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Evolution of telemedicine in the space program and earth applications

Remote monitoring of crew, spacecraft, and environmental health has always been an integral part of the National Aeronautics and Space Administration's (NASA's) operations. Crew safety and mission success face a number of challenges in outerspace, including physiological adaptations to microgravity, radiation exposure, extreme temperatures and vacuum, and psychosocial reactions to space flight. The NASA effort to monitor and maintain crew health, system performance, and environmental integrity in space flight is a sophisticated and coordinated program of telemedicine combining cutting-edge engineering with medical expertise. As missions have increased in complexity, NASA telemedicine capabilities have grown apace, underlying its role in the field. At the same time, the terrestrial validation of telemedicine technologies to bring healthcare to remote locations provides feedback, improvement, and enhancement of the space program. As NASA progresses in its space exploration program, astronauts will join missions lasting months, even years, that take them millions of miles from home. These long-duration missions necessitate further technological breakthroughs in tele-operations and autonomous technology. Earth-based monitoring will no longer be real-time, requiring telemedicine capabilities to advance with future explorers as they travel deeper into space. The International Space Station will serve as a testbed for the telemedicine technologies to enable future missions as well as improve the quality of healthcare delivery on Earth.

long duration↗

Management of Asymptomatic Renal Stones in Astronauts

Introduction: Management guidelines were created to screen and manage asymptomatic renal stones in U.S. astronauts. The risks for renal stone formation in astronauts due to bone loss and hypercalcuria are unknown. Astronauts have a stone risk which is about the same as commercial aviation pilots, which is about half that of the general population. However, proper management of this condition is still crucial to mitigate health and mission risks in the spaceflight environment. Methods: An extensive review of the literature and current aeromedical standards for the monitoring and management of renal stones was done. The NASA Flight Medicine Clinic's electronic medical record and Longitudinal Survey of Astronaut Health were also reviewed. Using this work, a screening and management algorithm was created that takes into consideration the unique operational environment of spaceflight. Results: Renal stone screening and management guidelines for astronauts were created based on accepted standards of care, with consideration to the environment of spaceflight. In the proposed algorithm, all astronauts will receive a yearly screening ultrasound for renal calcifications, or mineralized renal material (MRM). Any areas of MRM, 3 millimeters or larger, are considered a positive finding. Three millimeters approaches the detection limit of standard ultrasound, and several studies have shown that any stone that is 3 millimeters or less has an approximately 95 percent chance of spontaneous passage. For mission-assigned astronauts, any positive ultrasound study is followed by low-dose renal computed tomography (CT) scan, and flexible ureteroscopy if CT is positive. Other specific guidelines were also created. Discussion: The term "MRM" is used to account for small areas of calcification that may be outside the renal collecting system, and allows objectivity without otherwise constraining the diagnostic and treatment process for potentially very small calcifications of uncertain significance. However, a small asymptomatic MRM or stone within the renal collecting system may become symptomatic, and so affect launch and flight schedules, cause incapacitation during flight, and ultimately require medical evacuation. For exploration class missions, evacuation is unlikely. The new screening and management algorithm allows better management of mission risks, and will define the true incidence of renal stones in U.S. astronauts. This information will be used to refine future screening, countermeasures and treatment methods; and will also inform the needed capabilities to be flown on exploration-class missions.

Reyes, David↗

Management of Asymptomatic Renal Stones in Astronauts

Introduction: Management guidelines were created to screen and manage asymptomatic renal stones in U.S. astronauts. The risks for renal stone formation in astronauts due to bone loss and hypercalcuria are unknown. Astronauts have a stone risk which is about the same as commercial aviation pilots, which is about half that of the general population. However, proper management of this condition is still crucial to mitigate health and mission risks in the spaceflight environment. Methods: An extensive review of the literature and current aeromedical standards for the monitoring and management of renal stones was done. The NASA Flight Medicine Clinic's electronic medical record and Longitudinal Survey of Astronaut Health were also reviewed. Using this work, a screening and management algorithm was created that takes into consideration the unique operational environment of spaceflight. Results: Renal stone screening and management guidelines for astronauts were created based on accepted standards of care, with consideration to the environment of spaceflight. In the proposed algorithm, all astronauts will receive a yearly screening ultrasound for renal calcifications, or mineralized renal material (MRM). Any areas of MRM, 3 millimeters or larger, are considered a positive finding. Three millimeters approaches the detection limit of standard ultrasound, and several studies have shown that any stone that is 3 millimeters or less has an approximately 95 percent chance of spontaneous passage. For mission-assigned astronauts, any positive ultrasound study is followed by low-dose renal computed tomography (CT) scan, and flexible ureteroscopy if CT is positive. Other specific guidelines were also created. Discussion: The term "MRM" is used to account for small areas of calcification that may be outside the renal collecting system, and allows objectivity without otherwise constraining the diagnostic and treatment process for potentially very small calcifications of uncertain significance. However, a small asymptomatic MRM or stone within the renal collecting system may become symptomatic, and so affect launch and flight schedules, cause incapacitation during flight, and ultimately require medical evacuation. For exploration class missions, evacuation is unlikely. The new screening and management algorithm allows better management of mission risks, and will define the true incidence of renal stones in U.S. astronauts. This information will be used to refine future screening, countermeasures and treatment methods; and will also inform the needed capabilities to be flown on exploration-class missions.

Reyes, David↗

Haughton-Mars Project (HMP)/NASA 2006 Lunar Medical Contingency Simulation: An Overview

Medical requirements are currently being developed for NASA's space exploration program. Lunar surface operations for crews returning to the moon will be performed on a daily basis to conduct scientific research and construct a lunar habitat. Inherent to aggressive surface activities is the potential risk of injury to crew members. To develop an evidence-base for handling medical contingencies on the lunar surface, a simulation project was conducted using the moon-Mars analog environment at Devon Island, Nunavut, high Canadian Arctic. A review of the Apollo lunar surface activities and personal communications with Apollo lunar crew members provided a knowledge base of plausible scenarios that could potentially injure an astronaut during a lunar extravehicular activity. Objectives were established to 1) demonstrate stabilization, field extraction and transfer an injured crew member to the habitat and 2) evaluate audio, visual and biomedical communication capabilities with ground controllers at multiple mission control centers. The simulation project s objectives were achieved. Among these objectives were 1) extracting a crew member from a sloped terrain by a two-member team in a 1-g analog environment, 2) establishing real-time communication to multiple space centers, 3) providing biomedical data to flight controllers and crew members, and 4) establishing a medical diagnosis and treatment plan from a remote site. The simulation project provided evidence for the types of equipment and methods needed for planetary space exploration. During the project, the crew members were confronted with a number of unexpected scenarios including environmental, communications, EVA suit, and navigation challenges. These trials provided insight into the challenges of carrying out a medical contingency in an austere environment. The knowledge gained from completing the objectives of this project will be incorporated into the exploration medical requirements involving an incapacited astronaut on the lunar surface.

Scheuring, R. A.↗

Bioinformatics for Exploration

For the purpose of this paper, bioinformatics is defined as the application of computer technology to the management of biological information. It can be thought of as the science of developing computer databases and algorithms to facilitate and expedite biological research. This is a crosscutting capability that supports nearly all human health areas ranging from computational modeling, to pharmacodynamics research projects, to decision support systems within autonomous medical care. Bioinformatics serves to increase the efficiency and effectiveness of the life sciences research program. It provides data, information, and knowledge capture which further supports management of the bioastronautics research roadmap - identifying gaps that still remain and enabling the determination of which risks have been addressed.

Johnson, Kathy A.↗

Development of a Ground Test and Analysis Protocol for NASA's NextSTEP Phase 2 Habitation Concepts

The NASA Next Space Technologies for Exploration Partnerships (NextSTEP) program is a public-private partnership model that seeks commercial development of deep space exploration capabilities to support human spaceflight missions around and beyond cislunar space. NASA first issued the Phase 1 NextSTEP Broad Agency Announcement to U.S. industries in 2014, which called for innovative cislunar habitation concepts that leveraged commercialization plans for low-Earth orbit. These habitats will be part of the Deep Space Gateway (DSG), the cislunar space station planned by NASA for construction in the 2020s. In 2016, Phase 2 of the NextSTEP program selected five commercial partners to develop ground prototypes. A team of NASA research engineers and subject matter experts (SMEs) have been tasked with developing the ground-test protocol that will serve as the primary means by which these Phase 2 prototypes will be evaluated. Since 2008, this core test team has successfully conducted multiple spaceflight analog mission evaluations utilizing a consistent set of operational tools, methods, and metrics to enable the iterative development, testing, analysis, and validation of evolving exploration architectures, operations concepts, and vehicle designs. The purpose of implementing a similar evaluation process for the Phase 2 Habitation Concepts is to consistently evaluate different commercial partner ground prototypes to provide data-driven, actionable recommendations for Phase 3. This paper describes the process by which the ground test protocol was developed and the objectives, methods, and metrics by which the NextSTEP Phase 2 Habitation Concepts will be rigorously and systematically evaluated. The protocol has been developed using both a top-down and bottom-up approach. Top-down development began with the Human Exploration and Operations Mission Directorate (HEOMD) exploration objectives and ISS Exploration Capability Study Team (IECST) candidate flight objectives. Strategic questions and associated rationales, derived from these candidate architectural objectives, provide the framework by which the ground-test protocol will address the DSG stack elements and configurations, systems and subsystems, and habitation, science, and EVA functions. From these strategic questions, high-level functional requirements for the DSG were drafted and associated ground-test objectives and analysis protocols were established. Bottom-up development incorporated objectives from NASA SMEs in autonomy, avionics and software, communication, environmental control and life support systems, exercise, extravehicular activity, exploration medical operations, guidance navigation and control, human factors and behavioral performance, human factors and habitability, logistics, Mission Control Center operations, power, radiation, robotics, safety and mission assurance, science, simulation, structures, thermal, trash management, and vehicle health. Top-down and bottom-up objectives were integrated to form overall functional requirements - ground-test objectives and analysis mapping. From this mapping, ground-test objectives were organized into those that will be evaluated through inspection, demonstration, analysis, subsystem standalone testing, and human-in-the-loop (HITL) testing. For the HITL tests, mission-like timelines, procedures, and flight rules have been developed to directly meet ground test objectives and evaluate specific functional requirements. Data collected from these assessments will be analyzed to determine the acceptability of habitation element configurations and the combinations of capabilities that will result in the best habitation platform to be recommended by the test team for Phase 3.

Gernhardt, Michael L.↗

Beyond DNA Sequencing in Space: Current and Future Omics Capabilities of the Biomolecule Sequencer Payload

Why do we need a DNA sequencer to support the human exploration of space? (A) Operational environmental monitoring; (1) Identification of contaminating microbes, (2) Infectious disease diagnosis, (3) Reduce down mass (sample return for environmental monitoring, crew health, etc.). (B) Research; (1) Human, (2) Animal, (3) Microbes/Cell lines, (4) Plant. (C) Med Ops; (1) Response to countermeasures, (2) Radiation, (3) Real-time analysis can influence medical intervention. (C) Support astrobiology science investigations; (1) Technology superiorly suited to in situ nucleic acid-based life detection, (2) Functional testing for integration into robotics for extraplanetary exploration mission.

Wallace, Sarah↗

Verification of Dosimetry Measurements with Timepix Pixel Detectors for Space Applications

The current capabilities of modern pixel-detector technology has provided the possibility to design a new generation of radiation monitors. Timepix detectors are semiconductor pixel detectors based on a hybrid configuration. As such, the read-out chip can be used with different types and thicknesses of sensors. For space radiation dosimetry applications, Timepix devices with 300 and 500 microns thick silicon sensors have been used by a collaboration between NASA and University of Houston to explore their performance. For that purpose, an extensive evaluation of the response of Timepix for such applications has been performed. Timepix-based devices were tested in many different environments both at ground-based accelerator facilities such as HIMAC (Heavy Ion Medical Accelerator in Chiba, Japan), and at NSRL (NASA Space Radiation Laboratory at Brookhaven National Laboratory in Upton, NY), as well as in space on board of the International Space Station (ISS). These tests have included a wide range of the particle types and energies, from protons through iron nuclei. The results have been compared both with other devices and theoretical values. This effort has demonstrated that Timepix-based detectors are exceptionally capable at providing accurate dosimetry measurements in this application as verified by the confirming correspondence with the other accepted techniques.

Kroupa, M.↗

Reliability of Electronics for Cryogenic Space Applications Being Assessed

Many future NASA missions will require electronic parts and circuits that can operate reliably and efficiently in extreme temperature environments below typical device specification temperatures. These missions include the Mars Exploration Laboratory, the James Webb Space Telescope, the Europa Orbiter, surface rovers, and deep-space probes. In addition to NASA, the aerospace and commercial sectors require cryogenic electronics in applications that include advanced satellites, military hardware, medical instrumentation, magnetic levitation, superconducting energy management and distribution, particle confinement and acceleration, and arctic missions. Besides surviving hostile space environments, electronics capable of low-temperature operation would enhance circuit performance, improve system reliability, extend lifetime, and reduce development and launch costs. In addition, cryogenic electronics are expected to result in more efficient systems than those at room temperature.

Patterson, Richard L.↗

An Evaluation and Qualification of U.S.-Based Research Reactors for Irradiation Capabilities Supporting Advanced Nuclear Systems

Irradiation experiments are a prerequisite for evaluating nuclear reactor system designs, analyzing the performance of these systems, and obtaining licenses. Likewise, irradiation facilities are necessary for producing the radioisotopes used in industrial and medical applications. Recent developments in modeling and simulation capabilities and advancements in computational resources have further enabled the design of irradiation experiments for evaluating radiation-induced phenomena and determining nuclear fuel, material, and system design and safety criteria pertaining to both normal and accident scenarios. These computational tools and models require comprehensive experimental datasets acquired under prototypic radiation conditions—for exploring material and system performance under the uniquely harsh environments found in nuclear reactors—to enable verification and validation for qualification and licensing purposes. However, qualification of irradiation experimental facilities, primarily research and test reactors (RTRs), necessitates that their performance be evaluated based on the irradiation environment (e.g. flux, power, testing capabilities) using an appropriate scoring matrix. Although many university campus RTRs are available for research and development (R&D) activities and initiatives, this study focuses on evaluating and qualifying the irradiation facilities (mostly RTRs) within the United States that are suitable for advanced nuclear fuel, material, and system irradiation experiments aimed at establishing operational-performance limits and informing component and fuel designs so as to improve operational efficiencies and mitigate proliferation vulnerabilities, as well as for radioisotope production aimed at multipurpose applications. As a result, the findings of the present study support the acceleration of nuclear fuel and material qualifications, thus hastening new and advanced nuclear energy system demonstrations and radioisotope production efforts by using extended R&D.

irradiation experiment↗

Human Factors in Training

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

Barshi, Immanuel↗

Human Factors in Training

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

Barshi, Immanuel↗

AMO EXPRESS: A Command and Control Experiment for Crew Autonomy

NASA is investigating a range of future human spaceflight missions, including both Mars-distance and Near Earth Object (NEO) targets. Of significant importance for these missions is the balance between crew autonomy and vehicle automation. As distance from Earth results in increasing communication delays, future crews need both the capability and authority to independently make decisions. However, small crews cannot take on all functions performed by ground today, and so vehicles must be more automated to reduce the crew workload for such missions. NASA's Advanced Exploration Systems Program funded Autonomous Mission Operations (AMO) project conducted an autonomous command and control demonstration of intelligent procedures to automatically initialize a rack onboard the International Space Station (ISS) with power and thermal interfaces, and involving core and payload command and telemetry processing, without support from ground controllers. This autonomous operations capability is enabling in scenarios such as a crew medical emergency, and representative of other spacecraft autonomy challenges. The experiment was conducted using the Expedite the Processing of Experiments for Space Station (EXPRESS) rack 7, which was located in the Port 2 location within the U.S Laboratory onboard the International Space Station (ISS). Activation and deactivation of this facility is time consuming and operationally intensive, requiring coordination of three flight control positions, 47 nominal steps, 57 commands, 276 telemetry checks, and coordination of multiple ISS systems (both core and payload). The autonomous operations concept includes a reduction of the amount of data a crew operator is required to verify during activation or de-activation, as well as integration of procedure execution status and relevant data in a single integrated display. During execution, the auto-procedures provide a step-by-step messaging paradigm and a high level status upon termination. This messaging and high level status is the only data generated for operator display. To enhance situational awareness of the operator, the Web-based Procedure Display (WebPD) provides a novel approach to the issues of procedure display and execution tracking. For this demonstration, the procedure was initiated and monitored from the ground. As the Timeliner sequences executed, their high level execution status was transmitted to ground, for WebPD consumption.

Stetson, Howard K.↗

A Field-Deployable Magnetic Resonance Imaging Rhizotron for Modeling and Enhancing Root Growth and Biogeochemical Function

A collaborative team from Texas A&M AgriLife Research, ABQMR Inc., the Soil Health Institute, the Athinoula A. Martinos Center for Biomedical Imaging, and NIST developed low-field magnetic resonance imaging (LF-MRI) instrumentation capable of imaging intact soil-root systems. The system measured root biomass, architecture, 3D mass distribution, and growth rates, providing a non-destructive means to evaluate ideal plant characteristics based on root metrics. It also successfully generated three-dimensional images of soil water content, a key property influencing root growth and exploration. Operating much like an MRI used in a medical setting, the system functioned in field conditions without damaging plants, overcoming the limitations of traditional methods such as trenching, soil coring, and root excavation. Over the course of the project, the team designed and built three functional prototype systems. These prototypes provided new insights into root–water–soil interactions that drive processes such as nutrient uptake, water use, and carbon management. This information contributed to efforts to optimize plants for carbon sequestration without sacrificing economic yield. The project also supported the identification of desirable traits for energy sorghum, including high root growth rates, more vertical root angles, and enhanced drought resilience under water-limiting conditions.

09 BIOMASS FUELS↗

Space research - At a crossroads

Efforts which must be expended if U.S. space research is to regain vitality in the next few years are discussed. Small-scale programs are the cornerstone for big science projects, giving both researchers and students a chance to practice the development of space missions and hardware and identify promising goals for larger projects. Small projects can be carried aloft by balloons, sounding rockets, the Shuttle and ELVs. It is recommended that NASA continue the development of remote sensing systems, and join with other government agencies to fund space-based materials science, space biology and medical research. Increased international cooperation in space projects is necessary for affording moderate to large scale missions, for political reasons, and to maximize available space resources. Finally, the establishment and funding of long-range goals in space, particularly the development of the infrastructure and technologies for the exploration and colonization of the planets, must be viewed as the normal outgrowth of the capabilities being developed for LEO operations.

Mcdonald, Frank B.↗

IMPACT-ing Exploration Spaceflight Risk Prediction and Medical System Design

Human exploration spaceflight missions to the Moon and Mars present unprecedented challenges for in-mission medical care. Compared with the ISS, the greater distance from Earth will mean increased mission durations, communication delays, limited to no resupply opportunities, and significant limitations on the evacuation of ill or injured crew. Spacecraft mass, volume, and power will be curtailed while higher demands will be placed on the crew’s knowledge, skills, and abilities. In this higher risk environment, it is important to: a) quantitatively estimate human system risk attributable to medical conditions, a process known as Probabilistic Risk Analysis, and b) use these estimates to inform medical system design. IMPACT (Informing Mission Planning via Analysis of Complex Tradespaces) is a PRA and medical trade space analysis tool developed by NASA to advance exploration mission medical system design. IMPACT improves upon and will soon replace NASA’s existing tool, the Integrated Medical Model, with: a novel evidence base baselined to exploration environments; an expanded list of 120 medical conditions; a significant increase in the number of medical resources that can be utilized and in the flexibility of their use; and the modelling of time lost performing mission-specific tasks due to medical conditions. IMPACT provides evidence-based, mission-specific PRA estimates of in-flight medical risk and an initial list of clinical capabilities and medical resources/hardware to be considered. In addition, sophisticated trade space capabilities estimate how human system risk varies with changes to the mission architecture or medical capability set (e.g., if the system mass constraint decreases by 10% or ultrasound is removed). This panel will provide an overview of IMPACT, its intended use cases, and future development plans. The panel will be the first public presentation of IMPACT results, including medical risk estimates for extended duration Artemis missions, the medical conditions most influencing medical risk metrics, and the clinical capabilities that have the largest effect on medical risk.

Ben Easter↗

Direct ink writing of aqueous-based Gadolinium (III) oxide slurries

Gadolinium (III) oxide (gadolinia, Gd 2 O 3 ) has recently been identified as an intriguing material for applications in the medical, solid oxide fuel cell, and nuclear industries. This interest drives the need for developing and understanding manufacturing techniques that can produce dense Gd 2 O 3 structures. Direct ink writing (DIW), an extrusion-based additive manufacturing method, has also garnered interest because of its capability to produce dense ceramic parts with increased complexity in an economical manner. In this study, DIW was explored as a manufacturing technique for Gd 2 O 3 . Experiments were performed to develop Gd 2 O 3 bearing inks capable of being processed via DIW. Ink solids loading and sintering temperatures were varied to assess their impact on the final density and microstructure. Optimum sintering conditions are proposed and were experimentally verified at a dwell temperature of 1500°C. Gd 2 O 3 samples were successfully manufactured using DIW, achieving densities greater than 96 % of the theoretical density.

36 MATERIALS SCIENCE↗

Medical Lessons Learned from the Exploration Atmospheres Study

Background: The National Aeronautics and Space Administration’s (NASA) Exploration Atmospheres study (EA) was done to evaluate alternative cabin atmospheres for future spacecraft designs and planetary surface exploration of the Moon, Mars and beyond. Deep space exploration involves creating habitats and environments safe for human occupancy and means to explore the outside environment (extravehicular activities, EVA). In order to validate alternative atmospheres and pre-spacewalk procedures, the EA study was conducted to evaluate factors such as hypoxia risks, denitrogenation protocols, food limitations, medications, and the impact of other factors on human performance. Overview: Space travel is constrained by mass, volume, power and the cost of vehicle development, which creates tradeoffs in various capabilities, including breathing gasses. Higher atmospheric pressure in a vehicle means more gas, and a stronger containment vessel/habitat; while lower pressure requires higher oxygen partial pressure, which may increase fire risk. NASA’s EA study evaluated a proposed alternative cabin environment (8.2 psia, 34% Oxygen), for future spacecraft habitat, and planetary EVAs. EA included both a 3-day and a 11-day trial. These trials included a depressurization and saturation to 8.2psi at 34% O2 with additional depresses to 4.3 psia at 85% O2 for simulated EVAs, (1 EVA during the 3-day and 5 during the 11-day trials). Discussion: Planning for and executing the medical monitoring and response plan for a trial of this scope was a huge undertaking with no prior practice to fall back on. Food obstacles, sleeping issues, medications, joint injury, equipment limitations, medical privacy, multiple cases of decompression sickness, and even a COVID outbreak among the support team proved challenging. Conclusion: Testing of this nature is an essential part NASA’s preparation for the upcoming Lunar Artemis missions. As spaceflight transitions beyond low earth orbit, to planetary, even more trials of this nature will be required to learn what are the optimal atmospheric and associated operational constraints to maintain the optimal health of the crew and achieve mission objectives.

R Sanders↗