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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↗
DOE OSTI2023

Biofuels Information Center

The purpose of the Biofuels Information Center (BIC) task is to provide relevant data, information, reports, and web-based tools to all bioenergy stakeholders. The BIC task began in FY08 to meet the requirement under Title II, Sec. 229 of the Energy Independence and Security Act of 2007 (EISA) requires DOE to develop a "Biofuels and Biorefinery Information Center". The BIC task supports biofuels pages content on the EERE's most visited website - the Alternative Fuels Data Center (AFDC http://www.afdc.energy.gov) and the Bioenergy Atlas tools (currently archived) (previous address https://maps.nrel.gov). This task results in more than 1.7 million web pageviews (an instance of an internet user visiting a webpage) per year. In FY22, the task completed the final year of the 5 year USDA Biofuels Infrastructure Partnership (BIP). The USDA BIP expanded infrastructure for E15 and/or E85 to approximately 850 stations and NREL received and reviewed data for quality analyzed all infrastructure and sales data collected by USDA. Stations are privately held and previously it was difficult to ascertain infrastructure and sales data. This unique dataset allows insight into infrastructure data (number of pumps and tanks, costs to install new equipment) and sales data (price and volume for E10, E15, E85, and diesel by month). The 2021 USDA BIP National Summary Report is with DOE for review prior to publication. Future work will include the biannual Bioenergy Industry Status Report (4 previous versions have been published) . The task also supports the principal investigator's time to engage stakeholders on infrastructure and deployment of biofuels. This includes leading, membership, and participation in the following roles: member Board of Advisors at the Fuels Institute, voting member for multiple UL standards committees, Co-Chair of the Infrastructure team at Agriculture/Auto/Ethanol, Member of Coordination Research Council's ULSD Corrosion Committee. The Principal investigator routinely responds to industry inquires to assist in deployment of biofuels regularly.

biofuels↗
NASA NTRS2022

Directed Acyclic Graphs: A Tool for Understanding the NASA Human Spaceflight System Risks - Human System Risk Board

For over a decade, the National Aeronautics and Space Administration (NASA) has tracked and configuration-managed approximately 30 risks to astronaut health and performance that occur before, during and after spaceflight. The Human System Risk Board (HSRB), a Health and Medical Technical Authority (HMTA) Board at NASA Johnson Space Center, is the entity responsible for identifying, assessing, analyzing, and monitoring the official understanding of the risk or risk posture for each of the Human System Risks and determining – based on evaluation of the available evidence – when that risk posture changes. The ultimate purpose of tracking and researching these risks is to find ways to reduce the risk that astronaut crews face during spaceflight. Historically, research, development and operations relevant to one risk have been conducted in isolation from other risks; these individual risk ‘silos’ enabled initial characterization of each specific risk. In spaceflight however, the impact of exposure to risk for astronaut crews is cumulative, and not independent of exposures or other risks, as all the adverse effects of the spaceflight environment begin at launch, continue throughout the duration of the mission and in some cases across the lifetime of the crews. In January of 2020, the HSRB at NASA embarked on a pilot project designed to assess the potential value of causal diagramming as a tool to facilitate understanding of these cumulative and interdependent effects as applied within Human System Risk management. This process uses directed acyclic graphs as a means of formalizing a shared mental model of the causal flow of risk among Risk Board stakeholders. Initially this model was to improve communication among those stakeholders, but the potential value exceeds communication alone. The causal diagrams are formulated as directed acyclic graphs (DAGs) to function as a type of knowledge graph for reference for the board and its stakeholders. This document is a sister document to NASA/TM 20220006812 Directed Acyclic Graph Guidance Documentation (1). In that document, the basic guidance for creating and standardizing directed acyclic graphs as tools for cross-risk analysis is provided. This document contains the initial configuration managed DAGs that were created as a result of applying those principles. These initial versions were accepted by the HSRB in January of 2022. Each of the Human System Risks are represented by a DAG that has been reviewed by the larger Human Health and Performance community at NASA including life scientists, physical scientists, physicians, nurses, pharmacists, exercise specialists and more. These results show the starting point for Human System Risk DAGs as shared mental models and communication aids across the boundaries of the various expertise needed to understand and mitigate the human risks in spaceflight. Because they are a starting point, each of these DAGs can be expected to change over time as new or refined evidence becomes available. The process for updating these DAGs can be found in the JSC-66705 Human System Risk Management Plan (2) that is publicly available on the NASA Technical Reports Server.

Erik L. Antonsen↗
NASA NTRS1990

The Hubble Space Telescope optical systems failure report

The findings of the Hubble Space Telescope Optical Systems Board of Investigation are reported. The Board was formed to determine the cause of the flaw in the telescope, how it occurred, and why it was not detected before launch. The Board conducted its investigation to include interviews with personnel involved in the fabrication and test of the telescope, review of documentation, and analysis and test of the equipment used in the fabrication of the telescope's mirrors. The investigation proved that the primary mirror was made in the wrong shape (a 0.4-wave rms wavefront error at 632.8 nm). The primary mirror was manufactured by the Perkin-Elmer Corporation (Hughes Danbury Optical Systems, Inc.). The critical optics used as a template in shaping the mirror, the reflective null corrector (RNC), consisted of two small mirrors and a lens. This unit had been preserved by the manufacturer exactly as it was during the manufacture of the mirror. When the Board measured the RNC, the lens was incorrectly spaced from the mirrors. Calculations of the effect of such displacement on the primary mirror show that the measured amount, 1.3 mm, accounts in detail for the amount and character of the observed image blurring. No verification of the reflective null corrector's dimensions was carried out by Perkin-Elmer after the original assembly. There were, however, clear indications of the problem from auxiliary optical tests made at the time. A special optical unit called an inverse null corrector, designed to mimic the reflection from a perfect primary mirror, was built and used to align the apparatus; when so used, it clearly showed the error in the reflective null corrector. A second null corrector was used to measure the vertex radius of the finished primary mirror. It, too, clearly showed the error in the primary mirror. Both indicators of error were discounted at the time as being themselves flawed. The Perkin-Elmer plan for fabricating the primary mirror placed complete reliance on the reflective null corrector as the only test to be used in both manufacturing and verifying the mirror's surface with the required precision. This methodology should have alerted NASA management to the fragility of the process and the possibility of gross error. Such errors had been seen in other telescope programs, yet no independent tests were planned, although some simple tests to protect against major error were considered and rejected. During the critical time period, there was great concern about cost and schedule, which further inhibited consideration of independent tests.

Source record↗
NASA NTRS2022

Recommendations on the Use of Commercial-Off-The-Shelf (COTS) Electrical, Electronic, and Electromechanical (EEE) Parts for NASA Missions - Phase II

This assessment had two Phases. Phase I captured NASA Centers’ current practices for commercial-off-the-shelf (COTS) Electrical, Electronic, and Electromechanical (EEE) parts 1 used in spaceflight systems and ground support equipment (available at https://ntrs.nasa.gov/citations/20205011579) [ref. 1]. The Phase II report provides guidance for selecting and using COTS parts in NASA missions. The approaches proposed in this report differ from current agency practices. This top-level executive summary touches on these new approaches for using COTS parts but does not provide the detailed information that is critical in understanding the rationale behind these new approaches. Readers will need to read the entire report to gain full understanding and effectively use the recommendations herein. NASA’s historical approach to selecting and applying parts has been to define certain parts, primarily specific classes of military specification (MIL-SPEC) parts, as “standard”, leaving all others, including COTS parts, as nonstandard. Standard parts typically are used without further testing (“use-as-is”). Nonstandard parts are subjected to initial screening and subsequent lot acceptance testing of representative samples from each procured lot per MIL-SPEC or similar requirements. Decades later, top-tier commercial part manufacturers have evolved significant manufacturing, statistical control, and technological improvements that can now provide parts as reliable or more reliable than MIL-SPEC parts, when used within their datasheet limits. Concurrently, the space science and exploration community’s needs demand technological advances unavailable with MIL-SPEC parts. This ongoing change necessitates using COTS parts for space missions. Properly selected COTS parts in appropriate applications can offer performance and supply availability advantages compared to MIL-SPEC parts. Their utility and demonstrated reliability result from large volumes and automated production and testing processes. However, careful review and a thorough understanding of their specifications (i.e., datasheet limitations) is needed, and verifying that manufacturer specifications and reliability meet space hardware application needs are necessary. This report recommends MIL-SPEC screening and non-radiation-related lot acceptance testing be reduced or eliminated in cases where evidence of sufficient quality and reliability exists for COTS parts. The extent of NASA's insight into COTS manufacturers and the amount and nature of the needed evidence will differ by mission and will likely be driven by a mission's resources and associated risk posture. To facilitate this goal, two new terminologies have been defined and described: “Industry Leading Parts Manufacturer (ILPM)” and “Established COTS parts.” An ILPM is a COTS manufacturer that produces high quality and reliable parts. Some parts produced by ILPMs, defined as Established COTS parts, do not need any additional MIL-SPEC or NASA screening and lot acceptance testing to be used in space applications. This report provides guidance for selecting, procuring, and applying COTS parts and for performing part-, board-, and system-level COTS parts verification. The recommendation to select Established COTS parts from ILPMs will assure those COTS parts will have comparable quality to corresponding MIL-SPEC parts. Selecting, applying, and verifying Established COTS parts from ILPMs requires a holistic team approach, engaging parts engineers, circuit designers, quality, reliability, and systems engineers, procurement specialists, radiation specialists, avionics leads, and program/project managers. A mission-specific approach tailored to a project’s Mission, Environment, Applications and Lifetime (MEAL) [ref. 2] requirements should be developed and approved by program/project managers. Any associated risks should be clearly identified, quantified, mitigated, and/or accepted. Different approaches are recommended according to program/project Risk Classes A, B, C, and D [ref. 3] and human-rated missions [ref. 4]: 1. Recommend Classes A and B and human-rated missions consider a “MIL-SPEC parts- based design” approach. ”MIL-SPEC parts-based design” approach is one in which most parts are MIL-SPEC parts and Established COTS parts from ILPMs are used only when an equivalent MIL-SPEC part does not meet functional or size, weight, and power (SWaP) or performance requirements, or is not available. 2. Recommend Classes D and Sub-D missions consider a “System of COTS” approach. “System of COTS” approach is one which most parts are Established COTS parts from ILPMs. 3. Recommend Class C missions determine which approach is the best for their projects; that is, use either a “MIL-SPEC parts-based design” approach, “System of COTS” approach, or a combined approach utilizing elements of both. This report intends to provide guidance in using COTS parts for NASA missions with risk classifications of A through D and human-rated missions; but it does not address the costs of using COTS parts. Costs of using COTS parts in different NASA mission classes can vary significantly even if the same parts are used in different risk postures, due to differing verification levels needed. The guidance does not distinguish between critical or non-critical systems, and a given project will need to apply the appropriate guidance based on their risk posture. The intended audience of this report are NASA personnel and commercial practitioners who support NASA’s spaceflight missions, including spaceflight program or project managers, parts engineers, parts manufacturers, radiation engineers, avionics engineers, system engineers, circuit design engineers, reliability engineers, safety and mission assurance (SMA) personnel, and parts procurement specialists. The NEPP Program will perform a pathfinder study to explore implementing the guidance in this NESC report. An ILPM verification process is not the same as conventional vendor qualification processes performed according to military standards and specifications. This NESC report intends to provide guidance in utilizing available parts data from ILPM manufacturers for parts assurance assessments needed for NASA missions. The report also captured the current practices from DoD and Federal Aviation Administration (FAA) in Section 10. Note each DoD and FAA report was provided by the corresponding agencies regarding their practices, which are independent from the NESC recommendations in the report.

Commercial-Off-The-Shelf↗
NASA NTRS2024

ISS Technology Demonstrations for Future Spaceflight Medical Systems

Throughout the history of human spaceflight, crewmembers have experienced various in-flight medical conditions including illness and injury. Planned missions to the Moon and Mars will require capabilities to maintain the health of future space travelers. Mass, power, and volume available in the vehicles and habitats for these missions will be severely constrained; resupply of resources will be limited or non-existent, as will opportunities for evacuation to Earth. Furthermore, ground-based support will be hampered by communication latencies and blackouts. These vehicle and mission constraints will necessitate a medical system that has been efficiently planned, providing on-board procedural guidance in addition to a variety of medical devices and consumable resources. Medical capabilities required for the diagnosis and treatment of potential medical conditions during future spaceflight missions may include real-time health monitoring, medical imaging, and biomarker analyses ( e.g., blood or urine). Terrestrial medicine shares these needs, thus many of these medical capabilities could likely be satisfied by Commercial-Off-The-Shelf (COTS) devices and methodologies; however, in some cases the unique space environment and increased mission duration will drive the need to modify technologies and the way care is provided. NASA’s Human Research Program (HRP) Exploration Medical Capability (ExMC) Element and Mars Campaign Office’s Exploration Medical Integrated Product Team (XMIPT) are working together to decrease medical risk during exploration missions. Flight-tested medical diagnostic and treatment technologies are necessary to effectively manage medical conditions relevant to exploration missions while meeting vehicle constraints, integrating with medical decision-support tools, and enabling increasingly Earth-independent operations. Several projects have leveraged the ISS as a testbed for exploration, including 1) i n- situ blood analysis, 2) medical inventory, 3) intravenous fluid generation, and 4) autonomous medical procedure guidance. Management of several in-flight medical conditions, such as bacterial and viral infections and acute radiation syndrome, is dramatically improved with ability to assess blood cell populations, electrolytes, and metabolites. I n December 2020 and January 2021 ExMC performed an ISS technology demonstration (Tech Demo) of the HemoCue® WBC DIFF analyzer (HemoCue, Brea, CA), a COTS device that was modified to enable functionality in a spaceflight environment. This Tech Demo marked the first time that hematology measurements were successfully performed real-time in microgravity. Also modified and demonstrated was the reusable Handheld Electrolytes and Lab Technology for Humans (rHEALTH) ONE analyzer (rHEALTH, Bedford, MA), which uses flow cytometry and sheath-based hydrodynamic focusing methodologies. The rHEALTH ONE ISS Tech Demo in May 2022 demonstrated test results obtained in-flight matched those on the ground. NASA currently relies on crew self-reporting to manage and maintain medical inventory on ISS.The ability to maintain an accurate inventory becomes more critical during long duration missions since the crew will need to be increasingly autonomous in finding and utilizing medical items, including those scenarios when alternative treatments need to be considered due to limited or no resupply. HRP’s Medical Consumables Tracking (MCT) project was developed by ZIN Technologies, Inc. (Cleveland, OH), and demonstrated real-time tracking of medical supplies aboard the ISS between December 2016 and July 2018. The MCT system design utilized Radio Frequency Identification Device (RFID) technology to perform automated inventory and was installed in the Crew Health Care System (CHeCS) Resupply Stowage Rack (RSR). The challenge of limited shelf life, exacerbated by the lack of resupply opportunities, affects a plethora of medical system components including consumables, pharmaceuticals, and intravenous (IV) fluid. In 2010, ExMC funded ZIN Technologies, Inc. (Cleveland, OH), to develop the Intravenous Fluid Generation (IVGEN) system. IV fluids were successfully generated with IVGEN using the potable water supply on ISS during ISS Expedition 23. The XMIPT is in the process of developing a miniaturized version of the original IVGEN hardware for a future Tech Demo aboard the ISS. Current ISS medical operations rely heavily on preflight training and real-time remote guidance, both of which become impractical or impossible for exploration missions. The primary goal of the Autonomous Medical Officer Support (AMOS) Software Tech Demos on ISS was to confirm telemedical proof-of-concept for autonomous medical imaging in an operational setting. This novel software tool shifts emphasis from preflight training and real-time remote guidance to in-flight just-in-time instruction, a new and necessary paradigm for crew medical autonomy. AMOS introduces a novel, streamlined skill management concept for exploration missions featuring comprehensive training and guidance modules for ultrasound examinations using the ISS Ultrasound 2 (a modified GE Vivid-q™; General Electric HealthCare, Chicago, IL). With no prior crew training or remote guidance, two Tech Demos on the ISS (April 2020 and June 2022) resulted in high quality, clinically useful image sets. We will provide a review of historical, current, and planned medical devices and technologies considered for inclusion within future spaceflight medical systems and summarize hardware development activities and medical device tech demos conducted on the ISS.

Astronaut health and performance↗