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Metronome Use for Coordination of Breaths and Cardiac Compressions Delivered by Minimally-Trained Caregivers During Two-Person CPR

Astronaut crew medical officers (CMO) aboard the International Space Station (ISS) receive 40 hours of medical training over 18 months before each mission, including two-person cardiopulmonary resuscitation (2CPR) as recommended by the American Heart Association (AHA). Recent studies have concluded that the use of metronomic tones improves the coordination of 2CPR by trained clinicians. 2CPR performance data for minimally-trained caregivers has been limited. The goal of this study was to determine whether use of a metronome by minimally-trained caregivers (CMO analogues) would improve 2CPR performance. 20 pairs of minimally-trained caregivers certified in 2CPR via AHA guidelines performed 2CPR for 4 minutes on an instrumented manikin using 3 interventions: 1) Standard 2CPR without a metronome [NONE], 2) Standard 2CPR plus a metronome for coordinating compression rate only [MET], 3) Standard 2CPR plus a metronome for coordinating both the compression rate and ventilation rate [BOTH]. Caregivers were evaluated for their ability to meet the AHA guideline of 32 breaths-240 compressions in 4 minutes. All (100%) caregivers using the BOTH intervention provided the required number of ventilation breaths as compared with the NONE caregivers (10%) and MET caregivers (0%). For compressions, 97.5% of the BOTH caregivers were not successful in meeting the AHA compression guideline; however, an average of 238 compressions of the desired 240 were completed. None of the caregivers were successful in meeting the compression guideline using the NONE and MET interventions. This study demonstrates that use of metronomic tones by minimally-trained caregivers for coordinating both compressions and breaths improves 2CPR performance. Meeting the breath guideline is important to minimize air entering the stomach, thus decreasing the likelihood of gastric aspiration. These results suggest that manifesting a metronome for the ISS may augment the performance of 2CPR on orbit and thus may increase the level of care.

Hurst, Victor, IV

Novel Aprotic Heterocyclic Anion-based Ionic Liquids for Carbon Dioxide Capture

Ionic liquids (ILs), or organic salts with melting points at or below room temperature are an incredibly versatile class of materials with many possible applications for NASA’s exploration needs. In particular, appropriately designed ILs can have a high affinity for absorbing carbon dioxide, making them excellent candidates for use as liquid sorbents in cabin air revitalization systems. Unfortunately, many of these ILs have high viscosity, which is only exacerbated by carbon dioxide uptake. High viscosity limits the rate of carbon dioxide uptake. A new class of IL sorbent containing aprotic heterocyclic anions (AHA) has been shown to offer excellent carbon dioxide uptake without a corresponding increase in viscosity. However, there is a paucity of sorption data for these AHA ILs at low partial pressures of carbon dioxide. This paper reports on the characterization of sorption behavior for AHA ILs previously reported in the literature at low concentrations of carbon dioxide and the synthesis and characterization of new, water miscible AHA ILs. Characterization of the new ILs includes measurement of density, viscosity, thermal stability, carbon dioxide capacity, carbon dioxide absorption kinetics, and water-IL vapor liquid equilibrium. Overall, these news ILs are promising alternatives to many of the commonly used IL sorbents.

Eric Townsend Fox

Evidence for the involvement of carbonic anhydrase and urease in calcium carbonate formation in the gravity-sensing organ of Aplysia californica

To better understand the mechanisms that could modulate the formation of otoconia, calcium carbonate granules in the inner ear of vertebrate species, we examined statoconia formation in the gravity-sensing organ, the statocyst, of the gastropod mollusk Aplysia californica using an in vitro organ culture model. We determined the type of calcium carbonate present in the statoconia and investigated the role of carbonic anhydrase (CA) and urease in regulating statocyst pH as well as the role of protein synthesis and urease in statoconia production and homeostasis in vitro. The type of mineral present in statoconia was found to be aragonitic calcium carbonate. When the CA inhibitor, acetazolamide (AZ), was added to cultures of statocysts, the pH initially (30 min) increased and then decreased. The urease inhibitor, acetohydroxamic acid (AHA), decreased statocyst pH. Simultaneous addition of AZ and AHA caused a decrease in pH. Inhibition of urease activity also reduced total statoconia number, but had no effect on statoconia volume. Inhibition of protein synthesis reduced statoconia production and increased statoconia volume. In a previous study, inhibition of CA was shown to decrease statoconia production. Taken together, these data show that urease and CA play a role in regulating statocyst pH and the formation and maintenance of statoconia. CA produces carbonate ion for calcium carbonate formation and urease neutralizes the acid formed due to CA action, by production of ammonia.

Non-NASA Center

Comparison of Bystander Cardiopulmonary Resuscitation (BCPR) Performance in the Absence and Presence of Timing Devices for Coordinating Delivery of Ventilatory Breaths and Cardiac Compressions in a Model of Adult Cardiopulmonary Arrest

Astronaut crew medical officers (CMO) aboard the International Space Station (ISS) receive 40 hours of medical training during the 18 months preceding each mission. Part of this training ilncludes twoperson cardiopulmonary resuscitation (CPR) per training guidelines from the American Heart Association (AHA). Recent studies concluded that the use of metronomic tones improves the coordination of CPR by trained clinicians. Similar data for bystander or "trained lay people" (e.g. CMO) performance of CPR (BCPR) have been limited. The purpose of this study was to evailuate whether use of timing devices, such as audible metronomic tones, would improve BCPR perfomance by trained bystanders. Twenty pairs of bystanders trained in two-person BCPR performled BCPR for 4 minutes on a simulated cardiopulmonary arrest patient using three interventions: 1) BCPR with no timing devices, 2) BCPR plus metronomic tones for coordinating compression rate only, 3) BCPR with a timing device and metronome for coordinating ventilation and compression rates, respectively. Bystanders were evaluated on their ability to meet international and AHA CPR guidelines. Bystanders failed to provide the recommended number of breaths and number of compressions in the absence of a timing device and in the presence of audible metronomic tones for only coordinating compression rate. Bystanders using timing devices to coordinate both components of BCPR provided the reco number of breaths and were closer to providing the recommended number of compressions compared with the other interventions. Survey results indicated that bystanders preferred to use a metronome for delivery of compressions during BCPR. BCPR performance is improved by timing devices that coordinate both compressions and breaths.

Hurst, Victor, IV

Supported ionic liquid membranes (SILMs) with exceptional selectivity and permeability for dilute CO 2 separations

Supported ionic liquid membranes (SILMs), containing phosphonium ionic liquids with aprotic N-heterocyclic anions (AHA ILs) in an inert inorganic support, were tested under both dry and humidified (40 % RH) mixed-gas conditions down to 420 ppm CO 2 in N 2 at 35 °C. In the dry case, the best performing IL, triethyl(octyl)phosphonium 4-bromopyrazolide ([P 2228 ][4-BrPyra]) exhibited mixed-gas CO 2 permeabilities and CO 2 /N 2 permeability selectivities as high as 26,800 barrer and 7,000, respectively. In the presence of humidity, the CO 2 permeability and CO 2 /N 2 selectivity increased to 49,100 barrer and 13,200, respectively, and these are the highest reported combination in the literature. Humidity amplifies CO 2 permeabilities and CO 2 /N 2 permeability selectivities through increases in CO 2 capacity due to bicarbonate formation and through faster mobility of the mobile carrier from decreased viscosity. Furthermore, N 2 permeability stayed roughly invariant in the presence of humidity, likely from competing effects of viscosity reduction and lower N 2 solubility.

37 INORGANIC, ORGANIC, PHYSICAL, AND ANALYTICAL CH

Cardiopulmonary Resuscitation in Lunar and Martian Gravity Fields

Cardiopulmonary resuscitation is required training for all astronauts. No studies thus far have investigated how chest compressions may be affected in lunar and Martian gravities. Therefore a theoretical quantitative study was performed. The maximum downward force an unrestrained person can apply is mg N (g(sub Earth) = 9.78 ms(sup -2), g(sub moon) = 1.63 ms(sup -2), g(sub Mars) = 3.69 ms(sup -2). Tsitlik et a1 (Critical Care Medicine, 1983) described the human sternal elastic force-displacement relationship (compliance) by: F = betaD(sub s) + gammaD(sub s)(sup 2) (beta = 54.9 plus or minus 29.4 Ncm(sup -1) and gamma = 10.8 plus or minus 4.1 Ncm(sup -2)). Maximum forces in the 3 gravitational fields produced by 76 kg (US population mean), 41 kg and 93 kg (masses derived from the limits for astronaut height), produced solutions for compression depth using Tsitlik equations for chests of: mean compliance (beta = 54.9, gamma = 10.8), low compliance (beta = 84.3, gamma = 14.9) and high compliance (beta = 25.5, gamma = 6.7). The mass for minimum adequate adult compression, 3.8 cm (AHA guidelines), was also calculated. 76 kg compresses the mean compliance chest by: Earth, 6.1 cm, Mars, 3.2 cm, Moon, 1.7 cm. In lunar gravity, the high compliance chest is compressed only 3.2 cm by 93 kg, 120 kg being required for 3.8 cm. In Martian gravity, on the mean chest, 93 kg compresses 3.6 cm; 99 kg is required for 3.8 cm. On Mars, the high compliance chest is compressed 4.8 cm with 76 kg, 5.5 cm with 93 kg, with 52 kg required for 3.8 cm.

Sarkar, Subhajit

Using the Space Glove to Teach Spatial Thinking

The challenge of extending students' skills in spatial thinking to astronomical scales was the central focus of our K-8 curriculum development. When the project's lead teacher requested a curriculum that cumulatively built on each prior year's learning in a spiral fashion, I knew exactly what the school was asking for. Second and third graders began by noticing the cyclical patters that the sun, moon, and stars make in the sky. Fourth graders explored the phases of the moon by taking turns modeling and sketching them in their classroom and then comparing them to the real sky. Sixth !graders used real telescopes to observe a moving model of our solar system and walked a scale model of the planets' orbits. The curriculum is designed to expand students' capacity to visualize space in a hierarchical fashion that asks them to imagine themselves from a broader number of spatial perspectives through hands-on activities. The "situational awareness" Peter's story describes is a hallmark of high-performance engineering and innovation. Keeping in mind the potential outcomes of multiple paths of pursuit from multiple perspectives while keeping track of their relative merits and performance requirements is a demanding spatial task. What made it possible for Peter to transform the failure of his first glove into triumph was the mental space in which that failure provided exactly the information needed for a new breakthrough. In at least two cases, Peter could immediately "see" the full implications of what his hands were telling him. He tells the story of how putting his hands in a Phase VI astronaut glove instantly transformed his understanding of the glove challenge. Six months into his development, the failure of circumferentially wrapped cords to produce a sufficiently flexible glove again forced him to abandon his assumptions. His situational awareness was so clear and compelling it became a gut-level response. Peter's finely developed spatial skills enabled him to almost instinctively focus his full energy on a carefully constructed set of experiments. The finger's ability to sense pressure, force, and work gave him the immediate feedback required to solve this one central problem. Once properly understood, his failure quickly led to the magical "Aha!" moment of discovery; the rest is history. Just as children need opportunities to develop hands-on understanding, engineers need to explore new possibilities through incremental hands-on failure. High-performance innovation is all about learning to make maximum use of thinking spatially to direct this process. Peter Homer's glove also reminds us that efficient engineering decisions need to be made as close to the hardware as possible. Whether we're doing hands-on education or hands-on engineering, it is when we trust in our ability to "feel our way" through failure that we reach our highest potential.

Lord, Peter

Collaboration: It Is Much More Than the Technology

A joint study conducted with the University of Central Florida and the National Aeronautics and Space Agency's (NASA) Kennedy Space Center (KSC) resulted in a new approach to the collaboration issues that had troubled the Agency. We believe in teams. We believe in the concept of collaboration. We never doubted Douglas Engelbart's thesis-- "Our very survival depends on our ability to work together, more effectively, to get collectively smarter. Computers -- when used properly -- can help us do that". It was not lack of trying. Predictably, NASA engineers had worked as if better and better technology would resolve the matter. It had not. The study itself provided an insight, an "aha! moment that pointed us toward the problems of collaboration we had to solve. People quickly saw that we had to remove barriers and make it easier to share data, coordinate efficiently, work together to add value and create corporate memory. This paper describes what happened.

Elfrey, Priscilla

Cardiovascular Disease Outcomes Among the NASA Astronaut Corps

BACKGROUND: Acute effects of spaceflight on the cardiovascular system have been studied extensively, but the combined chronic effects of spaceflight and aging are not well understood. Preparation for and participation in spaceflight activities are associated with changes in the cardiovascular system such as decreased carotid artery distensibility and decreased ventricular mass which may lead to an increased risk of cardiovascular disease. Additionally, astronauts who travel into space multiple times or for longer durations may be at an increased risk across their lifespan. To that end, the purpose of this study was to determine the incidence of common cardiovascular disease (CVD) outcomes among the NASA astronaut corps during their active career and through retirement. METHODS: Cardiovascular disease outcomes were defined as reports of any of the following: myocardial infarction (MI), revascularization procedures (coronary artery bypass graft surgery [CABG] or percutaneous coronary intervention [PCI]), hypertension, stroke or transient ischemic attack [TIA], heart failure, or total CVD (as defined by the AHA - combined outcome of MI, Angina Pectoris, heart failure, stroke, and hypertension). Each outcome was identified individually from review of NASA's Electronic Medical Record (EMR), EKG reports, and death certificates using ICD-9 codes as well as string searches of physician notes of astronaut exams that occurred between 1959 and 2016. RESULTS: Of 338 NASA astronauts selected as of 2016, 9 reported an MI, 12 reported a revascularization procedure, (7 PCI and 5 CABG), 4 reported Angina (without MI), 5 reported heart failure, 9 reported stroke/TIA, and 96 reported hypertension. Total CVD was reported in 105 astronauts. No astronaut who had an MI or revascularization procedure flew a spaceflight mission following the event. All MI, revascularization, and stroke events occurred in male astronauts. When reviewing astronaut ECG reports, abnormal ECG reports were found in only 8% of records (n=430) and mainly among retired astronauts (82%), with marked sinus bradycardia being the reason for the abnormal classification.

Charvat, Jacqueline M.

Enhancing Cloud Cybersecurity: Prescriptive Controls for Operational Technology

This whitepaper provides strategic insights and recommendations into security cloud-based solutions for electric utilities, encompassing operational technology (OT), virtual power plants (VPP), distributed energy resources (DERs), applications, networks, and data storage as they transition to and leverage cloud infrastructure through managed service providers (MSPs) and cloud service providers (CSPs). Principles derived from established frameworks serve as a foundation for best practices across cybersecurity projects and remove the constraints of settling on a single framework. For organizations that prefer not to integrate a specific framework altogether, elements of the proposed approach could be adopted or tailored to best fit defined requirements and expected functionalities. The Cirrus assessment, a utility cloud feasibility tool, and the roadmap it provides serve as a precursor to this paper, which seeks to be a valuable resource for defining next steps following cloud technology integration feasibility appraisal. With its comprehensive approach to adoption, the Cirrus framework offers strategic guidance on responsibly preparing for or deploying a utility cloud solution. The previously published whitepaper, “Use Case-Informed Framework for Utility Cloud Migration,” details the guiding strategy, research, and deployment of cloud solutions within electric and interconnected grid systems. Before implementing the controls suggested in this document, it is recommended that stakeholders complete Cirrus's cloud integration assessment and pair the results with their unique cybersecurity controls to form a comprehensive cloud-based utility cybersecurity plan. The Cirrus outcome will consider a series of future architectures for the grid before and after the energy transition and evaluate the arguments for and against cloud applications for each electric and interconnected grid layer. This document is a companion to the original whitepaper, "Use Case-Informed Framework for Utility Cloud Migration" to further identify and recommend security controls based on Cirrus’s cloud integration assessment output. The following whitepaper outlines the cybersecurity controls that secure cloud-service models pertinent to the electric sector using the predefined categories identify, protect, detect, and respond and recover. The objective is to outline prescriptive security controls based on the type of architecture and data stored in the cloud. The focus includes dissecting the shared responsibility model and elucidating what on-premises Infrastructure as a Service (IaaS), Platform as a Service (PaaS), and Software as a Service (SaaS) entail. A pivotal consideration in this context is allocating responsibility for foundational cybersecurity aspects—having used Cirrus for the cloud integration assessment. The ensuing controls detailed herein also represent a checklist of controls necessary for a secure cloud transition, equipping utilities with the knowledge to navigate this digital transformation with confidence and strategic foresight in a safe and responsible manner.

42 ENGINEERING