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NASA NTRSDate not supplied

Assessments of Physiology and Cognition in Hybrid-Reality Environments (APACHE)

NASA is planning to return to the Moon in the mid-2020s as a stepping stone to Mars missions in the 2030s. Spacewalks, or extravehicular activities (EVAs), performed on the Moon and Mars will differ in a variety of ways from those that have been performed in decades past. NASA has identified multiple risks to human health and performance associated with a crewed mission to Mars, especially those associated with exploration EVAs which are expected to be a primary mission activity. Crew may be expected to conduct up to 24 hours of EVA per person per week, where the likelihood of injury and/or mental mistakes are increased compared to ground-based training or current microgravity EVAs and the consequences of which can be catastrophic. Current test environments for exploration EVA research and technology development are large, costly facilities that are limited in their availability or capabilities. Spacesuit testing in a reduced gravity environment such as NASA’s Neutral Buoyancy Laboratory, while a good representation of the crew’s physical workload during exploration EVAs, typically has small datasets and is difficult to integrate physiological sensors or other types of crew performance measures. Meanwhile, scientific field-based testing such as NASA’s Desert Research and Technology Studies offers an operationally relevant environment for exploration EVAs, particularly for cognitive workload, but is also limited by small datasets, lack of a pressurized spacesuit, and obtrusive measures. The limitations of current analogs for exploration EVAs identify a need for a new test environment that can approximate both the physical and cognitive demands associated with exploration EVAs to enable rapid, controlled, and repeatable evaluations of human health and performance risks of exploration missions. In response, the Human Physiology, Performance, Protection, and Operations Laboratory (H-3PO) at NASA Johnson Space Center has developed a hybrid reality exploration EVA analog named the Assessments of Physiology And Cognition in Hybrid-reality Environments (APACHE) to address these limitations using a combination of virtual, physical, and hybrid reality techniques. The APACHE facility resides at NASA Johnson Space Center and serves as a large “sandbox” for EVA research and simulation. At its center is a roughly 15x20ft space surrounded by a 14” tall sandbox partially filled with lunar regolith simulant to emulate the physical feeling of walking on a planetary surface and to allow for simulated geology operations. Nearby, a curved passive treadmill (Skillmill Connect, Technogym, Fairfield, NJ) and an omnidirectional treadmill (Infinadeck, Infinadeck, Rocklin, CA) are included to enable exploration of these large virtual environments while also imposing the physical demands, representative timelines, and cognitive burdens required to navigate and traverse these distances during exploration EVA. A 6DOF motion platform is used to simulate rover operations and supports various human performance evaluations and associated risks. Lastly, APACHE can support two extravehicular (EV) crewmembers working in tandem. A computer workstation is located nearby and also supports an intravehicular (IV) crewmember as part of a full mission simulation. The IV crewmember has direct video and audio communication with the EV crew in VR to provide operational and procedural support. The software used in APACHE was created by the JSC Engineering Directorate, in partnership with Buendea, powered by a custom Unreal Engine 5 (UE5.3, Epic Games) project. APACHE currently utilizes the HTC Vive Pro Eye in a wireless configuration for VR simulations. There are two virtual environments that subjects can explore within APACHE, a Lunar and Martian surface. The virtual Lunar surface was created from LIDAR data of the Lunar South Pole to create roughly 16 sq km of explorable terrain. The virtual Martian surface contains roughly 400 sq km of explorable terrain derived from Mars Reconnaissance Orbiter LIDAR data of the Jezero Crater. The immersion and related cognitive burdens of conducting a planetary EVA is simulated through a series of EVA-relevant tasks performed in the VR environment, using these high-fidelity visual representations. Additionally, APACHE includes biosensor driven informatics, such as real-time heart rate monitoring and/or derived values from model simulations, for active monitoring by the EV crew and added cognitive demand. A “Wizard of Oz” control panel enables test operators to activate contingency events such as simulated spacesuit malfunctions, loss of communications, and/or limited visibility. Embedded performance measures such as accuracy, completeness, and execution time have been developed for various exploration tasks to objectively quantify crew performance during an EVA and compare impacts to performance when different environmental stressors, both physical and cognitive, are added to or removed from the simulation. Additionally, validated cognitive and operational performance measures such as the Digit Symbol Substitution Task have been recreated and embedded in VR for direct and relatively unobtrusive measurement of motor perception. The APACHE environment currently supports multiple research studies at NASA. Examples include the CHAPEA project, a series of simulated year-long missions on Mars by a 4-person crew; and the CO2 Contingency Walk Back Study, an investigation of elevated CO2 exposure on crew performance during a contingency EVA scenario. APACHE also provides a test environment to support the development of the Crew State and Risk Model, which is a collection of individualized, mathematical models of crew physical and cognitive state; and the Personalized EVA Informatics and Decision Support system, an operational tool for flight controllers, and eventually a self-reliant Martian crew, to make biomedically-informed decisions in real-time to optimize the EVA planning and execution with respect to crew health and performance. Some technical challenges associated with developing the APACHE environment, as well as current limitations, include VR limitless natural walking with a hybrid spacesuit simulator, optimizing performance for wireless PC VR streaming while maintaining a high degree of visual fidelity, and the integration of various physiological (metabolic masks) and psychometric (eye tracking) sensors with the VR headset.

Human Performance↗

DOE OSTI2020

Artificial Intelligence Application to D and D - 20492

As aging facilities across the DOE complex await decommissioning, there is an ongoing need to understand any changes in the structural conditions. Many of these facilities were built over 50 years ago and, in some cases, these facilities have gone beyond the expected operational lifetime. Many facilities have been placed in a state of 'cold and dark,' sitting unused and awaiting decommissioning. Especially challenging are the aging facilities that provide unique operational/production capabilities to support critical DOE missions and cannot be shut down. In any of these scenarios, the structural integrity of these facilities may become compromised as time passes. It is critical that adequate inspections be performed on a continual basis and that the data collected undergoes sufficient analysis to support timely identification of any new or worsening structural issues as well as prompt needed maintenance and repairs to maintain the facilities in a safe condition. In recent days, Artificial Intelligence (AI) [1] and its application to various domains are growing at fast speed. FIU is performing research in this area and exploring the associated technologies to solve nuclear decommissioning problems. Artificial intelligence refers to the capability of a program to autonomously act, react and adapt to the working environment. AI enables the machine to behave like humans and perform the cognitive functions such as 'learning' and 'problem solving'. AI systems gradually moving from traditional approaches (algorithms and expert systems) towards more efficient and advanced technologies (machine learning [1] and deep learning [2] [3]). AI is the study of algorithms and statistical models that is being used by computers to perform specific tasks without using explicit instructions. FIU is working to develop a pilot-scale infrastructure to implement structural health monitoring using AI technologies with focus on machine learning, deep learning. This research is focused on Computer Vision/Image Classification area of AI applications. This can also be expanded to other areas of AI related to Object Recognition and Character Recognition in images. In addition to utilizing existing data sets, FIU will collect and investigate image and video data using FIU test-bed mockups to monitor structural health of the facility. Resulting data will be processed and analyzed using machine learning/deep learning technologies. The proposed pilot system is intended to serve as a starting point to engage the DOE field sites on related data sets and their decision making needs. It is anticipated that proposed machine learning/deep learning technologies can be effectively employed using anomaly detection to solve EM challenges in surveillance and maintenance of the D and D facilities. FIU will work with research stakeholders to identify applications at various sites and other DOE facilities. (authors)

12 MANAGEMENT OF RADIOACTIVE AND NON-RADIOACTIVE W↗

DOE OSTI2025

Contributions of major tau kinase activation and phospho-tau accumulation to cortical and hippocampal tangle formation and cognition in older adults

Aberrant activation of tau kinases (tauK) has been proposed as a major step in tau hyperphosphorylation and misfolding, and subsequent formation of neurofibrillary tangles (NFT) in Alzheimer's disease (AD). However, evidence of tauK hyperactivation in actual AD brains is scarce and inconsistent, and their role in age-related cognitive decline remains undocumented. We evaluated activated/inhibited species of CDK5/p35/p25, GSK3a/ß, and ERK1/2 as well as ten tau/phospho-tau (ptau) peptides (mapping Ser 202 , Thr 217 , Ser 262 , Ser 305 , and Ser 404 phospho-residues) by Western blot or selected reaction monitoring proteomics, respectively, in postmortem dorsolateral prefrontal cortex (DLPFC) and hippocampal samples of 150 participants from the Rush Memory and Aging Project (MAP). Regression models and mediation analyses assessed the contributions of these variables to tau phosphorylation, NFT deposition and antemortem cognitive status of MAP participants. Surprisingly, greater p25 and p35 (indices for CDK5 activation) and lower pSer 21/9 -GSK3a/ß (inhibited species) immunodensities were associated with lower ptau peptide amounts. Individuals with higher p25 cortical densities displayed better cognitive outcomes, particularly working memory. Statistical mediation analyses indicated that the beneficial effect of CDK5/p25 on cognition was mediated by lower densities of phospho-Thr 217 -tau and NFT deposition in DLPFC, and also identified Thr 217 and Ser 262 as the ptau sites with greatest influence in both NFT accumulation and cognitive impairment. The present data suggest that tau hyperphosphorylation, tangle deposition, and the subsequent cognitive impairment do not rely on aberrant activation of major tauKs. Additionally, novel evidence was provided for the beneficial contribution of cortical CDK5/p25 to the maintenance of working memory.

60 APPLIED LIFE SCIENCES↗

NASA NTRS2016

Risk of Adverse Cognitive or Behavioral Conditions and Psychiatric Disorders: Evidence Report

In April 2010, President Obama declared a space pioneering goal for the United States in general and NASA in particular. "Fifty years after the creation of NASA, our goal is no longer just a destination to reach. Our goal is the capacity for people to work and learn and operate and live safely beyond the Earth for extended periods of time, ultimately in ways that are more sustainable and even indefinite." Thus NASA's Strategic Objective 1.1 emerged as "expand human presence into the solar system and to the surface of Mars to advance exploration, science, innovation, benefits to humanity, and international collaboration" (NASA 2015b). Any space flight, be it of long or short duration, occurs in an extreme environment that has unique stressors. Even with excellent selection methods, the potential for behavioral problems among space flight crews remain a threat to mission success. Assessment of factors that are related to behavioral health can help minimize the chances of distress and, thus, reduce the likelihood of adverse cognitive or behavioral conditions and psychiatric disorders arising within a crew. Similarly, countermeasures that focus on prevention and treatment can mitigate the cognitive or behavioral conditions that, should they arise, would impact mission success. Given the general consensus that longer duration, isolation, and confined missions have a greater risk for behavioral health ensuring crew behavioral health over the long term is essential. Risk, which within the context of this report is assessed with respect to behavioral health and performance, is addressed to deter development of cognitive and behavioral degradations or psychiatric conditions in space flight and analog populations, and to monitor, detect, and treat early risk factors, predictors and other contributing factors. Based on space flight and analog evidence, the average incidence rate of an adverse behavioral health event occurring during a space mission is relatively low for the current conditions. While mood and anxiety disturbances have occurred, no behavioral emergencies have been reported to date in space flight. Anecdotal and empirical evidence indicate that the likelihood of an adverse cognitive or behavioral condition or psychiatric disorder occurring greatly increases with the length of a mission. Further, while cognitive, behavioral, or psychiatric conditions might not immediately and directly threaten mission success, such conditions can, and do, adversely impact individual and crew health, welfare, and performance.

Slack, Kelley J.↗

NASA NTRS2002

Astronauts Need Their Rest Too: Sleep-Wake Actigraphy and Light Exposure During Space Flight

The success and effectiveness of human space flight depends on astronauts' ability to maintain a high level of cognitive performance and vigilance. This alert state ensures the proper operation of sophisticated instrumentation. An important way for humans to remedy fatigue and maintain alertness is to get plenty of rest. Astronauts, however, commonly experience difficulty sleeping while in space. During flight, they may also experience disruption of the body's circadian rhythm - the natural phases the body goes through every day as we oscillate between states of high activity during the waking day and recuperation, rest, and repair during nighttime sleep. Both of these factors are associated with impairment of alertness and performance, which could have important consequences during a mission in space. The human body was designed to sleep at night and be alert and active during the day. We receive these cues from the time of day or amount of light, such as the rising or setting of the sun. However, in the environment of the Space Shuttle or the International Space Station where light levels are highly variable, the characteristics of a 24-hour light/dark cycle are not present to cue the astronauts' bodies about what time of the day it is. Astronauts orbiting Earth see a sunset and sunrise every 90 minutes, sending potentially disruptive signals to the area of the brain that regulates sleep. On STS-107, researchers will measure sleep-wake activity with state-of-the-art technology to quantify how much sleep astronauts obtain in space. Because light is the most powerful time cue to the body's circadian system, individual light exposure patterns of the astronauts will also be monitored to determine if light exposure is associated with sleep disruption. The results of this research could lead to the development of a new treatment for sleep disturbances, enabling crewmembers to avoid the decrements in alertness and performance due to sleep deprivation. What we learn about sleep in space informs treatment for earthbound populations, such as the elderly and insomniacs, who experience frequent sleep disturbances or altered sleep patterns.

Czeisler, Charles↗

NASA NTRSDate not supplied

Preliminary Design of an 'Autonomous Medical Response Agent' Interface Prototype for Long Duration Spaceflight

Major challenges for astronauts in future long-duration exploration missions (LDEMs) will be that crewmembers are not expected to be medical professionals, may be under high workload and stress, are facing physiological challenges caused by spaceflight, and will have limited, delayed voice communications with medical support from Earth. An autonomous medical response agent (AMRA) is envisioned to help astronauts address medical complaints, develop a differential diagnosis, and guide self-treatment until a healthy state is restored. AMRA develops a process of personalized diagnosis and treatment through a Bayesian predictive control system that recommends therapeutic control actions including diagnostic tests and treatments to crewmembers (Menon, 2020). The Human Computer Interaction (HCI) lab from NASA Ames Research Center’s Human Systems Integration Division (Code TH) has collaborated with Nahlia Inc in human-centered design augmentation research for AMRA. The project, titled Design of ‘Autonomous Medical Response Agent Interface Prototype for Long Duration Spaceflight, has been funded by the Translational Research Institute for Space Health (TRISH) and introduces an interactive user-interface prototype that guides astronauts through self-diagnosis, treatment, and rehabilitation while communicating with remote specialists in ground support (most notably a patient’s flight surgeon). Our project develops the interaction design for the crewmember using AMRA through user research, iterative design, and usability testing to evaluate the user interface and workflow designed. The interface design deliverable for this project, titled AMRA Aggregate Information Display (AMRA AID) is an integrated information display system for comprehensive autonomous medical guidance, diagnosis, and treatment of in-flight medical conditions experienced by crewmembers. AMRA AID demonstrates how we might ensure crew autonomy, increase the crew’s medical capabilities, and decrease cognitive burden within a front-end user interface. AMRA AID refrains from relying on input from ground or mission control for self-treatment of medical issues—though ground awareness and communication with ground is maintained as a means of ensuring trust between mission control and crew. AMRA AID demonstrates how the crew’s on-board medical system might integrate with information from vehicle monitoring and crew schedule, without assuming causal relationships. AMRA AID’s comprehensive view enables efficient information access for both crew and ground support, reducing cognitive burden in the event of an unplanned or emergency medical incident and enabling informed analytical decisions to be made based on both crew and vehicle health. Human-centered design augmentation advanced within the prototype included: enhanced workflow and treatment guidance for two medical scenarios for a non-specialist user base with various levels of medical training, interaction design which considered speech (conversational user interface) elements and on-screen interactions to be developed in future iterations of the project, communication design and functional requirements relevant to self-care versus caring for another astronaut, as well as user testing of the prototype with an international space medical community. This project arrives at critical findings regarding usability needs, communication requirements, and integrated information requirements for a future technology interface functioning to increase confidence between ground support and LDEM crewmembers.

TRISH↗

DOE OSTI2014

SU-E-QI-12: Morphometry Based Measurements of the Structural Response to Whole Brain Radiation

Purpose: Although state of the art radiation therapy techniques for treating intracranial malignancies have eliminated acute brain injury, cognitive impairment occurs in 50–90% of patients who survive >6mo post irradiation. Quantitative characterization of therapy response is needed to facilitate therapeutic strategies to minimize radiation induced cognitive impairment [1]. Deformation based morphometry techniques [2, 3] are presented as a quantitative imaging biomarker of therapy response in patients receiving whole brain radiation for treating medulloblastoma. Methods: Post-irradiation magnetic resonance imaging (MRI) data sets were retrospectively analyzed in N=15 patients, >60 MR image datasets. As seen in Fig 1(a), volume changes at multiple time points post-irradiation were quantitatively measured in the cerebrum and ventricles with respect to pre-irradiation MRI. A high resolution image Template, was registered to the pre-irradiation MRI of each patient to create a brain atlas for the cerebrum, cerebellum, and ventricles. Skull stripped images for each patient were registered to the initial pre-treatment scan. Average volume changes in the labeled regions were measured using the determinant of the displacement field Jacobian. Results: Longitudinal measurements, Fig 1(b-c), show a negative correlation p=.06, of the cerebral volume change with the time interval from irradiation. A corresponding positive correlation, p=.01, between ventricular volume change and time interval from irradiation is seen. One sample t-test for correlations were computed using a Spearman method. An average decrease in cerebral volume, p=.08, and increase in ventricular volume, p<.001, was observed. The radiation dose was seen directly proportional to the induced volume changes in the cerebrum, r=−.44, p<.001, Fig 1(d). Conclusion: Results indicate that morphometric monitoring of brain tissue volume changes may potentially be used to quantitatively assess toxicity and response to radiation and may provide insight in developing new therapeutic approaches and monitoring efficacy.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2026

Designing resilient IoT and Edge Computing with federated tinyML

The rapid growth of the Internet of Things (IoT) and Edge Computing (EC) has brought significant conveniences to modern society but has also greatly expanded the cyber attack surfaces, particularly as these technologies are being increasingly integrated into critical systems such as power grids, healthcare, and smart homes. Here, to improve IoT/EC’s cybersecurity posture, we leveraged Artificial Intelligence (AI) and Machine Learning (ML) by employing tinyML to monitor voluminous IoT data for cyber threats while addressing devices’ resource constraints, and utilizing Federated Learning (FL) to share local detection knowledge across the system while preserving privacy. Building on our three-layer architecture combining tinyML and FL to enhance autonomous cyber attack detection, this paper demonstrated that the architecture improves detection accuracy, reduces resource consumption, and enables lightweight, secure IoT device monitoring. These results were validated using the public N-BaIoT dataset as well as real IoT network traffic data collected under multiple attack scenarios from our testbeds. Additionally, we introduced an enhanced FL methodology with a novel preprocessing stage, including federated feature selection and global preprocessor construction, to address IoT/EC data heterogeneity. We developed a physical IoT testbed for attack simulations and data collection, implemented a tinyML-powered detector for realistic model validation, and also built a virtual testbed for scalable evaluations of FL models across diverse network environments.

Cognitive cyber↗

DOE OSTI2024

Using spatio-temporal graph neural networks to estimate fleet-wide photovoltaic performance degradation patterns

Accurate estimation of photovoltaic (PV) system performance is crucial for determining its feasibility as a power generation technology and financial asset. PV-based energy solutions offer a viable alternative to traditional energy resources due to their superior Levelized Cost of Energy (LCOE). A significant challenge in assessing the LCOE of PV systems lies in understanding the Performance Loss Rate (PLR) for large fleets of PV systems. Estimating the PLR of PV systems becomes increasingly important in the rapidly growing PV industry. Precise PLR estimation benefits PV users by providing real-time monitoring of PV module performance, while explainable PLR estimation assists PV manufacturers in studying and enhancing the performance of their products. However, traditional PLR estimation methods based on statistical models have notable drawbacks. Firstly, they require user knowledge and decision-making. Secondly, they fail to leverage spatial coherence for fleet-level analysis. Additionally, these methods inherently assume the linearity of degradation, which is not representative of real world degradation. To overcome these challenges, we propose a novel graph deep learning-based decomposition method called the Spatio-Temporal Graph Neural Network for fleet-level PLR estimation (PV-stGNN-PLR). PV-stGNN-PLR decomposes the power timeseries data into aging and fluctuation components, utilizing the aging component to estimate PLR. PV-stGNN-PLR exploits spatial and temporal coherence to derive PLR estimation for all systems in a fleet and imposes flatness and smoothness regularization in loss function to ensure the successful disentanglement between aging and fluctuation. We have evaluated PV-stGNN-PLR on three simulated PV datasets consisting of 100 inverters from 5 sites. Experimental results show that PV-stGNN-PLR obtains a reduction of 33.9% and 35.1% on average in Mean Absolute Percent Error (MAPE) and Euclidean Distance (ED) in PLR degradation pattern estimation compared to the state-of-the-art PLR estimation methods.

14 SOLAR ENERGY↗

NASA NTRSDate not supplied

Manual Crew Override of Vehicle Landings Following G-Transitions

BACKGROUND Manual control during exploration spaceflight consists of both planned automated supervisory control and unplanned crew override. This crew override capability is critical to enable overall mission success during landing contingencies. However, the introduction of manual override capabilities must be implemented to enable crews to mitigate risks introduced by human error. Adaptive changes in the sensorimotor system can manifest during g-transitions as spatial disorientation. While training and landing aids enable successful landing through disorientation, these adaptive changes may increase cognitive demand that needs to be accounted for in the manual control strategy. It is important to characterize these effects as soon as possible following the G-transition to develop appropriate countermeasures. METHODS The following study seeks to inform the risk associated with altered sensorimotor and vestibular function impacting critical mission tasks. We aim to characterize the effects of short and long-duration weightlessness on manual control following G-transitions using simulated lunar landing on a six-degree-of-freedom (6DOF) motion base, a fixed base simulation, and a supervisory control tablet task. The primary goal is to understand the impact of spaceflight on crew ability to perform manual crew override and supervisory control. This aim will be assessed by comparing pre- versus postflight simulation performance in crewmembers assigned to either short duration (< 30 day) or long duration (~6- month) missions to the International Space Station (ISS). We hypothesize there will be postflight increases in the percent time that pilots are outside of the acceptable range for recommended vehicle state parameters and the reaction time for secondary cognitive tasks. Ground-based control subjects, who are demographically matched to the crew considering age (± 5 years) and gender, will undergo the same testing schedule as the crew to examine the effects of flight phase independent of microgravity exposure. The second aim is to examine how adaptive changes in vestibular and cognitive function relate to changes in manual crew override proficiency. Crew performance for a sensorimotor perceptual test battery will evaluate motion perception tracking, roll nulling, and/or vection sensitivity using the 6DOF motion base. We hypothesize that a higher severity of vestibular alterations will be associated with increased percent time outside of guidance limits. Motion sickness severity and sleepiness will also be evaluated. To determine the impact of “just-in-time” training, the third aim seeks to compare performance during on-board lunar landing tasks conducted late in-flight to early postflight. We hypothesize that proficiency on the “just-in-time” laptop trainer late in mission will be positively correlated with early postflight proficiency on the same task. The final aim will establish assessments of performance, training protocols, and the learning progression in a ground-control cohort of first-time users. RESULTS The assessment of the learning progression associated with the piloting task on the motion base system with thirty ground subjects will be reported. Learning curves will be established across four distinct sessions and within session considering trial difficulty. The difficulty of the landing task can be modulated with the landing divert distance and cross or downrange difficulty. Results may include changes in performance across multiple trials of a multi-attribute lunar tablet supervisory control task. Preliminary investigations of eighteen subjects who completed vestibular threshold and motion perception tasks offer expected performance ranges for upcoming preflight crew evaluations. The results yielded an average roll threshold of 0.46 ± 0.30 deg/s and an average roll nulling root mean square error performance of 2.52 ± 0.52 deg/s. RELEVANCE This project will deliver an operational demonstration of crew monitoring capability following spaceflight and identify potential deficits that may require remediation. Comparison of individual vestibular and cognitive changes with crew performance will help better characterize the manual control risks associated with sensorimotor alterations. Ground testing will evaluate learning progression, refine training protocols, and serve as a control cohort for comparisons to crew performance. ACKNOWLEDGEMENTS: The authors acknowledge contributions from Draper, the Dynamic Skills Trainer (DST) Lab, and the Software, Robotics, and Simulation Division toward the development of the lunar landing simulation platforms. This project is funded by the Human Health Countermeasures Element.

Hannah M. Weiss↗

NASA NTRSDate not supplied

Summary of Technical Interchange Meetings (TIMs) Designed to Enable Earth Independent Medical Operations (EIMO)

The Exploration Medical Capability Element (ExMC) in NASA’s Human Research Program hosted a series of TIMs in 2023-2024 designed to stimulate discussion around specific topics with the goal of enabling EIMO. In context of the thematic constituent elements of EIMO, namely pre-mission planning, acute/emergent/prolonged medical decision making, supply/resource management and task load management, subject matter experts from industry, academia and government (NASA and other Agencies) provided valuable and actionable guidance and recommendations. Earth-based medical experts will remain indispensable for pre-mission planning, however, management of acute/emergent medical contingencies will require a gradual transition of medical care and decision making from terrestrial to space-based assets to enable support of astronaut health and performance and reduce overall mission risk. Key to achieving these enhancements is providing an integrated data system platform capable of utilizing multiple data streams in concert with a variety of on-board databases and passive monitoring of video and wearable sensors to enable a multi-modal, agentic AI-based clinical decision support system (CDSS) to support crew medical officer (CMO) medical decision-making. The EIMO series of TIMs (I-V) have proven to be instructive and portend a significant paradigm shift will be necessary to maintain crew health and performance on exploration class missions. Importantly, since the expected paradigm shift will be significantly different from the methods of operation that have been employed for the majority of missions from the inception of human spaceflight to date, any proposed methods must be deployed in the setting of ongoing operations early and be “tested, reviewed and practiced” while reliable back-up is available to facilitate an Enterprise-wide level of comfort and acceptance. Serious constraints on data transmission coupled with a large and expanding universe of on-board medical informatics data streams will necessitate implementation of a CDSS to supplant the current reliance on support provided by ground-based SMEs. Establishment of trust in the system by CMO/crew and the ground-based medical support team will be essential. Co-development of a CDSS with industry partners will assure that state of the art tools can be employed, and industry efficiencies can be leveraged. Training regimens, materials and tools must evolve to be responsive (just-in-time training) and facilitate autonomous execution of procedures. Proficiency metrics should be established and be based on validated competencies or milestones as opposed to a prescribed number of training hours. Training should be prioritized for broad, translatable skills that have universal application across a variety of medical conditions. Repetition was deemed to be the key to achieving proficiency and emphasis should lie in procedural training which is known to extinguish more rapidly than diagnostic skills. Advanced tools, e.g., extended reality, can provide more realistic and effective training. Use of advanced probabilistic risk assessment tools will be essential to optimize the medical system capability while carefully balancing risk relative to mass/power/volume limitations. Importance of factoring use-life of medical supplies and maintaining awareness of redundancy and opportunity to re-purpose under off nominal situations was emphasized. Consideration of adopting optimized performance standards vs. “good-enough” performance thresholds is warranted. The use of legacy systems as opposed to creating new systems may be preferable. Managing task load and associated cognitive load will be essential to maintain operational safety and behavioral health. ExMC aspires to create a shared EIMO paradigm and strategic vision for advancing medical system design through novel technologies, training, protocols, and support capabilities, built upon the spirit of successful strategies and innovations over the past six decades of space medicine operations.

Jay Lemery↗

NASA NTRS2022

Risk of Performance and Behavioral Health Decrements Due to Inadequate Cooperation, Coordination, and Psychosocial Adaptions within a Team

The Risk of Performance and Behavioral Health Decrements Due to Inadequate Cooperation, Coordination, Communication, and Psychosocial Adaptation within a Team (the Team Risk) is primarily performance-focused, with a secondary emphasis on behavioral health outcomes resulting from team performance and interpersonal interactions. Monitoring tools, measures, and countermeasures are aimed at enhancing team processes and team composition configurations to optimize team performance and functioning. Long-duration exploration missions (LDEMs) will include major challenges that could affect team performance, including social isolation, physical confinement, a small and diverse crew, communication delays between crew and ground, limited or no crew rotation or evacuation options, limited or no resupply, and a high-consequence environment. Each of these conditions will affect the crew’s coordination, cooperation, psychological well-being, and performance. Although the International Space Station (ISS) remains important for studies that require spaceflight testing and validation, the current conditions on the ISS do not adequately mimic the exploration environment that is required for National Aeronautics and Space Administration (NASA) teams research, and thus access to terrestrial or ground-based analogs of LDEM conditions is paramount. The emphasis on analogs for research is reflected in this updated evidence review of the Team Risk, and includes data from studies conducted at isolated, confined, extreme (ICE) environments (e.g., Antarctic stations), and from several mission simulation analogs such as the Human Exploration Research Analog (HERA) (HERA Experiment Information Package, 2014), also known as isolated, confined, controlled (ICC) environments. These studies have characterized many team factors regarding LDEMs, and the Team Risk has now matured from risk characterization to focusing more on countermeasure development. Because spaceflight evidence for team-level research is lacking, no reliable data is available to quantify the impact of team-level variables on individual and team-level outcomes during spaceflight missions. Until recently, no systematic attempt had been undertaken to measure the performance effects of team cohesion, team composition, team training, or team-related psychosocial adaptation during spaceflight. The Team Risk is a relatively young research area for NASA, with substantial growth only since the 2000s, and with limited access to spaceflight performance data. As a result, spaceflight evidence is lacking to identify specifically what team composition, level of training, amount of cohesion, or quality of psychosocial adaptation is necessary to reduce the risk of performance errors in space. However, astronaut journals and interviews and reports from spaceflight subject matter experts (SMEs) provide testimonies that team performance during spaceflight is important for mission success and to maintain crew health. Team spaceflight data is now being collected as part of the Spaceflight Standard Measures task (Clement, 2021)—a set of core measurements related to many human spaceflight risks that are collected from astronauts before, during, and after long-duration missions. The team-related standard measures focus on team cohesion, team performance, group living, team climate, and team processes. Collection of standard measures data is ongoing and published data is not yet available. Finally, although spaceflight evidence is lacking, evidence gleaned from ground studies and spaceflight analog studies will help close the gaps outlined in the Team Risk. Ground-based studies provide quantitative evidence for team functioning in ICE environments. Academic research on teams has produced dozens of meta-analyses that can be used to understand the general relationships among team inputs (e.g., team member characteristics and skills, job context), team processes, and emergent states (e.g., coordination, communication, cooperation, cohesion, trust, shared cognition), and team outcomes (e.g., effectiveness, errors, adaptation). Teams are complex, incorporating individual characteristics of team members, but also existing at a level that is greater than the sum of its parts. Therefore, the Team Risk must be integrated with other individual-focused NASA Human Research Program (HRP) risks, including Behavioral Medicine (BMed), Sleep, and Human-Systems Integration Architecture (HSIA), and emerging research indicates more integration may needed between the Team Risk and the physiologically oriented risks. Much of this integration occurs through the Human Systems Risk Board (HSRB). A lack of team functioning may be a stressor in some circumstances, but the team often acts as a countermeasure. For example, support for team leaders and teammates can facilitate individual functioning and encourage psychological and physically healthy behaviors and attitudes. However, more research is needed regarding teams during LDEMs and the remaining gaps in the research are described in the current report.

Lauren Blackwell Landon↗