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Human Monitoring for Medical Operator Assistance

Measurement of multiple biologic and non-biologic signals can be exploited for the task of monitoring the physiological status of individuals - either as patients during and following illness or injury or as those engaged in operational activities. Assessing physiological status is accomplished by measuring vital signs and wellness measures that support clinical decision-making for physical optimization, illness/injury prevention and treatment, recovery progression, and general delivery of care, or monitoring an operator's moment-to-moment personal "readiness" state. Physiological measures are beneficial for monitoring the medical state of vehicle operators, for example, through the detection of incapacitation in the realm of transportation safety. Measuring physiological signals or control inputs can also be beneficial for monitoring operator state to optimize human-autonomy-teaming performance for safety and efficiency. Similarly, monitoring a health care provider during the performance of medical procedures could provide valuable feedback on optimizing human-robot interactions and human teaming with autonomous systems. In this sense, the provider can be seen as a "Medical Operator" in the same way other "operators" drive, aviate, or control vehicles by performing manual, attention-demanding tasks during safety-critical activities.

Neuroergonomics↗

Derivation of the Most Influential Medical Conditions for An Extended Duration Artemis Mission

BACKGROUND: The risk of loss of mission due to medical conditions may be influenced by loss of crew life (LOCL), need for evacuation (RTDC; return to definitive care), and crew task time lost. Predicting what medical conditions are most likely to lead to crew morbidity and mortality may influence medical system design, clinical capability prioritization, and research strategies. NASA’s Informing Mission Planning via Analysis of Complex Tradespaces tool (IMPACT) applies Probabilistic Risk Assessment (PRA) methodology to assess these risks. OVERVIEW: A team of subject matter experts (SME) from a variety of medical disciplines developed a consensus-based process to determine 120 of the most clinically relevant medical conditions for long-duration exploration missions (LDEMs) . This IMPACT Condition List (ICL) expanded upon previous work done for Integrated Medical Model (IMM). For each condition a best-case and worst-case definition were derived. These definitions were used to identify probability of occurrence, proportion of cases that are best case vs. worst case, clinical phase duration, and risk of outcomes (task time loss [TTL], RTDC, and LOCL) for both treated and untreated states. These data were sources from existing spaceflight databases (e.g. Longitudinal Survey of Astronaut Health), relevant models (e.g. the ISS fire model), and/or terrestrial literature. Each condition was then tied to diagnostic and therapeutic resources and capabilities. IMPACT was then run for the LDLOLS DRM (see Abstract #2 for this panel). DISCUSSION: This abstract will present the process for generating the IMPACT condition list, the relevant data for each clinical condition, and present results for the ten most influential conditions impacting LOCL, RTDC, and TTL for a representative extended duration Artemis mission.

A Nelson↗

Biomedical Results of the Space Shuttle Program

The Space Shuttle Program (SSP), which was triumphantly completed by the flight of STS-135 on July 21, 2011, holds a special place in the history of Human Space Exploration. For the first time, a vehicle was built that could perform multiple flights in space and return to Earth. Many important questions regarding the ability of humans to adapt and function in space have been answered during the 30 years since the SSP was launched and many lessons have been learned. The multidisciplinary studies conducted during this program allowed NASA to define the normal responses and potential pathologic changes of the major physiological systems to short-duration space flights. The program significantly contributed to the development of in-flight medical care capabilities and multiple countermeasures. A comprehensive system of preflight, in-flight, and post-flight monitoring of the astronauts was built. It is important to emphasize that the SSP was essential for building the International Space Station (ISS) that significantly expanded the boundaries of space research, allowing for planning of long-term near-terrestrial and extraterrestrial missions. As the program was coming to completion, a decision was made by the NASA Lyndon B. Johnson Space Center Human Research Program senior management to summarize the medico-biological results of the SSP in one comprehensive edition. This was quite an ambitious goal. It required selection of a group of experts in different areas to become the chapters lead authors. These experts were charged with the task of reviewing what was learned in the consequent fields to make the chapters a comprehensive source of information for planning of research, operational activities, and medical care for future missions. We hope that we were able to accomplish this goal and the book will serve as a reliable reference edition for the international space biomedicine community, for new generation of space researchers and Flight Surgeons, as well as for all those interested in space exploration. As space exploration continues, the major question of whether humans are capable of adapting to long-term presence and adequately functioning in space habitats will remain open for a long time. we expect that the comprehensive review of the medico-biological results of the SSP along with the data collected during the missions on the space stations (the Russian space station _Mir_ and ISS) provides a good starting point in seeking the answer to this question.

Diana Risin↗

Reuniting philosophy and science to advance cancer research

Cancers rely on multiple, heterogeneous processes at different scales, pertaining to many biomedical fields. Therefore, understanding cancer is necessarily an interdisciplinary task that requires placing specialised experimental and clinical research into a broader conceptual, theoretical, and methodological framework. Without such a framework, oncology will collect piecemeal results, with scant dialogue between the different scientific communities studying cancer. We argue that one important way forward in service of a more successful dialogue is through greater integration of applied sciences (experimental and clinical) with conceptual and theoretical approaches, informed by philosophical methods. By way of illustration, we explore six central themes: (i) the role of mutations in cancer; (ii) the clonal evolution of cancer cells; (iii) the relationship between cancer and multicellularity; (iv) the tumour microenvironment; (v) the immune system; and (vi) stem cells. In each case, we examine open questions in the scientific literature through a philosophical methodology and show the benefit of such a synergy for the scientific and medical understanding of cancer.

59 BASIC BIOLOGICAL SCIENCES↗

A Revolution in the Making: Advances in Materials That May Transform Future Exploration Infrastructures and Missions

The NASA Strategic Plan identifies the long-term goal to provide safe and affordable space access, orbital transfer, and interplanetary transportation capabilities to enable research, human exploration, and the commercial development of space; and to conduct human and robotic missions to planets and other bodies in our solar system. Numerous scientific and engineering breakthroughs will be required to develop the technology necessary to achieve this goal. Critical technologies include advanced vehicle primary and secondary structure, radiation protection, propulsion and power systems, fuel storage, electronics and devices, sensors and science instruments, and medical diagnostics and treatment. Advanced materials with revolutionary new capabilities are an essential element of each of these technologies. This paper discusses those materials best suited for aerospace vehicle structure and highlights the enormous potential of one revolutionary new material, carbon nanotubes.

Harris, Charles E.↗

Crew Medical Training to Progressively Enable EIMO

Background. Onboard medical capabilities have greatly expanded over the history of the US space program. Newly identified space-related medical conditions, technological advances, and longer mission durations have led to an increasing need for on-demand medical expertise. Lengthy communications delays, lack of resupply and evacuation opportunities on exploration-class missions place an ever-increasing burden on the crew to provide medical care. Having adequate knowledge, skills, and abilities (KSA) available is an essential component of successful Earth Independent Medical Operations (EIMO). Without appropriate crew training and KSA, cutting-edge medical equipment has little value. Presumably, the crew will include a qualified physician; however, if the physician is incapacitated, a non-physician crew medical officer (CMO) will be needed. While more crew time is needed for medical training, there will be concomitant increases in preflight training demands for vehicle system management, operations, science, and contingencies. In truly independent operations, onboard resources such as just-in-time training, mixed reality, decision support tools, and AI-enabled chatbot “consultants” will be needed to augment KSA. Overview. Because of crew time constraints, topical priorities must be determined for preflight training. Curricula should be developed that emphasize management of conditions with relatively high incidence and morbidity/mortality. Defining the required KSA levels to treat each condition is essential, but all crewmembers should have basic lifesaving skills. Procedural and diagnostic training on live patients and simulators should be prioritized over classroom lectures. Crews must be trained with onboard equipment, resources, mixed reality, and AI-based decision support tools. Mission simulations should include medical problems with/without ground support and with appropriate communication delays. Certification guidelines for each level of KSA must be established. Skills rapidly decay for non-physician CMO’s; both pre-flight and in-flight refresher training will be needed. During spaceflight just-in-time training, simulations, and onboard CME with crew physician can help retain skills. Discussion. Medical technology, simulation design, mixed reality, and AI are advancing at a dizzying rate. Recognizing the severe constraints on crew time, it is critical that astronaut training is highly efficient and adapted to keep pace with new innovations both pre-flight and during exploration missions. These challenges will be discussed during this panel session.

Jay Lemery↗

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.↗

Design and Experimental Verification of Deployable/Inflatable Ultra-Lightweight Structures

Because launch cost of a space structural system is often proportional to the launch volume and mass and there is no significant gravity in space, NASA's space exploration programs and various science missions have stimulated extensive use of ultra-lightweight deployable/inflatable structures. These structures are named here as Highly Flexible Structures (HFSs) because they are designed to undergo large displacements, rotations, and/or buckling without plastic deformation under normal operation conditions. Except recent applications to space structural systems, HFSs have been used in many mechanical systems, civil structures, aerospace vehicles, home appliances, and medical devices to satisfy space limitations, provide special mechanisms, and/or reduce structural weight. The extensive use of HFSs in today's structural engineering reveals the need of a design and analysis software and a database system with design guidelines for practicing engineers to perform computer-aided design and rapid prototyping of HFSs. Also to prepare engineering students for future structural engineering requires a new and easy-to- understand method of presenting the complex mathematics of the modeling and analysis of HFSs. However, because of the high flexibility of HFSs, many unique challenging problems in the modeling, design and analysis of HFSs need to be studied. The current state of research on HFSs needs advances in the following areas: (1) modeling of large rotations using appropriate strain measures, (2) modeling of cross-section warpings of structures, (3) how to account for both large rotations and cross- section warpings in 2D (two-dimensional) and 1D structural theories, (4) modeling of thickness thinning of membranes due to inflation pressure, pretension, and temperature change, (5) prediction of inflated shapes and wrinkles of inflatable structures, (6) development of efficient numerical methods for nonlinear static and dynamic analyses, and (7) filling the gap between geometrically exact elastic analysis and elastoplastic analysis. The objectives of this research project were: (1) to study the modeling, design, and analysis of deployable/inflatable ultra-lightweight structures, (2) to perform numerical and experimental studies on the static and dynamic characteristics and deployability of HFSs, (3) to derive guidelines for designing HFSs, (4) to develop a MATLAB toolbox for the design, analysis, and dynamic animation of HFSs, and (5) to perform experiments and establish an adequate database of post-buckling characteristics of HFSs.

Pai, P. Frank↗

Crew Exploration Vehicle (CEV) Potable Water System Verification Description

The Crew Exploration Vehicle (CEV), also known as Orion, will ferry a crew of up to six astronauts to the International Space Station (ISS), or a crew of up to four astronauts to the moon. The first launch of CEV is scheduled for approximately 2014. A stored water system on the CEV will supply the crew with potable water for various purposes: drinking and food rehydration, hygiene, medical needs, sublimation, and various contingency situations. The current baseline biocide for the stored water system is ionic silver, similar in composition to the biocide used to maintain quality of the water transferred from the Orbiter to the ISS and stored in Contingency Water Containers (CWCs). In the CEV water system, the ionic silver biocide is expected to be depleted from solution due to ionic silver plating onto the surfaces of the materials within the CEV water system, thus negating its effectiveness as a biocide. Since the biocide depletion is expected to occur within a short amount of time after loading the water into the CEV water tanks at the Kennedy Space Center (KSC), an additional microbial

Peterson, Laurie↗

Novel Ways to use the International Spacer Station as an Exploration Analog: International Progress in Planning "ISS4Mars"

In October 2020, International Space Station (ISS) Partner Agencies held a set of international workshops to solicit and develop creative and forward-looking ideas for using the ISS as an analog for preparation for Mars missions during its 3rd decade of operations. The workshops brought together participants from nine international space agencies or organizations, with stakeholders consisting of research managers, discipline experts, technology developers, flight physicians, flight operators, and astronauts. Breakout meetings and brainstorming sessions were conducted focusing on the following topics: Critical hazards and countermeasures for the transit to Mars; gravity transitions and early surface operations; environmental control and life support systems; food systems; human microbiome, microbial monitoring, and planetary protection; medical operations for Mars missions; isolation and confinement; autonomous systems and crew-centered autonomy; and communications delay effects on operations. In many cases the scenarios and approaches identified were compelling but challenging to implement under the current utilization structure used to manage the ISS for experiments. Following the series of workshops, a team of utilization leaders across the ISS partnership worked to compile the workshop recommendations and extract a set of use-cases with their prerequisites and constraints. The work considered the following aspects: what can be effectively done on ISS; which new technologies, approaches and scenarios are feasible; what alternatives could be considered; and what steps should be taken to enable integrated testing and future use of ISS as an analog for Mars missions. The final report will be published so that the use cases can be considered in each agency’s strategic planning processes. This paper will cover the process of international assessment in detail and how this process has influenced and broadened the vision of ISS utilization beyond single experiments to integrated studies and testing for future Mars missions. This approach to international collaboration informs both the next decade of international exploration research on the ISS and advancement of its utilization as an analog for deep space missions. For many of the participating partners, it also helps to frame the strategy for human research in Artemis as we begin planning for human missions to the moon. We conclude with a summary of the progress on the actions in the report and the additional implementation discussions that have occurred across the partnership.

Julie A Robinson↗

Zero-Gravity Locomotion Simulators: New Ground-Based Analogs for Microgravity Exercise Simulation

Maintaining health and fitness in crewmembers during space missions is essential for preserving performance for mission-critical tasks. NASA's Exercise Countermeasures Project (ECP) provides space exploration exercise hardware and monitoring requirements that lead to devices that are reliable, meet medical, vehicle, and habitat constraints, and use minimal vehicle and crew resources. ECP will also develop and validate efficient exercise prescriptions that minimize daily time needed for completion of exercise yet maximize performance for mission activities. In meeting these mission goals, NASA Glenn Research Center (Cleveland, OH, USA), in collaboration with the Cleveland Clinic (Cleveland, Ohio, USA), has developed a suite of zero-gravity locomotion simulators and associated technologies to address the need for ground-based test analog capability for simulating in-flight (microgravity) and surface (partial-gravity) exercise to advance the health and safety of astronaut crews and the next generation of space explorers. Various research areas can be explored. These include improving crew comfort during exercise, and understanding joint kinematics and muscle activation pattern differences relative to external loading mechanisms. In addition, exercise protocol and hardware optimization can be investigated, along with characterizing system dynamic response and the physiological demand associated with advanced exercise device concepts and performance of critical mission tasks for Exploration class missions. Three zero-gravity locomotion simulators are currently in use and the research focus for each will be presented. All of the devices are based on a supine subject suspension system, which simulates a reduced gravity environment by completely or partially offloading the weight of the exercising test subject s body. A platform for mounting treadmill is positioned perpendicularly to the test subject. The Cleveland Clinic Zero-g Locomotion Simulator (ZLS) utilizes a pneumatic subject load device to apply a near constant gravity-replacement load to the test subject during exercise, and is currently used in conjunction with the General Clinical Research Center for evaluating exercise protocols using a bedrest analog. The enhanced ZLS (eZLS) at NASA Glenn Research Center features an offloaded treadmill that floats on a thin film of air and interfaces to a force reaction frame via variably-compliant isolators, or vibration isolation system. The isolators can be configured to simulate compliant interfaces to the vehicle, which affects mechanical loading to crewmembers during exercise, and has been used to validate system dynamic models for new countermeasures equipment designs, such as the second International Space Station treadmill slated for use in 2010. In the eZLS, the test subject and exercise device can be pitched at the appropriate angle for partial gravity simulations, such as lunar gravity (1/6th earth gravity). On both the eZLS and the NASA-Johnson Space Center standalone ZLS installed at the University of Texas Medical Branch in Galveston, Texas, USA, the subject's body weight relative to the treadmill is controlled via a linear motor subject load device (LM-SLD). The LM-SLD employs a force-feedback closed-loop control system to provide a relatively constant force to the test subject during locomotion, and is set and verified for subject safety prior to each session. Locomotion data were collected during parabolic flight and on the eZLS. The purpose was to determine the similarities and differences between locomotion in actual and simulated microgravity. Subjects attained greater amounts of hip flexion during walking and running during parabolic flight. During running, subjects had greater hip range of motion. Trunk motion was significantly less on the eZLS than during parabolic flight. Peak impact forces, loading rate, and impulse were greater on the eZLS than during parabolic while walking with a low external load (EL) and rning with a high EL. Activation timing differences existed between locations in all muscles except for the rectus femoris. The tibialis anterior and gluteus maximus were active for longer durations on the eZLS than in parabolic flight during walking. Ground reaction forces were greater with the LM-SLD than with bungees during eZLS locomotion. While the eZLS serves as a ground-based analog, researchers should be aware that subtle, but measurable, differences in kinematics and leg musculature activities exist between the environments. Aside from space applications, zero-gravity locomotion simulators may help medical researchers in the future with development of rehabilitative or therapeutic protocols for injured or ill patients. Zero-gravity locomotion simulators may be used as a ground-based test bed to support future missions for space exploration, and eventually may be used to simulate planetary locomotion in partial gravity environments, including the Moon and Mars. Figure: Zero-gravity Locomotion Simulator at the Cleveland Clinic, Cleveland, Ohio, USA

Perusek, Gail P.↗

LLMs and GenAI Tools to Depict Contributions of Human Systems to Spaceflight Tasks Execution

Recent advancements in Artificial Intelligence and Machine Learning (AI/ML) technologies, particularly Large Language Models (LLMs) capable of sophisticated syntax analysis, offer substantial potential in automating complex processes, thereby saving time and human resources. This study explores the development of an LLM-driven model designed to analyze and categorize a diverse set of Mars mission tasks into 18 predefined Human System Task Categories (HSTCs) based on their textual descriptions. As part of developing the Crew Health and Performance – Probabilistic Risk Assessment (CHP-PRA projects Performance Risk Model (PRisM) proof-of-concept, we established a framework to project performance scores from small-scale tests onto a preliminary list of Mars tasks. The foundation of our model was a comprehensive spreadsheet populated by NASA experts and clinicians, which detailed each Mars task alongside binary indicators of HSTC involvement. This dataset enabled the initial application of supervised ML, training and testing on existing HSTC labels. The HSTCs were originally defined from a medical system perspective, focusing on task impairments due to deteriorated human health. To expand our model's scope to include categories impacting performance, we face the challenge of generating binary labels (0 or 1) for new categories without pre-existing data. We address this by employing Generative AI (GenAI) software to determine whether a given task involved a new category by asking, "Does task A involve using category B?" We validate our approach by comparing the GenAI's binary classifications with the expert-provided labels for existing HSTCs. Notably, we utilize Ollama [4], a locally hosted GenAI tool that does not require cloud access, thus safeguarding NASA's proprietary data from unauthorized exposure. This study demonstrates the feasibility of leveraging cutting-edge AI tools to advance research, paving the way for automation and rapid decision-making in space exploration.

Mona Matar↗

Autonomous Mission Operations

NASA's Advanced Exploration Systems Autonomous Mission Operations (AMO) project conducted an empirical investigation of the impact of time-delay on todays mission operations, and of the effect of processes and mission support tools designed to mitigate time-delay related impacts. Mission operation scenarios were designed for NASA's Deep Space Habitat (DSH), an analog spacecraft habitat, covering a range of activities including nominal objectives, DSH system failures, and crew medical emergencies. The scenarios were simulated at time-delay values representative of Lunar (1.2-5 sec), Near Earth Object (NEO) (50 sec) and Mars (300 sec) missions. Each combination of operational scenario and time-delay was tested in a Baseline configuration, designed to reflect present-day operations of the International Space Station, and a Mitigation configuration in which a variety of software tools, information displays, and crew-ground communications protocols were employed to assist both crews and Flight Control Team (FCT) members with the long-delay conditions. Preliminary findings indicate: 1) Workload of both crew members and FCT members generally increased along with increasing time delay. 2) Advanced procedure execution viewers, caution and warning tools, and communications protocols such as text messaging decreased the workload of both flight controllers and crew, and decreased the difficulty of coordinating activities. 3) Whereas crew workload ratings increased between 50 sec and 300 sec of time-delay in the Baseline configuration, workload ratings decreased (or remained flat) in the Mitigation configuration.

Mission Operations↗

Internal Architecture of the Common Habitat

The core stage liquid oxygen tank of the Space Launch System can be manufactured as a habitat instead of as a propellant tank, with a common design such that it is equally suitable for use in 0g, 1/6g, 3/8g, 1g, or variable artificial gravity. This Common Habitat can be the central element of a human spaceflight architecture that encompasses the Moon, Mars, and other destinations within the inner solar system. The Common Habitat is specifically used within an alternative architecture study (that is not part of the current NASA baseline) as the core habitation element within a Lunar Basecamp, Mars Basecamp, and the Deep Space Exploration Vehicle. The Common Habitat internal architecture applies a design philosophy to separate crew functions according to deck. The lower deck is reserved for private functions. It includes eight private crew quarters and four waste and hygiene clusters – each with a private waste management compartment, private full body hygiene compartment, and foyer/clothes changing area. The mid deck is primarily allocated to mission-related working functions. It includes an exercise facility, fabrication / maintenance / repair facility, physical science laboratory (physics, geology, and astronomy), and life science laboratory (biology and human research). The mid deck also has four external hatches, clocked one every 90 degrees, centered on the vehicle vertical centerline. Each hatch has a 60-inch tall by 40-inch wide opening with the mid deck floor 16 inches below the bottom lip of the hatch opening. The upper deck is primarily allocated to group or social functions. It includes a large galley, wardroom with projector and display screen, plant growth chambers, bulk stowage, command and control station, medical facility, hygiene compartment, and vehicle subsystems. A Vertical Translation System, based in part on results from a GrabCAD public challenge, enables crew and equipment traverse between habitat decks in 0g, 1/6g, 3/8g, and 1g. A 40-inch by 60-inch vertical translation corridor ensures that anything that can fit through the external hatches can also be moved from deck to deck. The system includes three component systems: a deploying floor to safety barrier system that folds down to become a traversable floor when vertical translation is not in use and deploys to become a safety barrier during vertical translations; a folding ladder that stows in the ceiling when not in use; and an elevator platform that can attach to the ladder for cargo or incapacitated crew member transport. This system is complemented by a Horizontal Translation System, also based in part on the same GrabCAD challenge, provides for horizontal crew translation in microgravity but requires no vehicle reconfiguration for fractional or whole gravity operation. It relies primarily on gecko-inspired grippers, originally developed at Stanford and NASA JPL, attached to footwear to enable crew to emulate walking. Some handrails are also strategically placed throughout the Common Habitat to aid translation in both gravity and microgravity environments.

Common Habitat↗

Neutron Radiography and Computed Tomography of Biological Systems at the Oak Ridge National Laboratory's High Flux Isotope Reactor

Neutrons have historically been used for a broad range of biological applications employing techniques such as small-angle neutron scattering, neutron spin echo, diffraction, and inelastic scattering. Unlike neutron scattering techniques that obtain information in reciprocal space, attenuation-based neutron imaging measures a signal in real space that is resolved on the order of tens of micrometers. The principle of neutron imaging follows the Beer-Lambert law and is based on the measurement of the bulk neutron attenuation through a sample. Greater attenuation is exhibited by some light elements (most notably, hydrogen), which are major components of biological samples. Contrast agents such as deuterium, gadolinium, or lithium compounds can be used to enhance contrast in a similar fashion as it is done in medical imaging, including techniques such as optical imaging, magnetic resonance imaging, X-ray, and positron emission tomography. For biological systems, neutron radiography and computed tomography have increasingly been used to investigate the complexity of the underground plant root network, its interaction with soils, and the dynamics of water flux in situ. Moreover, efforts to understand contrast details in animal samples, such as soft tissues and bones, have been explored. This manuscript focuses on the advances in neutron bioimaging such as sample preparation, instrumentation, data acquisition strategy, and data analysis using the High Flux Isotope Reactor CG-1D neutron imaging beamline. The aforementioned capabilities will be illustrated using a selection of examples in plant physiology (herbaceous plant/root/soil system) and biomedical applications (rat femur and mouse lung).

Bilheux, Hassina↗

Laser Angioplasty

The principal method of dealing with coronary artery blockage is bypass surgery. A non-surgical alternative available to some patients is balloon angioplasty. For several years, medical researchers have been exploring another alternative that would help a wider circle of patients than the balloon treatment and entail less risk than bypass surgery. A research group is on the verge of an exciting development: laser angioplasty with a 'cool' type of laser, called an excimer laser, that does not damage blood vessel walls and offers non-surgical cleansing of clogged arteries with extraordinary precision. The system is the Dymer 200+ Excimer Laser Angioplasty System, developed by Advanced Intraventional Systems. Used in human clinical tests since 1987, the system is the first fully integrated 'cool' laser capable of generating the requisite laser energy and delivering the energy to target arteries. Thirteen research hospitals in the U.S. have purchased Dymer 200+ systems and used them in clinical trials in 121 peripheral and 555 coronary artery cases. The success rate in opening blocked coronary arteries is 85 percent, with fewer complications than in balloon angioplasty. Food and Drug Administration approval for the system is hoped for in the latter part of 1990. * Advanced Intraventional Systems became Spectranetics in 1994 and discontinued the product.

Source record↗

The International Space Station: A Low-Earth Orbit (LEO) Test Bed for Advancements in Space and Environmental 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.

Ruttley, Tara M.↗

Validation of Procedures for Monitoring Crewmember Immune Function

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 (if any) from prolonged immune dysregulation during exploration-class space flight has not yet been 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 status of immunity as it resolves over prolonged flight. 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 immunity, latent viral reactivation and physiological stress during both short and long duration flights. Upon completion, it is expected that any clinical risks resulting from the adverse effects of space flight on the human immune system will have been determined. In addition, a flight-compatible immune monitoring strategy will have been developed with which countermeasures validation could be performed. This study will determine, to the best level allowed by current technology, the in-flight status of crewmembers' immune systems. 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 R+0 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. The first in-flight activity for integrated immunity very recently occurred during the STS-120 Space Shuttle mission. The protocols functioned well from a technical perspective, and accurate in-flight data was obtained from 1 Shuttle and 2 ISS crewmembers. Crew participation rates for the study continue to be robust.

Crucian, Brian↗