Aerospace Medical Association

Introduction The idea of exploring space excites more than one person, and not only astronauts but health professionals are also not indifferent to it because for a long time, human healthcare in space has been a priority directly involving the nursing profession; however, there is not much information available on this subject that it’s becoming more relevant every day. Objective This study aims to explore, review, and analyze existing literature to identify the basic needs of astronauts, nursing roles, and the challenges they will face in the context of human space exploration. Methods A literature review was conducted with bibliographic evidence of documents annexed to the following databases: WoS, MEDLINE through PubMed, Scopus, SciELO, CINAHL-EBSCO and Google Scholar. Previously, a search strategy was designed with descriptors: “Astronauts,” “Space Flight,” and “Nursing in Care,” using Boolean operators “OR” and “AND”. The languages were English and Spanish, there were no restrictions on the type of document and date of publication. Results 23 documents were selected after applying the inclusion and exclusion criteria. The following results found in the present review have been categorized into 8 thematic areas: historical background, conceptual models and nursing theories applied to space, space environment, physiological changes in space flights, health problems and risks in space, nursing care in space and management of nursing care in space. Finally, future challenges of space nursing. Each of these categories is presented below. Conclusion Space Nursing has been constantly developing and its interventions will be required along with the advances in space exploration. It encourages innovation, implementation, building a knowledge base, and discovering new modalities of human healthcare to reach the frontiers of space.

Abstract The capabilities of Large Language Models (LLMs) have advanced since their popularization a few years ago. The healthcare sector operates on, and generates a large volume of data annually and thus, there is a growing focus on the applications of LLMs within this sector. There are a few medicine-oriented evaluation datasets and benchmarks for assessing the performance of various LLMs in clinical scenarios; however, there is a paucity of information on the real-world usefulness of LLMs in context-specific scenarios in resourceconstrained settings. In this study, 16 iterations of a decision support tool for medical emergencies using 4 distinct generalized LLMs were constructed, alongside a combination of 4 Prompt Engineering techniques: In-Context Learning with 5-shot prompting (5SP), chain-of-thought prompting (CoT), self-questioning prompting (SQP), and a stacking of self-questioning prompting and chain-of-thought (SQCT). In total 428 model responses were quantitatively and qualitatively evaluated by 22 clinicians familiar with the medical scenarios and background contexts. Our study highlights the benefits of In-Context Learning with few-shot prompting, and the utility of the relatively novel self-questioning prompting technique. We also demonstrate the benefits of combining various prompting techniques to elicit the best performance of LLMs in providing contextually applicable health information. We also highlight the need for continuous human expert verification in the development and deployment of LLM-based health applications, especially in use cases where context is paramount.

Muslims have attached great importance to preserving and strengthening science since the first centuries. For this purpose, the goals of Muslims have been to give every science to its own specialist. Thus, the scholars applied to criticism while dealing with the ta‘aqqub and their opinions about the classification before them. With the ta‘aqqub method, every subsequent scholar established a building on the previous ones, corrected what they said, criticized them, criticized their works and evaluated them. In this process, it is seen that methods of dealing with various sciences emerged within the framework of the knowledge and understanding of the scholars. Ta‘aqqub is an area in the scientific research area that is not given much value. Because the need for a detailed research on the subject, it is decided to this study. In this study, everything about ta‘aqqub’s meaning, roots, causes, benefits, method, the behaviors of scholars against the opinions of others, the moral values of Muslim scholars, their behavior towards their opponents or those who make mistakes is discussed. In addition, Arabic and Turkish studies are mentioned about the evaluations made by contemporary researchers on ta‘aqqub.

Sleep staging, the process of assigning labels to epochs of sleep, depending on the stage of sleep they belong, is an arduous, time consuming and error prone process as the initial recordings are quite often polluted by noise from different sources. To properly analyze such data and extract clinical knowledge, noise components must be removed or alleviated. In this paper a pre-processing and subsequent sleep staging pipeline for the sleep analysis of electroencephalographic signals is described. Two novel methods of functional connectivity estimation (Synchronization Likelihood/SL and Relative Wavelet Entropy/RWE) are comparatively investigated for automatic sleep staging through manually pre-processed electroencephalographic recordings. A multi-step process that renders signals suitable for further analysis is initially described. Then, two methods that rely on extracting synchronization features from electroencephalographic recordings to achieve computerized sleep staging are proposed, based on bivariate features which provide a functional overview of the brain network, contrary to most proposed methods that rely on extracting univariate time and frequency features. Annotation of sleep epochs is achieved through the presented feature extraction methods by training classifiers, which are in turn able to accurately classify new epochs. Analysis of data from sleep experiments on a randomized, controlled bed-rest study, which was organized by the European Space Agency and was conducted in the “ENVIHAB” facility of the Institute of Aerospace Medicine at the German Aerospace Center (DLR) in Cologne, Germany attains high accuracy rates, over 90% based on ground truth that resulted from manual sleep staging by two experienced sleep experts. Therefore, it can be concluded that the above feature extraction methods are suitable for semi-automatic sleep staging.

Introduction: Mitral annular calcification (MAC) has been associated with age, hemodialysis (HD) status, coronary disease, and mortality. While MAC is seen frequently in pts undergoing percutaneous edge-to-edge repair of mitral regurgitation (MR) its impact on survival is unknown. Hypothesis: MAC is not associated with mortality after percutaneous MR repair. Methods: Pts who underwent MitraClip repair of MR between Apr 2009 and May 2014 were included. Kaplan-Meier survival was plotted between pts with no MAC and pts with MAC. A multivariate Cox regression of all-cause mortality was performed simultaneously adjusting for MAC, age, HD status, and prior myocardial infarction (MI). Results: 173 pts were included. Mean age at percutaneous repair was 76.9 ± 12.6 yrs and 40.8% were females. MAC was present in 86/173 (49.7%) of pts, and was mild in 61/86 (70.9%) cases and moderate or severe in the remaining cases. In pts with MAC prevalence of prior MI was higher 28/86 (32.6%) vs. 16/87 (18.4%) p=0.037 but ejection fraction was similar 51.8 ± 17.1 vs. 50.4 ± 18.6 % p=0.603. Age was increased in pts with MAC 79.9 ± 10.1 vs. 74.3 ± 14.0 yrs p=0.003. MR was moderate-to-severe in 35/173 (20.2%) of pts and severe in 138/173 (79.8%) of pts. MR improved by 2 grades or more in 165/173 (95.4%) of pts after repair. Survival was decreased in pts with MAC as compared to pts with no MAC by Log Rank p=0.049 (Figure 1A). However, in a multivariate Cox regression model of all-cause mortality, MAC, after adjusting for age, HD status, and prior MI, was not associated with mortality with a hazard ratio of 1.166 (95% CI 0.707 - 1.922) p=0.548 (Figure 1B). In this model age and prior MI were associated with mortality with hazard ratios of 1.048 (95% CI 1.021 - 1.077) p=0.001 and 1.798 (95% CI 1.052 - 3.075) p=0.032, respectively. Conclusions: The presence of MAC was not associated with mortality after adjusting for age, HD status, and prior MI and should not preclude the MitraClip procedure. Procedural success was equally high.

Many institutions of higher education, educational organizations, the business community, and learners are embracing e-learning for a variety of reasons and needs. These parties refer to key factors such as flexibility, the use of mixed interactive multimedia, Internet research, archiving, electronic networks, telecommunications, and cost to support the idea that e-learning could serve as a viable and qualitative learning alternative. Some educators and learners, however, believe that e-learning cannot, and should not, replace classroom instruction, pointing out that the quality of face-to-face education must not be compromised by e-learning. Nevertheless, professional and scholastic individuals with such reservations often recognize that e-learning can be a valuable supplement and effective learning tool for mature and responsible students and should be pursued. Hence, quality of learning is a deciding factor as to whether e-learning should be considered as a total and effective learning environment.Recent educational statistics and forecasts have revealed that e-learning is gaining ground in community colleges and universities nationwide. Investigating and assessing the planning and implementation processes of e-learning courses and programs at these institutions of higher education is necessary to determine the quality of a Web-based learning environment. Quality e-learning is a Web-based learning environment designed, developed, and delivered based on several dynamic principles, such as institutional support, course development, teaching/learning, course structure, student support, faculty support, and evaluation and assessment (Phipps & Merisotis, 2000).Ensuring a quality e-learning environment is essential in providing students with the full range of benefits that e-learning entails.Advanced new technology has provided educators with valuable tools to design, develop, and teach quality e-learning courses. Educators could use effective technology-based applications, such as microworlds, virtual realities, and case studies to simulate active and quality e-learning environments that might otherwise be unavailable to the learner. Evolving technology is making it even very possible for learners at a distance to interact fully with fellow learners in course related activities. Participating in high-quality e-learning courses and programs, community college and university learners gain an ability to obtain educational instruction under almost any circumstances. There will be no more excuses about the lack of time or availability of courses or transportation.E-learning is now occupying part of the higher education agenda. Depending on the individual and type of degree, course, and program, e-learning could be described as a “total” education option. To achieve successful e-learning experiences for all student participants, institutions of higher education should ensure that the academic needs of the learner are met and the quality of education is guaranteed.There is a critical need for more research in the area of planning for quality e-learning courses and programs at colleges and universities. Educators must find ways to effectively plan for and offer comprehensive e-learning courses and programs in a variety of subject areas for learners and workers. Community colleges and universities could serve more individuals and businesses, at the location of their choosing, with a wide range of developing e-learning courses, programs, and projects. Technology has given us great opportunity to reach more potential learners and employers than we ever have had before. Institutions of higher education need to harness and manage this energy successfully and ride it into the future.Based on current distance learning research and personal e-learning experience, the author designed an operational definition of establishing a quality e-learning course and program. Figure 1 demonstrates the four main pillars of a solid foundation of building such a course and program: (1) Durable pedagogical strategies to design, develop, and implement effective e-learning courses and programs in which students assume significant responsibility toward their own learning; (2) flexible and convenient access to resources and support services; (3) an organizational base that has a long-term vision and mission in place, managed by proactive leaders who seek collaboration and monetary support to develop and implement quality e-learning courses and programs, driven by market needs, and complying with the laws of ownership and intellectual property rights; and (4) robust technological tools that meet the instructional and learning demands of students and instructors and integrate well with diverse content to obtain the desired learning outcomes. Figure 1 elaborates on and expands the current principles of quality e-learning identified in the e-learning literature.

In 1998, the Air Transport Medicine (ATM) Committee of the Aerospace Medical Association (AsMA) made its first recommendations concerning medical kits for commercial airlines. These were updated in 2002 and the ATM has continued to monitor medical kit usage, as well as pharmaceutical developments, and a further revision is now needed. This has taken into account ongoing work of the International Civil Aviation Organization and recommendations of the International Air Transport Association in the field of passenger and crew health. Based on the above, the Committee proposes the following update to its 2002 recommendations.

The latest (June 2005) draft of UNESCO's proposed Universal Declaration on Bioethics and Human Rights is a major disappointment. The committee of government 'experts' that produced it made sure that it would not introduce any new obligations for States, and so the document simply restates existing agreements and lists desirable goals without specifying how they can be achieved. This article focuses on the shortcomings of the document as it would apply to health care. These shortcomings are evident in the document's scope, aims and principles. The conclusion is that if UNESCO still thinks that such a declaration is needed, it should produce either an ethical document addressed to individuals and groups, which would be primarily educational in nature, or a legal document addressed to States, which should not have the word 'ethics' in its title.

With the anticipated growth of air travel, inflight illness and injury are expected to increase as well. This is because more elderly people and people with preexisting disease are taking to the air. Although inflight medical events and deaths are uncommon, physician passengers are occasionally called upon to render care. Resources for the physician may include emergency medical kits, automatic external defibrillators (AEDs), ECG monitors, portable oxygen bottles, and first-aid kits. Most airlines provide around-the-clock air-to-ground radio consultation either with their own medical department personnel or contracted medical consultants. Furthermore, some flight attendants are trained in cardiopulmonary resuscitation, first-aid, and operation of AEDs. This paper describes those inflight resources available to a physician who is called upon to treat an ill or injured passenger. In a broader sense, it is also providing advice to physicians who administer inflight medical care. The Aviation Medical Assistance Act of 1998 ("Good Samaritan act") is also discussed.