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Medical Optimization Network for Space Telemedicine Resources

INTRODUCTION: Long-duration missions beyond low Earth orbit introduce new constraints to the space medical system. Beyond the traditional limitations in mass, power, and volume, consideration must be given to other factors such as the inability to evacuate to Earth, communication delays, and limitations in clinical skillsets. As NASA develops the medical system for an exploration mission, it must have an ability to evaluate the trade space of what resources will be most important. The Medical Optimization Network for Space Telemedicine Resources (MONSTR) was developed over the past year for this reason, and is now a system for managing data pertaining to medical resources and their relative importance when addressing medical conditions. METHODS: The MONSTR web application with a Microsoft SQL database backend was developed and made accessible to Tableau v9.3 for analysis and visualization. The database was initially populated with a list of medical conditions of concern for an exploration mission taken from the Integrated Medical Model (IMM), a probabilistic model designed to quantify in-flight medical risk. A team of physicians working within the Exploration Medical Capability Element of NASA's Human Research Program compiled a list diagnostic and treatment medical resources required to address best- and worst-case scenarios of each medical condition using a terrestrial standard of care and entered this data into the system. This list included both tangible resources (e.g. medical equipment, medications) and intangible resources (e.g. clinical skills required to perform a procedure). The physician team then assigned criticality values to each instance of a resource, representing the importance of that resource to diagnosing or treating its associated condition(s). Medical condition probabilities of occurrence during a Mars mission were pulled from the IMM and imported into the MONSTR database for use within a resource criticality-weighting algorithm. DISCUSSION: The MONSTR tool is a novel approach to assess the relative value of individual resources needed for the diagnosis and treatment of medical conditions. Future work will add resources for prevention and long term care of these conditions. Once data collection is complete, MONSTR 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 any exploration medical system.

Rubin, D.↗

Developing Mission Segment-Specific Clinical Data for Impact

Space exploration missions represent a significant future objective for NASA’s human spaceflight operations for the near and long term. By operating missions during longer periods and over further distances, NASA’s mission planning models, hardware systems, and medical capabilities will be stretched beyond their original design constraints. The necessity of medical training and medical supply manifesting for such missions is likely to become incredibly intricate as trade-space analysis is performed over varying mission profiles. For this purpose, IMPACT was created to extend and improve the Integrated Medical Model (IMM) which is used for International Space Station (ISS) medical predications and consists of a probabilistic risk assessment tool that simulates missions to calculate risks given the constraints on crew complement, mission duration and activity (such as Extravehicular Activities), power, communication, mass, volume, and evacuation consideration as well as to predict mission outcomes. Currently, the medical evidence used to support IMPACT remains static, addressing risks of a medical condition and the impacts of the condition during spaceflight only, but is only calculated for a small number of mission parameters. Extended missions will consist of new and varied living environments, changing gravitational loads, and dynamic working requirements. Medical risks are not typically constant but will change depending upon the physical and physiological environment of the body during all phases of a mission. Risks are likely to shift during different mission segments, and understanding how components of a mission profile change risks will assist mission planners to increase chances for mission success.

Christopher Zahner↗

Designing a Composable Geometric Toolkit for Versatility in Applications to Simulation Development

Conceived and implemented through the development of probabilistic risk assessment simulations for Project Constellation, the Geometric Toolkit allows users to create, analyze, and visualize relationships between geometric shapes in three-space using the MATLAB computing environment. The key output of the toolkit is an analysis of how emanations from one "source" geometry (e.g., a leak in a pipe) will affect another "target" geometry (e.g., another heat-sensitive component). It can import computer-aided design (CAD) depictions of a system to be analyzed, allowing the user to reliably and easily represent components within the design and determine the relationships between them, ultimately supporting more technical or physics-based simulations that use the toolkit. We opted to develop a variety of modular, interconnecting software tools to extend the scope of the toolkit, providing the capability to support a range of applications. This concept of simulation composability allows specially-developed tools to be reused by assembling them in various combinations. As a result, the concepts described here and implemented in this toolkit have a wide range of applications outside the domain of risk assessment. To that end, the Geometric Toolkit has been evaluated for use in other unrelated applications due to the advantages provided by its underlying design.

Reed, Gregory S.↗

Medical Database Accomplishments and Lessons Learned - 2021

The Medical Database (MD) is a virtual repository consisting of two software components: the Medical Item Database (MedID) and the Evidence Library (EL). MedID consists of engineering data and associated information for specific medical resource items (e.g., pharmaceutical, medical devices, and supporting components), while the EL is a tool which provides all of the medical evidence necessary. The Medical Database will serve as the single “source of truth” for the Informing Mission Planning via Analysis of Complex Tradespaces (IMPACT) tool suite for both medical evidence and medical resource engineering data. It will be used in conjunction with the IMPACT tool suite to inform research prioritizations and perform systematic trade study evaluations using probabilistic risk assessment and simulated human spaceflight missions to aid stakeholders in making informed decisions during Pre-Phase-A planning of human spaceflight missions. The IMPACT project is conducted under the Exploration Medical Capability (ExMC) element of the Human Research Program (HRP), within NASA’s Human Exploration and Operations Mission Directorate. Over the past year, the MedID software has been successfully merged with the Evidence Library into one cohesive Medical Database with two independent user interface experiences for modifying either clinical evidence or resource engineering data. As MD has evolved substantially over the past year, a number of challenges have been encountered and overcome along the way. A number of ‘lessons learned’ and practical/logistical realizations have emerged which will be detailed in the forthcoming Medical Database presentation.

Exploration Medical Capability↗

Quantifying the Sensitivity of Condition Incidence Parameters in the Evidence Library

One approach to quantifying spaceflight risk at NASA makes use event driven probabilistic techniques. The Medical Extensible Dynamic Probabilistic Risk Assessment Tool (MEDPRAT) is such a tool that estimates medical risk metrics via simulation and enables optimization of medical resources subject to mission constraints [1]. Previous analyses have informed medical set composition, exercise countermeasures, and water intake, where each analysis quantifies the risk associated with proposed variations in system design. As future mission profiles extend beyond Low-Earth Orbit (LEO) and lengthen in duration, understanding these risks and contributing factors is critical. MEDPRAT employs Monte Carlo sampling techniques to simulate missions and track the occurrence of medical events. These events follow fault-tree-like progressions through levels of severity and mitigation via medical treatment to many possible outcomes and these are reported throughout the mission. Making this possible, are the medical databases that contain evidence gathered by the Human Research Program (HRP). Quantifying the impact of uncertainty or variability in the input data is an important step in evaluating the credibility of modeling and simulation results. In this work, we investigate the sensitivity of medical risk metrics with respect to the condition incidence parameters within the Evidence Library (EL) [2] as the medical database input for MEDPRAT. The medical conditions, contained in the EL, are equipped with incidence rates that describe the likelihood that the condition will occur. These incidence rates reflect historical spaceflight data or when appropriate, terrestrial data. In this presentation, we will explore how uncertainty in these rates propagate to the medical risk described by MEDPRAT. These results identify the conditions and parameters with the largest contribution to medical risks.

Ian Lim↗

Space Shuttle Main Engine Implications for the Abort-to-Orbit Off-the-Pad Study

In 2001, the Space Shuttle Main Engine (SSME) project office was contacted by the Space Shuttle Ascent Guidance, Navigation, and Control group to provide the engine perspective for an Abort-to-Orbit (ATO) study. The purpose of the AT0 Off-the-Pad study was to determine the feasibility of eliminating the Return to Launch Site and Transatlantic abort modes by using a five-segment solid rocket booster and throttling the remaining SSMEs to a higher power level. This would enable all abort modes to be Abort-to-Orbit. The SSME project office at Marshall Space Flight Center collaborated with MSFC's Space Transportation Directorate and Rocketdyne Propulsion and Power to provide the AT0 Off-the-Pad study with the analysis required. Power levels at 109%, 1 11% and 1 13% of rated power level were studied as well as mixture ratio decreases down to 5.85. SSME was to evaluate and define the technical and programmatic impacts to certify the SSME to these abort power levels. The SSME systems analysis group performed a steady state analysis using the SSME power balance model to determine if there were any technical issues associated with higher power level, low mixture ratio operation. Based on each power level/mixture ratio combination, an engine certification plan was created and a preliminary probabilistic risk assessment was performed. The results showed favorable results for higher power 1evel/lower mixture ratio SSME operation. In nearly all performance and redline parameters, the traded engine operation was encompassed by nominal engine performance of a prior engine configuration.

Schoffstoll, Dayna L.↗

A Pilot Project for Quantifying the Effect of Medical Provider Knowledge, Skills, and Abilities on Outcomes for Spaceflight Using a Probabilistic Risk Assessment Tool

In order to enable the future of long-duration deep space exploration we must confront the uncertainty in medical risk. Limitations of communication, resupply, and evacuation in deep space will require a high degree of crew autonomy and accurate risk assessment will be critical to ensure adequate crew training and medical system design. To address this, NASA’s Human Research Program Exploration Medical Capability Element has developed the Informing Mission Planning via Analysis of Complex Tradespaces Tool (IMPACT). IMPACT is a suite of tools that can provide evidence-based, data-driven trade space assessments between available medical resources in the mass- and volume-constrained environment of a deep space exploration vehicle. In the current model, medical conditions either can or cannot be treated based on the availability of medical system resources and equipment. However, medical outcomes often depend just as much on the knowledge, skills, and abilities (KSA) of the provider operating the system. This paper presents a method for modeling and quantifying the effect of medical officer KSA on medically relevant mission risk outcomes during spaceflight.

capabilities↗

Structural dynamics: Probabilistic structural analysis methods. Program overview

A brief description is provided of the fundamental aspects of a quantification process. Progress since the last structural durability conference in 1989 is summarized. The methodology to date and that to be developed during the life of the program is presented. The uncertain factors are presented. The approach is outlined that is required to achieve component and/or system certification in the shortest possible time for affordable reliability risk. Two new elements appear in a block diagram: (1) uncertainties in human factor, and (2) uncertainties in the computer code. Research to quantify the uncertainties in the human factor was initiated and is discussed.

Chamis, Christos C.↗

IMPACT - Information for the Development of Human Health and Performance Systems

IMPACT is a suite of computational and systems engineering tools. Currently being developed for NASA Exploration Medical Capabilities (ExMC) and could be extended to other Human Research Program (HRP) elements. The purpose is to provide a data-driven means to inform human health and performance risk mitigation during exploration missions considering resource constraints in the medical system. IMPACT enables systematic trade studies to evaluate options. IMPACT uses Probabilistic Risk Assessment (PRA) as a systematic methodology to evaluate risks. IMPACT is currently under development to inform decision-makers the risks involved with trade-options that have likelihoods and consequences backed by scientific research in a medical evidence library. IMPACT supports multi-segment analysis to determine probabilities and risks in different mission segments. There are currently 122 medical conditions and 900 resources in the IMPACT Medical Database. IMPACT modeling is using mission segments and multiple vehicles for the NASA Artemis campaign and could support future complex missions in deep space.

IMPACT PRA↗

Probabilistic Modeling Of Ocular Biomechanics In VIIP: Risk Stratification

Visual Impairment and Intracranial Pressure (VIIP) syndrome is a major health concern for long-duration space missions. Currently, it is thought that a cephalad fluid shift in microgravity causes elevated intracranial pressure (ICP) that is transmitted along the optic nerve sheath (ONS). We hypothesize that this in turn leads to alteration and remodeling of connective tissue in the posterior eye which impacts vision. Finite element (FE) analysis is a powerful tool for examining the effects of mechanical loads in complex geometries. Our goal is to build a FE analysis framework to understand the response of the lamina cribrosa and optic nerve head to elevations in ICP in VIIP. To simulate the effects of different pressures on tissues in the posterior eye, we developed a geometric model of the posterior eye and optic nerve sheath and used a Latin hypercubepartial rank correlation coef-ficient (LHSPRCC) approach to assess the influence of uncertainty in our input parameters (i.e. pressures and material properties) on the peak strains within the retina, lamina cribrosa and optic nerve. The LHSPRCC approach was repeated for three relevant ICP ranges, corresponding to upright and supine posture on earth, and microgravity [1]. At each ICP condition we used intraocular pressure (IOP) and mean arterial pressure (MAP) measurements of in-flight astronauts provided by Lifetime Surveillance of Astronaut Health Program, NASA Johnson Space Center. The lamina cribrosa, optic nerve, retinal vessel and retina were modeled as linear-elastic materials, while other tissues were modeled as a Mooney-Rivlin solid (representing ground substance, stiffness parameter c1) with embedded collagen fibers (stiffness parameters c3, c4 and c5). Geometry creationmesh generation was done in Gmsh [2], while FEBio was used for all FE simulations [3]. The LHSPRCC approach resulted in correlation coefficients in the range of 1. To assess the relative influence of the uncertainty in an input parameter on the peak strains, we ranked and then normalized these coefficients, considering that normalized values 0.5 implied a substantial influence on the range of the peak strains in the optic nerve head (ONH). IOP and ICP were found to have a major influence on the peak strains in the ONH, as did optic nerve and LC stiffness. Interestingly, the stiffness of the sclera far from the scleral canal did not have a large influence on peak strains in ONH tissues; however, the collagen fiber stiffness in the peripapillary sclera and annular ring both influenced the peak strains within the ONH. We have created a physiologically relevant model that incorporated collagen fibers to study the effects of elevated ICP. Elevated ICP resulted in strains in the optic nerve that are not predicted to occur on earth: the upright or supine conditions. We found that IOP, ICP, lamina cribrosa stiffness and optic nerve stiffness had the highest association with these extreme strains in the ONH. These extreme strains may activate mechanosensitive cells that induce tissue remodeling and are a risk factor for the development of VIIP.

biomechanics↗

Preliminary Approach to Assess the Seismic Hazard on a Lunar Site

The passive seismic network deployed on the Moon during the Apollo missions operated for eight years and allowed the observation of seismic activity. More than 12500 seismic events were registered, where 28 were classified as shallow moonquakes with moment magnitudes up to 4.1. Seismic events of this nature pose a significant risk to future long-term lunar habitats; thus, these events must be carefully studied and considered in the seismic design of these structures. This paper proposes a preliminary seismic hazard assessment imposed by shallow moonquakes. The hazard assessment is performed using the Probabilistic Seismic Hazard Analysis (PSHA) methodology, considering previous studies and theories regarding the seismic environment of the Moon. The study zone covers ~860 km2 of the Taurus-Littrow Valley, containing the Apollo 17 landing site and the Lee-Lincoln lobate scarp as the considered seismic source. The seismic hazard is quantified in terms of peak ground acceleration (PGA) and spectral acceleration (5% damped pseudo-acceleration, PSA). Seismic hazard deaggregation scenarios, Uniform Hazard Spectra (UHS) for different hazard levels, and a Conditional Mean Spectrum (CMS) for a target period of 0.2 s are obtained to quantify the seismic hazard on a specific site on the Moon. The developed seismic hazard assessment provides a preliminary approach for realistic scenarios to conduct structural designs that ensure the seismic performance of fully operational long-term lunar structures.

Moonquake↗

Probabalistic Risk Analysis and Thermal Margin Process for an Inflatable Aeroshell

Uncertainties always exist in atmospheric entry aeroheating environments and the thermal response of thermal protection system (TPS) material. These uncertainties are mitigated in the design by ap-plying margin and factors of safety to the TPS. Entry vehicle TPS is often conservatively over-sized for the heat loads that are experienced along the entry trajectory by stacking worst-case scenarios together. Additionally, the current TPS design and margin process used by NASA offers very little insight into the risk of over-temperature during flight and the reliability of the heat shield performance [1,3]. A probabilistic margin process can be used to calculate the amount of TPS margin necessary to survive a given entry heat load at a specified level of risk [2,3,4]. The vehicle’s initial entry state (entry velocity, flight path angle, and entry mass) determines the expected atmospheric entry environmental conditions and resulting heat load that the entry vehicle will experience. If there is flexibility in the entry state, then this process can be used to select an appropriate combination of entry state parameters and TPS size to target a desired reentry reliability. This probabilistic margin process allows engineers to make informed aeroshell design, entry-trajectory design, and TPS performance risk trades while preventing excessive TPS margin from being applied. The probabilistic TPS margin process has been performed to determine TPS thickness and entry heating constraints given an acceptable risk level for the Low Earth Orbit Flight Experiment of an Inflatable Decelerator (LOFTID) flight project. The process is used in a manner to size the entry heat load for a given flexible TPS (FTPS) thickness so that it meets project reliability standards while allowing the FTPS and the underlying inflatable structure (IS) to be pushed to adequately high temperatures. Since the LOFTID project is an experimental flight demonstration, it is de-sired to drive the FTPS and IS to temperatures that cover a large range of their thermal response models’ applicability. This will allow the thermal response models to be better improved and validated post-flight using LOFTID’s extensive instrumentation embedded within the aeroshell. The presentation demonstrates how uncertainty analysis is carried out using an end-to-end Monte Carlo process where three separate Monte Carlo simulations are run in sequence. The first Monte Carlo simulation operates on the entry trajectory model to generate trajectory parameter dispersions that are fed into the second Monte Carlo simulation. The second Monte Carlo simulation operates on the aerothermodynamics model to generate aeroheating parameter dispersions that are fed into the third Monte Carlo simulation. The third Monte Carlo simulation operates on the FTPS material thermal response model to generate the final FTPS/IS thermal response dispersions. The end-to-end Monte Carlo simulation propagates the uncertainties of each model into the next to quantify the resulting uncertainty of the FTPS/IS thermal response. The fractional contributions of the uncertain parameters in the trajectory, aerothermal, and thermal response models to the variance in the FTPS/IS thermal response is determined as a byproduct of the Monte Carlo analysis. The structural uncertainty of the FTPS thermal response model is evaluated by flight relevant ground testing and model error analysis using test measurements. This probabilistic TPS margin process had never been applied to an entry vehicle and it is one of the LOFTID project’s goals to demonstrate its merits.

Steven A. Tobin↗

An Extreme-Value Approach to Anomaly Vulnerability Identification

The objective of this paper is to present a method for importance analysis in parametric probabilistic modeling where the result of interest is the identification of potential engineering vulnerabilities associated with postulated anomalies in system behavior. In the context of Accident Precursor Analysis (APA), under which this method has been developed, these vulnerabilities, designated as anomaly vulnerabilities, are conditions that produce high risk in the presence of anomalous system behavior. The method defines a parameter-specific Parameter Vulnerability Importance measure (PVI), which identifies anomaly risk-model parameter values that indicate the potential presence of anomaly vulnerabilities, and allows them to be prioritized for further investigation. This entails analyzing each uncertain risk-model parameter over its credible range of values to determine where it produces the maximum risk. A parameter that produces high system risk for a particular range of values suggests that the system is vulnerable to the modeled anomalous conditions, if indeed the true parameter value lies in that range. Thus, PVI analysis provides a means of identifying and prioritizing anomaly-related engineering issues that at the very least warrant improved understanding to reduce uncertainty, such that true vulnerabilities may be identified and proper corrective actions taken.

Everett, Chris↗

Investigating Risks Due to Artemis EVA Tempo Via Probabilistic Risk Assessment

Spaceflight operations pose unique challenges to crew health, safety, and resource management. As space agencies and private companies continue to push the boundaries of human exploration, it is essential to understand the risks associated with Extravehicular Activities (EVAs) and develop strategies to mitigate them. The tempo at which EVAs are conducted – the total number and frequency of these activities – can have a profound impact on medical risks, resource consumption, and overall mission success. Probabilistic risk assessment (PRA) provides a powerful framework for evaluating complex systems and identifying potential hazards. Our work employs the Medical Extensible Dynamic Probabilistic Risk Assessment Tool (MEDPRAT) [1] to simulate mission events, occurrence and treatment of medical conditions, and track the utilization of resources. Coupled with the Evidence Library [2], a medical evidence base for exploration-class missions developed by the Exploration Medical Capability within NASA’s Human Research Program, we can estimate these risks with increased fidelity and optimize medical kit contents to meet specific mission requirements. This presentation provides a detailed examination of how EVA tempo influences medical risk estimates for a lunar surface design reference mission. A comprehensive analysis is conducted to assess the additional mass and volume burden imposed on medical kits required to maintain adequate levels of risk mitigation. Furthermore, we estimate the distribution of the number of successful EVAs completed based on the level of task impairment imposed by medical events and flight rules related to specific medical events, such as decompression sickness.

Modeling↗

A Comprehensive Reliability Methodology for Assessing Risk of Reusing Failed Hardware Without Corrective Actions with and Without Redundancy

This paper deals with the development of a reliability methodology to assess the consequences of using hardware, without failure analysis or corrective action, that has previously demonstrated that it did not perform per specification. The subject of this paper arose from the need to provide a detailed probabilistic analysis to calculate the change in probability of failures with respect to the base or non-failed hardware. The methodology used for the analysis is primarily based on principles of Monte Carlo simulation. The random variables in the analysis are: Maximum Time of Operation (MTO) and operation Time of each Unit (OTU) The failure of a unit is considered to happen if (OTU) is less than MTO for the Normal Operational Period (NOP) in which this unit is used. NOP as a whole uses a total of 4 units. Two cases are considered. in the first specialized scenario, the failure of any operation or system failure is considered to happen if any of the units used during the NOP fail. in the second specialized scenario, the failure of any operation or system failure is considered to happen only if any two of the units used during the MOP fail together. The probability of failure of the units and the system as a whole is determined for 3 kinds of systems - Perfect System, Imperfect System 1 and Imperfect System 2. in a Perfect System, the operation time of the failed unit is the same as that of the MTO. In an Imperfect System 1, the operation time of the failed unit is assumed as 1 percent of the MTO. In an Imperfect System 2, the operation time of the failed unit is assumed as zero. in addition, simulated operation time of failed units is assumed as 10 percent of the corresponding units before zero value. Monte Carlo simulation analysis is used for this study. Necessary software has been developed as part of this study to perform the reliability calculations. The results of the analysis showed that the predicted change in failure probability (P(sub F)) for the previously failed units is as high as 49 percent above the baseline (perfect system) for the worst case. The predicted change in system P(sub F) for the previously failed units is as high as 36% for single unit failure without any redundancy. For redundant systems, with dual unit failure, the predicted change in P(sub F) for the previously failed units is as high as 16%. These results will help management to make decisions regarding the consequences of using previously failed units without adequate failure analysis or corrective action.

Putcha, Chandra S.↗

PROBABALISTIC RISK ANALYSIS AND THERMAL MARGIN PROCESS FOR AN INFLATABLE AEROSHELL

Atmospheric entry vehicle thermal protection systems (TPS) are margined due to the uncertainties that exist in entry aeroheating environments and the thermal response of the materials and structures. Traditional approaches typically over-margin TPS and offer very little insight into the risk of over-temperature during flight. A probabilistic margin process can be used to apply thermal margin to an aeroshell based on a rigorously calculated risk of failure. This probabilistic margin process allows engineers to make informed aeroshell design, entry-trajectory modifications, and risk trades while preventing excessive margin from being applied. This methodology can also be applied to other TPS applications, hot structures, and other engineering disciplines.

Steven A Tobin↗

Process-Based Cost Estimation for Ramjet/Scramjet Engines

Process-based cost estimation plays a key role in effecting cultural change that integrates distributed science, technology and engineering teams to rapidly create innovative and affordable products. Working together, NASA Glenn Research Center and Boeing Canoga Park have developed a methodology of process-based cost estimation bridging the methodologies of high-level parametric models and detailed bottoms-up estimation. The NASA GRC/Boeing CP process-based cost model provides a probabilistic structure of layered cost drivers. High-level inputs characterize mission requirements, system performance, and relevant economic factors. Design alternatives are extracted from a standard, product-specific work breakdown structure to pre-load lower-level cost driver inputs and generate the cost-risk analysis. As product design progresses and matures the lower level more detailed cost drivers can be re-accessed and the projected variation of input values narrowed, thereby generating a progressively more accurate estimate of cost-risk. Incorporated into the process-based cost model are techniques for decision analysis, specifically, the analytic hierarchy process (AHP) and functional utility analysis. Design alternatives may then be evaluated not just on cost-risk, but also user defined performance and schedule criteria. This implementation of full-trade study support contributes significantly to the realization of the integrated development environment. The process-based cost estimation model generates development and manufacturing cost estimates. The development team plans to expand the manufacturing process base from approximately 80 manufacturing processes to over 250 processes. Operation and support cost modeling is also envisioned. Process-based estimation considers the materials, resources, and processes in establishing cost-risk and rather depending on weight as an input, actually estimates weight along with cost and schedule.

Singh, Brijendra↗