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NASA NTRS2023

Enabling Human Space Exploration Missions Through Progressively Earth Independent Medical Operations (EIMO)

Goal: Current Space Medicine operations depend on terrestrial support to manage medical events. As astronauts travel to destinations such as the Moon, Mars, and beyond, distance will substantially limit this support and require increasing medical autonomy from the crew. This paper defines Earth Independent Medical Operations (EIMO) and identifies key elements of a conceptual EIMO system. Methods: The NASA Human Research Program Exploration Medical Capability Element held a 2-day conference at Johnson Space Center in Houston, TX with NASA experts representing all aspects of Space Medicine. Results: EIMO will be a process enabling progressively resilient deep space exploration systems and crews to reduce risk and increase mission success. Terrestrial assets will continue to provide pre-mission screening, planning, health maintenance, and prevention, while onboard medical care will increasingly be the purview of the crew. Conclusions: This paper defines and describes the key components of EIMO.

ExMC↗

NASA NTRSDate not supplied

Evaluation of Markerless Motion Capture for Monitoring Sensorimotor Performance

BACKGROUND Astronauts returning from long-duration exposure to microgravity frequently exhibit alterations in sensorimotor function leading to postural imbalance, impaired locomotion, and operational challenges to manual control. Mission duration and individual responses often influence both the severity of performance decrements and the variability in adaptation timelines. Postflight disruptions during functional tasks are often detected through body-worn inertial measurement unit (IMU) devices. While IMU sensors are relatively compact, the long-term wear may lead to discomfort, displacement of the sensors on the body, and restrictions in movement or crew behavior. Although IMU data offers valuable insights from a research standpoint, interpreting changes in pre- and post-flight measures can be difficult for crew support personnel beyond the research domain, which can hinder the application for medical assessments and rehabilitation. Finally, the availability of inertial sensors in-flight is limited. There is a need for unobtrusive monitoring tools to improve our ability to monitor adaptation following gravitational transitions in various postflight evaluations and rehabilitation settings. Markerless motion capture (MMC) is an evolving unobtrusive technology that builds upon decades of research with marker-based motion capture systems to provide 3D human pose estimation from multiple synchronized 2D camera views using deep learning algorithms. Markerless technology can revolutionize how data is captured pre- and post-flight and potentially in-flight during intravehicular activity by enabling pose estimation of multiple crew members from onboard camera hardware. METHODS The following presents the initial evaluation of a state-of-the-art commercial-off-the-shelf MMC system, Theia Markerless, compared to IMU devices during various ground-based functional tasks and environmental conditions. The featured functional tasks include assessments from Human Research Program (HRP) funded studies such as Sensorimotor Standard Measures and Sensorimotor Assessments. Synchronous data collected using both motion capture and IMUs are analyzed for six male and female subjects of varying anthropometry. The analysis includes limited assessments of clothing, capture volume configurations, and the tool's sensitivity to detecting performance changes after a spaceflight analog centrifuge exposure. The development of visualization tools to enhance the application of the pose estimation output is also presented. RESULTS Initial results demonstrate comparable root mean square error (RMSE) to existing literature evaluating markerless and marker-based motion capture systems. Considering the relative functional range of motion of the cervical spine, normalized error values for the markerless system’s accuracy of the head was 0.032 in pitch, 0.025 in roll, and 0.018 in yaw plane of motion across a subset of functional tasks. The raw RMSE values were 3.49, 2.25, and 2.81 degrees respectively. For the torso, results suggest normalized errors of 0.469 in pitch, 0.191 in roll, and 0.307 in yaw planes of motion and raw RMSE values of 3.52, 1.53, and 3.07 degrees respectively. The data suggests the functional demands of a particular task influences the estimation accuracy of the MMC system where more dynamic motion and cases where subjects are not upright may introduce diminished tracking accuracy. DISCUSSION The following work lays the foundation for future implementations leveraging markerless motion capture to assess the time course of recovery and provide insight for rehabilitation protocols to enhance crew readiness for the resumption of daily activities. These tools offer effective methods for anonymizing sensitive crew data, facilitating numerous applications across research, medical, and rehabilitation groups. Collaborations with the Anthropometry and Biomechanics Facility will provide further comparisons of the Markerless system to a marker-based system. ACKNOWLEDGEMENT</ This work is supported by NASA’s Exploration Systems Development Mission Directorate Mars Campaign Office Crew Health Countermeasures.

Hannah M. Weiss↗

NASA NTRSDate not supplied

Clinical Trials at NASA: What Makes A Clinical Trial & What Are the Requirements for International Partners?

ClinicalTrials.gov is a public registry designed to fulfill ethical obligations by providing information about clinical research studies to the general public, patients, medical practitioners and the research community. In the United States, recent revisions to human subject’s regulations have prompted new criteria for what constitutes a clinical trial along with requirements not typically requested for other types of human subject’s research. Identification of investigational clinical trials is the shared responsibility of NASA, the IRB, and the scientific investigators designing and conducting the research. This talk aims to educate attendees on the history of the development of Clinicaltrials.gov, discussion of why these requirements are important to both participants and researchers, and information on how to identify clinical trials research. In addition, we will provide information on the different requirements for clinical trials conducted at NASA or aboard the International Space Station.

Clinicaltrials.gov↗

NASA NTRS2006

Recommendations from NASA's Operational and Research Musculoskeletal Summit

Introduction: Continuously evolving medical standards of care, limited crew training time, and the inherent constraints of space flight necessitate regular revisions of the mission medical support infrastructure and methodology. A three-day Operational and Research Musculoskeletal Summit was held to review NASA s current strategy for preflight health maintenance and injury screening, risk mitigation for musculoskeletal injuries or syndromes, treatment methods during flight, and research topics to mitigate risks to astronaut health. The Summit also undertook consideration of the best evidence-based terrestrial musculoskeletal practices to recommend their adaptation for use in space. Methods: The types and frequencies of musculoskeletal injuries sustained by short- and long-duration astronauts were obtained from the Longitudinal Study of Astronaut Health. The Summit panel was comprised of experts from the clinical and research communities, as well as representatives from NASA Headquarters, the Astronaut corps, and the offices of JSC Medical Operations, JSC Human Adaptation and Countermeasures, Glenn Research Center Human Research, and Astronaut Strength Conditioning and Rehabilitation. Before the summit, panelists participated in a Web-based review of NASA s Space Medical Conditions List (SMCL). Results: The Summit generated seventy-five operational and research recommendations to the NASA Office of Space Medicine, including changes to the SMCL and to the musculoskeletal section of the ISS debrief questionnaire. From these recommendations, seven were assigned highest value and priority, and could be immediately adopted for the exploration architecture. Discussion: Optimized exercise and conditioning to improve performance and forestall musculoskeletal damage on orbit were the primary area of focus. Special attention was paid to exercise timing and muscle group specificity. The panel s recommendations are currently in various stages of consideration or integration into the ISS and Exploration programs. This effort serves to enhance the on-orbit system so comprehensive treatment can be delivered in a more effective and standardized manner.

Jones, J. A.↗

NASA NTRS2012

ExMC Technology Watch

The Technology Watch (Tech Watch) project is a NASA endeavor conducted under the Human Research Programs (HRP) Exploration Medical Capability (ExMC) element, and focusing on ExMC technology gaps. The project involves several NASA centers, including the Johnson Space Center (JSC), Glenn Research Center (GRC), Ames Research Center (ARC), and the Langley Research Center (LaRC). The objective of Tech Watch is to identify emerging, high-impact technologies that augment current NASA HRP technology development efforts. Identifying such technologies accelerates the development of medical care and research capabilities for the mitigation of potential health issues encountered during human space exploration missions. The aim of this process is to leverage technologies developed by academia, industry and other government agencies and to identify the effective utilization of NASA resources to maximize the HRP return on investment. The establishment of collaborations with these entities is beneficial to technology development, assessment and/or insertion and further NASAs goal to provide a safe and healthy environment for human exploration. In 2011, the major focus areas for Tech Watch included information dissemination, education outreach and public accessibility to technology gaps and gap reports. The dissemination of information was accomplished through site visits to research laboratories and/or companies, and participation at select conferences where Tech Watch objectives and technology gaps were presented. Presentation of such material provided researchers with insights on NASA ExMC needs for space exploration and an opportunity to discuss potential areas of common interest. The second focus area, education outreach, was accomplished via two mechanisms. First, several senior student projects, each related to an ExMC technology gap, were sponsored by the various NASA centers. These projects presented ExMC related technology problems firsthand to collegiate laboratories. Second, a RASC-AL (Revolutionary Aerospace Systems Concepts Academic Linkage) topic for FY12 was developed for medical systems and astronaut health under the Human-Focused Mars Mission Systems and Technologies theme. Announcement of the competition was made to the public in August 2011. Finally, critical Tech Watch information was prepared for public release in the form of gap reports. Complementing the ExMC technology gaps in the public domain, gap reports were generated, reviewed and revised through a series of technical, medical and subject matter expert reviews before approval for public release. An important vehicle for the public release of such documents was development of the ExMC wiki website, which will continue to be populated with gap reports and relevant documents throughout the upcoming year.

Krihak, M.↗

NASA NTRS2009

Human Factors in Training

Future space missions will be significantly longer than current shuttle missions and new systems will be more complex than current systems. Increasing communication delays between crews and Earth-based support means that astronauts need to be prepared to handle the unexpected on their own. As crews become more autonomous, their potential span of control and required expertise must grow to match their autonomy. It is not possible to train for every eventuality ahead of time on the ground, or to maintain trained skills across long intervals of disuse. To adequately prepare NASA personnel for these challenges, new training approaches, methodologies, and tools are required. This research project aims at developing these training capabilities. By researching established training principles, examining future needs, and by using current practices in space flight training as test beds, both in Flight Controller and Crew Medical domains, this research project is mitigating program risks and generating templates and requirements to meet future training needs. Training efforts in Fiscal Year 08 (FY08) strongly focused on crew medical training, but also began exploring how Space Flight Resource Management training for Mission Operations Directorate (MOD) Flight Controllers could be integrated with systems training for optimal Mission Control Center (MCC) operations. The Training Task addresses Program risks that lie at the intersection of the following three risks identified by the Project: (1) Risk associated with poor task design (2) Risk of error due to inadequate information (3) Risk associated with reduced safety and efficiency due to poor human factors design

Barshi, Immanuel↗

NASA NTRS2010

Human Factors in Training

Future space missions will be significantly longer than current shuttle missions and new systems will be more complex than current systems. Increasing communication delays between crews and Earth-based support means that astronauts need to be prepared to handle the unexpected on their own. As crews become more autonomous, their potential span of control and required expertise must grow to match their autonomy. It is not possible to train for every eventuality ahead of time on the ground, or to maintain trained skills across long intervals of disuse. To adequately prepare NASA personnel for these challenges, new training approaches, methodologies, and tools are required. This research project aims at developing these training capabilities. By researching established training principles, examining future needs, and by using current practices in space flight training as test beds, both in Flight Controller and Crew Medical domains, this research project is mitigating program risks and generating templates and requirements to meet future training needs. Training efforts in Fiscal Year 09 (FY09) strongly focused on crew medical training, but also began exploring how Space Flight Resource Management training for Mission Operations Directorate (MOD) Flight Controllers could be integrated with systems training for optimal Mission Control Center (MCC) operations. The Training Task addresses Program risks that lie at the intersection of the following three risks identified by the Project: 1) Risk associated with poor task design; 2) Risk of error due to inadequate information; and 3) Risk associated with reduced safety and efficiency due to poor human factors design.

Barshi, Immanuel↗

NASA NTRS2013

ExMC Technology Watch

The Technology Watch (Tech Watch) project is a NASA project that is operated under the Human Research Programs (HRP) Exploration Medical Capability (ExMC) element, and focuses on ExMC technology gaps. The project coordinates the efforts of several NASA centers, including the Johnson Space Center (JSC), Glenn Research Center (GRC), Ames Research Center (ARC), and the Langley Research Center (LaRC). The objective of Tech Watch is to identify emerging, high-impact technologies that augment current NASA HRP technology development efforts. Identifying such technologies accelerates the development of medical care and research capabilities for the mitigation of potential health issues encountered during human space exploration missions. The aim of this process is to leverage technologies developed by academia, industry and other government agencies and to identify the effective utilization of NASA resources to maximize the HRP return on investment. The establishment of collaborations with these entities is beneficial to technology development, assessment and/or insertion and further NASAs goal to provide a safe and healthy environment for human exploration. In 2012, the Tech Watch project expanded the scope of activities to cultivate student projects targeted at specific ExMC gaps, generate gap reports for a majority of the ExMC gaps and maturate a gap report review process to optimize the technical and managerial aspects of ExMC gap status. Through numerous site visits and discussions with academia faculty, several student projects were initiated and/or completed this past year. A key element to these student projects was the ability of the project to align with a specific ExMC technology or knowledge gap. These projects were mentored and reviewed by Tech Watch leads at the various NASA centers. Another result of the past years efforts was the population of the ExMC wiki website that now contains more the three quarters of the ExMC gap reports. The remaining gap reports will be completed in FY13. Finally, the gap report review process for all ExMC gaps was initiated. This review process was instrumental in ensuring that each gap report was thoroughly reviewed for accuracy and relevant content prior to its public release. In the upcoming year, the gap report review process will be refined such that in addition to the gap report update, programmatic information related to gap closure will also be emphasized.

Krihak, M.↗

NASA NTRS2014

ExMC Technology Watch

The Technology Watch (Tech Watch) project is directed by the NASA Human Research Programs (HRP) Exploration Medical Capability (ExMC) element, and primarily focuses on ExMC technology gaps. The project coordinates the efforts of multiple NASA centers, including the Johnson Space Center (JSC), Glenn Research Center (GRC), Ames Research Center (ARC), and the Langley Research Center (LaRC). The objective of Tech Watch is to identify emerging, high-impact technologies that augment current NASA HRP technology development efforts. Identifying such technologies accelerates the development of medical care and research capabilities for the mitigation of potential health issues encountered during human space exploration missions. The aim of this process is to leverage technologies developed by academia, industry and other government agencies and to identify the effective utilization of NASA resources to maximize the HRP return on investment. The establishment of collaborations with these entities is beneficial to technology development, assessment and/or insertion, and advance NASAs goal to provide a safe and healthy environment for human exploration. In fiscal year 2013, the Tech Watch project maintained student project activity aimed at specific ExMC gaps, completed the gap report review cycle for all gaps through a maturated gap report review process, and revised the ExMC Tech Watch Sharepoint site for enhanced data content and organization. Through site visits, internships and promotions via aerospace journals, several student projects were initiated and completed this past year. Upon project completion, the students presented their results via telecom or WebEx to the ExMC Element as a whole. The upcoming year will continue to forge strategic alliances and student projects in the interest of technology and knowledge gap closure. Through the population of Sharepoint with technologies assessed by the gap owners, the database expansion will develop a more comprehensive technology set for each gap. By placing such data in Sharepoint, the gap report updates in fiscal year 2014 are anticipated to be streamlined since the evaluated technologies will be readily available to the gap owners in a sortable archive, and may be simply exported into the final gap report presentation.

Technology gaps↗

NASA NTRS2023

Exploration Medical Capability Clinical Decision Support System Architecture Recommendation

A new era in space exploration has arrived with the goal of establishing a long-term presence on the Moon and using those learning to take the next giant leap: sending the first astronauts to Mars. These ambitious goals will require significant changes in in-flight medical care due to constraints on mass, volume, power, crew time, and medical evacuation capabilities. Furthermore, while crews currently rely on real-time communications with ground-based medical providers, as distance from Earth increases, so do communication delays and disruptions. The crew will need to autonomously detect, diagnose, treat, and prevent medical events. These constraints require development of transformative solutions and new technologies. Through participation in the Human Research Program’s (HRP) Exploration Medical Capability (ExMC) research, NASA has developed and demonstrated a Medical Data Architecture (MDA), a platform upon which a robust capability of Clinical Decision Support (CDS) can be built. As a result, NASA is now positioned to build an advanced autonomous CDS System (CDSS) which will aid in crew health decision-making. The CDSS combines data management aspects of a system that would lead to the autonomy required by NASA-STD-3001, Section 3, Health and Medical Care Standards. The project addresses the ExMC gap Medical-701: We need to increase inflight medical capabilities and identify new capabilities that (a) maximize benefit and/or (b) reduce “costs” on human system/mission/vehicle resources. This architecture recommendation document introduces an integrated data architecture that provides self-sufficient medical care for crews on long-duration spaceflight missions.

ExMC↗

NASA NTRS1978

Medical Image Analysis Facility

To improve the quality of photos sent to Earth by unmanned spacecraft. NASA's Jet Propulsion Laboratory (JPL) developed a computerized image enhancement process that brings out detail not visible in the basic photo. JPL is now applying this technology to biomedical research in its Medical lrnage Analysis Facility, which employs computer enhancement techniques to analyze x-ray films of internal organs, such as the heart and lung. A major objective is study of the effects of I stress on persons with heart disease. In animal tests, computerized image processing is being used to study coronary artery lesions and the degree to which they reduce arterial blood flow when stress is applied. The photos illustrate the enhancement process. The upper picture is an x-ray photo in which the artery (dotted line) is barely discernible; in the post-enhancement photo at right, the whole artery and the lesions along its wall are clearly visible. The Medical lrnage Analysis Facility offers a faster means of studying the effects of complex coronary lesions in humans, and the research now being conducted on animals is expected to have important application to diagnosis and treatment of human coronary disease. Other uses of the facility's image processing capability include analysis of muscle biopsy and pap smear specimens, and study of the microscopic structure of fibroprotein in the human lung. Working with JPL on experiments are NASA's Ames Research Center, the University of Southern California School of Medicine, and Rancho Los Amigos Hospital, Downey, California.

Source record↗

NASA NTRS2011

Exploration Medical Capability - Technology Watch

The objectives of the Technology Watch process are to identify emerging, high-impact technologies that augment current ExMC development efforts, and to work with academia, industry, and other government agencies to accelerate the development of medical care and research capabilities for the mitigation of potential health issues that could occur during space exploration missions. The establishment of collaborations with these entities is beneficial to technology development, assessment and/or insertion. Such collaborations also further NASA s goal to provide a safe and healthy environment for human exploration. The Tech Watch project addresses requirements and capabilities identified by knowledge and technology gaps that are derived from a discrete set of medical conditions that are most likely to occur on exploration missions. These gaps are addressed through technology readiness level assessments, market surveys, collaborations and distributed innovation opportunities. Ultimately, these gaps need to be closed with respect to exploration missions, and may be achieved through technology development projects. Information management is a key aspect to this process where Tech Watch related meetings, research articles, collaborations and partnerships are tracked by the HRP s Exploration Medical Capabilities (ExMC) Element. In 2011, ExMC will be introducing the Tech Watch external website and evidence wiki that will provide access to ExMC technology and knowledge gaps, technology needs and requirements documents.

Krihak, Michael↗

NASA NTRS2017

Medical Optimization Network for Space Telemedicine Resources

INTRODUCTION: Long-duration missions beyond low Earth orbit introduce new constraints to the space medical system such as the inability to evacuate to Earth, communication delays, and limitations in clinical skillsets. NASA recognizes the need to improve capabilities for autonomous care on such missions. As the medical system is developed, it is important to have an ability to evaluate the trade space of what resources will be most important. The Medical Optimization Network for Space Telemedicine Resources was developed for this reason, and is now a system to gauge the relative importance of medical resources in addressing medical conditions. METHODS: A list of medical conditions of potential concern for an exploration mission was referenced from the Integrated Medical Model, a probabilistic model designed to quantify in-flight medical risk. The diagnostic and treatment modalities required to address best and worst-case scenarios of each medical condition, at the terrestrial standard of care, were entered into a database. This list included tangible assets (e.g. medications) and intangible assets (e.g. clinical skills to perform a procedure). A team of physicians working within the Exploration Medical Capability Element of NASA's Human Research Program ranked each of the items listed according to its criticality. Data was then obtained from the IMM for the probability of occurrence of the medical conditions, including a breakdown of best case and worst case, during a Mars reference mission. The probability of occurrence information and criticality for each resource were taken into account during analytics performed using Tableau software. RESULTS: A database and weighting system to evaluate all the diagnostic and treatment modalities was created by combining the probability of condition occurrence data with the criticalities assigned by the physician team. DISCUSSION: Exploration Medical Capabilities research at NASA is focused on providing a medical system to support crew medical needs in the context of a Mars mission. MONSTR is a novel approach to performing a quantitative risk analysis that will assess the relative value of individual resources needed for the diagnosis and treatment of various medical conditions. It will provide the operational and research communities at NASA with information to support informed decisions regarding areas of research investment, future crew training, and medical supplies manifested as part of the exploration medical system.

Shah, R. V.↗

NASA NTRSDate not supplied

Exploration Medical Capability - Advancing Medical System Design and Risk-Informed Decision Making for Deep Space Exploration

BACKGROUND: Within NASA’s Human Research Program, the Exploration Medical Capability (ExMC) Element has three primary focus areas: clinical and scientific research, systems engineering and trade space analysis, and technology development and demonstrations. These focus areas feed into the overarching goal of enabling progressively Earth-Independent Medical Operations (EIMO), a new paradigm that will be necessary for future Artemis and Mars medical and vehicle systems. This EIMO end state aligns with NASA’s Moon to Mars Objectives, which clearly outline the need for NASA deep space exploration missions to reduce their reliance upon Earth and become increasingly autonomous, in preparation for the first human Mars mission. OVERVIEW: To advance exploration medical systems and ultimately, integrated crew health and performance systems, ExMC’s portfolio includes: funding ground development & testing of novel medical capabilities; creation of new approaches for the development of medical protocols and procedures; deployment of innovative technologies into analog environments; technology demonstrations in spaceflight; and eventual transition to operations of new capabilities for deep space exploration missions. The portfolio also includes: pharmaceutical research targeting stability, pharmacokinetics, and pharmacodynamics; integrated data architectures and clinical decision support tools; and systems engineering and trade space analysis tools to assist NASA in the development of future medical system models as well as the medical system requirements that can serve as a foundation for deep space exploration missions. All of these investments are done in a collaborative and coordinated fashion with other NASA stakeholders, such as the Environmental Control and Life Support Systems – Crew Health and Performance System Capability Leadership Team and the Health and Medical Technical Authority. DISCUSSION: In this presentation, ExMC will provide an overview of our work from across our portfolio, all of which will inform future EIMO efforts at NASA. ExMC’s research and development investments are targeted to reduce the human system risks associated with deep space exploration to the Moon and Mars.

Kris Lehnhardt↗

NASA NTRS2018

Introduction to Medical Extensible Dynamic Probabilistic Risk Assessment Tool (MEDPRAT)

A key component in the development of NASA Human Research Programs (HRP) next generation risk model, the Medical Extensible Dynamic Probabilistic Risk Assessment Tool (MEDPRAT) intends to deliver a means to quantify how HRP products impact astronaut medical and health risks. MEDPRAT is extensible to the majority of exploration missions. Similar to other risk models, the tool utilizes the available space and terrestrial medical data. MEDPRAT is designed to be extended with additional human health research information, medical equipment, space and terrestrial standards and practices to assess space flight medical risk in a manner consistent with other risk measures used in spacecraft and mission design. This tool provides risk-based medical system design information necessary to evaluate new technologies, procedures, research insights and mission plans.

physiological response↗

NASA NTRS2018

Validation of the Nasa Integrated Medical Model: a Space Flight Medical Risk Prediction Tool

The Human Research Program funded the development of the Integrated Medical Model (IMM) to quantify the medical component of overall mission risk. The IMM uses Monte Carlo simulation methodology, incorporating space flight and ground medical data, to estimate the probability of mission medical outcomes and resource utilization. To determine the credibility of IMM output, the IMM project team completed two validation studies that compared IMM predicted output to observed medical events from a selection of Shuttle Transportation System (STS) and International Space Station (ISS) missions. The validation study results showed that the IMM underpredicted the occurrence of ~10% of the modeled medical conditions for the STS missions and overpredicted ~20% of the modeled medical conditions for the ISS missions. These findings imply that the strength of IMM predictions to inform decisions depends on simulated mission specifications including length. This discrepancy could result from medical recording differences between ISS and STS that possibly influence observed incidence rates, IMM combining all "mission type" data as constant occurrence rate or fixed proportion across both mission types, misspecification of symptoms to conditions, and gaps in the literature informing the model. Some of these issues will be alleviated by updating the IMM source data through incorporation of the observed validation data.

medical equipment↗

NASA NTRS2018

Validation of the NASA Integrated Medical Model: a Space Flight Medical Risk Prediction Tool

risk assessment↗

NASA NTRS2020

Dynamic Medical Risk Assessment Supported by Inference Networks

The Human Research Program's next generation risk model, the Medical Extensible Dynamic Probabilistic Risk Assessment Tool (MEDPRAT), provides researchers with estimates of astronaut medical and health risk. MEDPRATs Susceptibility Inference Network (SIN) facilitates the dynamic component of this tool. The SIN provides MEDPRAT with a "memory" that allows the system to use knowledge of what simulation events have occurred to alter the representative probability that future simulation events will occur during a given trial. The SIN allows for the medical events being simulated to be related to, and influence the likelihood of one another, providing a more robust risk estimate. We present initial work of our efforts to mathematically quantify and represent these dependent relationships between medical events.

McIntyre, L.↗