Advance care planning in perinatal settings: national survey of implementation using Normalisation Process Theory.

BACKGROUND: Perinatal advance care planning (PnACP) is a process of formal decision-making to help families plan for their baby's care when recognised that they may have a life-limiting condition. While PnACP is recommended in policy, there is a lack of evidence to support implementation and development in the perinatal setting. OBJECTIVE: To conduct an online survey of UK and Ireland perinatal providers to examine how PnACP is operationalised in current practice. METHODS: A secure online questionnaire was developed to collect data on (1) 'what' is being implemented, (2) the 'processes' being used, (3) perceived impact and (4) unmet support needs. Data were analysed using basic descriptive statistics, thematic analysis and through a conceptual lens of Normalisation Process Theory. RESULTS: Questionnaires were completed by 108 health professionals working in 108 maternity and neonatal services, representing 90 organisations across the UK and Ireland. This revealed many resources and examples of good practice to support PnACP. However, there was wide variation in how PnACP was conceptualised and implemented. Existing frameworks, pathways and planning tools are not routinely embedded into care, and respondents identified many barriers that negatively impact the quality of care. They called for better integration of palliative care principles into acute settings and more investment in staff training to support families at existentially difficult times. CONCLUSIONS: Priorities for additional perinatal service development include greater sharing of best practice and effective strategies to target the unique challenges of PnACP, such as time-sensitive collaborative working and decision-making in the face of high uncertainty.

Report of the 6th (Virtual) Meeting on the Planetary Protection Knowledge Gaps for Human Missions to Mars on June 1-2, 2022.

This paper reports the sixth in a series of meetings held under the auspices of COSPAR (with space agencies support) to identify, refine and prioritize the knowledge gaps that need to be addressed for planetary protection for crewed missions to Mars, as well as to describe where and how needed data can be obtained. This approach is consistent with current scientific understanding and COSPAR policy, that the presence of a biological hazard in Martian material cannot be ruled out, and appropriate mitigations need to be in place. The workshops in the series were intentionally organized to obtain a diverse set of inputs from subject matter experts across a range of expertise on conduct of a potential future crewed Mars exploration mission, identifying and leveraging precursor ground, cis-lunar crewed and Mars robotic activities that can be used to close knowledge gaps. The knowledge gaps addressed by this meeting series fall into three major themes: 1. Microbial and human health monitoring; 2. Technology and operations for biological contamination control, and; 3. Natural transport of biological contamination on Mars. This report describes the findings of the 2022 meeting, which focused on measures needed to protect the crew and the returning Mars samples during the mission, both on the Martian surface and during the return to Earth. Much of this approach to crewed exploration is well aligned with the Principles and Guidelines for Human Missions to Mars described in section 9.3 of the current (2021) COSPAR policy, in terms of goals and intent. There were three specific recommendations.

Development of a NASA roadmap for planetary protection to prepare for the first human missions to Mars.

As part of planning for future space exploration, COSPAR (The Committee on Space Research) together with participating space agencies, organized and held interdisciplinary meetings to consider next steps in addressing knowledge gaps for planetary protection for future human missions to Mars. Beginning with the results of these meetings and earlier work by NASA, ESA, and COSPAR (e.g., Criswell et al., 2005; Hogan et al., 2006; Rummel et al., 2008) as a base the authors of this paper carried out a follow-on NASA planning activity to identify the necessary steps to be accomplished to close knowledge gaps. We identified significant overlap between the planetary protection needs and other sets of Mars preparation roadmaps (1) microbial monitoring requirements for crew health and medical systems, (2) studies of the microbiome of the built environment, (3) environmental control and life support systems (ECLSS), (4) waste management, and (5) planetary surface operations. In many cases, efforts to mature exploration class systems for Mars that are occurring in other domains can be leveraged with minor changes to address planetary protection gaps as well. In other cases, work planned for testing on the International Space Station (ISS) as an analog for crew Mars transit, or on the lunar surface as an analog for Mars surface operations can be used to close planetary protection technology and knowledge gaps. An overall strategic framework that combines these domains has the advantage of being more comprehensive, efficient, and timely for closing gaps. This approach has led to the development of a NASA roadmap for addressing planetary protection integrated with other related roadmaps. NASA's development and execution of the planetary protection is now viewed in an integrated way with related technology development and testing. Key features of the integrated capabilities roadmap include.

Comprehensive census of bacteria in clean rooms by using DNA microarray and cloning methods.

A census of clean room surface-associated bacterial populations was derived from the results of both the cloning and sequencing of 16S rRNA genes and DNA microarray (PhyloChip) analyses. Samples from the Lockheed Martin Aeronautics Multiple Testing Facility (LMA-MTF), the Kennedy Space Center Payload Hazard and Servicing Facility (KSC-PHSF), and the Jet Propulsion Laboratory Spacecraft Assembly Facility (JPL-SAF) clean rooms were collected during the various assembly phases of the Phoenix and Mars Science Laboratory (MSL) spacecraft. Clone library-derived analyses detected a larger bacterial diversity prior to the arrival of spacecraft hardware in these clean room facilities. PhyloChip results were in agreement with this trend but also unveiled the presence of anywhere from 9- to 70-fold more bacterial taxa than cloning approaches. Among the facilities sampled, the JPL-SAF (MSL mission) housed a significantly less diverse bacterial population than either the LMA-MTF or KSC-PHSF (Phoenix mission). Bacterial taxa known to thrive in arid conditions were frequently detected in MSL-associated JPL-SAF samples, whereas proteobacterial lineages dominated Phoenix-associated KSC-PHSF samples. Comprehensive bacterial censuses, such as that reported here, will help space-faring nations preemptively identify contaminant biomatter that may compromise extraterrestrial life detection experiments. The robust nature and high sensitivity of DNA microarray technologies should prove beneficial to a wide range of scientific, electronic, homeland security, medical, and pharmaceutical applications and to any other ventures with a vested interest in monitoring and controlling contamination in exceptionally clean environments.

The microbiology of spacecraft hardware: lessons learned from the planetary protection activities on the Beagle 2 spacecraft.

We consider the aseptic assembly of the Beagle 2 Mars probe and how the requirements of COSPAR planetary protection category IVa were achieved. Several areas for future investigation became apparent. An ESA mission is outlined in which a microbial bioburden is recovered after Earth orbit to assess viability following re-entry through the atmosphere.

Atmospheric entry simulations of Mars lander bioload--experiments in support of Beagle 2.

Simulations of the temperature and vacuum effects of Martian atmospheric entry upon Bacillus atrophaeus (formerly Bacillus subtilis var niger; 8058; NCIMB) endospores were carried out inside a purpose-built vacuum chamber. The work formed part of the study in support of planetary protection for the Beagle 2 Mars lander and investigated to what extent the outer surface of the lander's back heat shield would be sterilised during Mars atmospheric entry. The spores were heated to peak temperatures up to 300 degrees C over 30 s under vacuum conditions (10(-3) mbar). There was no effect on spore viability until peak temperatures reached 180-200 degrees C (12-15 s of heat exposure). Spore viability then fell rapidly with increasing temperature. Once peak temperatures exceeded 300 degrees C, no further spore viability was detected. The average heating rate was rapid (10 degrees C s(-1)); thus spores were exposed to peak temperatures for less than a second. These data inform on the process of determining bioburden reduction and control steps necessary for external surfaces of spacecraft which are non-sterile at launch, as well as providing new information about the ability of a model resistant organism to survive rapid, short-duration heating.

The effect of knee position on torque output during inversion and eversion movements at the ankle.

The purpose of this study was to compare the effect of knee position on the magnitude of torque generated during the isokinetic movements of inversion and eversion at the ankle. Mean peak torque values at 30 and 120 degrees /sec were collected from 12 subjects, ages 21-31, from two test positions. The knee was stabilized in 10 degrees of flexion for the first test position and 70 degrees for the second. Additionally, mean peak amplitude of hamstring motor unit action potentials was compared between the two test positions to demonstrate differences in hamstring activity. At both speeds, mean peak torque values of the inversion-eversion movements, as well as mean peak amplitude of hamstring motor unit action potentials, was significantly lower in 10 degrees compared to 70 degrees of knee flexion (p < 0.01). It was concluded that isokinetic testing at the ankle with the knee in a close packed position, near full extension, provides a more valid representation of isolated muscular performance than testing with the knee in a loose packed position of midrange flexion.J Orthop Sports Phys Ther 1988;10(5):177-183.

Deposition of extreme-tolerant bacterial strains isolated during different phases of Phoenix spacecraft assembly in a public culture collection.

Extreme-tolerant bacteria (82 strains; 67 species) isolated during various assembly phases of the Phoenix spacecraft were permanently archived within the U.S. Department of Agriculture's Agricultural Research Service Culture Collection in Peoria, Illinois. This represents the first microbial collection of spacecraft-associated surfaces within the United States to be deposited into a freely available, government-funded culture collection. Archiving extreme-tolerant microorganisms from NASA mission(s) will provide opportunities for scientists who are involved in exploring microbes that can tolerate extreme conditions.

Expanding the role of the clinical nurse consultant.

This paper describes the phases that were experienced by clinical nurse consultants during a role transition from ward-based experts to facility-oriented resource people. The six prerequisites that the consultants identified as required for successful transition from the ward-based to the facility-oriented role are discussed. The increased productivity of the CNCs is summarised and recommendations for further action are identified.