

The Interactive Telemedicine Systems (ITS) system was specifically developed to address the ever widening gap between our medical care expertise and our medical care delivery system. The frustrating reality is that as our knowledge of how to diagnose and treat medical conditions has continued to advance, the system to deliver that care has remained in an embryonic stage. This has resulted in millions of people being denied their most basic health care needs. Telemedicine utilizes an interactive video system integrated with biomedical telemetry that allows a physician at a base station specialty medical complex or teaching hospital to examine and treat a patient at multiple satellite locations, such as rural hospitals, ambulatory health centers, correctional institutions, facilities caring for the elderly, community hospital emergency departments, or international health facilities. Based on the interactive nature of the system design, the consulting physician at the base station can do a complete history and physical examination, as if the patient at the satellite site was sitting in the physician's office. This system is described.

Sanders, Jay H.↗
NASA NTRS1992

Medical care capabilities for Space Station Freedom: A phase approach

As a result of Congressional mandate Space Station Freedom (SSF) was restructured. This restructuring activity has affected the capabilities for providing medical care on board the station. This presentation addresses the health care facility to be built and used on the orbiting space station. This unit, named the Health Maintenance Facility (HMF) is based on and modeled after remote, terrestrial medical facilities. It will provide a phased approach to health care for the crews of SSF. Beginning with a stabilization and transport phase, HMF will expand to provide the most advanced state of the art therapeutic and diagnostic capabilities. This presentation details the capabilities of such a phased HMF. As Freedom takes form over the next decade there will be ever-increasing engineering and scientific developmental activities. The HMF will evolve with this process until it eventually reaches a mature, complete stand-alone health care facility that provides a foundation to support interplanetary travel. As man's experience in space continues to grow so will the ability to provide advanced health care for Earth-orbital and exploratory missions as well.

Doarn, C. R.↗
NASA NTRS1994

Influence of the helicopter environment on patient care capabilities: Flight crew perceptions

Flight crew perceptions of the effect of the rotary wing environment on patient care capabilities have not been subject to statistical analysis. We hypothesized that flight crew perceived significant difficulties in performing patient care tasks during air medical transport. A survey instrument was distributed to a convenience sample of flight crew members from twenty flight programs. Respondents were asked to compare the difficulty of performing patient care tasks in rotary wing and standard (emergency department or intensive care unit) settings. Demographic data collected on respondents included years of flight experience, flights per month, crew duty position, and primary aircraft in which the respondent worked. Statistical analysis was performed as appropriate using Student's t-test, type 111 sum of squares, and analysis of variance. Alpha was defined as p is less than or equal to .05. Fifty-five percent of programs (90 individuals) responded. All tasks were rated significantly more difficult in the rotary wing environment. Ratings were not significantly correlated with flight experience, duty position, flights per month, or aircraft used. We conclude that the performance of patient care tasks are perceived by air medical flight crew to be significantly more difficult during rotary wing air medical transport than in hospital settings.

Meyers, K. Jeffrey↗
NASA NTRS2007

Autonomous Medical Care for Exploration Class Space Missions

The US-based health care system of the International Space Station (ISS) contains several subsystems, the Health Maintenance System, Environmental Health System and the Countermeasure System. These systems are designed to provide primary, secondary and tertiary medical prevention strategies. The medical system deployed in Low Earth Orbit (LEO) for the ISS is designed to enable a "stabilize and transport" concept of operations. In this paradigm, an ill or injured crewmember would be rapidly evacuated to a definitive medical care facility (DMCF) on Earth, rather than being treated for a protracted period on orbit. The medical requirements of the short (7 day) and long duration (up to 6 months) exploration class missions to the Moon are similar to LEO class missions with the additional 4 to 5 days needed to transport an ill or injured crewmember to a DCMF on Earth. Mars exploration class missions are quite different in that they will significantly delay or prevent the return of an ill or injured crewmember to a DMCF. In addition the limited mass, power and volume afforded to medical care will prevent the mission designers from manifesting the entire capability of terrestrial care. NASA has identified five Levels of Care as part of its approach to medical support of future missions including the Constellation program. In order to implement an effective medical risk mitigation strategy for exploration class missions, modifications to the current suite of space medical systems may be needed, including new Crew Medical Officer training methods, treatment guidelines, diagnostic and therapeutic resources, and improved medical informatics.

Hamilton, Douglas↗
NASA NTRSDate not supplied

Medicine in the Final Frontier Technologies to Enable Autonomous Prolonged (Field) Care in Space

N: The planning and execution of comprehensive “Prolonged Care” strategies are increasingly considered as fundamental operational concepts within the spheres of both military and non-military expeditionary medicine. Numerous advances in recent years have enabled the decentralization of health-related technology that has empowered medical - and even non-medical providers - to offer quality care farther afield and for increasingly extended periods of separation from traditional support structures. However, the operational concepts behind today’s Prolonged Care paradigms are still largely dependent upon external support, including high-bandwidth telemedicine communications technologies (that allow ready access to centralized expertise), robust resupply pathways, and ultimately, on the timely evacuation of the sick and injured. What would happen if none of these support systems were readily available? Extremely remote Prolonged Care is one of the most significant challenges that the National Aeronautics and Space Administration (NASA) faces when preparing to expand human space exploration beyond the International Space Station (ISS) to deep space including the Moon and Mars. Continuous human presence on the International Space Station (ISS) in low Earth orbit for the past 20 years has demonstrated that indeed medical operations can be successfully executed with continuous real-time communications, frequent resupply missions, and the availability of rapid evacuation options. However, as time-distance factors from Earth increase with our pursuit and changing focus towards deep space missions, these resources and capabilities will no longer be available. As a result, space medicine operations will need to become more autonomous and less dependent upon mission support from Earth – requiring our attention and efforts to build robust capabilities that support the ultimate expression of the term “Prolonged Field Care.”

K R Lehnhardt↗
NASA NTRSDate not supplied

Principles for Termination of Medical Care in Austere Analog Environments for Development of Spaceflight Protocols

INTRODUCTION: When compared to operations in low earth orbit, exploration class missions will have substantially limited resources and ground medical support while the risk of a significant medical event is projected to be higher. Termination of care (TOC) may need to be considered in certain instances. We aim to utilize data from earth-based analogs to identify common principles that can help develop future guidelines to this complex medical and ethical challenge. METHODS: A comprehensive literature review was conducted in medline, nasa.gov, Defense Technical Information Center(DTIC) and google scholar. Key search terms including “withdrawal of care, termination of care, termination of CPR, military medicine, wilderness medicine, futility, potentially inappropriate” and others were used to identify analog studies of relevance. These were qualitatively evaluated for recurring principles or themes that were reviewed and structured. RESULTS: Mission planning termination of care principles: definitions of clear medical goals, separate protocols for each relevant condition, protocols developed using best available evidence, crew involvement in development, protocols rehearsal pre-launch, and inclusion of palliative capabilities. In-mission termination of care principles: 1. Crew Medical Officer directed stabilization of the patient; 2. Consultation with mission control with standardized information exchange; 3. Multidisciplinary medical and ethical conference among the mission directors, flight surgeons and relevant specialist experts; 4. Multidisciplinary risk review examining both medical and mission risks for relevant options; 5. Provision of a transparent explanation of the process and decision to crew; 6. Allowing crew feedback and inquiry to review board; 7. Support of the crew in the enacted decision. DISCUSSION: By utilizing the best available evidence in conjunction with expert opinion we have identified common principles from earth-based analogs that could be used to help design future TOC protocols.

Samuel Stephenson↗
DOE OSTI2020

Determinants of rural-urban differences in health care provider visits among women of reproductive age in the United States

Background Rural health disparities and access gaps may contribute to higher maternal and infant morbidity and mortality. Understanding and addressing access barriers for specialty women’s health services is important in mitigating risks for adverse childbirth events. The objective of this study was to investigate rural-urban differences in health care access for women of reproductive age by examining differences in past-year provider visit rates by provider type, and quantifying the contributing factors to these findings. Methods and findings Using a nationally-representative sample of reproductive age women (n = 37,026) from the Medical Expenditure Panel Survey (2010–2015) linked to the Area Health Resource File, rural-urban differences in past-year office visit rates with health care providers were examined. Blinder-Oaxaca decomposition analysis quantified the portion of disparities explained by individual- and county-level sociodemographic and provider supply characteristics. Overall, there were no rural-urban differences in past-year visits with women’s health providers collectively (65.0% vs 62.4%), however differences were observed by provider type. Rural women had lower past-year obstetrician-gynecologist (OB-GYN) visit rates than urban women (23.3% vs. 26.6%), and higher visit rates with family medicine physicians (24.3% vs. 20.9%) and nurse practitioners/physician assistants (NPs/PAs) (24.6% vs. 16.1%). Lower OB-GYN availability in rural versus urban counties (6.1 vs. 13.7 providers/100,000 population) explained most of the rural disadvantage in OB-GYN visit rates (83.8%), and much of the higher family physician (80.9%) and NP/PA (50.1%) visit rates. Other individual- and county-level characteristics had smaller effects on rural-urban differences. Conclusion Although there were no overall rural-urban differences in past-year visit rates, the lower OB-GYN availability in rural areas appears to affect the types of health care providers seen by women. Whether rural women are receiving adequate specialized women’s health care services, while seeing a different cadre of providers, warrants further investigation and has particular relevance for women experiencing high-risk pregnancies and deliveries.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2023

Enabling Cybersecurity, Situational Awareness and Resilience in Distribution Grids with High Penetration of Photovoltaics (CARE-PV) (Final Report)

Since legacy distribution systems have very limited visibility beyond the substation, high penetration of PV at the grid edge presents some unique operational challenges. One approach to address these challenges is to use information from advanced metering infrastructure (AMI) and µPMUs. However, exploiting this information is impacted by a number of factors, including multi-timescale measurements, volume of data generated, communication network impairments (e.g., information loss and latency) and susceptibility to cyber-attacks. Therefore, one of the critical tasks involved in the management of a distribution grid is to develop complete situational awareness by integrating cyber-security mechanisms with state estimation strategies and leveraging this situational awareness to assure energy services at strategic locations while exploiting AMI/PV inverter/ µPMU data. This CARE-PV project addresses the fundamental challenges in situational awareness and resilience to cyber and physical vectors by exploiting the synergy between innovative modeling, estimation, data analytics, testing and validation using smart PV inverters designed at K-State and facilities at NREL. Specifically, the project involved the development, testing and validation of the following novel enabling technologies: (Thrust 1) Resilience to cyber vectors that impact data integrity was addressed via a two-level defense strategy that combines cyber intrusion detection using self-learning, cooperative smart PV inverters, and a novel moving target defense framework to combat data integrity attacks. (Thrust 2) Resilience to cyber-physical vectors that impact situational awareness by limiting data availability was addressed via novel centralized and decentralized, sparsity-based static and dynamic state estimation approaches that enhance observability even when the underlying system is unobservable. (Thrust 3) Leveraging a unique probabilistic sensitivity analysis approach accompanied by one-of-a-kind dominant influencer set computation, the vulnerability of critical infrastructure at strategic locations was evaluated so that proactive PV-based control strategies can be used to support operations under normal/outage scenarios. These CARE-PV project innovations were demonstrated on both small-scale IEEE and larger utility-scale testbeds (Thrust 4). Feedback from Industry Advisory Board members was used to formulate a commercialization pathway for a subset of CARE-PV technologies. These CARE-PV technologies will ultimately lead to reliable and secure, large-scale integration of renewable energy and mitigate the risk of energy disruption resulting from cyber incidents and other emerging threats within the energy environment.

14 SOLAR ENERGY↗
NASA NTRS1987

Tutorial and hands-on demonstration of a fluent interpreter for CARE 3

This document updates one originally written as part of a workshop on the CARE 3 capability held at NASA Langley Research Center on February 22 to 24, 1984. Subsequent to the workshop, CARE 3 and its interface program were enhanced and extensive changes to the original document became necessary. This document, like its predecessor, is designed to illustrate the user interface capability and the salient CARE 3 features by describing various examples of reliability models and their solutions through the use of CARE 3.

Martensen, Anna L.↗
NASA NTRS1988

CARE 3 User's Workshop

A user's workshop for CARE 3, a reliability assessment tool designed and developed especially for the evaluation of high reliability fault tolerant digital systems, was held at NASA Langley Research Center on October 6 to 7, 1987. The main purpose of the workshop was to assess the evolutionary status of CARE 3. The activities of the workshop are documented and papers are included by user's of CARE 3 and NASA. Features and limitations of CARE 3 and comparisons to other tools are presented. The conclusions to a workshop questionaire are also discussed.

Source record↗