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NASA NTRS2004

Code Blue on Orbit: Treating Cardiac Arrest on the ISS

As a result of the Columbia tragedy on February 1,2003, the International Space Station (ISS) crew size has been temporarily reduced from three to two. This change forces adaptations in many operational procedures used by the crew, including medical protocols which were designed for scenarios involving one casualty and two caregivers. The Office of Space Medicine directed that the procedure for the resuscitation of a crewmember in cardiac arrest be rewritten for use by a single care provider. Methods: Adaptation of this procedure made use of current American Heart Association Advanced Cardiac Life Support (ACLS) procedures and reflects necessary compromises between the realities of the operational environment and prompt provision of medical care. Results: Numerous changes were incorporated due to the diminution in available personnel, including substitution of endotracheal rather than intravenous delivery of drugs, more rapid defibrillation, addition of a precordial thump, removal of transcutaneous pacing, streamlining of procedural steps, and clarification of termination criteria. Discussion: The on-orbit care available to the ISS crewmembers is constrained by numerous factors, including crew medical training, minimal medical assets, limited air/ground communication , and a single caregiver for the foreseeable future. All of these combine to make a successful resuscitation unlikely, however, this procedure must ultimately deal with not only the patient's welfare, but also that of the caregiver, the mission, and the program.

Bacal, Kira↗

NASA NTRS2011

Ambulatory Healthcare Utilization in the United States: A System Dynamics Approach

Ambulatory health care needs within the United States are served by a wide range of hospitals, clinics, and private practices. The Emergency Department (ED) functions as an important point of supply for ambulatory healthcare services. Growth in our aging populations as well as changes stemming from broader healthcare reform are expected to continue trend in congestion and increasing demand for ED services. While congestion is, in part, a manifestation of unmatched demand, the state of the alignment between the demand for, and supply of, emergency department services affects quality of care and profitability. The central focus of this research is to provide an explanation of the salient factors at play within the dynamic demand-supply tensions within which ambulatory care is provided within an Emergency Department. A System Dynamics (SO) simulation model is used to capture the complexities among the intricate balance and conditional effects at play within the demand-supply emergency department environment. Conceptual clarification of the forces driving the elements within the system , quantifying these elements, and empirically capturing the interaction among these elements provides actionable knowledge for operational and strategic decision-making.

Diaz, Rafael↗

NASA NTRS2009

The NASA Clinic System

NASA maintains on site occupational health clinics at all Centers and major facilities NASA maintains an on-site clinic that offers comprehensive health care to astronauts at the Johnson Space Center NASA deploys limited health care capability to space and extreme environments Focus is always on preventive health care

Scarpa, Philip J.↗

NASA NTRS2011

Exploration Medical System Demonstration Project

A near-Earth Asteroid (NEA) mission will present significant new challenges including hazards to crew health created by exploring a beyond low earth orbit destination, traversing the terrain of asteroid surfaces, and the effects of variable gravity environments. Limited communications with ground-based personnel for diagnosis and consultation of medical events require increased crew autonomy when diagnosing conditions, creating treatment plans, and executing procedures. Scope: The Exploration Medical System Demonstration (EMSD) project will be a test bed on the International Space Station (ISS) to show an end-to-end medical system assisting the Crew Medical Officers (CMO) in optimizing medical care delivery and medical data management during a mission. NEA medical care challenges include resource and resupply constraints limiting the extent to which medical conditions can be treated, inability to evacuate to Earth during many mission phases, and rendering of medical care by a non-clinician. The system demonstrates the integration of medical technologies and medical informatics tools for managing evidence and decision making. Project Objectives: The objectives of the EMSD project are to: a) Reduce and possibly eliminate the time required for a crewmember and ground personnel to manage medical data from one application to another. b) Demonstrate crewmember's ability to access medical data/information via a software solution to assist/aid in the treatment of a medical condition. c) Develop a common data management architecture that can be ubiquitously used to automate repetitive data collection, management, and communications tasks for all crew health and life sciences activities. d) Develop a common data management architecture that allows for scalability, extensibility, and interoperability of data sources and data users. e) Lower total cost of ownership for development and sustainment of peripheral hardware and software that use EMSD for data management f) Provide better crew health via the reduction in crew errors, crew time, and ground time.

Chin, D. A.↗

NASA NTRS2014

Exploration Medical System Demonstration

BACKGROUND: Exploration class missions will present significant new challenges and hazards to the health of the astronauts. Regardless of the intended destination, beyond low Earth orbit a greater degree of crew autonomy will be required to diagnose medical conditions, develop treatment plans, and implement procedures due to limited communications with ground-based personnel. SCOPE: The Exploration Medical System Demonstration (EMSD) project will act as a test bed on the International Space Station (ISS) to demonstrate to crew and ground personnel that an end-to-end medical system can assist clinician and non-clinician crew members in optimizing medical care delivery and data management during an exploration mission. Challenges facing exploration mission medical care include limited resources, inability to evacuate to Earth during many mission phases, and potential rendering of medical care by non-clinicians. This system demonstrates the integration of medical devices and informatics tools for managing evidence and decision making and can be designed to assist crewmembers in nominal, non-emergent situations and in emergent situations when they may be suffering from performance decrements due to environmental, physiological or other factors. PROJECT OBJECTIVES: The objectives of the EMSD project are to: a. Reduce or eliminate the time required of an on-orbit crew and ground personnel to access, transfer, and manipulate medical data. b. Demonstrate that the on-orbit crew has the ability to access medical data/information via an intuitive and crew-friendly solution to aid in the treatment of a medical condition. c. Develop a common data management framework that can be ubiquitously used to automate repetitive data collection, management, and communications tasks for all activities pertaining to crew health and life sciences. d. Ensure crew access to medical data during periods of restricted ground communication. e. Develop a common data management framework that allows for scalability, extensibility, and interoperability of data sources and data users. f. Lower total cost of ownership for development and sustainment of peripheral hardware and software that use EMSD for data management. g. Provide a better standard of healthcare for crew members through reductions in the time required by crew and ground personnel to provide medical treatment and the number of crew errors experienced during treatment.

Rubin, D. A.↗

NASA NTRS2016

Surgical Capabilities for Exploration and Colonization Space Flight - An Exploration Symposium

Surgical capabilities in human space flight, whether on a space-based platform in low Earth orbit or on a long duration planetary exploration mission, will be challenging to conduct for a variety of reasons, some of which will be ameliorated by training, technology, and pre-flight planning. Nevertheless, inherent risks and challenges remain. Early space missions did not have any surgical capability. It was not until NASA's Skylab mission that serious consideration was given to this fundamental medical care capability. Over the past 30 years, subject matter experts have been brought together for discussion on the myriad of challenges and opportunities in this endeavor. The last such meeting was held in 2005 at the NASA Johnson Space Center. As we continue to move forward with human space flight activities for the International Space Station and beyond, the capabilities of information technology, robotics, sensors and imaging have rapidly changed since the last gathering of expertise. In December 2015, through sponsorship of the National Space Biomedical Research Institute (NSBRI), a diverse group of individuals from government, academia, and industry representing three countries gathered at the NSBRI Space 4 Biomedicine facility in Houston, TX. This two day symposia included comprehensive sessions that addressed the challenges that we all face in developing, deploying, and utilizing surgical care capabilities in all human space missions, regardless of mission duration or profile. The symposium benefited from the knowledge and experience of three seasoned NASA physician astronauts, Drs. Jay Buckey, Thomas Marshburn, and Lee Morin. At the end of the first day, the assembled group heard from the crew members about their experiences and their ideas. It is clear that the discussion of surgical capabilities is part of the larger discussion of consideration of advanced healthcare, including critical care, on exploration space missions. This report represents the culmination of the symposium, capturing knowledge, experience, conceptual dialogue, and a narrative that can be used in supporting the development of future programs and potential policy. Each of the presentations that were provided by the guest speakers is included in the appendices. Those presentations that are not included were due to sensitivity of the material or at the request of the speaker. In addition, each speaker was offered an opportunity to provide comments in a 'lightning round' format. All of these comments and speaker abstracts also appear in the appendices. At the conclusion of the second day, a discussion was held that reviewed the priorities that perhaps add value to decision makers. These are also summarized. This report will serve as the final product of this symposium. Additional material may be produced for the peer-reviewed literature.

Doarn, Charles R.↗

NASA NTRS2017

Medical Data Architecture Project Capabilities and Design

Mission constraints will challenge the delivery of medical care on a long-term, deep space exploration mission. This type of mission will be restricted in the availability of medical knowledge, skills, procedures and resources to prevent, diagnose, and treat in-flight medical events. Challenges to providing medical care are anticipated, including resource and resupply constraints, delayed communications and no ability for medical evacuation. The Medical Data Architecture (MDA) project will enable medical care capability in this constrained environment. The first version of the system, called "Test Bed 1," includes capabilities for automated data collection, data storage and data retrieval to provide information to the Crew Medical Officer (CMO). Test Bed 1 seeks to establish a data architecture foundation and develop a scalable data management system through modular design and standardized interfaces. In addition, it will demonstrate to stakeholders the potential for an improved, automated, flow of data to and from the medical system over the current methods employed on the International Space Station (ISS). It integrates a set of external devices, software and processes, and a Subjective, Objective, Assessment, and Plan (SOAP) note commonly used by clinicians. Medical data like electrocardiogram plots, heart rate, skin temperature, respiration rate, medications taken, and more are collected from devices and stored in the Electronic Medical Records (EMR) system, and reported to crew and clinician. Devices integrated include the Astroskin biosensor vest and IMED CARDIAX electrocardiogram (ECG) device with INEED MD ECG Glove, and the NASA-developed Medical Dose Tracker application. The system is designed to be operated as a standalone system, and can be deployed in a variety of environments, from a laptop to a data center. The system is primarily composed of open-source software tools, and is designed to be modular, so new capabilities can be added. The software components and integration methods will be discussed.

Data architecture↗

NASA NTRS2017

Medical Data Architecture Capabilities and Design

Mission constraints will challenge the delivery of medical care on a long-term, deep space explorationmission. This type of mission will be restricted in the availability of medical knowledge, skills, procedures and resourcesto prevent, diagnose, and treat in-flight medical events. Challenges to providing medical care are anticipated, includingresource and resupply constraints, delayed communications and no ability for medical evacuation. The Medical DataArchitecture (MDA) project will enable medical care capability in this constrained environment.The first version of thesystem, called Test Bed 1, includes capabilities for automated data collection, data storage and data retrieval to provideinformation to the Crew Medical Officer (CMO). Test Bed 1 seeks to establish a data architecture foundation and developa scalable data management system through modular design and standardized interfaces. In addition, it will demonstrateto stakeholders the potential for an improved, automated, flow of data to and from the medical system over the currentmethods employed on the International Space Station (ISS). It integrates a set of external devices, software andprocesses, and a Subjective, Objective, Assessment, and Plan (SOAP) note commonly used by clinicians. Medical datalike electrocardiogram plots, heart rate, skin temperature, respiration rate, medications taken, and more are collectedfrom devices and stored in the Electronic Medical Records (EMR) system, and reported to crew and clinician. Devicesintegrated include the Astroskin biosensor vest and IMED CARDIAX electrocardiogram (ECG) device with INEED MDECG Glove, and the NASA-developed Medical Dose Tracker application.The system is designed to be operated as astandalone system, and can be deployed in a variety of environments, from a laptop to a data center. The system isprimarily composed of open-source software tools, and is designed to be modular, so new capabilities can be added. Thesoftware components and integration methods will be discussed.

Exploration medical system↗

NASA NTRS2019

Predictive Modeling for Differential Diagnosis and Mortality Risk Assessment

The prevalence of electronic health record (EHR) systems has brought prodigious biomedical informatics opportunity. Automated machine learning methods can effectively utilize such data and have become common tools for healthcare predictive modeling. Researches in medical informatics have explored the potential of deep learning and classical models in emergent care scenarios. In particular, predicting differential diagnoses for admissions have proven useful in decreasing unnecessary lab tests and improving inpatient triage decision-making. Moreover, identification of high-risk patients for in-hospital mortality is vitally important to maximize allocation of medical resources.The Medical Information Mart for Intensive Care (MIMIC-III) database, containing de-identified critical care inpatient was used in our study. This data set captures hospital patient laboratory measurements, pharmacologic prescriptions, diagnostic data and procedure event recordings. When considering adult patients and discounting admissions with ICU length of stay less than 24 hours, there were 37,787 unique admissions and 30,414 total patients. We examined the top 25 most prevalent ICD-9 group-level disease specificities in MIMIC-III using a multi-label classification model. In-hospital mortality was modeled as binary classification with 4,155 (13%) adult patients that expired, of which 3,138 (75.5%) were in the ICU setting. The metrics AUC, F1 score, sensitivity and specificity values calculated for each disease label measured prediction performance.The usage of ICD-9 group codes reduced feature dimension from 14,567 to 942 and greatly improved distribution of patient diagnostic categories. Disease temporal patterns were captured by considering the most frequently sampled 6 vital signs and 13 laboratory values. Missing data were imputed at each time-stamp. Time-series raw hourly average values were converted into 5 summary features (mean, standard deviation, number of observations, min & max values). Patient demographic variables such as age, gender, marital status and ethnicity were also factored into the modeling. Choi et al showed that contextual embedding of medical data, diagnostic and procedural codes alone can predict future diagnoses with sensitivity as high as 0.79. We utilized an embedding technique called word2vec which allowed sparse representations of medical history to be transformed into dense word vectors. The mappings captured contextual information by treating each admission as a sentence and learning the most likely neighboring words in a sliding window fashion. Binary and multi-label classification was achieved via collapse models, which do not consider temporal information, as well as recurrent neural networks with regularization, Softmax output layer activation together with categorical cross-entropy as the loss function.

US Army collaboration↗

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 NTRSDate not supplied

CLINICAL DECISION SUPPORT: PATH TO FUNCTIONAL REQUIREMENTS

Long-duration, deep-space exploration missions present significant challenges to crew health and performance. These challenges include the individual and combined effects of microgravity, radiation exposure, isolation, limited resources (mass, volume, power, data and crew time), limited options for evacuation and those associated with delayed or constrained communications, all of which demand greater crew autonomy. Specifically, as the communication delays intensify the further we explore space, the unqualified need for Earth-independent medical operations focused on autonomous diagnosis, treatment and prevention will be key to mission continuation and success. To augment the requisite knowledge, skills and abilities (KSAs) of a time-constrained crew operating under stressful conditions, combatting fatigue, and facing a potential medical crisis, a robust clinical decision support system (CDSS) is a probable solution that would facilitate, guide and inform Earth-independent medical operations, while assisting crewmembers through various clinical presentations. The Exploration Medical Capability (ExMC) Element of the Human Research Program (HRP) is expanding the boundaries of space medical systems to advance the care of astronauts on future exploration missions beyond low Earth orbit. ExMC is actively identifying and testing next-generation medical care and crew health maintenance technologies. The Clinical Decision Support (CDS) project addresses gap Medical-701 within the Inflight Medical Conditions risk: “Enhance medical capabilities within an exploration medical system.” Though mass, volume, and power will face increasing constraints, the projected computational capabilities of spacecraft systems will increase exponentially as information technology continues to advance this decade and beyond. Hence, data, software and computational resources will play an essential and synergistic role in maintaining crew health, wellness and performance in deep space missions. The focus of the CDS project is to develop recommended requirements for an in-vehicle CDSS that acts as a ‘virtual assistant’ for delivering optimal health, performance and medical care during exploration missions. The CDSS is envisioned as an integrated, software-based tool deployed on a laptop computer or handheld device. The CDSS will assist the crew and ground support when interacting with knowledge/databases (e.g. records, pharmacy, schedule), instrumentation (e.g. imaging, physiological monitoring devices), and habitat (e.g. wellness system, task performance system) and vehicle systems (e.g. environmental system, communication system). In addition, the human interface will employ a context-based approach that accounts for the crew’s situation. Thus, extraneous and clinically/operationally non-relevant information are reduced to avoid an increase in cognitive load. The framework of an ideal spaceflight CDSS is to include core and advanced analytical features that incorporate work from collaborators yet maintain a flexible platform for integrating new technology in the future. In fiscal year 2021 (FY21), the CDS project identified requirements through two primary mechanisms: (i) the development of software implementation prototypes and (ii) the application of systems engineering processes. The CDS project developed and tested a series of increasingly complex system prototypes that were based on use cases derived from the CDSS concept of operations (ConOps). These software implementations yielded insights on CDSS functionality as well as lessons learned that provided the initial requirements for CDSS capability. By applying a systems engineering (SE) approach, medical scenarios provided in the ConOps and the use cases for software implementation underwent functional decomposition to identify CDSS functionality. Also, systems-based modeling language (SysML) tools such as activity diagrams were developed from the same ConOps and use cases to identify CDSS functionality. The lessons learned from software implementation defined both specific requirements and broad areas of requirements. Within these defined broad requirement areas, further analysis of the SE products identified specific capability that resulted in the final functional requirements. In summary, the software prototypes, functional decomposition of the ConOps and use cases, and SysML diagrams provided the basis for the CDSS requirements developed in FY21. In the upcoming year, these requirements will be refined for their final ExMC baseline review in latter FY22.

clinical decision support↗

NASA NTRSDate not supplied

Spaceflight Medical Evacuation Risk Assessment Principles - A Qualitative Investigation

BACKGROUND Future human space exploration beyond Low Earth Orbit (LEO) will require innovative solutions in many areas, primarily those that provide direct medical support to crew on long-duration missions and optimize their health and performance. The associated challenges therein will be numerous, including but not necessarily limited to extended one-way or "asynchronous" communication delays, minimal to non-existent resupply, and a prolonged transit time to "definitive care" ranging from 3-days to 9-months. At the same time, long-duration exploration spacecraft and crew will face restrictions on mass, power, volume, and data far more significant than that seen in current LEO settings. Given these limitations, medical risk assessment is of primary importance, especially evaluating the implications of a medical evacuation of an ill or injured crewmember. Such evacuations are complicated, potentially dangerous, and well may be impossible in certain phases of the mission. Regardless, such issues must be weighed against the risks of the injured crew remaining aboard a spacecraft with limited medical resources. OBJECTIVE This qualitative study drew from the experiences of subject matter experts (SMEs) in spaceflight and appropriate analog environments (i.e., military, disaster, and extreme environment fields) to identify unique principles common amongst medical evacuation considerations helpful in informing future risk assessment tools. Appropriate analog environments included austere operational settings where multiple factors (weather, logistics/limited resupply, denied/extreme environments, and patient condition) resulted in a limited ability to provide definitive local medical care. The fundamental principles in question revolved around scenarios where evacuation became a complicating yet necessary consideration and where life-threatening medical concerns had to be weighed against critical mission objective(s). The primary authors collected semi-structured data gathered through in-depth interviews with 16 subject matter experts (SMEs). Interview questions investigated how these SMEs consider and weigh the attendant risks present in medical evacuation scenarios. Among the critical questions posed were those that sought to understand how the SME balanced the challenges and requirements of medical evacuation (or keeping an injured patient "on-site" aka: "prolonged field care") against the evacuation operation's risks on impacting overarching mission success. The team analyzed interview transcripts for common themes and principles using the qualitative methods of thematic analysis based on consensus, co-occurrence, and comparison. As a result, nine primary risk consideration themes and nine contributing factor themes emerged, all of which will ideally inform future medical evacuation decision-making tools and operational decision-making for exploration class missions. Specific aims for this study included: 1. Identification of common principles used to assess risks and benefits of medical evacuations in extreme environments 2. Identification of common points of friction or complication and challenges in extreme environment evacuations

A T Almand↗

NASA NTRSDate not supplied

Clinical Decision Support: Path to Functional Requirements

Clinical decision support↗

NASA NTRS2021

Remote Concurrent Engineering: A-Team Studies in the Virtual World

NASA Jet Propulsion Laboratory’s (JPL’s)Architecture Team (A-Team) has nearly a decade of experiencein maturing early formulation mission and technology conceptsby combining innovative collaborative engineering methodswith cutting-edge subject matter expertise and advancedanalysis tools in an in-person environment. When COVID-19forced JPL’s workforce to work remotely in March 2020, ATeamhad to quickly pivot from an in-person collaborativeenvironment to a remote working environment.Through introspection, careful planning, and considerablepractice, A-Team was able to develop new operating proceduresto effectively continue early formulation studies in a virtualenvironment. A-Team has held over 57 remote studies in the 10months since the start of mandatory telework at JPL in March2020. In the remote setting, A-Team conducts studies in half-daysessions with clients and subject matter experts (SMEs) viavideoconferencing, shared computer screens, and digitalcollaborative tools.The key lesson is that increased staffing and planning is neededto prepare and successfully run remote A-Team studies. RemoteA-Team studies require careful selection of the appropriatetools for security, accessibility, and usability within theNASA/JPL environment. Knowledge capture methods andtemplates need to be thought out and agreed upon in advance asthere is less room for improvising in a remote format. Variouscommunication channels have to be monitored to allow for teamcoordination while maintaining fruitful participant engagementduring a session. In addition, technical backup for all roleswithin the A-Team have to be identified to allow the study tocontinue even if a team member’s connectivity is temporarilyinterrupted. Finally, careful thought has to be put into methodsand processes to create a collaborative environment in a virtualspace such that a group of experts who are only connected viathe internet can experience the creative spark and flow of a greatcollaborative and innovative study.

Zusack, Steven↗

NASA NTRSDate not supplied

The Evolution of the Impact Evidence Library Methods – What We Learned

During fiscal years 2020-2022 NASA’s Human Research Program, Exploration Medical Capability Element has worked to source this evidence for the model. During the process several lessons learned have been identified and drive recommendations for future efforts. The ICL 1.0: Spaceflight Medical Operational expertise should be consulted regarding the addition of future conditions. A clinician experienced with the nuances of spaceflight is recommended to have a minimum of 20 hours per condition to adequately source the evidence. Condition definitions should be carefully crafted to maintain mutual exclusivity. Common side effects from medications, common and consequential incidental findings in laboratory studies, and consequential side effects of diagnostic and procedural capabilities should be considered for inclusion as unique conditions in future iterations of the ICL 1.0. Incidence: Spaceflight incidence, although based on small population sizes, is the gold standard. Terrestrial incidence should be applied cautiously. Probability of minor vs. severe cases of the condition: Data informing severity probability of the medical condition are nearly always terrestrial. Special attention should be paid to this metric as it drives outcomes in the model and terrestrial data often overestimate severity of expected cases in spaceflight. Condition duration: Three clinical phases currently exist in the model. They represent the time necessary for diagnosis, treatment/convalescence/recurrence, and the remaining duration of the mission after maximal recovery, respectively. Further subdivision of acute and convalescent treatment/recurrence is recommended. Probability of need for evacuation: Surrogates for “Return to Definitive Care” were chosen prior to data collection. In most cases these surrogates were “need for hospitalization” or “need for surgery.” For many conditions these may not be realistic drivers of “Return to Definitive Care” and should be re-examined. Probability of Crew Mortality: Terrestrial mortality data is difficult to apply to astronauts who, invariably, have less comorbidities than terrestrial subjects. It must be applied judiciously. The proportion of mission tasks impaired by the condition: “Task Impairment” was assigned to each condition prior to the condition duration data becoming available. Future efforts should assign Task Impairment as the final step in sourcing the evidence.

A.J. Kreykes↗

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 NTRS2023

Risk of Impaired Performance Due to Reduced Muscle Mass, Strength &, Endurance (Short Title: Muscle) and Risk of Reduced Physical Performance Capabilities Due to Reduced Aerobic Capacity (Short Title: Aerobic)

This report reviews the scientific literature regarding the human system risks to the microgravity environment of space flight in relation to human performance. The primary human performance-related risks involve deconditioning of the cardiovascular and skeletal muscles systems due to prolonged exposure to the reduced gravitational input. The chronological history of U.S. space flight is reviewed as a starting point to inform and understand the gaps in the knowledge to these risks. Maintenance of physical performance capabilities involves understanding the health of many organ systems (peripheral [vascular, heart, blood volume, skeletal muscle] and central [brain]) that ultimately contribute to the submaximal and maximal capacity of the aerobic (VO2peak), skeletal muscle (strength and endurance) systems. Maintaining astronaut VO2peak, muscle mass, strength, and endurance before, during, and after space flight is a significant priority to NASA for the current International Space Station (ISS) era, as well as for future exploration missions. A growing research database from both space flight and ground-based analog studies finds that the cardiorespiratory system is compromised and skeletal muscles (predominantly postural muscles of the lower limbs) undergo atrophy. These structural and metabolic responses to living in microgravity conditions contribute to physiological deconditioning during space flight that potentially increase the risks to astronauts returning to surface operations (i.e., Moon, Mars, or Earth). The time course changes from short to long-duration space flight and the relationships between in-flight performance deconditioning levels are not well characterized. Moreover, there are large interindividual variabilities that may be dependent on genetics, age, sex, preflight fitness levels, and individual exercise prescriptions that need further careful evaluations. Efforts should be made to understand the current status of preflight, in-flight, and postflight exercise performance capability and to define the operational goals and target areas for protection with the in-flight exercise program. There is a bi-directional relationship between exercise prescription and hardware countermeasures that need further understanding in-flight. For example, hardware with limited capabilities/modalities may be counterbalanced by changes in exercise prescription (i.e., frequency, time, intensity, volume) for providing effective responses to maintain fitness. Importantly, the minimal requirements for exercise prescription on ISS hardware may not translate to lower capability hardware on exploration missions. Due to limited volume on exploration vehicles, future Artemis missions to the Lunar surface will not have similar exercise hardware capabilities as ISS. This may alter the effectiveness of hardware to provide adequate physiological stress on bodily systems allowing for adaptations to maintain aerobic capacity, strength, and bone density. Thus, it will be important to understand the exercise responses of current ISS countermeasures to develop individualized exercise prescriptions that minimize aerobic and muscular risks, accounting for the large variability of responses among crewmembers. Newer exploration exercise hardware is currently being evaluated that is more compact (i.e., E4D and Orion Flywheel) and will require careful evaluation of the hardware on the stressor (i.e., metabolic rate, oxygen uptake, and heart rate work relationships, and force plate load profiles) needed the human body to protect and maintain crew health and performance. Moreover, exercise responses on the hardware need careful evaluation on the chronic adaptations. Lastly, in-flight evaluation of hardware exercise response may differ in 0-g or partial-g compared to 1-g. Therefore, it cannot be assumed that the stress on the body will be the same in each environment. Understanding this has a direct impact on exercise prescriptions. This document provides an overview of key scientific investigations that have been conducted before, during, and after human space flight missions, as well as from human ground-based analog studies that contribute to the evidence base on changes in aerobic capacity and muscle mass, strength, and endurance. Additional data from rodent and nonhuman primate experiments of skeletal muscle unloading completed during space flight or ground-based flight-simulations provide supportive information about this risk topic. Most importantly, a recent, large dataset from long-duration ISS crew has been added to give improved insight into the variability of exercise response of crew, demonstrating that a large portion of the crew population return to Earth with greater than 10-20% loss of aerobic capacity and muscle strength and endurance. Data from human space flight and ground-based studies are narrowing in on the required exercise paradigms but thus far still provide an incomplete answer to an effective approach for maintaining skeletal muscle function and aerobic fitness of all human space travelers. Finally, the relationship of this risk topic to various space flight operational scenarios is examined and discussed.

Eric Rivas↗

NASA NTRS2023

Capitol Reef Ecological Conservation: Mapping Vegetation Functional Groups to Inform Invasive Vegetation Management, Ecological Conservation and Restoration in Capitol Reef National Park

Invasive exotic plant (IEP) species have been found within the park boundaries of Capitol Reef National Park (CARE) in Utah. Currently, remotely sensed datasets such as the Rangeland Analysis Platform (RAP) from the United States Department of Agriculture (USDA) have been used to investigate IEP species within the park, but validation of the national RAP program is necessary for informing decisions at a local scale. CARE seeks a remote monitoring solution that can precisely target managerial efforts within the park’s challenging terrain and hard-to-reach locations. To fulfill this objective, we harnessed Landsat 8 Operational Land Imager (OLI) imagery and leveraged Random Forest (RF) modeling to generate classification maps characterizing vegetation functional groups for 2013 and 2022 within the park. Subsequently, the Land Change Modeler (LCM) in Idrisi TerrSet facilitated the production of a predicted classification map for 2033. The team also devised an annual grass probability map to accentuate areas impacted by exotic grasses. A comparative assessment between the RF classification map and the RAP map for 2022 revealed an overall agreement of 47.41%, with disparities primarily arising from differences in bare soil and shrub areas. Significantly, the 2022 RF-generated classification map showcased an impressive overall accuracy of 92.17%. In short, the probability map, the land cover change detection spanning 2013 to 2022, and the forecasting of observed trends into the future aids in the evaluation of invasive plant impacts and facilitation of CARE’s preparedness for potential ecological disturbances. Notably, in comparison to the RAP, the RF classification method generates functional group maps that are more representative of the study area.

Vanchy Li↗