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The physical exercise and medical monitoring programs conducted during the Salyut-6-Soyuz space flight are discussed. A special suit for physical exercise which provides a load in the longitudinal direction of the body is described. A vacuum device to create reduced pressure and thus prevent disruption of blood circulation is reported. Medical examination of the cosmonauts upon landing and their reported health is discussed.
Current and future Space exploration missions and extended human presence in space aboard the ISS will expose crew to risks that differ both quantitatively and qualitatively from those encountered before by space travelers and will impose an unknown risk of safety and crew health. The technology development challenges for optimizing therapeutics in space must include the development of pharmaceuticals with extended stability, optimal efficacy and bioavailability with minimal toxicity and side effects. Innovative technology development goals may include sustained/chronic delivery preventive health care products and vaccines, low-cost high‐efficiency noninvasive, non‐oral dosage forms with radio‐protective formulation matrices and dispensing technologies coupled with self‐reliant tracking technologies for quality assurance and quality control assessment. These revolutionary advances in pharmaceutical technology will assure human presence in space and healthy living on Earth. Additionally, the Joint Commission on Accreditation of Healthcare Organizations advocates the use of health information technologies to effectively execute all aspects of medication management (prescribing, dispensing, and administration). The advent of personalized medicine and highly streamlined treatment regimens stimulated interest in new technologies for medication management. Intelligent monitoring devices enhance medication accountability compliance, enable effective drug use, and offer appropriate storage and security conditions for dangerous drug and controlled substance medications in remote sites where traditional pharmacies are unavailable. These features are ideal for Exploration Medical Capabilities. This presentation will highlight current novel commercial off‐the‐shelf (COTS) intelligent medication management devices for the unique dispensing, therapeutic drug monitoring, medication tracking, and drug delivery demands of exploration space medical operations.
The astronaut community is unique, and may be disproportionately exposed to occupational hazards not commonly seen in other communities. The extent to which the demands of the astronaut occupation and exposure to spaceflight-related hazards affect the health of the astronaut population over the life course is not completely known. Provision of health screening services to active and former astronauts ensures individual, mission, and community health and safety. Currently, the NASA Johnson Space Center (JSC) Flight Medicine Clinic (FMC) provides extensive medical monitoring to active astronauts throughout their careers. Upon retirement, astronauts may voluntarily return to the JSC FMC for an annual preventive exam. However, current retiree monitoring includes only selected screening tests, representing an opportunity for augmentation. The potential latent health effects of spaceflight demand an expanded framework of testing for former astronauts. The need is two-fold: screening tests widely recommended for other aging communities are necessary for astronauts to rule out conditions resulting from the natural aging process (e.g., colonoscopy, mammography), as opposed to conditions resulting directly from the astronaut occupation; and increased breadth of monitoring services will improve the understanding of occupational health risks and longitudinal health of the astronaut community, past, present, and future. To meet this need, NASA has begun an extensive exploration of the overall approach, cost, and policy implications of expanding existing medical monitoring under the Astronaut Occupational Health program for former NASA astronauts.
When the U.S. first embarked on a manned space flight program, NASA's use of medical telescience was focused on crew health monitoring. In recent years, medical telescience use has been expanded to include support of basic research in space medicine. It enables ground support personnel to assist on-board crews in the performance of experiments and improves the quality and quantity of data return. NASA is continuing to develop its telescience capabilities. Future plans include telemedicine that will enable physicians on Earth to support crewmembers during flight and telescience that will enable investigators at their home institutions to support and conduct in-flight medical research. NASA's use of telescience for crew safety and biomedical research from Project Mercury to the present is described and NASA's plans for the future are presented.
The astronaut community is unique, and may be disproportionately exposed to occupational hazards not commonly seen in other communities. The extent to which the demands of the astronaut occupation and exposure to spaceflight-related hazards affect the health of the astronaut population over the life course is not completely known. A better understanding of the individual, population, and mission impacts of astronaut occupational exposures is critical to providing clinical care, targeting occupational surveillance efforts, and planning for future space exploration. The ability to characterize the risk of latent health conditions is a significant component of this understanding. Provision of health screening services to active and former astronauts ensures individual, mission, and community health and safety. Currently, the NASA-Johnson Space Center (JSC) Flight Medicine Clinic (FMC) provides extensive medical monitoring to active astronauts throughout their careers. Upon retirement, astronauts may voluntarily return to the JSC FMC for an annual preventive exam. However, current retiree monitoring includes only selected screening tests, representing an opportunity for augmentation. The potential long-term health effects of spaceflight demand an expanded framework of testing for former astronauts. The need is two-fold: screening tests widely recommended for other aging populations are necessary to rule out conditions resulting from the natural aging process (e.g., colonoscopy, mammography); and expanded monitoring will increase NASA's ability to better characterize conditions resulting from astronaut occupational exposures. To meet this need, NASA has begun an extensive exploration of the overall approach, cost, and policy implications of e an Astronaut Occupational Health program to include expanded medical monitoring of former NASA astronauts. Increasing the breadth of monitoring services will ultimately enrich the existing evidence base of occupational health risks to astronauts. Such an expansion would therefore improve the understanding of the health of the astronaut population as a whole, and the ability to identify, mitigate, and manage such risks in preparation for deep space exploration missions.
The current status, progress, and future plans for development of the Crew Health Care System (CHeCS) for the International Space Station Freedom are presented. Essential operational biomedical support requirements for the astronauts, including medical care, environmental habitat monitoring, and countermeasures for the potentially maladaptive physiological effects of space flight will be provided by the CHeCS. Three integral parts will make up the system: a health maintenance facility, an environmental health system, and the exercise countermeasures facility. Details of each of the major systems and their subsystems are presented.
To meet the need for continuous, automated monitoring of animal subjects, including; humans, during space flight, NASA is developing advanced physiologic sensor and biotelemetry system technologies. The ability to continuously track basic physiological parameters, such as heart rate, blood pH, and body temperature, in untethered subjects in space is a challenging task. At NASA's Ames Research Center, where a key focus is gravitational biology research, engineers have teamed with life scientists to develop wireless sensor systems for automated physiologic monitoring of animal models as small as the rat. This technology is also being adapted, in collaboration with medical professionals, to meet human clinical monitoring needs both in space and on the ground. Thus, these advanced monitoring technologies have important dual-use functions; they meet space flight data collection requirements and constraints, while concurrently addressing a number of monitoring and data acquisition challenges on the ground in areas of clinical monitoring and biomedical research. Additional applications for these and related technologies are being sought and additional partnerships established that enhance development efforts, reduce costs and facilitate technology infusion between the public and private sectors. This paper describes technology transfer and co-development projects that have evolved out of NASA's miniaturized, implantable chemical sensor development efforts.
Technical aspects of using electronic logic circuits for automatic monitoring in space biology and medicine
Ground-based space analog projects such as the NASA Extreme Environment Mission Operations (NEEMO) can be valuable test beds for evaluation of experimental design and hardware feasibility before actually being implemented on orbit. The International Space Station (ISS) is an closed-system laboratory that orbits 240 miles above the Earth, and is the ultimate extreme environment. Its inhabitants spend hours performing research that spans from fluid physics to human physiology, yielding results that have implications for Earth-based improvements in medicine and health, as well as those that will help facilitate the mitigation of risks to the human body associated with exploration-class space missions. ISS health and medical experiments focus on pre-flight and in-flight prevention, in-flight treatment, and postflight recovery of health problems associated with space flight. Such experiments include those on enhanced medical monitoring, bone and muscle loss prevention, cardiovascular health, immunology, radiation and behavior. Lessons learned from ISS experiments may not only be applicable to other extreme environments that face similar capability limitations, but also serve to enhance standards of care for everyday use on Earth.
The "black bag" is outgrowth of astronaut monitoring technology from NASA's Johnson Space Center. Technically known as the portable medical status system, a highly advanced physician's "black bag" weighs less than 30 pounds, yet contains equipment for monitoring and recording vital signs, electrocardiograms, and electroencephalograms. Liquid crystal displays are used to present 15 digits of data simultaneously for long periods of time without excessive use of battery power. Single printed circuit card contains all circuitry required to measure and display vital signs such as heart and respiration rate, temperature, and blood pressure.
A contract for the development of an astronaut monitoring system in the early days of the space program provided Mennen Medical, Inc. with a foundation in telemetry that led to the development of a computerized medical electronic system used by hospitals. Mennen was the first company to adopt solid state design in patient monitoring and to offer multipatient telemetry monitoring. Telemetry converts instrument data to electrical signals and relays them to a remote receiver where they are displayed. From a central station, a nurse can monitor several patients. Company products include VISTA systems and Horizon 2000 Monitor.
A key science goal of the NASA “Moon to Mars” campaign is to understand how biology responds to the Lunar, Martian, and deep space environments in order to advance fundamental knowledge, reduce risk, and support safe, productive human space missions. Through the powerful emerging approaches of artificial intelligence (AI) and machine learning (ML), a paradigm shift has begun in biomedical science and engineered astronaut health systems, to enable Earth independence and autonomy of mission operations. Here we present an overview of AI/ML architecture to support deep space mission goals, developed with leaders in the field. First, we focus on the fundamental biological research that supports our understanding of physiological responses to spaceflight, and we describe current efforts to support AI/ML research including data standardization and data engineering through maximally open and FAIR (findable, accessible, interoperable, reusable) databases and the generation of AI-ready datasets for reuse and analysis. We also discuss remote data management frameworks for research data as well as environmental and health data that are generated during deep space missions. We highlight several research projects that leverage data standardization and management for fundamental biological discovery to uncover the complex effects of space travel on living systems. Next, we provide an overview of cutting-edge AI/ML approaches that can be integrated to support remote monitoring and analysis during deep space missions, including generative models and large language models to learn the underlying biomedical patterns and predict outcomes or answer questions during off world medical scenarios. We also describe current AI/ML methods to support this research and monitoring through automated cloud-based labs which enable limited human intervention and closed-loop experimentation in remote settings. These labs could support mission autonomy by analyzing environmental data streams, and would be facilitated through in situ analytics capabilities to avoid sending large raw data files through low bandwidth communications. Finally, in the context of deep space missions with limited communications or access to medical advice from Earth, we describe a solution for integrated, real-time mission biomonitoring across hierarchical levels from continuous environmental monitoring, to wearables and point-of-care devices, to molecular and physiological monitoring. We introduce a precision space health system that will ensure that the future of space health is predictive, preventative, participatory and personalized.
NASA’s Exploration Medical Integrated Product Team (XMIPT) has identified Clinical Decision Support (CDS) technology as a critical need for future human space exploration. Such technology will support real time diagnosis, monitoring, and treatment of spaceflight medical conditions. The need for such tools and support systems is critical for in-mission clinical decision-making, especially when Earth-based support is unavailable due to communication delays or blackouts. Supporting technologies may or may not involve Artificial Intelligence (AI), and would support astronaut crew with minimal clinical training, or even those with advanced training if they are, for example, in need of a refresher, experiencing multiple stressors, or temporarily overloaded with tasking. This need traces to the Development of Earth Independent Operations Technologies for NASA’s Mars Campaign Office. The CDS Market Survey purpose, methods, outcomes thus far, and near-term steps will be discussed.
The use of automated, analytical techniques to aid medical support teams is suggested. Recommendations are presented for characterizing crew health in terms of: (1) wholebody function including physiological, psychological and performance factors; (2) a combination of critical performance indexes which consist of multiple factors of measurable parameters; (3) specific responses to low noise level stress tests; and (4) probabilities of future performance based on present and periodic examination of past performance. A concept is proposed for a computerized real time biomedical monitoring and health care system that would have the capability to integrate monitored data, detect off-nominal conditions based on current knowledge of spaceflight responses, predict future health status, and assist in diagnosis and alternative therapies. Mathematical models could play an important role in this approach, especially when operating in a real time mode. Recommendations are presented to update the present health monitoring systems in terms of recent advances in computer technology and biomedical monitoring systems.
Radiation Assessment DuRing Exposure And long-Duration Spaceflight (RADREADS) demonstrates space-compatible point-of-care technology for quantitative biological monitoring of blood miRNA biomarkers in response to long-term low dose radiation exposure. This individualized monitoring approach will inform targeted treatment strategies to maximize medical resource utilization by accounting for individual susceptibility to radiation-related illnesses. As human spaceflight progresses beyond Earth’s magnetic shielding, radiation exposure poses a significant risk to astronaut health and safety. Extended operation in this environment comes with an increased risk of radiation exposure, leading to higher risks of radiation sickness, cancer, central nervous system effects, and degenerative diseases. While conventional physical dosimetry techniques capture radiation dose, individualistic susceptibility to radiation damage is varied. Multiple characteristics, including age, body weight, sex, genetics, and immune status, have been found to influence radiosensitivity (Liu et al. 2011, and Bouffler 2016). This differential response necessitates individualized monitoring and targeted treatment strategies to maximize medical resource utilization; however, a practical diagnostic platform for quantifying long-term, low dose radiation-induced tissue damage does not currently exist. MicroRNAs (miRNAs) are a class of small, non-coding RNAs that regulate gene expression by mediating the degradation of messenger RNA. The levels of particular miRNAs are influenced by biological processes such as inflammation and serve as biomarkers for a variety of conditions including cancer (Singh et al. 2017). MicroRNAs are found in various bodily fluids and are amenable to collection via liquid biopsies, providing a minimally invasive and easily quantifiable readout for a variety of radiosensitive reporters. A preliminary signature of 15 spaceflight sensitive miRNA has been identified in rodent and human studies, including miR-21-5p, miR-24-3p, miR-92a-3p, miR-17-5p, miR-16a-3p, miR-34a-3p, and miR-223-3p. These targets generally increased expression with radiation dose and linear energy transfer, though variation between individuals is not yet described. Current gaps in the field include a lack of understanding of longitudinal biological responses to long-term, low dose radiation exposure and the absence of space-compatible point-of-care technology for quantitative biological monitoring. In this body of work, we aim to develop an automated bleed-to-read system to process whole blood for the detection of miRNA biomarkers in order to monitor individualistic responses to radiation exposure. This will be achieved via separating serum (or plasma) from whole blood, followed by extraction, amplification, and quantification of the miRNA using a RT-qPCR reaction. Previously, the WetLab-2 hardware enabled execution of a RT-qPCR reaction aboard ISS; however, it is a manual system that requires crew manipulation and bulky components (Parra et al. 2017). To address these issues, automated fluid handling hardware was developed for each stage of sample preparation. Extraction of total RNA is achieved by sequentially pumping reagents through an off-the-shelf nucleic acid binding column (miRNeasy Serum/Plasma Advanced Kit, Qiagen). This approach eliminates several manual pipetting and centrifuging steps and limits the use of toxic chemicals commonly found in other sample processing techniques. The resulting elution will then be automatically dispensed for RT-qPCR analysis using a compact rotary qPCR (Mic qPCR Cycler, Bio Molecular Systems) that will improve spaceflight compatibility by removing bubbles from the detection region, another challenge highlighted by WetLab-2 (Parra et al. 2017). Efforts are also being made to simplify the RT-qPCR reaction to a 1-step air-dryable mix to improve long-term reagent stability at room temperature and reduce system complexity. By automating the RT-qPCR processes via microfluidic manipulation, RADREADS will reduce crewmember hands-on time and enable the personalized detection of radiation-induced tissue damage during long duration missions. Minimally invasive, longitudinal monitoring of individual’s response to radiation exposure will inform how the physiological system responds to long-term low dose space radiation and enables development of targeted countermeasures by the medical team. Ultimately, this portable technology will require minimal technical expertise and can also be used to monitor miRNA biomarkers associated with other diseases.
A C14-CO2 radiorespirometry-computer system for monitoring human metabolism during space missions is described. Data collection using this apparatus is an effective 'real time' system allowing rapid, low-cost data processing which is ideal for telemetering signals from spacecraft to earth.
Recent U.S. policy developments on the commercial use of space are summarized and their international implications are considered. Attention is given to successful applications of technology developed in space, including an implantable cancer medication system, an implantable defibrillator, an ultrasonic residual stress monitor, and aquaculture treatment techniques. NASA projects involving bioengineering and rehabilitation applications are summarized, and plans to investigate high-temperature superconductors in space are addressed. Recent agreements entred into by NASA for space commercial studies are reviewed.
Astronauts will be away from Earth-based medical care for long periods during future exploration missions. Thus, it will be necessary for the astronauts to perform various medical tasks to monitor and maintain their health in the microgravity environment of space. Performance of these tasks will be constrained due to the limited volume available to perform the task, the absence of gravity and the limited resources and capabilities available in the medical work area. It is therefore necessary to evaluate exploration medical workstation designs for how well the designs will support crew performance of medical tasks. This evaluation featured two trained medical caregivers (99th percentile male, 26th percentile female) performing emergent care procedures (alone and in tandem) on a medical manikin. The procedures came from the The procedures came from the International Space Station Medical Checklist, and they are designed for spaceflight. The objectives of the evaluation included determining the operational volume required to perform the tasks, examining the effect of constraining the operational volume with partitions, determining candidate locations for foot restraints and equipment placements and determining the effect of single vs. dual caregiver on the operational volume.A marker-based motion capture system collected the motion data, which enabled computation of operational volumes and foot placement maps using custom Python code. Additional data collected included heart rate, time to perform the procedures, and feedback from the caregivers in the form of the NASA Task Load Index (TLX), the US Government System Usability Survey, and an open-ended questionnaire.