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Lynn Boley

Publications and source records attributed to Lynn Boley.

17 records
All sourcesNASA NTRSDOE OSTI
NASA NTRS2021

Comparison of Health and Performance Risk for Accelerated Mars Mission Scenarios

This document details the results for a quantitative estimate of the difference in human health and performance risk that crews would face for two hypothetical variations on Mars mission scenarios: an Accelerated Mars Mission (AMM) and a Standard Mars Mission(SMM).NASA goals for Mars mission concepts, duration, and tasks have varied over the years. While neither of the cases considered here are likely to accurately represent the initial mission to Mars, the exercise of evaluating significant differences in mission duration from an astronaut health perspective can provide bounding insight to the level of risk that is likely to be encountered in an eventual Mars mission. Medical Probabilistic Risk Assessment using the Integrated Medical Model (IMM)(1–3)and the NASA Space Radiation Cancer Risk Model (NSCR)(4,5) are used here to help mission planners gain the best insight currently available into the expected magnitude of impacts to astronaut health when undertaking a Mars mission. These impacts occur both in-mission as well as in the long-term health of the astronauts post-mission. These evaluations are currently the best available modeling estimates to characterize and bound the health risks in a proposed mission domain where humans have no experience.

Erik Antonsen↗
NASA NTRSDate not supplied

Leveraging Nurse Informaticists for Development of the Impact Tool

The American Nurses Association (ANA) defines nursing informatics as the integration of “nursing science, computer science, and information science to manage and communicate data, information, knowledge, and wisdom in nursing practice. [1]” In additional to nursing education and clinical experience, this field requires additional education in areas of data analysis, database management, and clinical information systems. Nursing informaticists help bridge the communication gap between clinical and technical stakeholders which help align common goals. NASA is currently developing a new medical system trade analysis and decision support tool called IMPACT (Informing Mission Planning via Analysis of Complex Tradespaces). The development team is comprised of multiple specialties including but not limited to clinicians (pharmacists, physicians, and nurse informaticists), software and program developers, human factors experts, and engineers. The nurse informaticists play a significant role in the development, operation, and results interpretation of IMPACT. Their expert knowledge and skills in both clinical nursing, information science, and database management place them in a unique position to collaborate and integrate with the clinical, engineering, and software development members of the team to achieve a cohesive, functional, and user-friendly model.

Lynn Boley↗
NASA NTRSDate not supplied

Artificial Intelligence (AI) Methods for Augmenting the IMPACT Tool Evidence Library

Development of the Evidence Library for use with the IMPACT probability risk assessment tool took several years and involved a staggering amount of effort from a multi-disciplinary team. A very significant amount of the labor effort to collect, assess and finalize the Clinical Finding Form (CliFF) for each of the 119 medical conditions was provided by physician subject matter experts from the Exploration Medical Capability (ExMC) Element Clinical and Science Team. Many AI tools such as ChatGPT are excellent at summarizing large amounts of information and the current project was initiated to determine how such tools might streamline laborious processes, e.g., review and summarization of many scientific research publications, to execute key steps more efficiently in the process of developing CliFFs. The process for collecting the evidence which is found in the CliFFs is well documented in the Evidence Library Methods document (ELM; HRP-48036*). Using ELM and the CliFF development instructions as a guideline, a team of developers is leveraging Microsoft Azure AI tools and services along with open-source frameworks, to construct an AI-assisted automated pipeline. This pipeline is designed to search, retrieve, and process the necessary data sources, and ultimately help generate the final version of a CliFF. Currently, the large language model evaluates the relevance of each source material to spaceflights, either as direct evidence or as an analog. Additionally, the model assists in extracting keywords and generating brief summaries to enhance augmented retrieval and search processes in later stages of CliFF development. Once the data is ready, the model can perform semantic search and retrieval, generating and extracting valuable information for the CliFF. For instance, it can handle epidemiological statistical data, such as incidence rates and the likelihood of best or worst-case scenarios. The steps that required reading and summarizing articles were viewed as providing the greatest return on investment since large language models are very efficient and accurate in summarizing large amounts of text. Since labor effort to complete the original CliFF was not recorded with sufficient granularity, comparisons with an AI tool-generated CliFF will provide merely an approximation of time saved. Upon completion of the process, the CliFF for the medical condition “appendicitis” generated with the support of AI-based methods will serve as a proof-of-concept and will be compared to the original appendicitis CliFF to determine if use of the tools resulted in content and conclusory similarity. Based upon the results from face validation of the two CliFFs, modifications to the process will be made if necessary and additional condition CliFFs will be evaluated. Ultimately, CliFFs for the entire set of medical conditions will be created with the assistance of AI tools. Depending on the cost savings realized, CliFFs for additional medical conditions can be created to expand the Evidence Library. Future direction includes specifying the characteristics of the reviewer (prompting the AI tools to generate output assuming the reviewer is a sub-specialist physician, or nurse or EMT/medic) to determine if the effects on AI-generated output are different based on knowledge, skills and abilities. *Exploration Medical Capability Evidence Library Methods, HRP-48036 Rev A, July 2022.

Ali Al↗
NASA NTRSDate not supplied

Objective Structured Clinical Evaluation (OSCE) of an Artificial Intelligence (AI) Clinical Decision Support System (CDSS) Tool

BACKGROUND Objective Structured Clinical Evaluations (OSCEs) have long been established as a robust methodology for summative assessment of clinical skills and decision-making during medical education. The recent integration of Artificial Intelligence (AI) into clinical decision-making processes has prompted the need for novel evaluation frameworks to assess the efficacy and reliability of AI clinical decision support system (CDSS) tools. This abstract outlines the process of quantitatively evaluating a novel CDSS (“Doc in a Box” Google 2024) trained on curated medical spaceflight data in the psychomotor domain as it interfaces with a human volunteer acting as the crew medical officer (CMO). PURPOSE The AI CDSS under review was developed as part of the Lunar Command and Control Interoperability (LuCCI) project, which is intended to address a gap in how Lunar Surface Systems (LSS) would interoperate across multiple programs, commercial partners, and international partners. The project objective is to define, prototype, integrate, and evaluate an interoperable lunar command, control, data, and software reference architecture to enable autonomy and informatics capability through common standards across LSS. A multi-modal AI-based CDSS compatible with Federated LSS will assist clinicians in diagnosing and managing complex medical conditions by providing evidence-based recommendations through predictive analytics. Given the critical role of decision-support as NASA continues to evolve its Earth-independent medical operations (EIMO), it is imperative to ensure that such AI tools perform reliably and align with clinical standards during progressive lunar and Martian exploration class missions. METHODS The OSCE framework, traditionally used for evaluating human clinicians, was adapted to assess the AI tool's decision-making capabilities in simulated clinical scenarios. In this adapted OSCE, the AI CDSS was tested across a series of structured clinical scenarios designed to mimic real-life spaceflight patient cases. These scenarios included a range of conditions and complexities, allowing for comprehensive assessment of the tool's performance. Key evaluation metrics included accuracy of diagnosis, timeliness of decision-making, and appropriate recommendations for therapies. The OSCE was scored by human physician evaluators who assessed the AI's recommendations in comparison with expert clinicians' medical decision making to ensure alignment with best practices and the standard of care. RESULTS Preliminary results indicate that the AI CDSS demonstrated high accuracy in diagnostic recommendations and decision support across various scenarios. However, certain limitations were noted, such as occasional discrepancies in handling complex or nuanced cases that required a more contextual understanding. Additionally, the tool scored higher on the diagnostic portion of the rubric, with lower scores in the therapeutic recommendations. These findings highlight the importance of continuous refinement and validation of AI tools through rigorous evaluation frameworks like the OSCE. The adaptation of OSCEs for AI tools presents several advantages, including a structured and reproducible approach to evaluation, the ability to test AI systems in diverse clinical scenarios, and the opportunity to benchmark AI performance against established clinical standards to permit charting of future progress as aerospace medicine evolves as a discipline. Remaining challenges include ensuring that these evaluations capture the full spectrum of clinical decision-making scenarios that will be confronted by CMOs during missions and adequately reflecting real-world variability of the austere spaceflight environment. CONCLUSION Employing OSCEs to evaluate AI clinical decision support tools offers a promising approach to validating their clinical utility and efficacy. This methodology not only provides insights into the tool's performance but also fosters ongoing improvement and alignment with standard of care practices. Future research should focus on refining these evaluation processes and addressing limitations to enhance the integration of AI tools in clinical spaceflight settings. REFERENCES Scott S, Hearns V, Barker MA. Testing Clinical Skills: A Look at the OSCE and USMLE Clinical Skills Exams. S D Med. 2019 Oct;72(10):451-453. Majumder MAA, Kumar A, Krishnamurthy K, Ojeh N, Adams OP, Sa B. An evaluative study of objective structured clinical examination (OSCE): students and examiners perspectives. Adv Med Educ Pract. 2019 Jun 5;10:387-397. Karam VY, Park YS, Tekian A, Youssef N. Evaluating the validity evidence of an OSCE: results from a new medical school. BMC Med Educ. 2018 Dec 20;18(1):313.

Ariana M Nelson↗
NASA NTRSDate not supplied

Artificial Intelligence (AI) Methods for Automating the Impact Tool Evidence Library

INTRODUCTION: The development of the Evidence Library for use with the IMPACT (Informing Mission Planning via Analysis of Complex Tradespaces) probability risk assessment tool involved a multilayered, time intensive process of data collection and analysis by subject matter experts from the Exploration Medical Capability (ExMC) Element Clinical and Science Team to produce clinical findings forms (CliFFs) for 120 medical conditions. Artificial Intelligence Large Language Models (LLMs) can be leveraged to facilitate this process, thus reducing labor and time. TOPIC: CliFFs contain information about medical conditions as they pertain to spaceflight. This includes condition definitions, incidence data, crew task impairment estimates caused by conditions, treatment protocols and references to literature used for gathering condition evidence. Guided by the Evidence Library Methods document and the CliFF development instructions, a team has leveraged Microsoft Azure AI services and open-source documentation to construct an AI-assisted automated pipeline for CliFF development. This process is designed to search, retrieve, and evaluate the applicable data, and ultimately generate a completed CliFF. The LLM evaluates the relevance of each of the source materials to spaceflight, either as direct evidence or as an analog. The model extracts keywords and generates brief summaries to enhance search and retrieval in later stages of CliFF development. For instance, it can calculate epidemiological statistical data, such as incidence rates and the likelihood of best or worst-case scenarios. APPLICATION: Large Language Models (LLMs) can efficiently summarize large amounts of text. Leveraging this technology will automate data retrieval and evidence gathering for medical databases, like the IMPACT tool, by aiding in the labor-intensive process of analyzing large bodies of literature and organizing it into a formatted document like a CliFF. This added efficiency will enable expeditious expansion of the Evidence Library with additional medical conditions and update previous CLiFFs as new technology becomes available.

Ali Al↗
NASA NTRSDate not supplied

Assessing the Added Value of Miniature X-Ray in the Setting of US in Spaceflight

INTRODUCTION: Point-of-care ultrasound (POCUS) has become the standard of care for imaging diagnosis and management in lowEarth Orbit (LEO) spaceflight and it has long been hypothesized that POCUS will also be the standard of care for exploration spaceflight. However, like the trajectory for which ultrasound became more portable and user-friendly, the mass, volume, and power requirements of radiography devices for both diagnostic and therapeutic applications have also been dramatically reduced. This study seeks to determine the clinical utility and added value of miniature x-ray (XR) for the diagnosis and management of each of the 119 conditions within NASA Exploration Medical Capability’s IMPACT Condition List (ICL) given that the medical system is presumed to already be carrying a handheld portable POCUS device. METHODS: For each condition, a team of reviewers performed a rapid systematic literature review seeking sensitivity and specificity data for both handheld portable ultrasound and miniature XR. When there was a paucity of data, subject matter expertise and clinical experience was added to semi-quantitatively score the added value of miniature XR, given an US was already available for both diagnosis and management. Diagnostic utility of a modality for a condition was evaluated in the setting of both the best- and worst-case scenario definitions included and defined by the ICL. Evidence tracing and quality of evidence scores were also recorded. RESULTS/DISCUSSION: Conditions for which it was determined that miniature XR added diagnostic or therapeutic value are provided in this presentation. Previously presented work by our team has demonstrated that XR provides diagnostic and management capabilities that are hypothesized to complement or surpass ultrasound for over one-third of medical conditions that may arise during exploration spaceflight (i.e., diagnosis of injuries to the axial skeleton, teeth, and lungs as well as management of orthopedic reductions, endotracheal tube placement, and drain placement confirmation). In the setting of known inclusion of a handheld portable POCUS device, there remains significant added value of portable miniature XR. Whether or not this added clinical benefit is worth the mass, volume, and power requirements of the radiography system remains yet unknown and is the focus of future work. LEARNING OBJECTIVES: 1) Understand the value of ultrasound and radiography in the diagnosis and management of medical comorbidities that may arise in exploration spaceflight; 2) Understand the medical conditions of highest concern on exploration class missions for which miniature x-ray may provide added value to portable ultrasound.

Jon Steller↗