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NASA NTRS2017

Risk of Cardiac Rhythm Problems During Spaceflight

NASA has concerns regarding the incidence and clinical significance of cardiac arrhythmias that could occur during long-term exposure to the spaceflight environment, such as on the International Space Station (ISS) or during a prolonged (e.g., up to 3 years) sojourn to Mars or on the Moon. There have been some anecdotal reports and a few documented cases of cardiac arrhythmias in space, including one documented episode of non-sustained ventricular tachycardia. The potential catastrophic nature of a sudden cardiac death in the remote space environment has led to concerns from the early days of the space program that spaceflight might be arrhythmogenic. Indeed, there are known and well-defined changes in the cardiovascular system with spaceflight: a) plasma volume is reduced, b) left ventricular mass is decreased, and c) the autonomic nervous system adapts to the weightless environment. Combined, these physiologic adaptations suggest that changes in cardiac structure and neuro-humoral environment during spaceflight could alter electrical conduction, although the evidence supporting this contention consists mostly of minor changes in QT interval (the time between the start of the Q wave and the end of the T wave on an electrocardiogram tracing) in a small number of astronauts after long-duration spaceflight. Concurrent with efforts by NASA Medical Operations to refine and improve screening techniques relevant to arrhythmias and cardiovascular disease, as NASA enters the era of exploration-class missions it will be critical to determine with the highest degree of certainty whether spaceflight by itself alters cardiac structure and function sufficiently to increase the risk of arrhythmias.

Lee, Stuart M. C.↗
NASA NTRS2020

Design Variants of a Common Habitat for Moon and Mars Exploration

The Common Habitat is a long-duration habitat concept based on the Skylab II architecture that leverages a single, multi-destination design applicable to microgravity Mars transit, 1/6 g lunar surface, 3/8 g Mars surface, and 1 g Earth. A trade study for the Common Habitat will address vertical versus horizontal internal orientation and a crew size of four or eight crew. This has resulted in the creation of four variants of the Common Habitat: Four Crew Horizontal Configuration, Four Crew Vertical Configuration, Eight Crew Horizontal Configuration, and Eight Crew Vertical Configuration. Design guidelines that shaped the four configurations are discussed, including: mission duration, destinations/missions, pressure vessel, hatches and docking, subsystems and utilities, lander integration and offloading, and eight-crew extensibility. Functional capabilities for crew-related systems are also discussed, including: private habitation, meal preparation, meal consumption, medical operations, exercise, group socialization and recreation, human waste collection, hygiene, logistics, spacecraft monitoring and commanding, mission planning, robotics and teleoperation, scientific research, maintenance and fabrication, and EVA. Each of the four Common Habitat designs will be presented, with a deck-by-deck description of each workstation, crew station, or subsystem along with an assessment of its degree of compliance with the guidelines and functional capabilities. Finally, forward work will be identified that will down-select a single Common Habitat. This includes multiple analyses that will be performed on the four variants, a down-selection process, and design refinement goals for the selected variant.

Habitability↗
NASA NTRSDate not supplied

The Exploration Crew Medical Officer of the Future

The current paradigm for Crew Medical Officer (CMO) credentials and training in Low Earth Orbit medical operations is likely to be insufficient for exploration-class missions. Long duration lunar surface stays and Mars missions will require increasing levels of autonomy of the CMO. This presentation will investigate the roles and responsibilities of the CMO of the future, including a discussion of clinical competency and training needs

Moriah S. Thompson↗
NASA NTRSDate not supplied

The BioMole Facility: Advancement of In Situ Microbiome Analysis for the International Space Station

Characterization of the International Space Station (ISS) microbiome has been enabled by sample return and Earth-based analysis. As human exploration pushes beyond low-Earth orbit, microbial-related crew health, planetary protection, and space research requires in situ capabilities. Steps toward reducing Earth-dependence for complex sample analysis began in 2016 with the amplification of DNA within the miniPCR thermal cycler and DNA sequencing with the MinION sequencer onboard the ISS; for both, samples were prepared on Earth. In 2017, these platforms synergistically enabled the in-situ identification of unknown bacteria collected and cultured from ISS surfaces, thereby shifting the paradigm that microbial cultures had to be returned to Earth. The following year, a culture-independent, swab-to-sequencer method further advanced spaceflight microbiology, demonstrating that culturing could be excluded and provided enhanced insight into the bacterial profile of ISS surfaces. Based on the success of these payloads in confirming the ability to meet crew health identification requirements and the benefits accompanying a culture-independent method, the BioMole Facility was established by the medical operations Crew Health Care Systems team. BioMole is the set of hardware, consumables, and procedures required to support sample preparation and nanopore sequencing onboard the ISS. BioMole goals include expanding sample sources, comparing data to previous methods, demonstrating onboard data analytics, and validating new hardware. To date, comparative surface analysis, molecular- and culture-based, has been completed. Additionally, the demonstration of a sample-to-answer process was achieved when BioMole data was processed onboard using the IBM Open Data and AI Edge software platform installed on the ISS-residing Spaceborne Computer-2. The taxonomic profiles generated from the edge analysis were as expected and paralleled that of the downlinked processed data. Future BioMole efforts involve microbial profiling of the ISS water system, ISS validation of the MinION Mk1C, and an expansion to a research facility available to investigators.

Sarah L. Castro-Wallace↗
NASA NTRSDate not supplied

Assessing Crew Medical Officer Preparedness for International Space Station Missions

INTRODUCTION Astronaut crew medical officers (CMO) undergo additional, specialized training to provide medical support onboard the International Space Station (ISS). CMO training focuses on utilizing resources on-station and optimizing communication with ground-based expertise to manage both common minor conditions as well as emergency/trauma situations. As NASA moves towards future Artemis and exploration class missions, we sought CMO perspectives on past, present, and future CMO training and medical resourcing to help inform mission planners regarding medical risk mitigation considerations. We present an interview-based qualitative assessment of CMO preparedness for the International Space Station with the aim to help iterate future training flows for Low Earth Orbit, Artemis, and exploration-class missions. METHODS A semi-structured interview tool was developed to assess CMO experience and their recommendations for future mission training considerations. Participants were recruited from former or current US astronauts who were designated as CMO and subsequently flew to the International Space Station. 10 former CMOs took part in the study. Interview transcripts were deidentified and evaluated for qualitative thematic analysis by two independent coders with NVivo Software suite (Lumivero, Denver, CO), and emergent themes were compiled. RESULTS Former CMO crew expressed appropriate preparedness for current ISS medical capabilities and requirements. They identified the role of the CMO as serving as a healthcare extender to ground-based flight surgeons for ISS and other LEO missions. Individuals with prior medical experience were preferred though not felt to be necessary for LEO missions. For exploration class missions with limitations in ground communication, a physician-as-CMO and more rigorous training curricula for both the CMO and astronaut crew were desired. DISCUSSION Former NASA astronaut crew were interviewed to retrospectively assess their preparedness as ISS crew medical officers and hypothesize future medical knowledge, skill, and ability needs. Along with medical operations subject matter expert opinion and advanced probabilistic risk assessment modeling, past CMO experience can help inform future CMO training considerations and responsibilities for future Artemis and exploration class missions.

M A Labarbera↗
NASA NTRSDate not supplied

Developing a Medical System Concept of Operations for Level of Care IV: Long-Duration Lunar Orbital and Surface Operations

A goal of the Human Research Program (HRP) Exploration Medical Capability (ExMC) Element Systems Engineering (SE) team is to define the technical system needed to support crew medical system capabilities for future exploration missions, including a mission with lunar orbital and long duration surface operations. The medical system concept of operations (ConOps) is the starting point of creating a foundation for a medical system that meets Level of Care IV requirements, as defined by NASA’s space flight human-system standards. This ConOps illustrates how NASA can provide a Level of Care IV medical system for crews within the various cis-lunar orbit and lunar surface habitat environments. The use case scenarios included in this ConOps illustrate required medical system capabilities for Level of Care IV and enable the ExMC SE team to develop integrated medical system requirements and identify capabilities required to meet those requirements. This discussion will focus on how this concept of operations was constructed – by utilizing the lessons learned from ExMC’s existing Short-Duration Lunar Orbit Medical System Concept of Operations, by employing Model-Based Systems Engineering, and by collaborating with stakeholders in order to ensure the necessary assumptions were made.

M. Kaetzer↗
NASA NTRS2017

Medical System Concept of Operations for Mars Exploration Missions

Future exploration missions will be the first time humanity travels beyond Low Earth Orbit (LEO) since the Apollo program, taking us to cis-lunar space, interplanetary space, and Mars. These long-duration missions will cover vast distances, severely constraining opportunities for emergency evacuation to Earth and cargo resupply opportunities. Communication delays and blackouts between the crew and Mission Control will eliminate reliable, real-time telemedicine consultations. As a result, compared to current LEO operations onboard the International Space Station, exploration mission medical care requires an integrated medical system that provides additional in-situ capabilities and a significant increase in crew autonomy. The Medical System Concept of Operations for Mars Exploration Missions illustrates how a future NASA Mars program could ensure appropriate medical care for the crew of this highly autonomous mission. This Concept of Operations document, when complete, will document all mission phases through a series of mission use case scenarios that illustrate required medical capabilities, enabling the NASA Human Research Program (HRP) Exploration Medical Capability (ExMC) Element to plan, design, and prototype an integrated medical system to support human exploration to Mars.

Urbina, M.↗
NASA NTRS2017

Medical System Concept of Operations for Mars Exploration Missions

Future exploration missions will be the first time humanity travels beyond Low Earth Orbit (LEO) since the Apollo program, taking us to cis-lunar space, interplanetary space, and Mars. These long-duration missions will cover vast distances, severely constraining opportunities for emergency evacuation to Earth and cargo resupply opportunities. Communication delays and blackouts between the crew and Mission Control will eliminate reliable, real-time telemedicine consultations. As a result, compared to current LEO operations onboard the International Space Station, exploration mission medical care requires an integrated medical system that provides additional in-situ capabilities and a significant increase in crew autonomy. The Medical System Concept of Operations for Mars Exploration Missions illustrates how a future NASA Mars program could ensure appropriate medical care for the crew of this highly autonomous mission. This Concept of Operations document, when complete, will document all mission phases through a series of mission use case scenarios that illustrate required medical capabilities, enabling the NASA Human Research Program (HRP) Exploration Medical Capability (ExMC) Element to plan, design, and prototype an integrated medical system to support human exploration to Mars.

Urbina, Michelle↗
NASA NTRS2015

Can We Trust Computational Modeling for Medical Applications?

Operations in extreme environments such as spaceflight pose human health risks that are currently not well understood and potentially unanticipated. In addition, there are limited clinical and research data to inform development and implementation of therapeutics for these unique health risks. In this light, NASA's Human Research Program (HRP) is leveraging biomedical computational models and simulations (M&S) to help inform, predict, assess and mitigate spaceflight health and performance risks, and enhance countermeasure development. To ensure that these M&S can be applied with confidence to the space environment, it is imperative to incorporate a rigorous verification, validation and credibility assessment (VV&C) processes to ensure that the computational tools are sufficiently reliable to answer questions within their intended use domain. In this presentation, we will discuss how NASA's Integrated Medical Model (IMM) and Digital Astronaut Project (DAP) have successfully adapted NASA's Standard for Models and Simulations, NASA-STD-7009 (7009) to achieve this goal. These VV&C methods are also being leveraged by organization such as the Food and Drug Administration (FDA), National Institute of Health (NIH) and the American Society of Mechanical Engineers (ASME) to establish new M&S VV&C standards and guidelines for healthcare applications. Similarly, we hope to provide some insight to the greater aerospace medicine community on how to develop and implement M&S with sufficient confidence to augment medical research and operations.

Mulugeta, Lealem↗
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 NTRS2011

Humans in Space: Summarizing the Medico-Biological Results of the Space Shuttle Program

As we celebrate the 50th anniversary of Gagarin's flight that opened the era of Humans in Space we also commemorate the 30th anniversary of the Space Shuttle Program (SSP) which was triumphantly completed by the flight of STS-135 on July 21, 2011. These were great milestones in the history of Human Space Exploration. Many important questions regarding the ability of humans to adapt and function in space were answered for the past 50 years and many lessons have been learned. Significant contribution to answering these questions was made by the SSP. To ensure the availability of the Shuttle Program experiences to the international space community NASA has made a decision to summarize the medico-biological results of the SSP in a fundamental edition that is scheduled to be completed by the end of 2011 beginning 2012. The goal of this edition is to define the normal responses of the major physiological systems to short-duration space flights and provide a comprehensive source of information for planning, ensuring successful operational activities and for management of potential medical problems that might arise during future long-term space missions. The book includes the following sections: 1. History of Shuttle Biomedical Research and Operations; 2. Medical Operations Overview Systems, Monitoring, and Care; 3. Biomedical Research Overview; 4. System-specific Adaptations/Responses, Issues, and Countermeasures; 5. Multisystem Issues and Countermeasures. In addition, selected operational documents will be presented in the appendices. The chapters are written by well-recognized experts in appropriate fields, peer reviewed, and edited by physicians and scientists with extensive expertise in space medical operations and space-related biomedical research. As Space Exploration continues the major question whether humans are capable of adapting to long term presence and adequate functioning in space habitats remains to be answered We expect that the comprehensive review of the medico-biological results of the SSP along with the data collected during the missions on the space stations (Mir and ISS) provides a good starting point in seeking the answer to this question.

Risin, Diana↗
NASA NTRS2000

A strategic vision for telemedicine and medical informatics in space flight

This Workshop was designed to assist in the ongoing development and application of telemedicine and medical informatics to support extended space flight. Participants included specialists in telemedicine and medical/health informatics (terrestrial and space) medicine from NASA, federal agencies, academic centers, and research and development institutions located in the United States and several other countries. The participants in the working groups developed vision statements, requirements, approaches, and recommendations pertaining to developing and implementing a strategy pertaining to telemedicine and medical informatics. Although some of the conclusions and recommendations reflect ongoing work at NASA, others provided new insight and direction that may require a reprioritization of current NASA efforts in telemedicine and medical informatics. This, however, was the goal of the Workshop. NASA is seeking other perspectives and views from leading practitioners in the fields of telemedicine and medical informatics to invigorate an essential and high-priority component of the International Space Station and future extended exploration missions. Subsequent workshops will further define and refine the general findings and recommendations achieved here. NASA's ultimate aim is to build a sound telemedicine and medical informatics operational system to provide the best medical care available for astronauts going to Mars and beyond.

Aerospace Medicine/organization & administration↗
NASA NTRS2008

Validation of On-Orbit Methodology for the Assessment of Cardiac Function and Changes in the Circulating Volume Using Ultrasound and "Braslet-M" Occlusion Cuffs

Recent advances in remotely guided imaging techniques on ISS allow the acquisition of high quality ultrasound data using crewmember operators with no medical background and minimal training. However, ongoing efforts are required to develop and validate methodology for complex imaging protocols to ensure their repeatability, efficiency, and suitability for use aboard the ISS. This Station Developmental Test Objective (SDTO) tests a cardiovascular evaluation methodology that takes advantage of the ISS Ultrasound capability, the Braslet-M device, and modified respiratory maneuvers (Valsalva and Mueller), to broaden the spectrum of anatomical and functional information on human cardiovascular system during long-duration space missions. The proposed methodology optimizes and combines new and previously demonstrated methods, and is expected to benefit medically indicated assessments, operational research protocols, and data collections for science. Braslet-M is a current Russian operational countermeasure that compresses the upper thigh to impede the venous return from lower extremities. The goal of the SDTO is to establish and validate a repeatable ultrasound-based methodology for the assessment of a number of cardiovascular criteria in microgravity. Braslet-M device is used as a means to acutely alter volume distribution while focused ultrasound measurements are performed. Modified respiratory maneuvers are done upon volume manipulations to record commensurate changes in anatomical and functional parameters. The overall cardiovascular effects of the Braslet-M device are not completely understood, and although not a primary objective of this SDTO, this effort will provide pilot data regarding the suitability of Braslet-M for its intended purpose, effects, and the indications for its use.

Bogomolov, V. V.↗
NASA NTRS1981

Space Shuttle Program: STS-1 Medical Report

The necessity for developing medical standards addressing individual classes of Shuttle crew positions is discussed. For the U.S. manned program the conclusion of the Apollo era heralded the end of water recovery operations and the introduction of land-based medical operations. This procedural change marked a significant departure from the accepted postflight medical recovery and evaluation techniques. All phases of the missions required careful re-evaluation, identification of potential impact on preexisting medical operational techniques, and development of new methodologies which were carefully evaluated and tested under simulated conditions. Significant coordination was required between the different teams involved in medical operations. Additional dimensions were added to the concepts of medical operations, by the introduction of different toxic substances utilized by the Space Transportation Systems especially during ground operations.

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