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NASA NTRS2010

Life Sciences Research and Development Opportunities During Suborbital Space Flight

Suborbital space platforms provide a unique opportunity for Space Life Sciences in the next few years. The opportunities include: physiological characterization of the first few minutes of space flight; evaluation of a wide-variety of medical conditions during periods of hyper and hypo-gravity through physiological monitoring; and evaluation of new biomedical and environmental health technologies under hyper and hypo-gravity conditions

Davis, Jeffrey R.↗
NASA NTRS2011

Integration of an Evidence Base into a Probabilistic Risk Assessment Model. The Integrated Medical Model Database: An Organized Evidence Base for Assessing In-Flight Crew Health Risk and System Design

This slide presentation reviews the Integrated Medical Model (IMM) database, which is an organized evidence base for assessing in-flight crew health risk. The database is a relational database accessible to many people. The database quantifies the model inputs by a ranking based on the highest value of the data as Level of Evidence (LOE) and the quality of evidence (QOE) score that provides an assessment of the evidence base for each medical condition. The IMM evidence base has already been able to provide invaluable information for designers, and for other uses.

Saile, Lynn↗
NASA NTRS2011

The Extravehicular Suit Impact Load Attenuation Study for Use in Astronaut Bone Fracture Prediction

The NASA Integrated Medical Model (IMM) assesses the risk, including likelihood and impact of occurrence, of all credible in-flight medical conditions. Fracture of the proximal femur is a traumatic injury that would likely result in loss of mission if it were to happen during spaceflight. The low gravity exposure causes decreases in bone mineral density which heightens the concern. Researchers at the NASA Glenn Research Center have quantified bone fracture probability during spaceflight with a probabilistic model. It was assumed that a pressurized extravehicular activity (EVA) suit would attenuate load during a fall, but no supporting data was available. The suit impact load attenuation study was performed to collect analogous data. METHODS: A pressurized EVA suit analog test bed was used to study how the offset, defined as the gap between the suit and the astronaut s body, impact load magnitude and suit operating pressure affects the attenuation of impact load. The attenuation data was incorporated into the probabilistic model of bone fracture as a function of these factors, replacing a load attenuation value based on commercial hip protectors. RESULTS: Load attenuation was more dependent on offset than on pressurization or load magnitude, especially at small offsets. Load attenuation factors for offsets between 0.1 - 1.5 cm were 0.69 +/- 0.15, 0.49 +/- 0.22 and 0.35 +/- 0.18 for mean impact forces of 4827, 6400 and 8467 N, respectively. Load attenuation factors for offsets of 2.8 - 5.3 cm were 0.93 +/- 0.2, 0.94 +/- 0.1 and 0.84 +/- 0.5, for the same mean impact forces. Reductions were observed in the 95th percentile confidence interval of the bone fracture probability predictions. CONCLUSIONS: The reduction in uncertainty and improved confidence in bone fracture predictions increased the fidelity and credibility of the fracture risk model and its benefit to mission design and operational decisions.

Lewandowski, Beth E.↗
NASA NTRS2012

Exploration Medical System Demonstration (EMSD) Project

The Exploration Medical System Demonstration (EMSD) is a project under the Exploration Medical Capability (ExMC) element managed by the Human Research Program (HRP). The vision for the EMSD is to utilize ISS as a test bed to show that several medical technologies needed for an exploration mission and medical informatics tools for managing evidence and decision making can be integrated into a single system and used by the on-orbit crew in an efficient and meaningful manner. Objectives: a) Reduce and even possibly eliminate the time required for on-orbit crew and ground personnel (which include Surgeon, Biomedical Engineer (BME) Flight Controller, and Medical Operations Data Specialist) to access and move medical data from one application to another. b) Demonstrate that the on-orbit crew has the ability to access medical data/information using an intuitive and crew-friendly software solution to assist/aid in the treatment of a medical condition. c) Develop a common data management framework and architecture that can be ubiquitously used to automate repetitive data collection, management, and communications tasks for all crew health and life sciences activities.

Chin, Duane↗
NASA NTRS2013

Estimated Probability of Traumatic Abdominal Injury During an International Space Station Mission

The Integrated Medical Model (IMM) is a decision support tool that is useful to spaceflight mission planners and medical system designers when assessing risks and optimizing medical systems. The IMM project maintains a database of medical conditions that could occur during a spaceflight. The IMM project is in the process of assigning an incidence rate, the associated functional impairment, and a best and a worst case end state for each condition. The purpose of this work was to develop the IMM Abdominal Injury Module (AIM). The AIM calculates an incidence rate of traumatic abdominal injury per person-year of spaceflight on the International Space Station (ISS). The AIM was built so that the probability of traumatic abdominal injury during one year on ISS could be predicted. This result will be incorporated into the IMM Abdominal Injury Clinical Finding Form and used within the parent IMM model.

Lewandowski, Beth E.↗
NASA NTRS2013

Estimated Probabililty of Chest Injury During an International Space Station Mission

The Integrated Medical Model (IMM) is a decision support tool that is useful to spaceflight mission planners and medical system designers when assessing risks and optimizing medical systems. The IMM project maintains a database of medical conditions that could occur during a spaceflight. The IMM project is in the process of assigning an incidence rate, the associated functional impairment, and a best and a worst case end state for each condition. The purpose of this work was to develop the IMM Chest Injury Module (CIM). The CIM calculates the incidence rate of chest injury per person-year of spaceflight on the International Space Station (ISS). The CIM was built so that the probability of chest injury during one year on ISS could be predicted. These results will be incorporated into the IMM Chest Injury Clinical Finding Form and used within the parent IMM model.

Lewandowski, Beth E.↗
NASA NTRS2014

Effects of Long Duration Spaceflight on Venous and Arterial Compliance in Astronants

1. Project Overview Visual impairment and intracranial pressure (VIIP) is a spaceflight-associated medical condition affecting at least a third of American astronauts who have flown International Space Station (ISS) missions. VIIP is defined primarily by visual acuity deficits and anatomical changes to eye structures. In some astronauts, eye-related changes do not revert back to the preflight state upon return to Earth. Our team will study some of the possible causes for this syndrome. This will be achieved by reviewing previous astronaut data for factors that may predispose astronauts to higher rates of developing this syndrome or greater severity of symptoms. Additionally, we will conduct 3 separate experiments that will characterize vessels in the head and neck and measure the effects of the experimental conditions on ocular structures and function. 2. Technical Summary The primary objective of this study is to determine whether vascular compliance is altered by spaceflight and whether such adaptations are related to the incidence of the VIIP. In particular, we will measure ocular parameters and vascular compliance in vessels of the head and neck in astronauts who have no spaceflight experience (Ground), in astronauts before, during, and after spaceflight (Flight), and in bed rest subjects with conditions similar to spaceflight (Bed Rest). Additionally, we will analyze astronaut data from the Lifetime Surveillance of Astronaut Health (LSAH) archives to determine which factors might be predictive of the development of VIIP (Data Mining). The project will be conducted in four separate, but related parts. Hypothesis The central hypothesis of this proposal is that exposure to the spaceflight environment aboard the ISS may lead to development of the VIIP syndrome (increased intracranial pressure and impaired visual acuity) and that this may be related to alterations in venous and/or arterial compliance in the head and neck. Specific Aims 1. To determine whether noninvasive measures of venous and arterial compliance are altered by long-duration spaceflight exposure in ISS astronauts and whether these changes are related to the development of the VIIP syndrome. (Flight) 2. To determine whether previous spaceflight experience predispose astronauts to lower venous compliance and/or the development of the VIIP syndrome. (Ground + Flight) 3. To use a 14-day, 6deg head-down-tilt bed rest as a model of spaceflight, to evaluate the effect of aging on vascular compliance using a subject population similar to younger (25-35 yr) and older (45-55 yr) astronaut cohorts. (Bed Rest) 4. To determine what factors contribute to lower venous compliance and/or the development of the VIIP syndrome in astronauts. (Data Mining) 3. Earth Applications This research may inform the mechanisms that regulate blood/fluid flow in and out of the brain in the head and neck. This information may help with understanding of the mechanisms behind idiopathic intracranial hypertension. 4. Link to NASA Taskbook Entry Not Yet Available

Platts, Steven↗
NASA NTRS2011

IVGEN

The Exploration Medical Capabilities Element of NASA's Human Research Program chartered the IV fluid GENeration (IVGEN) project at the NASA Glenn Research Center to develop a system that could produce IV fluid in a microgravity environment meeting USP standards. NASA's flight surgeons have identified medical conditions likely to arise during exploration missions of various length and distance from the earth. Adequately treating some of those conditions will require the ability to utilize Intravenous (IV) therapy to either serve as a method for delivering pharmaceuticals that can only be administered via that route, or to hydrate patients that are unable to hydrate themselves. Given that need, NASA currently maintains a reserve of IV fluid on ISS sufficient to treat an astronaut until they can be returned to earth, which is generally within 24 hours. Because such a rapid return will not be an designed to produce United States Pharmacopeia ( USP) grade IV fluid in a reduced gravity p option for missions extending beyond low earth orbit, NASA must either fly as many as 100 liters of IV fluid, with a total mass of 100 Kg, or provide systems that can use vehicle resources to produce such fluid if it is needed. The IVGEN hardware, a compact water purification and mixing system, was environment using available resources.

DeVon, Griffin↗
NASA NTRS2016

Effects of Spaceflight on Venous and Arterial Compliance

The visual impairment and intracranial pressure (VIIP) syndrome is a spaceflight-associated medical condition consisting of a constellation of symptoms affecting less than 70% of American astronauts who have flown International Space Station (ISS) missions. VIIP is defined primarily by visual acuity deficits and anatomical changes to eye structures and is hypothesized to be related to elevated intracranial pressure secondary to spaceflight-induced cephalad fluid shifts, although other space flight factors (e.g., diet, environmental factors) may contribute. Loss of visual acuity could be a significant threat to crew health and performance during and after an exploration mission and may have implications for years postflight.

Platts, S. H.↗
NASA NTRS2016

Example of Occupational Surveillance in a Telemedicine Setting: Application of Epidemiologic Methods at NASA Johnson Space Center

In 2010, NASA implemented Lifetime Surveillance of Astronaut Health, a formal occupational surveillance program for the U.S. astronaut corps. Because of the nature of the space environment, space medicine presents unique challenges and opportunities for epidemiologists. One such example is the use of telemedicine while crewmembers are in flight, where the primary source of information about crew health is verbal communication between physicians and their crewmembers. Due to restricted medical capabilities, the available health information is primarily crewmember report of signs and symptoms, rather than diagnoses. As epidemiologists at NASA, Johnson Space Center, we have shifted our paradigm from tracking diagnoses based on traditional terrestrial clinical practice to one in which we also incorporate reported symptomology as potential antecedents of disease. In this presentation we describe how characterization of reported signs and symptoms can be used to establish incidence rates for inflight immunologic events. We describe interdisciplinary data sources of information that are used in combination with medical information to analyze the data. We also delineate criteria for symptom classification inclusion. Finally, we present incidence tables and graphs to illustrate the final outcomes. Using signs and symptoms reported via telemedicine, the epidemiologists provide summary evidence regarding incidence of potential inflight medical conditions. These results inform our NASA physicians and scientists, and support evaluation of the occupational health risks associated with spaceflight.

Babiak-Vazquez, Adriana↗
NASA NTRS2016

Impacts of Extreme Events on Human Health

Increased Exposure to Extreme Events Key Finding 1: Health impacts associated with climate-related changes in exposure to extreme events include death, injury, or illness; exacerbation of underlying medical conditions; and adverse effects on mental health[High Confidence]. Climate change will increase exposure risk in some regions of the United States due to projected increases in the frequency and/or intensity of drought, wildfires, and flooding related to extreme precipitation and hurricanes [Medium Confidence].Disruption of Essential Infrastructure Key Finding 2: Many types of extreme events related to climate change cause disruption of infrastructure, including power, water, transportation, and communication systems, that are essential to maintaining access to health care and emergency response services and safeguarding human health [High Confidence].Vulnerability to Coastal Flooding Key Finding 3: Coastal populations with greater vulnerability to health impacts from coastal flooding include persons with disabilities or other access and functional needs, certain populations of color, older adults, pregnant women and children, low-income populations, and some occupational groups [High Confidence].Climate change will increase exposure risk to coastal flooding due to increases in extreme precipitation and in hurricane intensity and rainfall rates, as well as sea level rise and the resulting increases in storm surge.

floods↗
NASA NTRS2019

The Effect of Heroic Medical Care on Mission Medical Outcomes

Study Objective: A catastrophic medical event depletes medical resources. What happens to the rest of the mission’s medical outcomes after such an event? Use Probabilistic Risk Assessment (PRA) to see if we can find out. What is the Integrated Medical Model? PRA model using Monte Carlo methodology; Used to assess mission risk due to in-flight medical events; User defined Design Reference Missions (DRM) (crew, duration, EVA (Extra-Vehicular Activity), etc.); Considers outcomes for 100 medical conditions that have or may occur in-flight; 100,000 trials conducted per DRM.

Reyes, David P.↗
NASA NTRS2019

Recommendation for a Medical System Concept of Operations for Gateway Missions

NASA’s exploration missions to cis-lunar space will establish a permanent gateway to future transport missions to Mars. These missions mandate a significant paradigm change for mission planning, spacecraft design, human systems integration, and in-flight medical care due to constraints on mass, volume, power, resupply, and medical evacuation capability. These constraints require medical system development to be tightly integrated with mission and habitat design to provide a sufficient medical infrastructure and enable mission success. This concept of operations provides a vision of medical care needs that will be used to guide the development of a medical system for the cis-lunar Gateway Habitat. This medical system will serve as the precursor to what is implemented in future exploration missions to Mars. This concept of operations documents an overview of the stakeholder needs and system goals of a medical system and provides examples of the types of activities for which the system will be used during the mission. This concept of operations informs the ExMC systems engineering effort to define the Gateway Habitat Medical System by documenting the medical activities and capabilities relevant to Gateway missions, as identified by the ExMC clinician community. In addition, this concept of operations will inform the subsequent systems engineering process of developing technical requirements, system architectures, interfaces, and verification and validation approaches for the medical system. This document supports the closure of ExMC Gap Med01: We do not have a concept of operations for medical care during exploration missions, corresponding to the ExMC-managed human system risk: Risk of Adverse Health Outcomes & Decrements in Performance due to Inflight Medical Conditions.

Rubin, David↗
NASA NTRS2019

Medical System Concept of Operations for Mars Exploration Mission-11: Exploration Medical Capability (ExMC) Element - Human Research Program

NASA’s exploration missions to Mars will have durations of 2-3 years and will take humans farther away from Earth than ever before. This will result in a paradigm shift for mission planning, spacecraft design, human systems integration, and in-flight medical care. Constraints on real-time communication, resupply, and medical evacuation are major architectural drivers. These constraints require medical system development to be tightly integrated with mission and vehicle design to provide crew autonomy and enable mission success. This concept of operations provides a common vision of medical care for developing a medical system for Mars exploration missions. It documents an overview of the stakeholder needs and goals of a medical system and provides examples of the types of activities the system will be used for during the mission. Development of the concept of operations considers mission variables such as distance from Earth, duration of mission, time to definitive medical care, communication protocols between crewmembers and ground support, personnel capabilities and skill sets, medical hardware and software, and medical data management. The information provided in this document informs the ExMC Systems Engineering effort to define the functions to be provided by the medical system. In addition, this concept of operations will inform the subsequent systems engineering process of developing technical requirements, system architectures, interfaces, and verification and validation approaches for the medical system. This document supports the closure of ExMC Gap Med01: We do not have a concept of operations for medical care during exploration missions, corresponding to the ExMC-managed human system risk: Risk of Adverse Health Outcomes & Decrements in Performance due to Inflight Medical Conditions. This document is applicable to the ExMC Element Systems Engineering process and may be used for collaboration within the Human Research Program.

Urbina, Michelle↗
NASA NTRSDate not supplied

Envisioning the Future Role of an Exploration Clinical Decision Support System

The Exploration Medical Capability Element of the NASA Human Research Program seeks to fuse new and existing technologies with practical mission goals into feasible and fiscally realizable human missions to the Moon and Mars. Expected communication delays with Earth-based medical experts will require unprecedented crew self-reliance to rapidly identify and treat anticipated and unforeseen medical conditions using constrained onboard resources with limited crew clinical skill. During this session, the current status of this project will be presented. We will discuss how current modes of decision support (e.g., alerts of critical values, reminders of overdue preventive health tasks, guided clinical workflows, advice for drug prescribing, critiques of existing health care orders, and suggestions for various active care issues) can be tailored to exploration crew needs.

human-system integration↗
NASA NTRSDate not supplied

Human System Risk Changes in 2021

The Human System Risk Board (HSRB) has the overall responsibility for tracking the evolution of the top ~30 human system risks that it has identified to be associated with human spaceflight. As part of this process, the Board is charged with maintaining a consistent, integrated process to mitigate those risks, and developing evidence-based risk posture recommendations. Risks are re-evaluated in a Continuous Risk Management (CRM) process. This session will summarize the risk posture changes that have occurred in the last year and what high level research, performance, and epidemiologic data have informed those changes. Human System Risks updated in 2021 include: Dynamic Loads, Sensorimotor, EVA, Crew Egress, Behavioral Medicine, Electrical Shock, Human System Integration Architecture (HSIA), Toxic Exposure, Bone Fracture, Cardiovascular, Medical Conditions, Renal Stone, CO2 Exposure, and Pharmacology.

Mary Van Baalen↗
NASA NTRSDate not supplied

Lessons Learned from Medical System Foundation Development for Long-Duration Lunar Orbit and Lunar Surface Missions

The Human Research Program (HRP) Exploration Medical Capability (ExMC) Element has been tasked with the development of Medical System Foundations for Level of Care IV for both short-duration lunar orbital missions and, subsequently, long-duration lunar orbital and surface operations missions. These Medical System Foundations serve as a framework to aid in early medical system design and mission planning. The content of both Foundation models is similar, consisting of a concept of operations, functional decomposition, clinical content (medical conditions, capabilities, and resources), technical requirements (interface, non-functional, and functional), and traces between these components and to the NASA standards documents and parent-level (Program- and Vehicle habitat system-level) requirements. Additionally, the development of both Foundations employed systems engineering principles and a model-based systems engineering (MBSE) approach. Throughout the development of these Foundations, ExMC has strived to improve the efficiency and robustness of its processes and to be more responsive to change (i.e., in design reference mission parameters and assumptions) and to stakeholders’ feedback. The most significant improvements made between the short- and long-duration Foundation models during this transformation process are the following: • Replacement of the traditional document-based ConOps with a model-based ConOps according to MBSE principles, which facilitated more efficient understanding of the material and the consolidation of all relevant information into a centralized location. • Utilization of an agile approach with tasks organized into sprints. This approach enabled solicitation of more frequent usability feedback from stakeholders, incorporation of more human factors reviews into the sprints, and more efficient tasking of team members. This presentation will discuss the journey of developing both Foundation models, as well as the lessons learned and resulting improvements made between the Short- and Long-Duration models.

M Kaetzer↗
NASA NTRS2023

Extravehicular Activity on the Lunar Surface: Mapping Mitigation Risk Consequence for Crew Needing Assistance or Rescue

The lunar environment offers unique challenges for human health and safety over the course of performing Extravehicular Activities (EVAs) during early Artemis missions. Driver medical conditions leading to an injured EVA crewmember needing assistance or rescue were analyzed and correlated to established, defined consequence categories. Catastrophic Drivers were identified, and three mitigation strategies were analyzed to determine if there was a potential change in consequence with their application. Risk consequence across the mitigations were compared with each other and the original risk without mitigations. Mitigations were further evaluated in a broader context with prospective preventions to understand the design and risk trade space associated with an early Artemis EVA.

Risk↗