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At least 379 records · Page 21
All sourcesNASA NTRSDOE OSTI
NASA NTRS2011

Risk of Therapeutic Failure due to Ineffectiveness of Medication

Given that terrestrial medical practices must be used as the basis for drug choice and use on missions, there is a possibility that medications used will be ineffective or inappropriate for the actual circumstances encountered on missions. Because the human body undergoes a variety of physiological changes during spaceflight, there is a risk that terrestrial medications may not perform as expected when used during spaceflight. Alterations in physiology due to spaceflight could result in unexpected drug action on the body (pharmacodynamics) or in unusual drug absorption, distribution, metabolism or excretion (pharmacokinetics). The spaceflight environment may also have direct effects on stored drugs themselves, leading to premature inactivation or degradation of stored drugs.

Woring, Virginia E.↗
NASA NTRS2012

Development and Evaluation of the Habitat Demonstration Unit Medical Operations Workstation and Opportunities for Future Research

As NASA develops missions to leave Earth orbit and explore distant destinations (Mars, Moon, Asteroids) it is necessary to rethink human spaceflight paradigms in the life sciences. Standards developed for low earth orbit human spaceflight may not be fully applicable and in-space research may be required to develop new standards. Preventative and emergency medical care may require new capabilities never before used in space. Due to spacecraft volume limitations, this work area may also be shared with various animal and plant life science research. This paper explores the prototype Medical Operations Workstation within the NASA Habitat Demonstration Unit and discusses some of the lessons learned from field analogue missions involving the workstation. Keywords: Exploration, medical, health, crew, injury emergency, biology, animal, plant, science, preventative, emergency.

Howard, Robert L., Jr.↗
NASA NTRS2012

EVA Physiology and Medical Considerations Working in the Suit

This "EVA Physiology and Medical Considerations Working in the Suit" presentation covers several topics related to the medical implications and physiological effects of suited operations in space from the perspective of a physician with considerable first-hand Extravehicular Activity (EVA) experience. Key themes include EVA physiology working in a pressure suit in the vacuum of space, basic EVA life support and work support, Thermal Protection System (TPS) inspections and repairs, and discussions of the physical challenges of an EVA. Parazynski covers the common injuries and significant risks during EVAs, as well as physical training required to prepare for EVAs. He also shares overall suit physiological and medical knowledge with the next generation of Extravehicular Mobility Unit (EMU) system designers.

Parazynski, Scott↗
NASA NTRS2012

Interoperability Standards for Medical Simulation Systems

The Modeling and Simulation Community successfully developed and applied interoperability standards like the Distributed Interactive Simulation (DIS) protocol (IEEE 1278) and the High Level Architecture (HLA) (IEEE 1516). These standards were applied for world-wide distributed simulation events for several years. However, this paper shows that some of the assumptions and constraints underlying the philosophy of these current standards are not valid for Medical Simulation Systems. This paper describes the standards, the philosophy and the limits for medical applications and recommends necessary extensions of the standards to support medical simulation.

Tolk, Andreas↗
NASA NTRS2015

Are Medications Involved in Vision and Intracranial Pressure Changes Seen in Spaceflight

The Food and Drug Association Adverse Event Reports (FDA AER) from 2009-2011 were used to create a database from millions of known and suspected medication-related adverse events among the general public. Vision changes, sometimes associated with intracranial pressure changes (VIIP), have been noted in some long duration crewmembers. Changes in vision and blood pressure (which can subsequently affect intracranial pressure) are fairly common side effects of medications. The purpose of this study was to explore the possibility of medication involvement in crew VIIP symptoms.

Wotring, Virginia E.↗
NASA NTRS2014

Integrated Medical Model Verification, Validation, and Credibility

The Integrated Medical Model (IMM) was designed to forecast relative changes for a specified set of crew health and mission success risk metrics by using a probabilistic (stochastic process) model based on historical data, cohort data, and subject matter expert opinion. A probabilistic approach is taken since exact (deterministic) results would not appropriately reflect the uncertainty in the IMM inputs. Once the IMM was conceptualized, a plan was needed to rigorously assess input information, framework and code, and output results of the IMM, and ensure that end user requests and requirements were considered during all stages of model development and implementation. METHODS: In 2008, the IMM team developed a comprehensive verification and validation (VV) plan, which specified internal and external review criteria encompassing 1) verification of data and IMM structure to ensure proper implementation of the IMM, 2) several validation techniques to confirm that the simulation capability of the IMM appropriately represents occurrences and consequences of medical conditions during space missions, and 3) credibility processes to develop user confidence in the information derived from the IMM. When the NASA-STD-7009 (7009) was published, the IMM team updated their verification, validation, and credibility (VVC) project plan to meet 7009 requirements and include 7009 tools in reporting VVC status of the IMM. RESULTS: IMM VVC updates are compiled recurrently and include 7009 Compliance and Credibility matrices, IMM VV Plan status, and a synopsis of any changes or updates to the IMM during the reporting period. Reporting tools have evolved over the lifetime of the IMM project to better communicate VVC status. This has included refining original 7009 methodology with augmentation from the NASA-STD-7009 Guidance Document. End user requests and requirements are being satisfied as evidenced by ISS Program acceptance of IMM risk forecasts, transition to an operational model and simulation tool, and completion of service requests from a broad end user consortium including Operations, Science and Technology Planning, and Exploration Planning. CONCLUSIONS: The VVC approach established by the IMM project of combining the IMM VV Plan with 7009 requirements is comprehensive and includes the involvement of end users at every stage in IMM evolution. Methods and techniques used to quantify the VVC status of the IMM have not only received approval from the local NASA community but have also garnered recognition by other federal agencies seeking to develop similar guidelines in the medical modeling community.

Validation↗
NASA NTRS2015

Electronic Procedures for Medical Operations

Electronic procedures are replacing text-based documents for recording the steps in performing medical operations aboard the International Space Station. S&K Aerospace, LLC, has developed a content-based electronic system-based on the Extensible Markup Language (XML) standard-that separates text from formatting standards and tags items contained in procedures so they can be recognized by other electronic systems. For example, to change a standard format, electronic procedures are changed in a single batch process, and the entire body of procedures will have the new format. Procedures can be quickly searched to determine which are affected by software and hardware changes. Similarly, procedures are easily shared with other electronic systems. The system also enables real-time data capture and automatic bookmarking of current procedure steps. In Phase II of the project, S&K Aerospace developed a Procedure Representation Language (PRL) and tools to support the creation and maintenance of electronic procedures for medical operations. The goal is to develop these tools in such a way that new advances can be inserted easily, leading to an eventual medical decision support system.

Source record↗
NASA NTRS2018

Protecting Astronaut Medical Privacy: Review of Presentations and Publications for Attributability

Retrospective research and medical data collected on astronauts can be a valuable resource for researchers. This data can be requested from two separate NASA Archives. The Lifetime Surveillance of Astronaut Health (LSAH) holds astronaut medical data, and the Life Sciences Data Archive (LSDA) holds research data. One condition of use of astronaut research and medical data is the requirement that all abstracts, publications and presentations using this data must be reviewed for attributability. All final versions of abstracts, presentations, posters, and manuscripts must be reviewed by LSDA/LSAH prior to submission to a conference, journal, or other entities outside the Principal Investigator (PI) laboratory [including the NASA Export Control Document Availability Authorization (DAA) system]. If material undergoes multiple revisions (e.g., journal editor comments), the new versions must also be reviewed by LSDA/LSAH prior to re-submission to the journal. The purpose of this review is to ensure that no personally identifiable information (PII) is included in materials that are presented in a public venue or posted to the public domain. The procedures for submitting materials for review will be outlined. The process that LSAH/LSDA follows for assessing attributability will be presented. Characteristics and parameter combinations that often prompt attributability concerns will be identified. A published case report for a National Football League (NFL) player will be used to demonstrate how, in a population of public interest, a combination of information can result in inadvertent release of private or sensitive information.

Wear, M. L.↗
NASA NTRS2020

MEDPRAT-SEL: Medical Resource Set Selector Searching High-Dimensionality Space

NASA Human Research Program's (HRP) next generation risk model closes the loop on medical risk and resource evaluation, providing researchers with a tool to assess and choose capabilities scientifically. The Medical Extensible Dynamic Probabilistic Risk Assessment Tool (MEDPRAT) simulator (SIM) evaluates resources in terms of medical benefit, such as reduced crew quality time lost (QTL), vs. cost, in mass or volume. The MEDPRAT resource set selector (SEL) searches the space of resource benefits v. cost, closing a feedback loop around the simulator, thus selecting resource sets with best benefit for cost. We discuss the design and results of the resource set selector. NASA HRP's emphasis on scientific assessment of risk, PRA, has led to the Cross-cutting Computational Modeling Project (CCMP).

Leinweber, Lawrence↗
NASA NTRS2019

Development of a Point of Care Technology for Military Medical Applications in Austere Environments

NASA, Lawrence Livermore National Laboratory (LLNL) and the Department of Defense (DoD) share a common interest in compact medical diagnostic technologies—also known as “point of care testing” (POCT) technologies. For NASA, the need is to take care of astronauts on deep space missions. For LLNL, the focus is on technologies needed to support homeland security applications. For DoD, the need is to support warfighters in military theaters of operation, especially for prolonged field care and en route care. A recently patented technology, “Portable Medical Diagnosis Instrument” (U.S. Patent 9824870), co-invented by NASA and LLNL, is being developed further in a partnership between NASA, LLNL and Travis Air Force Base, with a focus on military applications. This instrument, the NASA-LLNL Medical Tricorder, can be used for a wide range of clinical samples including breath, saliva and blood. One component of the Tricorder is the NASA E-Nose, a carbon nanotube-based chemical sensor, integrated into a hand-held smart phone, that can detect and measure “breath biomarkers” in the gas phase of exhaled breath. The response of the NASA E-Nose is rapid, which makes it possible to detect various gas-phase substances in real time. The NASA E-Nose, with modification, can also be used for breath condensate analysis. Another component of the Tricorder is a miniaturized microfluidic analyzer, under development by LLNL, that does not require any pumps. The microfluidic analyzer can detect and measure biomarkers in liquid samples, such as blood, saliva and breath condensate. This microfluidic system requires small quantities of liquid sample and can perform analysis very rapidly (seconds to minutes), which makes it possible to detect relevant biomarkers in near real time in the field. The Clinical Investigation Facility (CIF) at Travis Air Force Base is currently conducting research with the goal to develop improved field-able technologies and procedures for the emergency response to life threatening injuries soldiers may receive in theater. This work includes experimental large animal systems and comprehensive collection of clinical specimens and physiological data. NASA and LLNL are partnering with Travis to test and further develop the Tricorder technology for high priority military applications, initially focused on lung injury models and traumatic brain injury.

Loftus, David J.↗
NASA NTRSDate not supplied

Enabling Progressively Autonomous Medical Operations for Space Exploration

As NASA and its International Partners prepare to expand human space exploration beyond the International Space Station (ISS) to the Moon (and ultimately Mars) with the Artemis missions, the importance of evolving space medical operations in an Earth independent fashion becomes increasingly clear. Continuous human presence on the ISS for the past 20 years has demonstrated the successful development and execution of medical operations in low Earth orbit. However, this paradigm of ISS medical operations is dependent upon continuous real-time communications, frequent resupply missions, and the availability of rapid evacuation options. As the distance and time away from Earth increases, all of these dependencies will no longer be available. As a result, the paradigm of space medicine operations will need to become progressively more autonomous and less dependent upon mission support personnel on Earth

Kris Lehnhardt↗
NASA NTRSDate not supplied

Supporting Crew Medical Decisions on Deep Space Missions: A Real-Time Performance Monitoring

Crewed missions into deep space will require astronauts to respond autonomously to safety- and time-critical anomalies. These and other potential issues will require the continuous monitoring and recognition of potentially subtle, but complex, anomalous data patterns. NASA continues to investigate real-time metrics for Extravehicular Operations1 and for providing feedback to improve performance2. Since it is unknown how long-term exposure to deep space will affect crew health, continuous monitoring of clinical and subclinical status is warranted. NASA is characterizing crew medical decision-support needs and identifying the recommended requirements of a Clinical Decision Support System (CDSS) within the Exploration Medical Capability Element (ExMC) of the Human Research Program3. Early detection, and continuous monitoring, of performance may provide an effective prognostic capability for assessing crew health state, and the identified requirements could be provided for an in-vehicle CDSS that acts as an assistant for delivering optimal health and performance and medical care during exploration missions. There is evidence to suggest that automatic, unobtrusive collection of keystroke features, such as alphanumeric key latencies, backspaces or typing rhythm, could be a valuable performance screening tool. Keystroke features show significant differences between control subjects and patients with overt clinical illness, such as multiple sclerosis4 and Parkinson’s disease5, as well as behavioral health and performance issues, such as mild cognitive impairment6 and depression7. This work is exploring a capability for the assessment of early task performance decline in crew as they perform daily activities. Timestamped keyboard entries are continuously collected and stored. Nominal keystroke interactions are compared to those obtained after exposure to spaceflight stressors, e.g., fatigue, to determine the methods sensitivity. This work will pave the way toward an objective detection tool that may be deployed in a spaceflight setting.

clinical↗
NASA NTRSDate not supplied

How Autonomous Intelligent Systems Can Facilitate Earth-independent Medical Care: Going Beyond Telepresence

During the last decade, teleoperated robotic systems have extended humans’ sensorimotor competence to digitally fly beyond the physical barrier of distance and scale and thus transmit sensorimotor skills of the human through direct communication. Telepresence capabilities have enabled tele-physical remote access at small scales thanks to telerobotic mediums. Although the concept was initially motivated by space applications, such technologies quickly have expanded into the medical domain and resulted in teleoperated medical robots, including telerobotic surgical systems (such as the da Vinci surgical system). Effective telepresence fundamentally depends on an agile, reliable, and secure communication medium that can transmit real-time information between the operator and a remote device. However, direct telepresence may not be achievable for long-duration exploration spaceflight missions. Thus, autonomous systems and local intelligence represent potential solutions to the aforementioned issues. One example solution employs demonstration systems which enable learning from the pre-captured inputs of a skilled human operator. These will be computationally modeled and later probabilistically replicated toward the completion of remote physical tasks when direct telepresence is not viable - such as under communication blackout conditions. In other words, trained autonomous systems (e.g., robots) can perform remote operations that mimic the physical performance of experts during remote operations/training. Beyond learning the physics of the task, autonomous agents can also be used to conduct algorithmic decision-making that mimics the higher-level cognition of the expert. Thus, using an autonomous system, pre-trained cognitive and manipulation-based skills can be leveraged (acquired during pre-mission events) to produce digital twins of an intelligent operator. Such systems can be used for the real-time conduction of intricate tasks in complex and unstructured environments. Such systems will operationalize “cognitive digital twins” and can expand the reach of human cognition and manipulation through the power of data-driven learning from demonstration algorithms. This system category will be discussed as a fully autonomous operation in this talk. In addition to the above, we will also propose and discuss the possibility of partial-automation using remote intelligence and remote sensing. In contrast to full automation, partial automation can close the loop through a local operator equipped with augmented sensory awareness through wearable systems. Such technologies will allow the local operator to conduct delicate tasks while being guided using sensory augmentation and being monitored to gauge her/his level of cognitive focus and performance. The difference with the previous category is that a remote human will conduct the task. Further, rather than making a digital twin of human cognition, we will augment the control inputs of the local human to match those of the skilled expert operator who is not accessible in real-time. Going beyond classic telepresence and thus approaching intelligent telepresence, our vision is that autonomous agents will eventually enable the safe, consistent and efficient delivery of complex, remote and smart medical care during space exploration across operators in an Earth-independent fashion. We will discuss our collective vision from NASA and MERIIT@NYU lab in this talk.

Telepresence↗
NASA NTRSDate not supplied

Autonomous Medical Officer Support (AMOS) ISS Technology Demonstration: Enabling Earth-Independnt Procedure Guidance

Successful performance of medical procedures during missions beyond low Earth orbit requires novel solutions to replace real-time support from the ground since the communication delay will be longer as the crew travels farther from Earth. The Autonomous Medical Officer Support software Technology Demonstration project (AMOS Tech Demo) on the International Space Station (ISS) evaluates a novel software tool that shifts the emphasis from preflight training and real-time guidance (current ISS paradigm) to in-flight just-in-time (JIT) instruction (a new paradigm for crew medical autonomy). The AMOS platform introduces a novel, streamlined, skill-management archetype for exploration missions; the current AMOS version features comprehensive training and guidance modules for urinary bladder and kidney ultrasound examinations. The primary goal of the AMOS Tech Demo was to confirm telemedical proof-of-concept through initial use of the platform for autonomous imaging activities in an operational setting. Success metrics encompassed 1) successful software deployment, 2) collection of click tracking data, and 3) recording of ultrasound images. Additional aims included collecting crew feedback on a) AMOS implementation, and b) integrated training and procedure support concepts, as well as c) evaluation of AMOS use in an operational setting.

D. Ebert↗
NASA NTRSDate not supplied

NASA Commercial Crew Program and Medical Operational Challenges

This abstract is submitted as part of the USSPACECOM Command Surgeon’s panel demonstrating the medical capabilities and challenges involved in human space flight support operations. BACKGROUND: NASA embarked on the Commercial Crew Program to launch astronauts into low-earth orbit from US soil and dock with the International Space Station (ISS). The eventual industry providers selected were SpaceX (SpX) and Boeing. These commercial transportation systems are vital to ensure crew availability on ISS for research and discovery. OVERVIEW: NASA/SpaceX Demo-2 (DM2) mission launched from the Kennedy Space Center in 2020 as the historic first crewed test-flight of the Crew Dragon spacecraft with two NASA Astronauts onboard. DM2 represented the first flight in 9-years from US soil since STS-135 in 2011. The 63-day mission ended with splashdown in the Gulf of Mexico, the first US water recovery in 45-years since Apollo-Soyuz. Validation of system hardware and operations allowed four-person crews to launch on subsequently missions (Crew-1, Crew-2, Crew-3, Crew-4, Crew-5 to date), which included International Partner crewmembers. DISCUSSION: A multitude of operational, training, medical, and technical issues needed to be addressed between NASA Medical Operations, the commercial provider SpaceX, and the Department of Defense. These included Flight rule development, occupant protection, pressurized suit testing, communication plans during mission phases, and emergency simulations for supporting Flight Surgeons and Biomedical Engineers. In providing crew experience with expected launch and entry G-force profile, Centrifuge training was established. Preventive health measures via the Health Stabilization Program were especially vital during the global COVID-19 pandemic. Unique aspects arise for SpX Dragon parachute splashdown and shipboard recovery operations in the Atlantic Ocean and Gulf of Mexico. The new Commercial Crew Program is indeed a wonderfully challenging and exciting era for human spaceflight.

Joseph Dervay↗
NASA NTRS2023

Exploration Medical Capability Clinical Decision Support Use Cases for CDSS Test Bed

Long-duration, deep-space exploration missions present significant challenges to crew health and performance. These challenges include the individual and combined effects of microgravity, radiation exposure, isolation, limited resources (mass, volume, power, data, and crew time), limited options for evacuation, and those associated with delayed or constrained communications. Each of these challenges necessitates greater degrees of crew autonomy as our distance from Earth increases. Specifically, as communication delays intensify - and evacuation capability diminishes the further we explore space - the unqualified need for Earth-independent medical operations focused on autonomous diagnosis, treatment and prevention will become key to mission continuation and success. This need will be especially true should a crewmember become ill or injured wherein treatment and disposition “in-situ” ultimately falls to the crew itself to determine. To augment the requisite knowledge, skills, and abilities (KSAs) of a time-constrained exploration mission crew operating under stressful conditions, combatting fatigue, and facing a potential medical crisis, a robust clinical decision support system (CDSS) is a probable solution. A CDSS would facilitate, guide, and inform Earth-independent medical operations while assisting crewmembers through various clinical presentations. The CDSS would allow crewmembers to take advantage of pre-mission training tied to the in-flight/in-mission use of pre-planned protocols that offer both a range of diagnostic options and “just-in-time” (refamiliarization) training and assistance. CDSS will expand such capabilities by improving the utility and effectiveness of various available diagnostic, treatment, and health maintenance tools, techniques, and measures.

ExMC↗
NASA NTRS2023

Flight Surgeon Survey Results Review: Long-Duration Artemis Medical System ConOps

The Artemis Mission Functional Medical Concept of Operation (ConOp) is an operational document that describes the functional medical capabilities and concept of operations for early Artemis missions of around 30 days duration. It is currently under revision for longer missions (180+ days), aiming to build a foundational diagnostic and treatment capabilities list considering mission parameters, crew selection and training, and mass/volume constraints. An interview of NASA operational flight surgeons was completed to start the revision of the medical ConOp.

Andrew Bushong↗