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Challenges, Considerations, and Opportunities for Exercise and Medical Accommodation Inside a Small Pressurized Rover

Pressurized Rovers (PR) can enable crew to explore away from a lander or surface habitat at distances not possible on foot or even in unpressurized rovers. Sustaining crew for multiple days, they can rove for weeks, independent of other surface elements. Because these are essentially mobile habitats, it is critical that they provide sufficient volume to accommodate the exercise and medical systems to maintain human health in remote, low gravity environments such as the Moon and Mars. This is an area of extensive unknowns as requirements have not yet been developed for exercise or medical systems in pressurized rovers. Yet they must be considered in vehicle sizing studies as they are significant volume drivers, requiring allocation for stowed and deployed hardware inside the rover cabin. Previously flown spacecraft have allocated varying amounts of volume based on the expected crew mission and the state of the art in these systems. NASA-STD-3001 provides high-level requirements for standards of medical care and exercise capabilities. Crew injuries are possible both inside the cabin and on extravehicular activities (EVA), therefore requiring medical capability. Exercise countermeasures are needed to counteract the debilitating effects of lowered gravity. This may include both reconditioning following a lengthy microgravity transit as well as ongoing countermeasures against the effect of low surface gravity. The NASA reference concept for the PR dates back to the Constellation Program and prototypes have been extensively tested in NASA’s Desert Research and Technology Studies (DRATS) program as well as at the NASA Johnson Space Center. The PR cabin is designed to accommodate two crewmembers and is subdivided into a forward cockpit area and a main body for crew habitation. EVAs are accomplished by transitioning through suit ports in the aft bulkhead into spacesuits. While no exercise devices have been developed for the PR, some have been prototyped and demonstrated in DRATS analog missions. A cycle ergometer performed reasonably well in DRATS testing as an aerobic exercise device and recent analysis work has theorized that a combination aerobic and resistive device could be packaged into a form factor similar to the DRATS ergometer. It is therefore suitable for use as an initial volumetric placeholder. No sensorimotor devices have been considered for the PR to aid in adaptation to surface gravity. However, there are commercially available treadmills that at minimum represent examples of the type of exercise system that could potentially be used for such a purpose. A combination of field test data, analysis, and CAD modeling will be used to perform a first pass assessment of whether these exercise devices can be stowed and deployed within the PR. Medical inventories from the International Space Station will be used as a volume placeholder for the PR medical system. A configuration will be discussed for medical deployment, including positioning of caregiver, patient, and medical equipment / supplies.

Pressurized Rover↗

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.↗

Turning Limitations into Opportunities in the Development of the Orion Medical System: Incorporation of mHealth Devices

INTRODUCTION: Selection of medical devices for the Orion medical system is a complex task which is dependent on the current state of terrestrial technology. In this work we review the interplay between NASA requirements, constraints, and opportunities for synergy during the development of the Orion medical system. METHODS: The “plan to treat” list of conditions, and subsequently the medical resource list for the Orion Artemis II lunar flyby mission was completed using semi-quantitative methods. During this process, some medical resources were excluded to comply with mass and volume limits, while other resources applicable to multiple medical requirements were prioritized for inclusion. Choices were also examined considering NASA level of care standards for the Artemis design reference missions. As a means to optimize capabilities in spite of mass and volume constraints, ideas for integration of multiple devices into a single platform were explored, including a ‘hackathon’ challenge which was conducted to generate and evaluate concepts for combining medical devices into a single app-based mobile device (ultrasound, ECG, etc.). RESULTS: The Orion team identified 128 medical conditions that we “plan to treat”, with 139 unique medical resources to address these conditions, including 5 digital diagnostic devices (ECG, otoscope, stethoscope, pulse oximeter, and blood pressure monitor). During selection of these digital devices the team noted that miniaturized medical devices often use mobile device platforms (mHealth), some displaying and transmitting data exclusively via mobile device. Of the 5 initially selected devices, all are capable of mobile connection, one which cannot function without a mobile device (ECG). Furthermore, only one of these devices connects natively to a Windows platform, which is currently the only operating system available on Orion. DISCUSSION: Significant savings in mass and volume as well as training and usability improvements can be achieved by leveraging mHealth technologies. However, the platform presents significant challenges for deployment within the Artemis Program including lack of internet connectivity, incompatible operating systems, and radiation concerns. Each of these drawbacks are surmountable with investment in the supporting vehicle architecture, which may become necessary to support the technology trends seen in commercially available medical devices today. Objective: Learn about the opportunities and challenges of leveraging mHealth devices in the development of medical capabilities for austere environments. Learn about the constraints of the NASA spaceflight environment with regards to digital medical device integration.

Douglas Ebert↗

Technology Development to Support Human Health and Performance in Exploration Beyond Low Earth Orbit

In the course of defining the level of risks and mitigating the risks for exploration missions beyond low Earth orbit, NASA s Human Research Program (HRP) has identified the need for technology development in several areas. Long duration missions increase the risk of serious medical conditions due to limited options for return to Earth; no resupply; highly limited mass, power, volume; and communication delays. New space flight compatible medical capabilities required include: diagnostic imaging, oxygen concentrator, ventilator, laboratory analysis (saliva, blood, urine), kidney stone diagnosis & treatment, IV solution preparation and delivery. Maintenance of behavioral health in such an isolated, confined and extreme environment requires new sensory stimulation (e.g., virtual reality) technology. Unobtrusive monitoring of behavioral health and treatment methods are also required. Prolonged exposure to weightlessness deconditions bone, muscle, and the cardiovascular system. Novel exercise equipment or artificial gravity are necessary to prevent deconditioning. Monitoring of the degree of deconditioning is required to ensure that countermeasures are effective. New technologies are required in all the habitable volumes (e.g., suit, capsule, habitat, exploration vehicle, lander) to provide an adequate food system, and to meet human environmental standards for air, water, and surface contamination. Communication delays require the crew to be more autonomous. Onboard decision support tools that assist crew with real-time detection and diagnosis of vehicle and habitat operational anomalies will enable greater autonomy. Multi-use shield systems are required to provide shielding from solar particle events. The HRP is pursuing the development of these technologies in laboratories, flight analog environments and the ISS so that the human health and performance risks will be acceptable with the available resources.

Kundrot, C.E.↗

Smart Ultrasound Remote Guidance Experiment (SURGE) Preliminary Findings

To date, diagnostic quality ultrasound images were obtained aboard the International Space Station (ISS) using the ultrasound of the Human Research Facility (HRF) rack in the Laboratory module. Through the Advanced Diagnostic Ultrasound in Microgravity (ADUM) and the Braslet-M Occlusion Cuffs (BRASLET SDTO) studies, non-expert ultrasound operators aboard the ISS have performed cardiac, thoracic, abdominal, vascular, ocular, and musculoskeletal ultrasound assessments using remote guidance from ground-based ultrasound experts. With exploration class missions to the lunar and Martian surfaces on the horizon, crew medical officers will necessarily need to operate with greater autonomy given communication delays (round trip times of up to 5 seconds for the Moon and 90 minutes for Mars) and longer periods of communication blackouts (due to orbital constraints of communication assets). The SURGE project explored the feasibility and training requirements of having non-expert ultrasound operators perform autonomous ultrasound assessments in a simulated exploration mission outpost. The project aimed to identify experience, training, and human factors requirements for crew medical officers to perform autonomous ultrasonography. All of these aims pertained to the following risks from the NASA Bioastronautics Road Map: 1) Risk 18: Major Illness and Trauna; 2) Risk 20) Ambulatory Care; 3) Risk 22: Medical Informatics, Technologies, and Support Systems; and 4) Risk 23: Medical Skill Training and Maintenance.

Hurst, Victor↗

Space Radiation Technologies for Human Missions beyond Low-Earth-Orbit

Ionizing radiation exposure is a pervasive occupational risk to astronauts and remains a major health risk associated with human exploration beyond low-Earth-orbit. Sustained lunar and Mars exploration crew will be at increased risk of radiogenic cancers and cardiovascular disease, as well as, the potential for in-mission performance decrements, immune system decrements, and late neurodegenerative conditions impacting crew health. Optimizing astronaut space radiation protection will incorporate both physical and biological radiological aspects and will implement protection strategies that span pre-mission, in-flight, and post mission timelines. Major facets of physical risk mitigation include accuracy in predicting the space radiation solar environment, monitoring environmental and human exposures, and minimizing exposure through vehicle shielding and design. Biological mitigation facets include understanding and predicting biological response to the space environment, developing advanced medical countermeasures, and identifying appropriate surveillance strategies to preserve long-term health. Coordinated investments in these major capability areas will support development of an integrated radiation protection solution to minimize astronaut risk for moon to Mars exploration missions.

Lisa C Simonsen↗

Physical interpretation and development of ultrasonic nondestructive evaluation techniques applied to the quantitative characterization of textile composite materials

In this Progress Report, we describe our continuing research activities concerning the development and implementation of advanced ultrasonic nondestructive evaluation methods applied to the inspection and characterization of complex composite structures. We explore the feasibility of implementing medical linear array imaging technology as a viable ultrasonic-based nondestructive evaluation method to inspect and characterize complex materials. As an initial step toward the application of linear array imaging technology to the interrogation of a wide range of complex composite structures, we present images obtained using an unmodified medical ultrasonic imaging system of two epoxy-bonded aluminum plate specimens, each with intentionally disbonded regions. These images are compared with corresponding conventional ultrasonic contact transducer measurements in order to assess whether these images can detect disbonded regions and provide information regarding the nature of the disbonded region. We present a description of a standoff/delay fixture which has been designed, constructed, and implemented on a Hewlett-Packard SONOS 1500 medical imaging system. This standoff/delay fixture, when attached to a 7.5 MHz linear array probe, greatly enhances our ability to interrogate flat plate specimens. The final section of this Progress Report describes a woven composite plate specimen that has been specially machined to include intentional flaws. This woven composite specimen will allow us to assess the feasibility of applying linear array imaging technology to the inspection and characterization of complex textile composite materials. We anticipate the results of this on-going investigation may provide a step toward the development of a rapid, real-time, and portable method of ultrasonic inspection and characterization based on linear array technology.

Miller, James G.↗

Validation of Procedures for Monitoring Crewmember Immune Function SDBI-1900, SMO-015 - Integrated Immune

There is ample evidence to suggest that space flight leads to immune system dysregulation. This may be a result of microgravity, confinement, physiological stress, radiation, environment or other mission-associated factors. The clinical risk from prolonged immune dysregulation during space flight are not yet determined, but may include increased incidence of infection, allergy, hypersensitivity, hematological malignancy or altered wound healing. Each of the clinical events resulting from immune dysfunction has the potential to impact mission critical objectives during exploration-class missions. To date, precious little in-flight immune data has been generated to assess this phenomenon. The majority of recent flight immune studies have been post-flight assessments, which may not accurately reflect the in-flight condition. There are no procedures currently in place to monitor immune function or its effect on crew health. The objective of this Supplemental Medical Objective (SMO) is to develop and validate an immune monitoring strategy consistent with operational flight requirements and constraints. This SMO will assess the clinical risks resulting from the adverse effects of space flight on the human immune system and will validate a flight-compatible immune monitoring strategy. Characterization of the clinical risk and the development of a monitoring strategy are necessary prerequisite activities prior to validating countermeasures. This study will determine, to the best level allowed by current technology, the in-flight status of crewmembers immune system. Pre-flight, in-flight and post-flight assessments of immune status, immune function, viral reactivation and physiological stress will be performed. The in-flight samples will allow a distinction between legitimate in-flight alterations and the physiological stresses of landing and readaptation which are believed to alter landing day assessments. The overall status of the immune system during flight (activation, deficiency, dysregulation) and the response of the immune system to specific latent virus reactivation (known to occur during space flight) will be thoroughly assessed. Following completion of the SMO the data will be evaluated to determine the optimal set of assays for routine monitoring of crewmember immune system function, should the clinical risk warrant such monitoring.

Crucian, Brian↗

The space life sciences strategy for the 21st century

In the 21st century, NASA's long-term strategy for the exploration of the solar system will combine the assurance of human health and performance for long periods in space with investigations aimed at searching for traces of life on other planets and acquiring fundamental scientific knowledge of life processes. Implementation of this strategy will involve a variety of disciplines including radiation health, life support, human factors, space physiology and countermeasures, medical care, environmental health, and exobiology. It will use both ground-based and flight research opportunities such as those found in current ongoing programs, on Spacelab and unmanned biosatellite flights, and during Space Station Freedom missions.

Nicogossian, Arnauld E.↗

Space Medicine in the Human System Integration Process

This slide presentation reviews the importance of integration of space medicine in the human system of lunar exploration. There is a review of historical precedence in reference to lunar surface operations. The integration process is reviewed in a chart which shows the steps from research to requirements development, requirements integration, design, verification, operations and using the lessons learned, giving more information and items for research. These steps are reviewed in view of specific space medical issues. Some of the testing of the operations are undertaken in an environment that is an analog to the exploration environment. Some of these analog environments are reviewed, and there is some discussion of the benefits of use of an analog environment in testing the processes that are derived.

Scheuring, Richard A.↗

Overview of the Translational Radiation Research and Countermeasures (TRRaC) Project in Space Radiation

The Translational Radiation Research and Countermeasures (TRRaC) Project was initiated by the Space Radiation (SR) Element within NASA’s Human Research Program (HRP) to support the SR mission to understand and characterize the space radiation environment, understand and quantify radiation-associated risks, and mitigate the impacts of radiation-induced adverse health outcomes to enable human space exploration. TRRaC’s mission is to translate radiation research results from experimental studies and epidemiological data to humans and astronauts using bioinformatics and computational modeling. TRRaC will leverage existing datasets such as those available from NASA’s GeneLab repository and human medical radiation exposure registries, along with relevant data generated from ground-based research at molecular, cellular, tissue, and system levels, to: (1) refine the radiation dose rate effectiveness factor, (2) characterize radiation quality effects to improve estimates of the risk of exposure-induced death (REID) from space-relevant radiation exposures, and (3) identify pathways and biomarkers for cancer, cardiovascular disease, and central nervous system changes that are impacted by space radiation exposure.

Parastou Eslami↗

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↗

The Fluids and Combustion Facility: Enabling the Exploration of Space

The Fluids and Combustion Facility (FCF) is an International Space Station facility designed to support physical and biological research as well as technology experiments in space. The FCF consists of two racks called the Combustion Integrated Rack (CIR) and the Fluids Integrated Rack (FIR). The capabilities of the CIR and the FIR and plans for their utilization will support the President's vision for space exploration. The CIR will accommodate physical research and technology experiments that address needs in the areas of spacecraft fire prevention, detection and suppression, incineration of solid wastes, and power generation. Initial experiments will provide data to support design decisions for exploration spacecraft. The CIR provides a large sealed chamber in a near-weightless environment. The chamber supports many simulated atmospheres including lunar or Martian environments. The FIR will accommodate experiments that address needs for advanced life support, power, propulsion, and spacecraft thermal control systems. The FIR can also serve as a platform for experiments that address human health and performance, medical technologies, and biological sciences. The FIR provides a large volume for payload hardware, reconfigurable diagnostics, customizable software, active rack-level vibration isolation, and data acquisition and management in a nearly uniform temperature environment.

Weiland, Karen J.↗

THE FLUIDS AND COMBUSTION FACILITY: ENABLING THE EXPLORATION OF SPACE

The Fluids and Combustion Facility (FCF) is an International Space Station facility designed to support physical and biological research as well as technology experiments in space. The FCF consists of two racks called the Combustion Integrated Rack (CIR) and the Fluids Integrated Rack (FIR). The capabilities of the CIR and the FIR and plans for their utilization will support the President s vision for space exploration. The CIR will accommodate physical research and technology experiments that address needs in the areas of spacecraft fire prevention, detection and suppression, incineration of solid wastes, and power generation. Initial experiments will provide data to support design decisions for exploration spacecraft. The CIR provides a large sealed chamber in a near-weightless environment. The chamber supports many simulated atmospheres including lunar or Martian environments. The FIR will accommodate experiments that address needs for advanced life support, power, propulsion, and spacecraft thermal control systems. The FIR can also serve as a platform for experiments that address human health and performance, medical technologies, and biological sciences. The FIR provides a large volume for payload hardware, reconfigurable diagnostics, customizable software, active rack-level vibration isolation, and data acquisition and management in a nearly uniform temperature environment.

Weiland, Karen J.↗

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.↗

Introduction to Medical Extensible Dynamic Probabilistic Risk Assessment Tool (MEDPRAT)

A key component in the development of NASA Human Research Programs (HRP) next generation risk model, the Medical Extensible Dynamic Probabilistic Risk Assessment Tool (MEDPRAT) intends to deliver a means to quantify how HRP products impact astronaut medical and health risks. MEDPRAT is extensible to the majority of exploration missions. Similar to other risk models, the tool utilizes the available space and terrestrial medical data. MEDPRAT is designed to be extended with additional human health research information, medical equipment, space and terrestrial standards and practices to assess space flight medical risk in a manner consistent with other risk measures used in spacecraft and mission design. This tool provides risk-based medical system design information necessary to evaluate new technologies, procedures, research insights and mission plans.

physiological response↗

Datascope to Enable Earth Independent Medical Operations (EIMO)

BACKGROUND: NASA has amassed sixty years of knowledge and experience relevant to maintenance of crew health and performance in low earth orbit. The Apollo Program introduced the importance of ensuring progressively autonomous operational capability. Earth Independent Medical Operations (EIMO) will require a gradual shift in the balance of medical responsibility, management, and authority from terrestrial to space-based assets. Terrestrial assets will continue to be essential for pre-mission screening and planning in addition to maintenance of crew health and performance. However, new capabilities are needed to enable EIMO and the amount of data required to support these systems, and mitigate the impacts of data transmission delays and reduced bandwidth coupled with lack of cloud-like resources and on-board computing capacity that is currently unclear or operationally insufficient. OVERVIEW: The overall goal of EIMO is to develop artificial intelligence (AI)-based solutions to analyze crew health and performance data utilizing a clinical decision support system (CDSS) to provide crew medical officers (CMO) with the equivalent of real-time, on-board medical consults. The EIMO ecosystem is envisioned as a “system of systems” where embedded reference databases and real-time data streams from multiple input vectors continuously and seamlessly assess crew health and performance. EIMO will be designed to make recommendations to the CMO using multi-modal AI-based natural language processing and machine learning methods with interoperability to push/pull data within and between multiple vehicle and habitat architectures. DISCUSSION: Data flows and storage/retrieval capacity are severely constrained during space missions and the challenges will become even greater during exploration missions. Just as each past program from Mercury to the International Space Station (ISS) required rethinking the interaction between ground-based controllers and space-based crew, so too will future missions to the Moon and Mars. While the NASA High-Performance Spaceflight Computing Processor project aims to increase computational capacity by 100 times over current spaceflight computers, the projected deliverable still lags considerably behind what will be needed to enable an AI-driven CDSS. Restrictions in processing speed and data storage capacity, coupled with transmission bottlenecks and delays, necessitate definition and optimization of an integrated data architecture to enable a progressively autonomous medical capability.

Medical operations↗

Human Health and Performance Considerations for Exploration of Near-Earth Asteroids

This presentation will describe the human health and performance issues that are anticipated for the human exploration of near-Earth asteroids (NEA). Humans are considered a system in the design of any such deep-space exploration mission, and exploration of NEA presents unique challenges for the human system. Key factors that define the mission are those that are strongly affected by distance and duration. The most critical of these is deep-space radiation exposure without even the temporary shielding of a nearby large planetary body. The current space radiation permissible exposure limits (PEL) restrict mission duration to 3-10 months depending on age and gender of crewmembers and stage of the solar cycle. Factors that affect mission architecture include medical capability; countermeasures for bone, muscle, and cardiovascular atrophy during continuous weightlessness; restricted food supplies; and limited habitable volume. The design of a habitat that can maintain the physical and psychological health of the crew and support mission operations with limited intervention from Earth will require an integrated research and development effort by NASA s Human Research Program, engineering, and human factors groups. Limited abort and return options for an NEA mission are anticipated to have important effects on crew psychology as well as influence medical supplies and training requirements of the crew. Other important factors are those related to isolation, confinement, communication delays, autonomous operations, task design, small crew size, and even the unchanging view outside the windows for most of the mission. Geological properties of the NEA will influence design of sample handling and containment, and extravehicular activity capabilities including suit ports and tools. A robotic precursor mission that collects basic information on NEA surface properties would reduce uncertainty about these aspects of the mission as well as aid in design of mission architecture and exploration tasks.

Kundrot, Craig↗